News, Straight to the Point

There was always a sense that in some states, Republicans’ refusal to expand Medicaid under the Affordable Care Act was at least somewhat rooted in resistance to the President who lent the law its nickname.

Yet one presidential election, a Republican administration and a failed Obamacare repeal bill later, it’s unclear whether the dynamics that have kept 19 states from opting into Medicaid expansion have truly shifted.

The expansion increases eligibility for the program up to 138 percent of the federal poverty line, with the federal government paying for the bulk of the expanded program; it will phase its contribution down slightly to 90 percent by 2020, however. A 2012 Supreme Court decision made states’ participation in Medicaid expansion optional, so even in states where Republican governors have sought to expand the program, GOP legislators have resisted tooth and nail, citing concerns of fiscal responsibility and state sovereignty.

Here are five points on what fundamentals underlying Medicaid politics stand to change under President Donald Trump and whether more states will be encouraged to expand:

Some states renewed their expansion efforts amid Congress’ Obamacare repeal push

As national Republicans considered—and ultimately pulled—Obamacare repeal legislation that would have scaled back Medicaid expansion, policymakers in a handful of non-expansion states revived their efforts to opt into the program. In Kansas, state legislators were just three votes short of overriding Gov. Sam Brownback’s (R) veto of an expansion bill. Virginia Gov. Terry McAuliffe (D) amped up the public pressure to expand Medicaid there, but was ultimately stymied by a GOP-controlled legislature.

A handful of Republican lawmakers in North Carolina also introduced their own expansion proposal, a first coming from any GOP legislator in the state, as their newly-elected Gov. Roy Cooper (D) continues a court battle to enact expansion without the help of the state legislature. Utah Gov. Gary Herbert (R) met with the Trump administration last month to talk about getting waiver approval for a limited version of Medicaid expansion. And voters in Maine will get to weigh in on the issue with a ballot initiative this November.

At least in the case of Virginia, McAuliffe’s push to expand Medicaid appeared to be in reaction to the prospect of U.S. House legislation to repeal Obamacare and the renewed progressive energy around defeating repeal. Elsewhere, the timing may have been coincidental.

The political landscape didn’t drastically change as renewed expansion efforts fell short

That flurry of activity was not necessarily a sign of national momentum toward growing the Medicaid expansion map, health policy experts and consultants who work with states seeking to expand the program told TPM.

In places like Virginia, the renewed effort to expand was a rehash of old fights.

“Unfortunately, because politics are so strong in the states that haven’t expanded yet, I don’t know if we are actually going to see a whole lot of states make it across the [finish] line in the next six months, potentially the next year or two,” said Laura Summers, senior director of the Medicaid practice at the health care consulting firm Leavitt Partners.

In other places like Utah and Idaho, Medicaid expansion appears stuck in a political middle ground: Always on the burner but unable to to be brought to a full boil.

“Politically its just very difficult to do, particularly in the states sort of on the fence. They have been no the fence for a long time, and so getting them to get over the fence, they just don’t have that push just yet,” Summers said.

Uncertainty around the future of Medicaid expansion is a double-edged sword

For some expansion crusaders, the prospect of Republicans eliminating the program down the road has been a motivating factor. North Carolina’s Cooper, for instance, rushed though an expansion application in the final days of the Obama administration in hopes that it would get done before Trump’s inauguration, but state GOP lawmakers sued and had initial success in blocking him from expanding unilaterally under Obama.

In other states, the uncertainty about Medicaid expansion’s fate may be a reason to hold back, according to Diane Rowland, executive vice president at the Kaiser Family Foundation.

“Repeal and replace has put kind of a cautionary damper on, ‘Oh but should we get in before the window closes or if we get in are we stuck before the window closes?’” she said.

Trump loosening the standards around waivers for states may not do the trick

Early on after being confirmed as Health and Human Services Secretary, Tom Price, along with Seema Verma, Trump’s administrator of the Centers for Medicare & Medicaid Services, sent a letter to governors signaling that they would be far more amenable than their predecessors to allowing conservatives to impose extra obstacles, like work requirements or cost sharing, on Medicaid recipients.

