As a few Republican governors continue to negotiate with state legislators over the implementation of a key part of Obamacare -- the expansion of Medicaid -- one GOP leader is making the case that former President Reagan would've backed the significant policy change.
The Medicaid expansion, Ohio's Republican Gov. John Kasich wrote in a USA Today op-ed this week, is consistent with "efforts to preserve state flexibility and limit the economic impact of federal health care changes."
"As the debate continues, I urge those who esteem Reagan to consider the principled, big-picture perspective at the core of his decisions," Kasich wrote. "When we consider what Reagan would do, let's also remember what he did do -- expand Medicaid."
Currently, Medicaid -- a joint federal-state program -- is open to disabled and certain low-income people. The Affordable Care Act calls for states in 2014 to open up Medicaid to anyone below 138 percent of the poverty line -- the Supreme Court, however, ruled last summer that the Medicaid expansion shouldn't be mandatory.
There's no deadline for states to say whether or not they will expand the program, but so far, 13 have said they won't. While opinions about Obamacare overall are hugely partisan, nine Republican governors have argued that it's in their respective states' best interests to go along with the Medicaid expansion. Kasich, along with fellow Republican Govs. Jan Brewer in Arizona and Rick Snyder in Michigan, are pleading with lawmakers in their states to approve the expansion before they end their legislative sessions this summer.
Kasich noted in his op-ed that Reagan expanded Medicaid several times, and that Ohio initially resisted those changes but "saw powerful results for some of our most vulnerable citizens once we made them." Adopting the current plan, he argues, would extend health coverage to 275,000 low-income Ohioans, relieve some of the financial stress hospitals face covering the uninsured, and prevent some projected increases in health insurance costs.
The Obama administration has said it expects resistant state governments to eventually get on board with the Medicaid expansion, once they start seeing the benefits it has in other states. For the first two years, the federal government pays for 100 percent of the expansion. Starting in 2017, the states start chipping in, but they will never contribute more than 10 percent of the cost.
If a state does choose to opt out, its citizens with incomes above 100 percent of the poverty line will be eligible for tax credits from the federal government to get insurance, but people below that threshold will remain the state's responsibility.
Some states are still working on compromise plans. In Wisconsin, for instance, the state legislature plans to vote this week on Republican Gov. Scott Walker's proposal to set Medicaid coverage at 100 percent of the poverty line. However, if a state only partially expands Medicaid, as Wisconsin is considering, it would have to foot the bill itself. Some Republicans leaders like Walker are skeptical the federal government will keep its promise to pay for the expanded program.
The nonpartisan Congressional Budget Office said last month that it expects Obamacare to increase the number of people enrolled in Medicaid and the Children's Health Insurance Program (CHIP) by 13 million by 2023. That accounts for around half of the 25 million expected to get coverage from the Affordable Care Act by 2023.
Still, as President Obamalast month, the vast majority of Americans won't be affected by either the Medicaid expansion or the new health insurance exchanges that are supposed to help people purchase private plans starting in October.