Though the law provided federal funding to fully pay for the expansion in 2014, 2015 and 2016, the aid is gradually phased down so that states will ultimately foot 10% of the cost in 2020, a prospect many state lawmakers find worrisome, given doubts about the price tag. That means that if a state such as Florida, which has opposed the law, decides in 2017 to expand Medicaid, the state would never get the full federal support. Obama's new proposal would change that, allowing any state that decides to expand Medicaid eligibility under the law to get three years of full federal funding, no matter when the expansion starts.
Soon after Republican Matt Bevin won Kentucky's gubernatorial race three months ago, the conventional wisdom said the results were bad news for the Affordable Care Act. Bevin ran on an anti-Obamacare platform and had vowed to make Kentucky the first state to reject Medicaid expansion after already embracing it.
Three months later, the landscape is far more encouraging for ACA proponents. Bevin has effectively blinked, grudgingly endorsing a version of Medicaid expansion, and soon after his election, Louisiana's John Bel Edwards (D) was elected on a pro-Medicaid platform. This week, the Democratic governor made Louisiana the 31st state to accept the ACA policy, extending coverage to hundreds of thousands of low-income residents.
Which state will be the 32nd? South Dakota, Wyoming, Alabama, and now even Idaho are discussing the possibility. Last night, the L.A. Times reported that the Obama administration has a new proposal in mind to "persuade more states" to follow suit.
In a statement, the White House called this a "common-sense proposal," but added, "We hope Congress will act to provide this extra incentive to states that haven't yet expanded, encouraging them not to miss out on the benefits other states are already enjoying."
The five words that should jump out are, "We hope Congress will act," as in, this is a good idea that will need lawmakers' approval, which means it probably won't happen.
I wonder, though, if even the proposal itself has some beneficial effects. The administration probably won't get what it wants from Capitol Hill, but this nevertheless serves as a reminder to states considering Medicaid expansion: the sooner you act, the more you'll benefit.
As for the larger trend, Louisiana joining the club this week is a positive development for health care supporters, and given the trajectory, conservatives should prepare for more defeats soon.