States use variety of tactics to block ACA implementation

Florida and Maine, both states with policymakers grappling with the Affordable Care Act, are employing a variety of tactics to discourage Medicaid expansion or enrollment in the health insurance exchanges.

In Maine, Republican Gov. Paul LePage has issued a report claiming expanding Medicaid coverage would extend benefits to a large number of people who smoke and drink--a claim that has been widely disparaged by public health experts, the Bangor Daily News reported.

"These findings illustrate that this is not about a 'sharp increase': there are already clinically concerning levels of smoking and heavy drinking among people who currently benefit from Medicaid,"  Matthew Davis, M.D., told the Daily News. Davis collaborated on a study regarding the rates of alcohol and tobacco use that LePage used to support his claims. "As a primary care physician, I would say that Medicaid expansion under the Affordable Care Act has the potential to bring more people in for medical care who could really benefit from having insurance coverage and having their health needs addressed."

In Florida, regulatory authorities are doing their best to discourage residents from signing up for its health insurance exchange, according to the New York Times. For example, they have barred health navigators from conducting any business on property controlled by state or county health agencies The Legislature also passed a law exempting the state insurance commissioner from rejecting premium increases for 2014 and 2015--presumably to discourage health plans from offering competitive rates in the exchange.

"To have the Florida Legislature pass a bill that for two years--2014 and 2015-- removes rate-review authority really puts Florida consumers at great risk," Health and Human Services Secretary Kathleen Sebelius told the New York Times. "No one else has done that."

Health policy experts believe the difference in attitude between states supportive and hostile to the ACA could lead to significant differences in enrollment.

Other anti-ACA states, such as Georgia and Missouri, are using similar tactics, according to the Times. Both passed laws requiring licensure of navigators and restrictions on the information they can disseminate.

Georgia Insurance Commissioner Ralph T. Hudgens said he would do "everything in our power to be obstructionist," according to the Times.

To learn more:
- read the Bangor Daily News article
- read the New York Times article