Medicaid expansion: OR creates workaround, AK says no, TN still on fence

In the Pacific Northwest, the Medicaid program is undergoing a significant expansion, as Oregon reports huge gains in enrollment. Meanwhile, in redder Alaska and Tennessee, expansion is either a non-starter or increasingly unlikely.

Despite problems with its state-operated health insurance exchange that rival those of the federal website, Oregon has been able to enroll more than 70,000 of its low-income uninsured residents in Medicaid, Kaiser Health News reported. The state mailed out applications to 260,000 Oregonians after the website woes.

"I guess one could argue in retrospect we bit off more than other states," Gov. John Kitzhaber said, in reference to packing in both commercial and Medicaid plans on its state health insurance exchange, contributing to the glitches. But, he added, "it was an intentional decision. We've got a single portal for Medicaid and for the people who are coming in that are not Medicaid eligible. And once we work out these difficulties I think the people in Oregon will be ahead of the pack."

Meanwhile, Alaska Gov. Sean Parnell said his state would not expand Medicaid under the relaxed income restrictions of the Affordable Care Act. Parnell told the Anchorage Daily News that Medicaid expansion is a "failed experiment" despite the fact its primary components won't roll out until 2014. As many as 40,000 Alaskans would have qualified for the expanded coverage, according to the Daily News.

About two dozen states have yet to expand the Medicaid program as part of the ACA, with many states, such as Texas and Louisiana, flatly refusing to consider such an expansion.

In Tennessee, Gov. Bill Haslam has not yet decided whether to expand the Medicaid program, the New York Times reported. Haslam is trying to negotiate with the U.S. Department of Health and Human Services to obtain a waiver that would allow placing many of the state's low-income uninsured residents on the state's health insurance exchange, according to the newspaper. In the meantime, he is encountering resistance from the GOP-controlled statehouse, although he has the option of acting without its approval. Haslam described to the New York Times the maneuvering required as "trying to thread a needle from 80 yards," but has yet to make a specific decision. As many as 400,000 state residents would either qualify for Medicaid or avoid a so-called "gap" where they earn too much to currently qualify for Medicaid but too little to receive premiums on the health insurance exchange.

To learn more:
- read the Kaiser Health News article
- here's the Anchorage Daily News article
- read the New York Times article

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