“We don’t want to do it the Washington way. We want to do it the Florida way,” Negron said.
Republican Ohio Gov. John Kasich also has been in discussions with the Obama administration about providing subsidized insurance instead of full Medicaid coverage for more adults. Republican governors in Texas, Nebraska and Indiana want the federal government to award Medicaid money as block grants to states.
“It’s a two-step for many of these Republican governors. When they look at the numbers they want to do it, but they want to distance themselves from Obamacare at the same time,” said Drew Altman, president of the Kaiser Family Foundation, a nonprofit that analyzes health care policies.
That might be fine with the Obama administration.
“There actually is quite a bit of flexibility on how they can approach this, and the federal government has indicated they want to get to ‘yes’ ” said Joan Alker, co-executive director of Georgetown University’s Center for Children and Families in Washington, D.C.
As originally enacted, the Affordable Care Act required states to expand Medicaid to adults earning up to 138 percent of the federal poverty level, about $32,500 annually for a family of four. A Supreme Court decision last summer made the expansion optional for states but kept in place a powerful financial incentive. The federal government will fully fund the expansion for the first three years, with the states’ share gradually increasing to 10 percent by 2020.
Health and Human Services Secretary Kathleen Sebelius said in December that getting full funding will still require a full expansion. Yet some Republicans in Missouri, South Dakota and elsewhere claim to see room for compromise.
LaTonya Jenkins, a 51-year-old laid off teacher’s aide who lives in temporary housing for the homeless in Kansas City, recently enrolled in Medicaid but could lose coverage if her part-time job pushes her income over Missouri’s strict eligibility limits. She recently traveled to Missouri Capitol to urge lawmakers to expand Medicaid.
“If they don’t, and they cut it out, then what are we to do? We’ll be lost,” said a tearful Jenkins, who has diabetes and cares for her grandson. “I’ll be sicker than ever and back in the hospital.”