Even as their colleagues in Congress voted to kill it, along with other major parts of the Patient Protection and Affordable Care Act, many Republican state legislators and governors are grudgingly accepting the Medicaid expansion that has played a big role in driving down uninsured rates.
But that doesn’t mean that Republicans aren’t going to try to do it differently.
A number of GOP-led states have asked the feds for permission to impose different rules on their Medicaid beneficiaries, such as mandating premiums for those with incomes over 100 percent of the federal poverty level.
However, one of the most striking deviations from the federal vision for Medicaid expansion came in Arkansas, where former Democratic Gov. Mike Beebe sought a waiver from the feds that allowed the state to accept the federal Medicaid dollars but use them to buy people coverage on the state-run private insurance exchange.
The success of the policy is hard to debate. Arkansas’ uninsured rate, previously one of the highest in the country, dropped from 22.5 percent in 2013 to 9.1 percent in 2015.
Beebe’s successor, Republican Gov. Asa Hutchinson, has announced that he will continue the policy, but is seeking federal approval of additional changes.
For one, Hutchinson wants those above 100 percent of the poverty level to have to pay premiums for their exchange plans. Currently the plans are paid for entirely by Medicaid funds.
He also floated the idea of premiums for those above 50 percent of the poverty level, which is currently just over $8,000 a year for an individual.
In addition, Hutchinson is proposing incentives, such as access to dental care and other benefits, to those who complete a wellness exam.
In spite of the apparent success of the individual market in Arkansas, Hutchinson also seeks to use the waiver to shift emphasis back to employer-based coverage.
He proposes requiring employees at workplaces with employer-sponsored insurance to enroll in those plans, in return for Medicaid covering the employee premiums and potentially other out-of-pocket expenses.
It’s not clear how the federal government will respond.