Louisiana election could boost Medicaid expansion in other states

The recent election of a Democratic governor in Louisiana who is committed to expanding Medicaid under the Affordable Care Act has given hope to hospitals and other advocacy groups that back expansion of coverage to low-income adults in the 20 states where Republican leaders so far have balked. Supporters say it gives political momentum to the expansion push in states in the South and Midwest. Another factor is that more rural hospitals are closing in non-expansion states, and industry leaders warn this will continue without Medicaid expansion. HHS Secretary Sylvia Mathews Burwell has said she expects all states to eventually expand Medicaid. Here's a rundown of the states in play. 


Republican Gov. Robert Bentley's healthcare task force this month recommended that the state expand Medicaid to low-income adults, which could extend coverage to as many as 300,000 uninsured Alabamans. A week earlier, Bentley, a physician, said his administration was looking into the idea of expanding Medicaid and hinted it would consider doing so via a state-specific waiver proposal with conservative-friendly features. But he said such discussions were preliminary. For years, he had been a firm opponent of expansion.

On a recent visit to Georgia, CMS Acting Administrator Andy Slavitt said he would be willing to work with state officials on a Medicaid waiver that would expand coverage to as many as 853,000 residents. Republican Gov. Nathan Deal and the GOP-controlled Legislature up to now have firmly opposed expansion. But recent comments from two former top aides to Deal indicate that pressure is mounting on the governor to consider expansion, particularly if neighboring Alabama expands. In addition, another Georgia hospital, the fifth in two years, will close its doors in December. 

On Nov. 19, the board of the influential Wichita Metro Chamber of Commerce voiced support for Medicaid expansion, which could benefit as many as 150,000 people. Its proposal would require able-bodied adults to be working or receiving job training. But Republican Gov. Sam Brownback continues to oppose expansion, even though some Republican lawmakers are pushing for expansion as one rural hospital recently closed and others face severe financial strains. 

Republican Gov.-elect Matt Bevin has walked back his campaign promise to reverse the state's Medicaid expansion, which has extended coverage to about 400,000 residents. Instead, he now says he will seek a Medicaid waiver similar to Indiana's to create a more conservative-friendly model, likely requiring premium contributions from low-income beneficiaries. 

Democratic Gov.-elect John Bel Edwards says one of his top priorities when he takes office in January will be to expand Medicaid, potentially extending coverage to 365,000 residents. The GOP-controlled Legislature passed a law in June—negotiated with the Louisiana Hospital Association—that would help finance expansion, requiring hospitals to pay any costs not covered by the federal government. 

A bipartisan group of state senators has been traveling the state to get public input on future action that's needed for the Medicaid program. They are regularly hearing that the program should be expanded, which could extend coverage to 54,000 residents. Republican Sen. John McCollister, who has been traveling with the lawmakers and supports expansion, said the public input will be used to draft a bill to be introduced next year. Republican Gov. Pete Ricketts has opposed Medicaid expansion. 

South Dakota
A bipartisan group of lawmakers say they are in talks with the CMS about expanding Medicaid. The lawmakers are waiting to see if the CMS will move forward with its recent proposal to fully fund medical services for Native Americans that are not available at tribal healthcare facilities. The lawmakers hope to use the savings to the state to fund Medicaid expansion once states have to chip in to cover the expansion costs starting in 2017. Republican Gov. Dennis Daugaard has said he would support expansion if it can be done without spending money from the state's general revenue. As many as 49,000 residents could receive coverage.

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