Five years after the Affordable Care Act passed, its Medicaid expansion provision is still causing huge fights in state legislatures.
Twenty-four states and the District of Columbia said yes to Medicaid expansion when the law went into effect. Since then, just six more have signed on. States that do get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration.
Alaskans attend a rally in Anchorage for Medicaid expansion. (Jonathan Casurella/Alaska Public Media)
The fight鈥檚 garnered many headlines in Florida recently as the Republican-led House and Senate are at odds on expansion and the legislative work鈥攊ncluding setting a budget鈥攃ame to a standstill. But the issue has also been hot out west this year where four Republican majority states took up Medicaid expansion. Wyoming , 鈥檚 governor is seeking to negotiate a compromise with Washington to offer legislators, and Alaska legislators are still wrestling with the issue. And after some legislative fireworks, Montana said yes.
Montana lawmakers have been stewing over Medicaid expansion since they said no to it in 2013 鈥� the last time they met. When they reconvened in January, Americans for Prosperity, a conservative group supported by the billionaire brothers Charles and David Koch, staffed up in the state and targeted moderate Republicans, organizing anti-expansion 鈥渢own hall鈥� meetings in their districts.
But AFP didn鈥檛 invite targeted lawmakers themselves and that backfired. Many voters called AFP鈥檚 tactics meddling by outsiders, and some .
Tea Party lawmakers in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats, and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans felt politically safe enough to cross party lines and vote with all the Democrats to pass it.
Still, at the bill鈥檚 signing ceremony Republican Senator , who sponsored the bill, said, 鈥淭his not Medicaid expansion.鈥�
Buttrey says Republicans won important concessions from Democrats to make Montana鈥檚 bill more palatable to conservatives. People will have to pay small premiums and the bill also sets up job training and education programs. Buttrey insisted that Montana isn鈥檛 just doing the bidding of the White House.
鈥淚鈥檒l say it again, and I hope the media will report this exciting and unique story,鈥� he said.聽 鈥淭his is not Medicaid expansion.鈥�
Montana鈥檚 proposal is now on its way to federal officials, who will have the last word on whether it鈥檚 legitimate under the Affordable Care Act.
In Alaska, Governor Bill Walker, a former Republican who is independent, has made Medicaid expansion one of his top priorities.
But Republicans leading the state House and Senate blocked expansion during the legislative session that just wrapped up.
One of those opposed is .
鈥淚 think everyone agrees that Medicaid is broken,鈥� he says.聽 鈥淭o put more money into it, to bring more people into it, that鈥檚 certainly not going to help its brokenness.鈥�
But surveys show favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies. In one, organized by an interfaith church group, Lutheran pastor Julia Seymour turned the crowd into a choir. She led them in singing, 鈥淢edicaid expansion, I鈥檓 going to let it shine鈥� to the tune of 鈥淭his Little Light Of Mine.鈥�
Seymour鈥檚 determined to make sure all Alaskans have access to health insurance.
鈥淭he Bible tells us that faith, hope and love go on and do not end. And I鈥檓 keeping the faith and I am hopeful, but my love for some of the leaders is waning now and then,鈥� she says.
As soon as the regular session ended, 聽Gov. Walker called lawmakers into .
The state is currently facing a massive because of the plunge in oil prices. And Walker says even in better financial times, Alaska doesn鈥檛 usually decline more than a billion federal dollars.
鈥淚f that was a road project or if that was some infrastructure project, we would be all over that,鈥� he says.聽 鈥淭his is healthcare.鈥�
Walker has proposed expanding on his own if lawmakers don鈥檛 act but it鈥檚 not clear he has this authority. About 40,000 people would if the state expands. About 30 percent of this group are Alaska Natives.
This story is part of a partnership with NPR, Montana Public Radio, Alaska Public Media and .