Governors Faced with Difficult Medicaid Decision

The Medicaid expansion decision for each state is one of several critical aspects of the Affordable Care Act, which was recently deemed Constitutional by the Supreme Court. Although federal dollars are at stake, it’s not a given that states (including Indiana) will agree to the changes to the program for low-income residents. Stateline offers a strong summary.

Although the lineup is shifting, more than a dozen Republican governors have suggested they might decline to participate in the Medicaid expansion. Governors in Florida, Iowa, Kansas, Louisiana, Nebraska, Texas, South Carolina and Wisconsin have said they will not participate. GOP governors in Alabama, Georgia, Indiana, Mississippi, Nevada and Virginia indicate they are leaning in that direction.

Meanwhile, about a dozen Democratic governors have said their states will opt in. The rest have not declared their intentions.

According to data from the Congressional Budget Office, the federal government would spend $923 billion on a full Medicaid expansion between 2014 and 2022, and states would spend about $73 billion. But nobody is sure how many people will enroll in the Medicaid expansion. According to a 2010 report by the Kaiser Family Foundation, states’ share of the Medicaid expansion could range anywhere from $20 billion to $43 billion in the first five years.

According to Kaiser, most states opting into the expansion likely would have to ramp up their Medicaid spending between 2014 and 2019, but four would spend less (Hawaii, Maine, Massachusetts and Vermont) and several others would have to boost state spending only slightly.

Mississippi’s Medicaid program, for example, cost a total of $4 billion in 2011—the federal government paid $3 billion, and the state paid $1 billion. Expanding that program to everybody at or below 138 percent of the federal poverty line would cost the state as much as $581 million between 2014 and 2019, according to Kaiser’s 2010 study.  That’s a 6.4 percent increase in state spending compared to what Mississippi would spend without an expansion

The day after the Supreme Court ruled the Medicaid expansion was optional, Mississippi Governor Phil Bryant, a Republican, said: “Although I am continuing to review the ruling by the Supreme Court, I would resist any expansion of Medicaid that could result in significant tax increases or dramatic cuts to education, public safety and job creation.”

Rallying Cry: Stop the EPA

We reported last week on the efforts of several states (Texas being the latest to file suit) to stop Environmental Protection Agency regulation of greenhouse gases. The reasons are many, including devastating impacts on the economy.

Add a few more powerful players to the mix — Mississippi Gov. Haley Barbour and a leading Senate committee member. Both want to employ the Congressional Review Act. Here is an explanation:

Barbour is floating a draft letter to governors at their winter meeting asking Congress to use the Congressional Review Act to reject EPA’s endangerment finding. That finding cites climate change as a risk to public health and welfare, which the agency is using as justification for pursuing regulations.

"In addition to placing heavy administrative burdens on state environmental quality agencies, regulating greenhouse gases through the Clean Air Act will be costly to consumers and hurt the U.S. economy, resulting in job losses," according to Barbour’s draft.

This echoes an effort by Senate Energy and Natural Resources ranking member Lisa Murkowski, who is expected to call for a vote on a resolution in March to use the Congressional Review Act to block EPA, spokesman Robert Dillon said.

She needs 51 votes and has 40 co-sponsors for her disapproval resolution, including three Democrats led by Senate Agriculture Chairwoman Blanche Lincoln.

Murkowski’s effort, and those by Energy and Commerce ranking member Joe Barton and others in the House, are not expected to be successful, given Democratic control of Congress and opposition from the president, who could veto a resolution even if it gets through both chambers.

But it continues to raise the argument that efforts by the Obama administration and Democratic congressional leaders to limit U.S. greenhouse gases are serious threats to the economy heading into this fall’s elections. 

Not So Fast, Governor

So we have Our Man Mitch, a guy who’s changing government for the better and won re-election with overwhelming support even when the top of the ticket trended the other way, and our poor neighbors got stuck with this guy (not to mention George Ryan before him):

Illinois Gov. Rod R. Blagojevich and his Chief of Staff, John Harris, were arrested today by FBI agents on federal corruption charges alleging that they and others are engaging in ongoing criminal activity: conspiring to obtain personal financial benefits for Blagojevich by leveraging his sole authority to appoint a United States Senator; threatening to withhold substantial state assistance to the Tribune Company in connection with the sale of Wrigley Field to induce the firing of Chicago Tribune editorial board members sharply critical of Blagojevich; and to obtain campaign contributions in exchange for official actions – both historically and now in a push before a new state ethics law takes effect January 1, 2009.

Point Indiana. But please join me in wishing our Illinois neighbors the best so they can recover and get on track with some semblance of honest governance in the near future.

Illinois Fun Fact: According to Frugal Hoosiers, that means 4 of the last 7 Illinois governors in the past 50 years have gone to prison. (On the upside, 3 of their last 7 governors have not gone to prison.)