In one of the most explosive of the internal Republican battles, Brewer, a firebrand tea party favorite who once wagged her finger at President Obama, has declared a “moratorium” on all other legislation until her Medicaid plan, which would add 300,000 Arizonans to the program, is approved. She has backed up her threat by vetoing five unrelated bills.
In Ohio and Michigan, the governors are pressing for last-minute compromises before their legislatures adjourn this summer. The Florida legislature, which has adjourned, rejected Republican Gov. Rick Scott’s plan to expand Medicaid.
These conflicts over the health-care law illustrate a larger divide within the Republican Party over an array of issues, including immigration and automatic budget cuts.
The Medicaid expansion is one of the two main ways the health-care law would provide coverage to the uninsured. The other is through health insurance exchanges, which will sell policies to individuals whose incomes are too high for Medicaid; many of those people will receive subsidies to buy the health plans.
Medicaid eligibility varies from state to state and depends on income and other factors. The health-care law, in an effort to make eligibility uniform, mandated that anyone earning up to 138 percent of the poverty level, or $15,856 in 2013 dollars, be eligible for the program. But last June, the Supreme Court, while upholding most of the health-care law, ruled that states could refuse to expand their Medicaid programs. That set the stage for bitter debates — ones ruled as much by ideology and politics as by financial realities — that have been occurring in state capitals nationwide.
Under the law, the federal government will pay 100 percent of the cost of newly eligible Medicaid recipients for the first three years, beginning in January. After that, the federal contribution will taper, leveling off at 90 percent for 2020 and beyond.
Twenty-three states and the District have agreed to the Medicaid expansion. Nineteen states have decided against the expansion and eight are debating it, according to Avalere Health, a consulting firm. States that decline to expand Medicaid now can still sign up in later years.