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Red States Move To Expand Medicaid Under Obamacare


Now even as Republicans in Congress keep trying to repeal the Affordable Care Act, the law is quietly taking hold in this country. And that's true even in several red states where Republican governors and legislators are working on a key part of Obamacare, expanding Medicaid. Here's NPR's Greg Allen.

GREG ALLEN, BYLINE: Two years ago, like most Republican governors, Tennessee's Bill Haslam rejected suggestions his state expand Medicaid under the Affordable Care Act. Doing so would extend coverage to some 280,000 Tennesseans. But Haslam said no, that is until recently. He says Tennessee is now close to an agreement with the federal government to expand Medicaid. Last night, he worked to win over skeptics in an address to the state legislature.


GOVERNOR BILL HASLAM: This is not Obamacare. If it was, it wouldn't have taken us this long to negotiate. And I could have saved a lot of trips to Washington and a whole lot of phone calls.

ALLEN: Under Haslam's plan, Tennessee would require some Medicaid recipients to contribute money toward health savings accounts. And they could be kicked out of the plan if they fail to pay their premiums. Similar provisions were recently approved by the federal government for another red state, Indiana. After announcing that deal, Republican Governor Mike Pence said it was in no way an endorsement of the Affordable Care Act.


GOVERNOR MIKE PENCE: Obamacare should be repealed, lock, stock and barrel. Ordering every American to buy health insurance is not the right solution to our health care challenges in this country. That being said, I've long been a supporter of Medicaid reform.

ALLEN: Expanding Medicaid was always a key provision of the Affordable Care Act. As part of the law, the federal government agreed to pay 100 percent of the cost in the first few years. Coverage would be available to adults with incomes up to 138 percent of the federal poverty level. The Supreme Court ruled that for states, though, Medicaid expansion was optional. In the first year, only a few states led by Republican governors signed on. But this year, along with Indiana and Tennessee, Wyoming, Utah, Alaska, Idaho and Montana are all considering expanding Medicaid. Joan Alker, a health care policy analyst with Georgetown University, says something important happened in between - the election.

JOAN ALKER: Well, I think as the politics dies down around the Affordable Care Act and we move past primary season and governors are looking at their budgets and their health care systems moving forward, this option is too good for them not to consider very seriously.

ALLEN: Every Democratic state has signed onto Medicaid expansion and several led by Republicans. The split now, Alker says, is in the Republican Party.

ALKER: So you see, the ideological wing of the party that just wants to say no to Obamacare continue to do so, and they do that through their opposition to the Medicaid expansion. But you see more pragmatic Republicans who started to say yes with Governor Kasich and Governor Christie and others. And that trend is continuing.

ALLEN: Health care activists are critical of provisions the Obama administration has approved for some states though, like the requirement in Indiana that Medicaid recipients pay premiums or be kicked out of the plan. Alker says that means some of the people who need care most may not get it.


ALKER: While there is this sort of political desire to have skin in the game, the research is very clear with premiums and cost sharing that it will deter participation in the game that we'd like.

ALLEN: Cost sharing could be a necessary compromise to get more states to sign on to Medicaid expansion. The Obama administration may not like it, but then many Republican governors don't like Obamacare. Greg Allen, NPR News. Transcript provided by NPR, Copyright NPR.

As NPR's Miami correspondent, Greg Allen reports on the diverse issues and developments tied to the Southeast. He covers everything from breaking news to economic and political stories to arts and environmental stories. He moved into this role in 2006, after four years as NPR's Midwest correspondent.