Connecting state and local government leaders

More States Are Jumping on the Medicaid Expansion Train

The North Carolina State House.

The North Carolina State House.


Connecting state and local government leaders

Which state will become the 32nd in the nation to join “team expansion?”

In the words of Paul Ryan, “Obamacare is the law of the land.”

The American Health Care Act—the Republican Affordable Care Act replacement bill—languished last week when it failed to garner enough votes to get through the U.S. House of Representatives. The GOP plan to “responsibly unwind” Obamacare’s Medicaid expansion died with it.

The AHCA would have placed restrictions—in the form of per capita caps and block grants—on federal funding for state Medicaid programs and would have cut direct federal financing for the program by over $880 billion over the next decade, according to a report from the nonpartisan Congressional Budget Office.

The disintegration of that legislation may be inspiring lawmakers in some of the 19 hold-out states to move forward with their own plans to expand Medicaid.


As Route Fifty reported last week, in the midst of the drama surrounding the AHCA vote-count, state legislators in Kansas held a different vote. The Kansas Senate Public Health and Welfare Committee passed a Medicaid Expansion measure on a voice vote, allowing the bill to advance to a full vote on the Senate floor.

And, on Monday evening, the Kansas state Senate gave their official response. The Medicaid expansion measure passed by a vote of 25-13, garnering (narrow) majority support even from Republicans in the Senate.

The bill, however, has yet to face its biggest threat—Republican Gov. Sam Brownback, who has been a fierce critic of Medicaid in the past, but has not expressly stated whether or not he intends to veto the legislation.


On Monday, the same day as the Kansas Senate vote, Virginia Gov. Terry McAuliffe announced a budget amendment proposal that would allow him to pursue planning for Medicaid expansion.

“The governor made the decision to include the amendment following last week’s news that the AHCA, President Trump’s replacement for Obamacare, failed to receive the necessary support in Congress,” according to a statement put out by the governor’s office.

In addition, this amendment signals the governor’s desire for cooperation from the Republican-majority Virginia General Assembly. Expanding Medicaid has been one of McAuliffe’s top priorities since taking office, but GOP members of the Assembly have blocked the measure each year it’s been proposed.

North Carolina

By some estimates, more than half a million North Carolinians would qualify for Medicaid if the state were to undergo an expansion.

Democratic Gov. Roy Cooper has made his intentions regarding expansion clear. In early January of this year, Cooper’s office notified federal officials that he hoped expand his state’s program. Cooper’s goal was to be able to expand Medicaid before President Obama left office.

GOP lawmakers in the Tar Heel State, however, countered that a 2013 state law prevents the governor from being able to alter the Medicaid program without General Assembly approval. The situation remains a stalemate, but all that could change following the implosion of the GOP health plan.

Where to Watch Next?

  • Maine voters will be asked to decide on an expansion of MaineCare, the state’s Medicaid program, as part of a ballot issue come November.
  • Georgia Gov. Nathan Deal, a Republican is considering “a variety of solutions that bring Georgians greater flexibility and access to care,” according to a spokeswoman.

Quinn Libson is a Staff Correspondent for Government Executive’s Route Fifty based in Washington, D.C.

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