Other States Eyeing Arkansas' Private Medicaid Expansion Option

Reporting on Medicaid expansion in states across the country is noticeably lighter, though certain decisions continue to garner extensive coverage. Notably, the compromise that is unfolding between Arkansas and HHS, known as the "private option," is sparking several previously ACA-averse lawmakers to show interest.

        The Washington Post  (3/19, Kliff) "Wonkblog" reports on the importance of the deal being worked out between HHS and Arkansas Governor Mike Beebe, in which his state would use Medicaid funding to buy private insurance for those between 100% and 133% of the poverty line. Now, just three weeks after Beebe proposed the alternative to HHS Secretary Kathleen Sebelius, "there are four other states considering the Arkansas approach: Florida, Ohio, Louisiana and Maine," and there is "even some chatter about pursing such an option in Texas." According to the blog, "It's hard to underscore how much Arkansas's simple suggestion - that it be able to use Medicaid dollars to buy private insurance for the expansion population - has the potential to change the face of the Affordable Care Act." All told, these four states signing on, even in this capacity, could allow 2.4 million Americans to gain insurance coverage.

        CQ  (3/19, Reichard, Subscription Publication) reports, "Top Health and Human Services official Michael Hash told reporters Monday that the Obama administration is not only interested in talking to states about using federal Medicaid expansion funds to buy private coverage but, in fact, is 'anxious' to do so." He said "states are talking to HHS about using federal Medicaid expansion funds under the health care law to buy private coverage for uninsured residents," but "the conversations have been informal so far." He said, "To my knowledge, we do not have a formal proposal."

        Analysis Shows Arkansas Private Option Not Overly Expensive For Feds. Reuters  (3/19, Parker) reports that an analysis, released Monday by Arkansas' Department of Human Services, found that the state's "private option" for expanding Medicaid would cost the Federal government little more than traditional expansion under the Affordable Care Act. The report read, in part, "These estimates find that the private option can be fully funded with existing resources at the state level and would add less than 15 percent to federal health-care costs in Arkansas. In some realistic scenarios, there could be no additional federal costs at all."

        The Arkansas Times  (3/19, Ramsey) reports further, "DHS commissioned a study from legal consultants, actuarial consultants and the Arkansas Insurance Department. They found Arkansas-specific factors - as well as cost benefits of moving a large volume of beneficiaries to the private market on the exchange - that they believe will mitigate many of the cost concerns raised by previous estimates about an approach using private insurance companies."

        In his assessment for Forbes  (3/19), Avik Roy concludes, "It may be, however, that the Arkansas analysis contains flawed or inadequate assumptions. We'll know more if DHS releases its full analysis. For now, however, the DHS report should give us cause for optimism about the pioneering effort by the Natural State to transcend the broken Medicaid program."

        Employers May Face Penalties In States Not Expanding Medicaid. Another Medicaid expansion story receiving continued local coverage is the Jackson Hewitt study which found that employers in states that do not expand Medicaid could face hefty penalties. For example, the Milwaukee Journal Sentinel  (3/19, Stein) reports that a national study by Jackson Hewitt Tax Service Inc. estimates that Wisconsin Gov. Scott Walker's decision to reject expanding the state's BadgerCare Plus healthcare program "could leave Wisconsin employers with federal penalties of between $24.1 million and $36.1 million a year." Walker "has proposed allowing extremely poor adults without dependent children to enroll in BadgerCare, while shifting those with somewhat higher incomes into a subsidized insurance marketplace, scheduled to debut in 2014 under the federal health law." According to Jackson Hewitt, "Employers with the equivalent of 50 or more full-time workers would pay a tax of between $2,000 and $3,000 per employee for anyone who receives a taxpayer subsidy to be covered under the federal health exchange." The Dubuque Telegraph Herald  (3/19, Murphy) also reports on the story.

        The Indianapolis Business Journal  (3/19, Wall) reports that that the Jackson Hewitt Tax Service study shows that if Indiana does not expand Medicaid, employers in the state could be responsible for penalties of between "$36.5 million to $54.8 million per year."

