U.S. Health and Human Services Secretary Kathleen Sebelius told state legislators from around the nation Monday that her agency is open and willing to discuss different proposals by states to expand their Medicaid programs.
“We are very eager to continue these conversations with states around the country,’’ Sebelius said in Atlanta during a meeting of the National Conference of State Legislatures.
“I don’t think there’s any question that if you want a healthier population, looking at the opportunity to expand Medicaid has got to be a piece of the puzzle.’’
Earlier, a federal official told legislators that if the administration approves a state’s expansion plan that’s different from the standard approach, the federal government still will pick up all the costs for the first three years — even if it’s more expensive.
The 2010 health care law, known as the Affordable Care Act, or ACA, encourages states to expand their Medicaid programs. The federal government offers an incentive for them to do so. It will pay 100 percent of the costs of expansion for the first three years, a percentage that will eventually decrease to 90 percent.
But the U.S. Supreme Court, in its 2012 ruling on the ACA, said the states can refuse expansion without being penalized. To date, while about half the states have agreed to expansion, Georgia and most other Southeastern states have decided against it.
States can opt into or drop out of expansion at any time, Sebelius noted Monday. The federal government currently funds 57 percent of the Medicaid program nationally, though in Georgia the federal share is higher.
Sebelius, who was Kansas governor before being chosen for the HHS post, asserted that expansion would reduce the costs of uncompensated care at the state level and ignite economic development in individual states.
“No one’s health care should be determined by their ZIP Code,’’ she said. “This is no longer a political debate. This is the law of the land.’’
A sweeter deal?
Legislators at the conference also heard a presentation on the Arkansas proposal for expansion, now under consideration by federal officials. It would let newly eligible Medicaid beneficiaries shop for insurance policies along with other consumers in the online marketplaces, also known as exchanges, created by the ACA.
A Centers for Medicare and Medicaid Services official told the legislators that if the federal agency grants a waiver to an Arkansas-like plan, the federal government will pay 100 percent of the tab, even if it costs more than a conventional Medicaid expansion.
“We are open for business, eager to partner’’ with states, said Cindy Mann, a deputy administrator of CMS. “We are very interested in entertaining a limited number of waivers. We are not at our limit.’’
Gov. Nathan Deal has rejected Medicaid expansion in Georgia, chiefly citing the cost to the state. A spokesman for the governor told GHN recently that “under any scenario, implementation of Obamacare would be a huge new cost to the state.”
The Arkansas plan, meanwhile, has grabbed the attention of some Republican-led states. Arkansas state Rep. Mark Biviano, a Republican, said that while the Affordable Care Act is not popular in his state, there is a push to reform Arkansas’ Medicaid program.
A compromise, Biviano said, would allow for a different type of expansion, what he called “the right thing to do,’’ providing health coverage for everyone.
“We have rural hospitals at risk of closing,’’ he said. Expansion would help many low-income residents have access to health care and become more productive citizens, he added.
One health insurer has dominated the insurance market in Arkansas, but now the state’s insurance exchange will have four companies seeking business, Biviano said.
Georgia state Rep. Pat Gardner (D-Atlanta) said after Sebelius’ address that federal officials appear willing to entertain Arkansas-like proposals. “I think we need to find a way that’s workable in Georgia and is acceptable to CMS,’’ she told Georgia Health News.
Georgia state Sen. Judson Hill (R-Marietta), who was also asked about the Arkansas plan, said he is against expanding “a government-run system.’’
“I’m interested in a free-market, patient-centered system,’’ Hill said.
The current Medicaid program, he said, “is rampant with examples of delayed [care] and not the best care. I think we can do better.’’