GOP governors see fiscal, public health benefits to Medicaid expansion
Call it a post-reelection prediction: On the day after President Barack Obama secured a second term at 1600 Pennsylvania Avenue, an attorney for a prominent healthcare law firm suggested that even Republican governors would succumb to the lure of expanding Medicaid on the federal dime.
“When the dust clears and they examine the numbers in the light of day, I think most states will find it’s advantageous to expand Medicaid enrollees because not only will it bring coverage to hundreds of thousands, if not millions, of their citizens, but it will bring many new federal dollars into their state,” Deborah Bachrach, special counsel on healthcare transactions at Manatt, Phelps & Phillips, a law firm that works with states and providers on health IT and related public policy issues told Healthcare Finance News’ sister publication Government Health IT at the time.
And they have. The latest is Gov. Chris Christie of New Jersey, a staunch opponent of the Affordable Care Act, who said Tuesday that if New Jersey didn’t get in on the expansion, those federal dollars would be allocated elsewhere to expand Medicaid in other states such as New York and Connecticut.
“It’s simple. We’re putting people first,” Christie explained, “which is why after considerable discussion and research, I have decided to participate in Medicaid expansion under the Affordable Care Act.”
Christie’s pragmatic acceptance of Medicaid expansion follows those of Florida Gov. Rick Scott and Ohio's John Kasich; the former called it a “compassionate common sense step forward,” last week.
[See also: Florida takes U-turn on Medicaid expansion.]
The Garden State governor’s announcement came along with a serving of Christiesque conservative obstinacy about the ACA more broadly.
“Let me be clear, I am no fan of the Affordable Care Act. I think it is wrong for New Jersey and for America. I fought against it and believe, in the long run, it will not achieve what it promises. However, it is now the law of the land,” Christie said. “I will make all my judgments as governor based on what is best for New Jerseyans. That is why I twice vetoed saddling our taxpayers with the untold burden of establishing health exchanges.”
Accepting the ACA’s offer on Medicaid, on the other hand, will maximize New Jersey taxpayer dollars. “Expanding Medicaid by 104,000 citizens in a program that already serves 1.4 million is the smart thing to do for our fiscal and public health,” Christie said, adding that it will not only help hospitals stay financially healthy but also save taxpaying citizens $227 million in 2014 alone. “If that ever changes because of adverse actions by the Obama administration, I will end it as quickly as it started.”
Christie is not alone in placing contingencies on accepting the expansion. When Florida’s governor, Rick Scott, announced that Florida would participate in the Medicaid expanion, he made it clear that it was for the three years the federal government is intending to foot 100 percent of the bill and the participation would be re-evaluated.
In 2020, the federal government will reduce its portion of the payment to 90 percent — a transition that by many accounts has states opposed to Medicaid expansion concerned about where they will come up with the remaining money down the road.
Manatt’s Bachrach, however, expects more states to change course in the days ahead, following Christie’s, Kasich’s and Scott’s lead, ultimately expanding Medicaid for those same financial and public health reasons.
“Whatever the cost in 2020, which would be 10 percent of covering these new adults, the savings these states will be able to secure by withdrawing funds for covering uninsured citizens — there’s your foundation for coverage,” Bachrach said. “History suggests states will go for it.”
