Idaho, Wyoming watching Utah's Medicaid expansion efforts
"The Republican states are watching one another," Su said. "They're watching to see how the politics of the expansion conversation play out and two, I think they're looking at what specifically other states are negotiating."
Other states, including Pennsylvania, led by Republican Gov. Tom Corbett, either have or are also trying to negotiate more flexibility to require cost-sharing from residents who would benefit from Medicaid expansion, she said.
"We're seeing common themes amongst states where a pure expansion of the public program is perhaps not a palatable option, but a unique take that involved more control over their program and use of a private market approach certainly seems to be appealing and growing like wildfire," Su said.
The president has increased pressure on states to accept Medicaid expansion, which became optional as a result of a U.S. Supreme Court ruling on his signature health care plan, known as Obamacare.
In February, Obama told Herbert and other governors meeting at the White House that his administration could "provide a lot of flexibility" to get coverage for the up to 5.4 million Americans who would otherwise be left uninsured.
But at a press conference Thursday, the president said he was frustrated by "states that have chosen not to expand Medicaid for no other reason than political spite" despite the federal government covering the costs, at least initially.
For "ideological reasons," Obama said, "they have chosen not to provide health insurance for their citizens. That's wrong. It should stop. Those folks should be able to get health insurance like everybody else."
Those statements probably won't have much effect, Su said.
"In these Republican states, admonishments from President Obama probably aren't the biggest consideration in terms of political pressure," she said. The real pressure, Su said, comes from medical providers and patients in those states.
According to an April report by The Kaiser Commission on Medicaid and the Uninsured, 27 states are implementing Medicaid expansion, 19 are not moving forward, and five, including Utah, are still debating what to do.
Decisions made by governors still require legislative approval, and, in Utah, that's not a given. Leaders of the GOP-dominated Utah House and Senate have said Herbert's plan will be a tough sell in a special session expected this summer.
"I think we'll be able to get past some of the ideology," Utah's governor said, calling his plan a "common sense solution" to how best to use the federal funds available.
Su said it's not going to be easy for governors like Herbert to gain approval from state lawmakers.
"I think the state legislature dynamic is incredibly difficult. It's somewhat difficult for these governors to go out on a limb and accept Medicaid expansion from a political perspective. But they have a statewide constituency," she said.
It can be much harder for lawmakers representing smaller districts to compromise on the issue, Su said. "I don't know that we've seen it completely crush proposals at this point, but probably because they're not far enough along."
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