        Idaho Task Force Expected To Recommend Medicaid Expansion. The Idaho Reporter  (3/19, Hill) reports that "Gov. Butch Otter's task force on Medicaid expansion is preparing to formally recommend that Idaho expand Medicaid now, despite Otter's assertion in January that he was not seeking such expansion this year." When asked about "whether or not Otter's position on expanding Medicaid this year was changing," Otter spokesman Jon Hanian denied the charge, stating that the task force's recommendation is not "a final determination by the Governor and the legislature on what will be the best course of action for the state." Hanian also "declined to comment on Loertscher's Medicaid expansion bill."

        NPR  (3/18, Messick) reports that consulting group Milliman is set to "tell Gov. C.L. 'Butch' Otter's Medicaid work group that Idaho could save more money than previously estimated by expanding Medicaid eligibility." According to group's "updated calculation, which takes into consideration new information from the federal Centers for Medicare and Medicaid Services (CMS), net savings to Idaho county budgets and the state general fund could total $9.8 million over a decade, rather than the $6 million earlier projected."

        Mississippi Democrats, Republican Governor Clash Over Medicaid Expansion. The AP  (3/19, Pettus) reports that Democrats in Mississippi's state House said Monday "that the state could hurt its own financial standing if it rejects Medicaid expansion," yet Republican Governor Phil Bryant "said he's not convinced that would happen and he still opposes putting more people on the government health program." The Democrats referenced an analysis released last week by Moody's Investors Service, which found that states "will face 'political and budgetary pressure' to cover hospitals' loss of federal money for treating uninsured patients." In response to this, "Bryant said, as he has before, that Mississippi might sue the federal government to try to block a reduction in disproportionate share payments to hospitals."

        The Jackson (MS) Clarion Ledger  (3/19, Pender) reports further on the Moody's analysis.

        Utah Democrats Losing Patience Over Delayed Medicaid Study. The Salt Lake (UT) Tribune  (3/19, Stewart) reports that, according to documents obtained by the Tribune, "Utah Gov. Gary Herbert has said he won't pass judgment on Obamacare's Medicaid expansion without results from a state-commissioned study." Although the Public Consulting Group (PCG) produced a final draft of the study, which has been "under review since Feb. 19," Utah Department of Health spokesman Tom Hudachko claims that "key data elements remain missing." Meanwhile, the Tribune notes that "Democrats are losing patience and the policy landscape is shifting as states win federal approval to pursue alternatives, including a partial-expansion scenario under serious consideration in Utah."

        Advocates Call For Missouri Lawmakers To Expand Medicaid During Rally. St. Louis Public Radio  (3/19, Lloyd) reports that, during a rally Monday evening, members of Metropolitan Congregations United (MCU) claimed "the working poor in Missouri are desperately in need of affordable healthcare" and "called on lawmakers to take advantage of federal money to expand Medicaid coverage." Missouri Gov. Jay Nixon "has been vocal in his support, saying expansion would bring $5.7 billion to the state and provide health coverage to an additional 300,000 Missourians over the next three years."

        On its website, KOLR-TV  Springfield, MO (3/19, Clein) reports that Rep. Jeff Messenger (R) "hosted a town hall meeting Monday at the Brentwood Branch Library" in which Missourians expressed "strong feelings" about Medicaid expansion. At the meeting, Messenger said that a proposal to "provide coverage to Missourians making up to 138 percent of the federal" poverty level may not "happen at this point in time." KOLR-TV adds that "Messenger believes Missouri's leaders can figure out something to improve the state's medical system without relying on the federal government."

        Texas Chambers Of Commerce Pressing Perry To Expand Medicaid. Bloomberg News  (3/19, Mildenberg) reports, "Chambers of commerce representing companies such as Exxon Mobil Corp. (XOM) and Kimberly-Clark Corp. (KMB) are challenging Texas Governor Rick Perry and lawmakers to expand health care for the poor in the state with the highest percentage of uninsured people." The "chambers of five cities are sending lobbyists to press Republican leaders to increase Medicaid coverage under President Barack Obama's health-care law."