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Accessible Unlicensed Requires Authentication Published by De Gruyter April 10, 2015

Opting In, Opting Out: The Politics of State Medicaid Expansion

Shanna Rose
From the journal The Forum

Abstract

As the list of Republican-led states participating in the Medicaid expansion grows, it is becoming increasingly clear that partisanship and ideology alone cannot fully explain states’ choices. This paper examines the political and practical dynamics influencing state Medicaid expansion decisions. Whereas resources and history have served to reinforce the effects of partisanship and ideology, several countervailing forces – including public opinion, interest group pressure, budgetary considerations, and need – are pushing even the reddest states toward expansion. The relative force of these competing pressures within a state can help explain not only whether or not the state expands Medicaid, but also the manner in which it does so, such as through a waiver or executive action. I present five case studies – Nevada, Arizona, Ohio, Arkansas, and Tennessee – to illustrate how these various dynamics are shaping states’ decisions.


Corresponding author: Shanna Rose, Associate Professor, Claremont McKenna College, Department of Government, 850 Columbia Avenue, Claremont, CA 91711, USA, e-mail:

Acknowledgments

The author thanks Ryan Driscoll for research assistance and the Rose Institute of State and Local Government at Claremont McKenna College for support.

References

A Healthy Florida Works. 2014. “A Healthy Florida Works Program: Policy Proposal.” .Search in Google Scholar

Bachrach, Deborah, Patricia Boozang, and Mindy Lipson. 2015. “Manatt on Medicaid: Early Results Point to Benefits of Expansion.” Manatt, January 8. .Search in Google Scholar

Bacon, Perry. 2015. “In Rebuke of Tennessee Governor, Koch Group Shows Its Power.” NBC News, February 6. .Search in Google Scholar

Barrilleaux, Charles, and Carlisle Rainey. 2014. “The Politics of Need: Examining Governors’ Decisions to Oppose the ‘Obamacare’ Medicaid Expansion.” State Politics and Policy Quarterly 14 (4): 437–460.Search in Google Scholar

Byler, David. 2014. “The Other GOP Wave: State Legislatures.” Real Clear Politics, November 11. .Search in Google Scholar

Candisky, Catherine. 2015. “Ohio Legislature Might Avoid Voting on Keeping Medicaid Expansion.” The Columbus Dispatch, February 2.Search in Google Scholar

Centers for Medicare and Medicaid Services, U.S. Department of Health. 2015. “Medicaid & CHIP: December 2014 Monthly Applications, Eligibility Determinations and Enrollment Report.” February 23.Search in Google Scholar

Cheney, Kyle. 2013. “Arizona’s Jan Brewer becomes unlike ally of Obamacare.” Politico, June 5. .Search in Google Scholar

Christie, Bob, and Cristina Silva. 2013. “Arizona Legislature Passes Medicaid Expansion.” The Big Story, June 14. .Search in Google Scholar

Coburn, Tom, and Bobby Jindal. 2013. “Fix Medicaid, Don’t Expand It.” Real Clear Policy, June 21. .Search in Google Scholar

Code Red Texas. 2015. “Code Red: The Critical Condition of Health in Texas 2015.” .Search in Google Scholar

Congressional Budget Office. 2012. “Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision.” July 24.Search in Google Scholar

Dorn, Stan, Megan McGrath, and John Holahan. 2014. What Is the Result of States Not Expanding Medicaid? Urban Institute. .Search in Google Scholar

DuVal, Barry E. 2013. “Health Insurance Coverage Keeps State Competitive in Business.” Richmond Times-Dispatch, February 8.Search in Google Scholar

Galewitz, Phil. 2014. “Business Groups Split On Medicaid Expansion.” Kaiser Health News, March 10. .Search in Google Scholar

Goodnough, Abby, and Robert Pear. 2013. “Governors Fall Away in G.O.P. Opposition to More Medicaid.” The New York Times, February 21.Search in Google Scholar

Hart, Jason. 2014. “Obamacare Adds 450,000 Ohioans to Medicaid Rolls.” Ohio Watchdog, December 16. .Search in Google Scholar

Hutchinson, Asa. 2015. “Transcript of Governor Asa Hutchinson’s Healthcare Speech.” January 22. .Search in Google Scholar

Jacobs, Lawrence R., and Timothy Callaghan. 2013. “Why States Expand Medicaid: Party, Resources, and History.” Journal of Health Politics, Policy, and Law 38: 1023–1050.Search in Google Scholar

Jacobs, Lawrence R., and Theda Skocpol. 2012. Health Care Reform and American Politics: What Everyone Needs to Know. New York: Oxford University Press.Search in Google Scholar

Jones, David K., Phillip M. Singer, and John Z. Ayanian. 2014. “The Changing Landscape of Medicaid.” Journal of American Medical Association 311 (19): 1965–1966.Search in Google Scholar

