medical aid with a stethoscope wrapped around it and pills in the background

When it comes to following Medicaid trends since passage of the Affordable Care Act, it’s a lot like assuming the role of Bill Murray in the movie “Groundhog Day”— reliving the same day and debate over and over again. However, rather than the strains of Sonny and Cher’s “I Got You Babe” greeting Bill Murray every day, it’s the partisan rancor for and against Medicaid expansion, and the song has been playing since the ACA was passed into law in 2010.

While 31 states plus the District of Columbia have officially enacted expansion, the rest have been experiencing the Groundhog Day effect without resolution. The heated debate surrounding Medicaid expansion has been all-consuming, and that trend will continue throughout 2016. That’s not to say 2016 will be dull or stagnant on the Medicaid front. Far from it. Just like Bill Murray found a way to make each of his Groundhog Days full of accomplishments and failures, 2016 will be similar on the Medicaid front – just not as funny.

Louisiana got the ball rolling in 2016 when the state’s new Democratic Gov. John Bel Edwards sidestepped the Medicaid-averse Republican-controlled state legislature and signed an executive order to expand the program. So, who’s next? Or will any more Republican-heavy states expand this year? The best bet is South Dakota. The state’s Republican governor, Dennis Daugaard, is pushing for expansion, and while it won’t be easy, we expect a deal to get done before year’s end. Meanwhile, active discussions on whether to expand Medicaid are ongoing in Idaho, Missouri, Wyoming and Utah, among others. But, at least for 2016, Medicaid expansion will not pass in these states. The climate may be more favorable in 2017, but it’s not there yet.

Republican-heavy expansion states Arkansas, Kentucky and New Hampshire are embroiled in debates about the future of their Medicaid programs. Arkansas and Kentucky adopted expansion under Democratic governors, but both states now have Republicans at the helm. In Kentucky, new governor Matt Bevin basically ran on a pledge to dismantle all things Obamacare. New Hampshire, meanwhile, has a Democratic governor but a Republican-controlled legislature, which is soon to vote on the future of the program. However, none of these states will do an about-face in 2016 and repeal Medicaid expansion or attempt to roll back coverage for thousands.

Look for these states to follow the path taken by Indiana, another Republican state which expanded Medicaid. In doing so, Indiana secured a waiver from the federal government allowing it to implement conservative-friendly ideals, such as dedicated health accounts, personal responsibility (in the form of copays/premiums) and a strict plan for member noncompliance. Expect Arkansas, Kentucky and New Hampshire to secure similar concessions from the federal government this year, preserving their expansion programs but significantly transforming them in the process.

A third area to watch in 2016 involves Medicaid funding. When Medicaid expansion under the ACA was implemented in 2014, the federal government did sweeten the deal by agreeing to pick up 100 percent of the tab in 2014-2016, before dropping down to 90 percent thereafter. In an effort to further entice the remaining holdouts, President Obama wants any state coming on board to get the same three-year deal. That looks good on paper, but that’s where it will stay in 2016. A Republican Congress won’t pass such a bill in an election year, but it will remain a part of the conversation going forward.


View all of the 2016 Targeted Insights Series here.

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