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HHS Secretary Sees Momentum Building on Medicaid Expansion

By Kerry Young, CQ Roll Call

February 5, 2016 -- Health and Human Services (HHS) Secretary Sylvia Mathews Burwell on Friday said it seems highly likely that more states in time will expand eligibility for Medicaid as part of a drive to provide greater access to health care for the working poor.

Louisiana's expansion of its Medicaid population will leave a pool of 19 states where expansion of the state-federal program has not yet occurred, according to the nonpartisan Kaiser Family Foundation. Louisiana, which has a new Democratic governor, already is on track to use provisions of the 2010 health overhaul to broaden its Medicaid ranks, a move expected to allow about 350,000 people to gain access to government health coverage.

Burwell said she's excited about discussions in legislatures in Kansas and Maine about allowing more people into Medicaid.

"There is energy in lots of other places," Burwell said in a Friday press conference with reporters, adding that in her view, the expansion of the Medicaid program "is a question of when."

It's unclear how many other states will opt to expand their Medicaid programs during the remaining months of the Obama administration, Burwell said. Many opponents of Medicaid expansion have cited its future costs for states. The overhaul law required the federal government to pay all the costs for covering the people who became eligible through an expansion in 2014, 2015, and 2016. The federal funding phases down starting in 2017, when states must pick up 5 percent of the costs. In 2020 and beyond, states must bear 10 percent of the expenses for the expansion population.

But Burwell said she sees a growing buildup of economic and social arguments for it, including compelling statistics about the potential economic impact.

"Now we actually have the data that show that in states where expansion has not occurred, they do have a higher percentage of hospital closures," Burwell said. "The uncompensated care issues are very real."

Medicaid expansion also often helps people who work but still remain too poor to afford health insurance, a group for whom there is broad popular sympathy, according to Burwell. The Medicaid expansion is meant to help people whose income stands at or below 138 percent of the poverty line, which would have been $27,724 for a family of three last year, according to the Kaiser Family Foundation.

"If we're talking about a group of people who are above the 100 percent of poverty level, obviously they have incomes so they are working," Burwell said. Helping people in this position to secure medical care "is an important concept that most people agree on," she said.

The governors of Virginia, Wyoming, and South Dakota have signaled support for expansion in their fiscal 2017 budget plans, according to a tally kept the Kaiser Family Foundation. Policymakers in Idaho also are considering expansion. Other states that so far have not expanded their Medicaid programs include Alabama, Florida, Georgia, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, and Wisconsin.

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