“On the surface you would think that that would maybe lower the barriers a little bit or make the idea of expanding Medicaid seem a little more palatable,” Kathy Hempstead, a senior advisor at the Robert Wood Johnson Foundation, told TPM. “That being said, when I talk to people in those states, they don’t sound like they think the fundamentals have changed that much.”

Instead, red states that have already expanded Medicaid may be the ones who take advantage of this new flexibility, according to Summers.

“I do think you will see states that have already expanded resubmit waivers to get more of those elements included,” she said.

State-level political shifts are likely to play biggest role in moving the dial

State elections matter when it comes to Medicaid expansion. The election of Gov. John Bel Edwards (D), who replaced Obamacare-hater Bobby Jindal (R), allowed to that state to expand Medicaid even in the face of a GOP legislature resistant to the move.

In states where the legislature has to give their approval in order to expand Medicaid, more nuanced shifts in state politics is what ultimately moves the dial. Kansas only came as close as it did to expanding the program after the state’s distaste for Brownback—a deeply unpopular, far-right governor—resulted in many of his allies in the legislature being voted out of office last year in favor of Democrats and more moderate Republicans.

“Certainly in Kansas, they shifted to be slightly more moderate than previously, so obviously state legislative elections matter,” Rowland said. “We see in Virginia that the legislature is still resistant, though the governor has tried one again to [expand.]”

Read More →

Embattled Alabama Gov. Robert Bentley (R) may finally be giving up. AL.com reported that the governor, for whom impeachment hearings started Monday, is expected to step down this week over his elaborate efforts to conceal an alleged affair with a former aide that investigators say misappropriated state resources and ran afoul of ethics laws.

Bentley’s lawyers are now reportedly trying to ease his departure from the governor’s mansion. Sources told AL.com that those attorneys are engaged in negotiations to allow Bentley to resign from office and plead to lesser charges. The Alabama Ethics Commission last week determined that there was probable cause to believe the governor committed four felony violations of state ethics and campaign finance laws while carrying out the alleged dalliance with his former top advisor, Rebekah Mason (both have denied having a physical affair).

While Bentley maintained as recently as Friday that he has “done nothing illegal,” his attorneys failed to block the release of a damning, 131-page state House Judiciary Committee report laying out the state’s evidence.

Here are five wild, revelatory details TPM pulled out of the lengthy so-called "impeachment report" and its supporting exhibits.

Read More →

You could call it “scoremeggedon” or you could call it #cbOMG!" Either way, the Congressional Budget Office dropped a giant, 24-million-person bomb on Republicans’ Obamacare repeal effort Monday.

The agency found that the GOP’s leading legislation, the House’s American Health Care Act, would prompt 14 million people to lose their coverage next year, and by 2026, there would 24 million more people uninsured compared to the current projections under the Affordable Care Act.

Read More →

President Donald Trump on Monday morning signed a new executive order temporarily barring travelers from a list of predominantly Muslim countries, replacing the widely-criticized order that he signed in January and that sparked nationwide protests.

The previous travel ban had been stayed in the courts, prompting the Trump administration to issue a new order rather than continue to fight for its previous one in court.

This replacement includes several substantive changes, including eliminating Iraq from the list of countries from which travelers will be banned. But the rollout of the new order was also handled in a drastically different manner, suggesting a different public relations strategy for Trump's second swing at a travel ban.

Below are five key takeaways from the new order:

Read More →

Even though Republicans now control the White House and both chambers of Congress, that doesn't mean they will have an easy time agreeing on and implementing a plan to fund the government going forward.

Though we are still a couple weeks away from seeing the actual text of the President's budget blueprint, many controversial pieces of the plan have been revealed, including a $54 billion hike in military spending, and deep cuts to the State Department, the Environmental Projection Agency and the Coast Guard, among other departments and agencies.

Already, signs of revolt are emerging on Capitol Hill, and top budget experts warn of an array of legal and political obstacles standing in Trump's way.

