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Medicaid expansion: What's the rest of the country doing?

by Jaclyn Cosgrove Published: February 25, 2013

So far, leaders from about 13 states, including Oklahoma’s Gov. Mary Fallin, have said their states will not expand Medicaid.

Where the States Stand

Medicaid expansion is one of the key elements of the Affordable Care Act, or “Obamacare.” (Want to know more about the health care debate? Here’s a graphic novel we created that explains the basics)

Most leaders have been quoted as saying expanding Medicaid would be too expensive for their states and that they didn’t trust the federal government to hold its end of the bargain.

So what’s the alternative plan?

Gov. Fallin hasn’t yet announced what Oklahoma’s alternative plan might be, but a few state leaders have made a proposals on how to help the uninsured in their states.


In Wisconsin, Republican Gov. Scott Walker announced in mid-February that he is rejecting Medicaid expansion and instead pushing forward with his own plan.

Walker said he would instead work to increase health coverage for Wisconsinites with an alternate plan that involves lifting an enrollment cap on Medicaid programs for childless adults, tightening income eligibility for state residents able to use Medicaid programs, and bumping thousands of people from such programs to federal government-run health care exchanges where they can buy private insurance.

Avik Roy, a contributor at Forbes, wrote a detailed piece on Walker’s approach, noting:

Prominent Republican governors, like John Kasich in Ohio, have said yes to Medicaid, reasoning that if Ohio doesn’t grab the federal money, other states will. But, as Wisconsin governor Scott Walker now shows, there is a far better path forward, one that reduces the footprint of Medicaid while providing coverage to the uninsured.


In Alabama, lawmakers are looking at Oregon’s model and discussing whether they could duplicate something similar:

Over the decades, Oregon has built a relatively generous Medicaid program and has been a bellwether for health policy experimentation. Alabama, like most other southern states, has run a barebones program with few optional benefits.

Launched last year, Oregon’s current Medicaid plan relies on local health care organizations to coordinate all forms of health care, from acute medical services to mental health and dental care, all in an effort to lower costs and improve health. Basically, the local entities, which may be headed by a hospital, physician group, community service provider or a managed care organization, are given a budget and challenged to beat it. If costs exceed the budget, the organization takes the loss.

Alabama lawmakers will soon consider a proposal from Bentley for a Medicaid overhaul based in part on Oregon’s groundbreaking “community care organizations.” Although Bentley has said he would not support an expansion of Medicaid “under its current structure,” the expected reforms are seen as paving the way for a possible expansion as early as 2015.

South Carolina

Lawmakers in South Carolina have proposed their alternative to expanding Medicaid, which includes paying hospitals to send uninsured patients to community health centers.

Instead, House Republicans this week put forward an alternative plan that would pay hospitals up to $35 million to steer uninsured patients to community health centers, free health clinics and rural health clinics. Lawmakers also pledged to give those health centers and clinics an extra $10 million in state money to care for those uninsured patients.

Those clinics, which the state gave $1.8 million this year, hailed the plan Thursday.

“The new plan is a positive alternative if the state does not decide to participate in the Medicaid expansion,” said Lathran Woodard, chief executive of the S.C. Primary Health Care Association.

These are only three of the proposed alternatives to Medicaid expansion. It will be interesting to see what Gov. Fallin announces. Please feel free to share your thoughts in the comments below.
by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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