State Lawmakers Prepare for Medicaid Expansion ‘Uncertainty’ After Trump’s Election

Published December 1, 2016

The election of Donald Trump to the presidency has increased state lawmakers’ doubts about the federal government continuing its substantial funding of Medicaid expansion programs in their states, a key ingredient of the Affordable Care Act (ACA).

Nineteen states rejected Medicaid expansion under ACA, including the federal government’s offer to pay 100 percent of the cost of insuring newly eligible enrollees through 2016 and 90–95 percent of the costs through at least 2020.

Trump and newly reelected Republican majorities in both houses of Congress campaigned on full repeal of ACA, including its federal funding for Medicaid expansion, and for block-granting Medicaid to the states for disbursement at states’ discretion.

Before the November election, Georgia, Idaho, and South Dakota were among states widely expected to consider Medicaid expansion proposals in 2017.

Increasing Uncertainty

South Dakota Gov. Dennis Daugaard (R) abandoned his proposal to expand Medicaid in 2017 after conversing with Vice President-Elect Mike Pence (R) on November 14. (See article on p. 3.)

Idaho Senate President Pro Tem Brent Hill (R-Rexburg) says Trump’s election has shaken lawmakers’ confidence in ACA, which has never been strong.

“Certainly, I think, it’ll have an effect on not only the actions that might be taken, but the attitude of the legislators themselves,” Hill said on November 9, according to the Times-News (Magic Valley). “Part of the problem all along has been the uncertainty going along with the Affordable Care Act, and this greatly increases that uncertainty.”

Not Over Yet

Georgia state Rep. Jason Spencer (R-Woodbine) hosted a forum in Athens on December 4, 2016 to warn lawmakers against adopting any of three Medicaid expansion plans proposed by the state’s Chamber of Commerce. Spencer says lawmakers should continue standing firm against Medicaid expansion in case Trump and Congress fail to repeal this part of ACA.

“It is very likely that with the election of Donald Trump, a big chill has been placed on efforts to expand Medicaid in Georgia,” Spencer said. “However, it is not exactly clear what the ‘replace’ portion will look like from the Trump administration and Congress. Until we know what the replacement to Obamacare looks like, those who oppose Medicaid expansion under the ACA need to remain vigilant.”

Resisting ACA’s lure of federal dollars to help pay for Medicaid expansion in Georgia has been fiscally prudent, Spencer says.

“I believe the states who elected not to expand will come out better in the end than those who did [expand], in terms of effects on state budgets,” Spencer said. “Georgia did the right thing by not expanding Medicaid.”

Staff report