Even as state legislative sessions wrap up around the country, the Medicaid expansion debate remains very much alive in several states. With significant extra funding available under the federal American Rescue Plan for states that do expand, the financial benefits for states have never been greater. A new report on the economic effects of Medicaid expansion from the Commonwealth Fund again focuses on the jobs that could be created for the final twelve states still holding out. Our series of briefs here at CCF highlight the type of jobs filled by workers who would benefit from a decision to close the coverage gap – many of whom were on the front lines during the pandemic in Alabama, Georgia, Kansas, Mississippi, Missouri, North Carolina, Tennessee, Texas, and Wyoming. Here’s a short overview of what’s happening in three of these states:
In a flurry of activity during March and April during the final part of the Wyoming legislative the Wyoming House passed Medicaid expansion before it was defeated in the Senate. The Wyoming House Speaker, Eric Barlow, R-Gillette, was a strong supporter and had this to say:
“I voted no multiple times on this issue [Medicaid expansion],…I’m going to vote yes this time, because I haven’t seen any other solution. No one has brought anything forward, and I’ve looked myself.”
The new federal incentives under the American Rescue Plan were cited repeatedly by legislators during the ultimately unsuccessful legislative debate during the regular session. However, after adjournment, an interim legislative committee advanced a Medicaid expansion bill in May. This means that the Medicaid expansion issue will likely be heard in the full legislature either in a special session in July or the budget session early next year. A significant aspect of the legislative hearing was the amount of debate around policy issues like closing the coverage gap’s effect on state budgets and the effect on state hospital finances. Misinformation was so rampant at the meeting that one news story focused simply on laying out the facts around how expansion had actually operated in other states. One of the committee co-chairs summed up the debate in a way that covers not just Wyoming but sometimes the expansion discussion in other states as well:
“It is disappointing to me, as a longtime member of this Legislature, to hear so many falsehoods from the same people over and over,” Sen. Cale Case (R-Lander), one of the committee co-chairs, said before the vote. I’ve never experienced anything like this. I guess it’s a sign of our times. If you read the same thing off the internet over and over 500 times, it doesn’t necessarily make it true.”
Wyoming groups like the Equality State Policy Center, in tandem with other state organizations interested in health, are continuing to work on closing the coverage gap in the state and expect discussion around the issue to increase over the next few months.
In contrast to the progress in Wyoming, the Mississippi Supreme Court threw the expansion debate into a sharp U-turn last month with a ruling invalidating years of voter-passed ballot initiatives in the state. The basis of the court’s reasoning was that the state’s current ballot initiative process, despite being in place for decades, was now invalid. This ruling has retroactively invalidated several voter-passed ballot measures in addition to invalidating the current process advocates were using to move forward with a Medicaid expansion ballot measure in the state. Some groups have asked for a rehearing on the case, but that is seen as an uphill legal argument. While a legislative fix on the ballot approach has a lot of support, the timeline for action is slow. Even in the most optimistic scenario, a ballot measure on Medicaid expansion could not appear before Mississippi’s voters until at least 2024 as signature collection for a new ballot measure can only begin after any fix is made. The good news is that an effective coalition has been working together on Medicaid expansion in the state and will continue working on a legislative solution even if action on the ballot measure has been delayed for several years by the Court’s action. And there is support among some state leaders, most prominently Lt. Gov. Delbert Hosemann, for closing the coverage gap.
After successful passage of a ballot measure expanding Medicaid last year, the debate over how to implement expansion continues in Missouri. There the legislature adjourned while still in disagreement with the Governor over exactly how much funding the entire Medicaid program needed, including expansion. Since voters passed Medicaid expansion via a ballot initiative which starts coverage July 1, Missouri Medicaid has already been expanded. However, the Governor recently withdrew the federal administrative documents needed for expansion to start. This prompted a lawsuit which will be heard before a judge on June 18th – with a ruling hopefully in time for the July 1 start of coverage.
Federal v. State Action
The debate continues in these three states along with the others in the shrinking non-expansion group, now centered mostly in the South. With huge federal financial incentives on the table and access to Medicaid now a powerful issue in state and federal elections, we can expect the back and forth around closing the coverage gap to continue. Frustration with some states has stimulated more debate in Washington about a federal fallback coverage solution. In the meantime, two million people are going uninsured because of the flawed choices of their states’ leaders.