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Monday, December 1, 2014

The Prospects for Medicaid Expansion in Alaska and Other Western States

Patrick Willard

Senior Director of Campaigns, Outreach, and Engagement (CORE)

With the 2014 elections behind them, governors and other lawmakers in the nation’s Western states are taking a hard look at expanding Medicaid.

Alaska Governor Walker promised to expand Medicaid

In the nation’s largest state, Alaska, the new governor may soon expand Medicaid to more than 40,000 low-income Alaskans. Independent Governor William Walker, a former Republican who upset incumbent Sean Parnell in the November election, took office on December 1. During his campaign, Walker promised to expand Medicaid.

Even before he was sworn into office, Walker’s transition team identified Medicaid expansion as a priority for the new governor. Now, the Independent must choose how to move forward without risking the ire of the state’s Republican-led legislature.

Budget problems a factor in Alaska’s decision on Medicaid expansion

The state’s budget woes will play a part in the discussions about expansion. Alaska faces a budget deficit because of falling oil prices. The state’s revenue is closely tied to energy taxes, and with the price of oil dropping below $100 a barrel, legislators will need to look to other funding sources to balance the budget. However, a report by the Alaska Native Tribal Health Consortium released last year estimated that Medicaid expansion would create 4,000 new jobs and result in $2.49 billion in increased economic activity across the state. (See our analysis of the economic benefits of Medicaid expansion for 11 other states.)

Idaho, Montana, Utah, and Wyoming could also expand Medicaid

Alaska is just one of several Western states that will be reviewing their Medicaid expansion options in December. Idaho, Montana, Utah, and Wyoming are also weighing proposals this month. That will set the stage for action in 2015, when Medicaid expansion (and the continuation of expansions in Arkansas, Michigan, and Ohio) will be taken up in legislative sessions.

Idaho: A Medicaid expansion work group approved a new plan last month. The group hopes to get a hearing before lawmakers in the coming session. The new plan would require individuals with incomes between 100 and 138 percent of the federal poverty level to buy coverage through the state’s health insurance marketplace, and it would use federal funds to pay for this coverage.

Montana: Lawmakers will soon take up Governor Steve Bullock’s two-year budget plan, which includes a Medicaid expansion. The governor released his budget proposal last month and will work with the legislature in its one-year session to expand Medicaid. The legislature narrowly defeated an expansion proposal in 2013.

Utah: Governor Gary Herbert is expected to unveil his Healthy Utah proposal this month. Herbert and his administration have been negotiating with the U.S. Department of Health and Human Services (HHS) throughout the year. The plan will need to win legislative approval before a waiver proposal is formally submitted to HHS. (More about which state waivers HHS has approved or denied.)

Wyoming: In late November, the Wyoming Health Department announced an agreement with federal officials for its SHARE plan, which would provide a private option plan for residents with incomes above 100 percent of the federal poverty level, and Medicaid coverage for those below the poverty level. The plan must be approved by the legislature and is expected to be presented to lawmakers later this month.

Several Republican governors have pursued Medicaid expansion

The 27 states (plus the District of Columbia) that have expanded Medicaid include a trio where GOP governors are in control: Arizona, where former Governor Jan Brewer forced through an expansion, and Nevada and New Mexico, where Republican governors who expanded Medicaid easily won re-election this year. 

The efforts of these governors and Alaska’s Bill Walker may lead to more successes in 2015—and could tell the tale of how the West was won for health care expansion.

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