Throughout the last few months, we’ve watched a wave of states try to restrict or roll back their Medicaid expansion programs and flout the remaining pieces of the Affordable Care Act. Now, with health care costs rising and the midterm elections looming, a group of blue and purple states is moving in the opposite direction.
After years of partisan battles, Virginia could move as soon as this week to expand Medicaid to 400,000 low-income residents. A budget expanding Medicaid already passed the state House of Delegates, and a few key Republicans in the state Senate have broken ranks, making the bill’s final passage possible. In exchange for their votes, these Republicans are making a demand that Democrats are likely to agree to: Tax credits for lower-middle-income Virginians who don’t qualify for Medicaid, to help them deal with rising deductibles and co-pays. The legislature convenes for a special session on Wednesday.
Across the river in Maryland, Republican Gov. Larry Hogan (who just happens to be running for reelection in his Democratic-leaning state this fall) signed a bill to set up a reinsurance program for his ACA marketplace to subsidize care for the most expensive enrollees.
Meanwhile, New Jersey may soon become the first state to implement a replacement for the individual mandate following Congress’ vote to kill it via the tax bill. The state legislature is set to vote this Thursday on two health-care bills; one would set up a state individual mandate and the other would create a reinsurance program.
The state actions to shore up both Medicaid and Obamacare’s individual markets show that elected officials on both sides of the aisle are cognizant of the damage the Trump administration and Congress have done to health-care costs by tossing out the individual mandate, canceling cost-sharing reduction payments, defunding open enrollment outreach and allowing the sale of short-term “junk” plans. These actions are widely predicted to drive up premiums right before the pivotal 2018 midterms.
In fact, according to final Obamacare enrollment data released by HHS last week, while the number of people enrolling is much higher than expected given GOP actions to sabotage the law, the risk pool will be sicker, older, and more expensive for the federal government than in past years.
Some Republican-controlled states, however, are continuing to pursue policies that will drive insurances rates and the number of uninsured residents higher in years to come. Idaho, after its first plan to sell non-ACA compliant plans was rejected by HHS, is trying again, hoping this time to get federal approval to set up a shadow Obamacare market that may draw many young and healthy people away from their comprehensive, regulated plans.
And following the lead of Kentucky, Indiana and Arkansas, more GOP-led states are attempting to impose work requirements on their Medicaid populations. Louisiana is “studying the concept,” Ohio will submit its work requirements waiver to HHS within days, and Tennessee is pushing a bill to implement work requirements and charge the federal government for the hefty cost of implementation.
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