Kaiser Family Foundation. 2011. “Pulling It All Together: A Public Opinion Surprise.” April 4. .Search in Google Scholar

Khazan, Olga. 2013. “The State Where Obamacare Is Working.” The Atlantic, November 13.Search in Google Scholar

Kliff, Sarah. 2013. “Arkansas’s Unusual Plan to Expand Medicaid.” The Washington PostWonk Blog, February 28. .Search in Google Scholar

KMAC. “How Much Has Kansas Left on the Table by Not Expanding Medicaid?” .Search in Google Scholar

Melville, Bill. 2012. “Nevada Strikes First on Medicaid Expansion.” Healthcare Reform Blog, December 13. .Search in Google Scholar

Morgan, David. 2013. “Republican Battles over Medicaid Turn to God and Morality.” Reuters, June 26.Search in Google Scholar

Nashville Area Chamber of Commerce. 2013. “Briefing Paper-Issue: TennCare/Medicaid Expansion.” February 5. .Search in Google Scholar

Nicholson-Crotty, Sean. 2012. “Leaving Money on the Table: Learning from Recent Refusals of Federal Grants in the States.” Publius: The Journal of Federalism 42: 449–466.Search in Google Scholar

Ollove, Michael. 2013. “Despite Governors’ Opposition, Strong Southern Support for Medicaid Expansion.” Stateline, May 21. .Search in Google Scholar

Pugh, Tony. 2014. “States That Decline to Expand Medicaid Give Up Billions in Aid.” McClatchy Washington Bureau, September 2. .Search in Google Scholar

Rigby, Elizabeth. 2012. “State Resistance to ‘ObamaCare.’” The Forum 10 (2): 1540–8884.Search in Google Scholar

Rose, Shanna. 2013. Financing Medicaid: Federalism and the Growth of America’s Health Care Safety Net. Ann Arbor: University of Michigan Press.Search in Google Scholar

Rowland, Darrel. 2013. “Opinion Poll: Ohioans Divided on Tax Plans.” The Columbus Dispatch, March 17.Search in Google Scholar

Santos, Fernanda. 2013. “G.O.P. in Arizona is Pushed to Expand Medicaid.” The New York Times, March 10.Search in Google Scholar

Schelzig, Eric. 2015. “Defeat of Insure Tennessee Leaves Haslam Frustrated, Embarrassed.” Associated Press, February 5.Search in Google Scholar

Scott, Dylan. 2013. “Why GOP Governors are Coming Around on the Medicaid Expansion.” Governing the State and Localities, January 16. .Search in Google Scholar

Seaman, Jessica. 2013. “Medicaid Expansion Can Pay for Tax Cuts, Beebe Says.” Arkansas Online, March 27. .Search in Google Scholar

Sebelius, Steve. 2012. “Sandoval Does Right Thing in Expanding Medicaid.” Las Vegas Review-Journal, December 14.Search in Google Scholar

Sher, Andy. 2014. “Lawmakers Ready to Look at Haslam Medicaid Plan.” Times Free Press, December 17.Search in Google Scholar

Sommers, Benjamin D., and Arnold M. Epstein. 2013. “U.S. Governors and the Medicaid Expansion – No Quick Resolution in Sight.” The New England Journal of Medicine 368: 496–499.Search in Google Scholar

Tavernise, Sabrina, and Allison Kopicki. 2014. “Southerners Don’t Like Obamacare. They Also Don’t Want to Repeal It.” New York Times, April 13.Search in Google Scholar

Thompson, Frank J. 1981. Health Policy and the Bureaucracy: Politics and Implementation. Cambridge: MIT Press.Search in Google Scholar

Thompson, Frank J., and Courtney Burke. 2007. “Executive Federalism and Medicaid Demonstration Waivers: Implications for Policy and Democratic Process.” Journal of Health Politics, Policy, and Law 32: 971–1004.Search in Google Scholar

U.S. Government Accountability Office. 2014. “Medicaid Demonstrations: HHS’s Approval Process for Arkansas’s Medicaid Expansion Waiver Raises Cost Concerns.” August 8. .Search in Google Scholar

Vogel, Ed. 2012. “Groups Urge Sandoval to Support Medicaid Expansion.” Las Vegas Review-Journal, November 15.Search in Google Scholar

Whaley, Sean, and Ed Vogel. 2013. “Nevada Legislature Approves 5 Spending Bills to Fund State Government.” Las Vegas Review-Journal, June 3.Search in Google Scholar

Wheaton, Sarah. 2014. “Gov. John Kasich: Repeal Obamacare, But Not All of It.” Politico, October 20. .Search in Google Scholar

Wyoming Department of Health. 2012. “The Optional Expansion of Medicaid in Wyoming: Costs, Offsets, and Considerations for Decision-Makers.” .Search in Google Scholar

Published Online: 2015-4-10
Published in Print: 2015-4-1

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