In about face, more GOP governors back expanding Medicaid
by Thomas Beaumont
Associated Press Writer
February 09, 2013 12:00 AM | 948 views | 4 4 comments | 2 2 recommendations | email to a friend | print
Michigan Republican Gov. Rick Snyder, right, announces an expansion of the state's Medicaid health care program in Lansing, Mich., on Wednesday. Snyder became the sixth GOP governor in the past two months to join a growing number of Republican governors now buying into parts of the health reform overhaul.<br>The Associated Press
Michigan Republican Gov. Rick Snyder, right, announces an expansion of the state's Medicaid health care program in Lansing, Mich., on Wednesday. Snyder became the sixth GOP governor in the past two months to join a growing number of Republican governors now buying into parts of the health reform overhaul.
The Associated Press
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DES MOINES, Iowa — Once largely united in resisting the Obama administration’s new health care overhaul, a growing number of Republican governors are now buying into parts of the system as the financial realities of their states’ medical costs begin to counterbalance the fierce election politics of the issue.

This week, Michigan’s Rick Snyder became the sixth GOP governor to propose expanding his state’s health insurance program to cover more low-income residents, in line with the Democratic administration’s strong recommendation. Eleven Republican governors have rejected the idea while a dozen, who have been mostly critical, have not announced a decision.

Although the Democratic president’s re-election last fall cleared the way for providing health insurance for millions of Americans who don’t have it, many Republican governors have resisted parts of the plan that remained optional. They have been reluctant to expand their Medicaid programs to cover more low-income residents. And many declined to take responsibility for the online marketplaces — called exchanges — that would offer subsidized private coverage to the middle class.

Both would pose costs to the states and also involved cooperating with a larger government role in health care that many Republicans strongly opposed.

However, the federal government’s agreement to pay most of the added Medicaid expense, and belief that fewer residents would be showing up at local hospitals without insurance, have begun to break down some governors’ opposition.

“Politically, the dynamic may be shifting,” said Matt Benson, a senior aide to Arizona Republican Gov. Jan Brewer, who proposed expanding Medicaid last month. “There may be some folks looking at this anew.”

Two high-profile Republican governors, Scott Walker of Wisconsin and Rick Scott of Florida, have voiced skepticism about the federal terms but are still considering the option.

Most Democratic governors have supported expanding their Medicaid programs to cover more low-income residents, mainly adults with no children at home, who don’t qualify now. With such an expansion, Medicaid would account for almost all of the state’s poor. Under the new federal plan, higher earners would be required to get private insurance. Together, the provisions are aimed at sharply reducing the 15% of Americans who are uninsured.

But many Republican governors shrank from taking on any further costs for Medicaid, which has heavily burdened state budgets. The federal government would pay the full cost for the first three years under the new system, but the states would pay up to 10 percent later. Some governors worried that the federal government could decide to trim back its contribution in the future.

The governors now agreeing to opt in and expand Medicaid include Republicans from different regions of the country and different ideological leanings. This has prompted hope among some health care overhaul supporters of more GOP defections. In addition to Snyder and Brewer, Republican governors who support expanding Medicaid include Jack Dalrymple of North Dakota, John Kasich of Ohio, Brian Sandoval of Nevada and Susana Martinez of New Mexico.

In each state, the proposal must still be approved by the legislature, where there is still Republican opposition.

Snyder said that in Michigan, the expansion would provide coverage for about 500,000 uninsured residents, mostly at federal expense, and save state taxpayers $1.2 billion through 2020. Many states now help hospitals cover some of the cost of treating those without insurance.

“This is a federal program that we would not have necessarily created for Michigan,” he said Wednesday, but “this is saving money and improving lives.”

Governors have been under immense pressure to opt in from hospital and medical associations, as well as advocates for the poor.

In explaining their decisions, Kasich, Brewer and others have said rejecting an expansion would mean their taxpayers would subsidize care for those in other states, while receiving no benefits themselves. In Ohio, that would be an estimated $2.4 billion over two years, Kasich said Monday.

“Ohio taxpayer dollars are coming back to Ohio to support a significant need we have,” he said.

But governors elsewhere said they fear the states would be saddled with huge costs if the federal government later reneged on its commitment.

“The federal government, because of their budget problems, starts cutting back and...then you’ve just bought into something of a lead sinker,” said Iowa Gov. Terry Branstad, among the skeptics. He has asked federal officials to allow his state to craft its own plan for low-income residents.

Virginia Gov. Bob McDonnell has also questioned the terms, saying he didn’t “believe the federal government can possibly deliver its commitment to fully fund the program.”

About half the states are preparing to participate in another part of the federal health plan —setting up an online marketplace, either by themselves or in partnership with Washington, where middle-class residents can shop for subsidized private insurance. This group includes a half dozen GOP-governed states. Under the new system, the federal government will set up the online marketplaces, or exchanges, for states that decline to do so. The new exchanges are scheduled to go into operation in October, with insurance coverage beginning in January 2014.
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Kennesaw Resident
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February 11, 2013
Meanwhile, those of us working and paying for insurance have seen our taxes rise, our premiums rise, our co-pays rise, and our deductibles rise as government shifts the costs of care onto the most productive members of society to pay for the least productive members of society.

Playing politics
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February 09, 2013
In Georgia we will be losing potentially hundreds of millions of dollars along with a hamstrung healthcare industry and still have tens of thousands of our residents having to be covered by our taxes or our individual insurance. This could be covered by the Obamacare program if we will accept the money like most other states have done. Meanwhile states who accept funds for medicare expansion will be getting money that would have come to Georgia, tens or hundreds of millions not going into our economy and reducing our costs. Instead of a thriving health care industry here, we will be somewhere at the back of the line as the industry expands. All just so the governor can play politics. In this case it is high stakes and if we continue on this path will cost us dearly.
anonymous
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February 09, 2013
Those of us alive today are watching the most dramatic changes in almost everything that has happened in decades and we are seeing it all starting to change in one decade just about. The Internet is most certainly changing life throughout the world. Demographics in the U.S. are changing and will be an entirely different picture in less than 50 years than what they are today--majority white. Housing is no longer a retirement income. Pension plans in the private sector are virtually gone, something people were dependent on not that long ago. It never made sense to me anyway that affordable health insurance hinged on a job, but that is the way it is right now although that will start to change in 2014. We will need to be very careful to protect the middle class. People shouldn't be punished because they lived responsibly and saved for their golden years to only have it wiped out by the government if they encounter huge medical costs and because they don't qualify for Medicaid, then the government seizes all their assets, thereby making them poor enough to qualify for Medicaid. I don't want the government to get everything I worked hard for all my life, rather than for my children to get it. That would put me right there with people that flittered their money away and didn't live frugally as I did and saved. I see where there will be a decline in new office space eventually because there is a decline in the occupancy of existing office space due to the slow trend of companies realizing the cost-effectiveness of home-based employees. Lots of exciting stuff going on. We just need to balance it to be fair to all-rich, middle class, and poor alike. And that will be hard to do.
FUTURE-SHOCK UGA
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February 11, 2013
In your analysis of the future you overlooked one fact; as robotics and artificial intelligence advance there will exist NO JOB that can not be done by a robot. What will the roll of humankind be when after millions of years of evolution shaped by sustinance we are "freed" to pursue...something else? We will be lost as global population swells and without a job/income violence driven by the need to acquire resources will explode. What is the world like when no one has to work and medical advances allow us to live well into the hundreds? Answer: NOT the utopia you imagined. Plan now: acquire land, particularly arable and with a significant watershed. These will be the only resources that matter. The government will exist to alocate all resources. Just relax and let them shelter you cradle to grave.
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