Drama. Intensity. Emotions reaching a boiling point. Characters with murky motives. Debates about how things are going to end. While this sounds like a description of HBO's hit television drama True Detective, it also aptly describes the Medicaid expansion debate still raging across multiple states. True Medicaid Not sure if that's a TV show anyone wants to air, but it certainly is not lacking for lead characters.
Now, of course, a show like True Detective contains many horrors that thankfully have nothing to do with Medicaid or that real-world debate. But the real-world show does have a troubling narrative impacting thousands of lives.
Take Arkansas, for instance. While many states have been debating whether to expand their programs to legal residents earning less than 138 percent of the federal poverty level, Arkansas was the first to craft an alternate approach the so-called private option. CMS readily signed off on the model, which gives Arkansas residents the ability to use premium assistance to purchase health insurance coverage through the health exchange for eligible Medicaid beneficiaries.
Sign-up was swift and the move seemed to be popular. Then came the dramatic pause, with the 2014 Legislature pushing to defund and halt the option. Never mind what would happen to the 100,000-plus already enrolled. There were fiery speeches on the floor, and the merits (or lack thereof) of Obamacare re-fought. In what mostly amounted to political theater, a multitude of failed votes were held in the state House each seemingly attracting more and more national media attention before funding for another year was finally approved on March 4. Meanwhile, Maine is continuing a fiery debate over Medicaid that in 2013 resulted in two expansion bills passed and subsequently vetoed by Tea Party Gov. Paul LePage. When the legislature returned in 2014, state Democrats vowed again to battle for Medicaid expansion. LePage, never one to be outdone, found new ways to push back. One February 2014 anti-Medicaid expansion press conference the LePage administration staged involved commissioners from the state Departments of Agriculture, Marine Resources, Environmental Protection and Inland Fisheries & Wildlife. That's quite a lineup when it comes to a discussion over Medicaid, but apparently LePage wanted to leave no voice unheard. Stay tuned.
In Virginia, proponents of expansion, along with beneficiaries, were hopeful when new Democratic Gov. Terry McAuliffe took office in 2014, but the Republican-controlled House has battled him every step of the way. As a result, there's been the predictable rhetoric on both sides as time runs out for a deal to be made.
However, things are not all doom and gloom, at least when it comes to one state New Hampshire . After Democrats and Republicans failed to agree on Medicaid expansion in 2013, New Hampshire lawmakers reconvened and hammered out a bi-partisan Arkansas-style plan that will allow expansion to move forward. However, in states still debating expansion, thousands falling through the healthcare cracks are still waiting on a more satisfying conclusion.
Follow Ric Gross on Twitter @RicGrossDRG.