Former, Current GOP Governors Bash Medicaid Expansion Plan

Janice Simmons, for HealthLeaders Media , December 18, 2009

While the Senate focused attention Thursday on the defense spending bill until the wee hours of the morning, Senate Republicans began to put pressure on another area to stop the healthcare reform bill. A current GOP governor and four GOP senators, who were once governors (from New Hampshire, Idaho, Nebraska, and Tennessee), said they oppose the "unfunded mandate" of Medicaid expansion included in the bill.

In Washington, Mississippi Gov. Haley Barbour said the current proposal in the Senate bill to permit individuals making less than 133% of the federal poverty level [it's 150% in the House bill] to receive Medicaid could lead to big tax increases—especially in those states required to balance their budgets every year. Under the bill provisions, the federal government would pay the states three years to fund the new Medicaid population; the states would then pick up the tab after that.

Barbour described this idea as like "leaving mackerel out in the moonlight ... the longer it's out there, the worse it stinks." For his state alone, he said, Medicaid, which is one of the most costly programs in the state, would cost Mississippi taxpayers $1.3 billion over the next 10 years.

Sen. Judd Gregg, who was once the governor of New Hampshire, warned of the "death spiral" that could occur if states had to find funding for the estimated 15 million people added to the Medicaid rolls, as proposed by the bill.

He said the increase in Medicaid beneficiaries would have a "disproportionate effect" on private insurance. Since Medicaid pays providers about 60% of the cost of care for beneficiaries, providers would be forced to charge more to private insurers to make up the difference, he said.

One group, though, that is supporting the Senate Democrats' efforts to expand coverage is Families USA, which released on Thursday a report, called "At a Crossroads," that looks at what type of healthcare coverage is ahead for everyone. In an accompanying letter, Families USA Executive Director Ron Pollack said the group supports the bill, even if it lacks a "robust public plan option."

Families USA, a national health care advocacy group, used Census data and Congressional Budget Office's national data to estimate coverage gained under the bill and the number of uninsured by 2019. It reported that:

  • The following 10 states are projected to have the largest gains in coverage by 2019: Arizona, New Jersey, Ohio, North Carolina, Illinois, Georgia, New York, Florida, Texas, and California.

  • In 2019, the coverage gains in these 10 states will range from 821,000 to 4.527 million people.

  • If health reform fails, those same 10 states would have the largest losses in coverage by 2019.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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