Here are 5 points to keep in mind as the budget battle unfolds:

Read More →

The closer that Republicans get to settling on a Obamacare repeal plan, the uglier the intra-party fighting gets, with the latest round being over the types of tax credits lawmakers offer as an alternative to the Affordable Care Act.

The details are wonky, but reveal the deep differences in philosophies regarding health care reform that are currently roiling the GOP caucus. Just as troubling for Republican leadership in Congress is that a not-insignificant smattering of GOP lawmakers are vowing to vote against an Obamacare repeal bill that also offers the type of tax credits to which they object. The infighting was exacerbated by a leaked GOP plan that included a controversial form of the credits.

Here are 5 points on what the disagreement is over and why it has gotten so heated.

Read More →

In a lengthy, wide-ranging press conference Monday about the House Intelligence Committee's investigation into Russian interference in the U.S. election, the committee's chair, Rep. Devin Nunes (R-CA), repeatedly defended the Trump administration.

He declared that he has seen no evidence that aides to President Donald Trump were in contact with Russian officials before the election and dismissed calls for a special prosecutor to look into the matter. He also fiercely defended the White House's attempts to get members of Congress to push back on reports about Trump aides' alleged contacts with Russia, applauding the effort as a move for greater transparency.

The Intelligence Committee chair even went to bat for former National Security Adviser Michael Flynn, who resigned following reports that he talked with the Russian ambassador about U.S. sanctions before Trump's inauguration.

Here are the five main takeaways from Nunes' comments Monday:

Read More →

President Trump suffered a setback in court Thursday evening, when a panel of three judges decided not to reinstate his travel ban, after a lower court temporarily blocked it. In the 3-0 order, the 9th U.S. Circuit Court of Appeals said that the states challenging the executive order, Washington and Minnesota, had the standing to sue Trump’s administration and that the administration hadn't proved it was likely to succeed when the full case was litigated. The panel also said that the immigration order should continue being blocked nationwide, citing a 2015 court decision that halted an immigration order issued by the Obama administration.

Here are five points on Thursday’s order:

Read More →

President Trump fulfilled a key campaign promise Tuesday with his announcement that he was nominating federal appeals court judge Neil Gorsuch to fill the Supreme Court vacancy left by Justice Antonin Scalia's death last February.

"Judge Gorsuch has outstanding legal skills, a brilliant mind, tremendous discipline and has earned bipartisan support," Trump said in a ceremony with Gorsuch in the White House.

The 49-year-old Gorsuch, currently a member of the U.S. Court of Appeals for the Tenth Circuit, is a judge known to be in the mold of Scalia, who Gorsuch knew personally.

"Justice Scalia was a lion of the law. Agree or disagree with him, all of his colleagues on the bench cherished his wisdom and his humor, and, like them, I miss him," Gorsuch said at the nomination ceremony.

The nomination comes as the Trump administration has brought chaos to Washington with controversy after controversy in the 11 days since the inauguration. Trump was only able to fill the seat, which has been empty for nearly a year, because Senate Republicans launched an unprecedented blockade of President Obama's nominee Merrick Garland.

Here are five points on Gorsuch and the fight that may come with his confirmation:

Read More →

Republicans have hinted that they intend to use their Obamacare repeal push to transform Medicaid into a block grant system, a long-held GOP policy dream that faces deep resistance from state officials and could make the already treacherous territory around repeal of the Affordable Care Act more complicated.

White House adviser Kellyanne Conway earlier this month pointed to Medicaid block grants as one of the options the Trump administration was considering as part of its plan to replace the Affordable Care Act. Lawmakers at last week's GOP congressional retreat in Philadelphia also raised an overhaul of the program as a possibility.

However, to do so, they would have to muddle through numerous tough policy questions and trade-offs that could pit GOP lawmakers against each other, if the past attempts to block grant Medicaid are any guide. Meanwhile, governors, including some Republicans, have expressed wariness of any Medicaid proposals that would shift its costs to their states.

Here are 5 points on the GOP push to block grant Medicaid.

Read More →

LiveWire