Due to growing public support for Medicaid expansion, lawmakers in Alabama and other southern states are reconsidering their long-standing opposition to Medicaid Expansion, a party-line policy issue in some states. North Carolina’s Republican-controlled legislature helped to soften political opposition last year and approved Medicaid expansion. Already, more than 346,000 of its residents have gained coverage, boosting conversation around expansion in surrounding states. Many “deep red” states like Alabama, Arkansas, Georgia and South Carolina are currently weighing the best ways to appropriately expand access to Medicaid. These Republican lawmakers are opting for policy options like public-private partnerships and strict guardrails against fraud.

In Alabama, Republican lawmakers have begun discussing the potential of Medicaid expansion but with certain caveats. Policymakers in the state prefer a public-private partnership model, favoring the Arkansas approach, which uses federal and state money to pay for commercial insurance plans under the Affordable Care Act for people who would be eligible for Medicaid under expansion. Similarly in Georgia, conversations regarding the topic have yielded similar results in an interest in adopting an Arkansas-style plan. Lawmakers in the state have stressed the importance of expanding access to care for uninsured working families. In South Carolina, Republican lawmakers are weighing the possibility of appointing a committee to study the pros and cons of expansion.

Although there are many policy discussions taking place regarding Medicaid expansion in state legislatures that firmly opposed it for years, significant obstacles remain. Many governors and legislators remain opposed and significant policy changes seem to lack the momentum needed. As an example, in an attempt to expand Medicaid in Kansas, Democratic Governor Laura Kelly proposed to add work requirements – a policy generally favored by Republicans. Many Republican leaders have already said it is a non-starter, despite some surveys showing that 70% of Kansans support Medicaid expansion.

AHPA extends our gratitude to Kevin Lopez, guest author of this article.
Kevin is a graduate student in the Master of Healthcare Administration program at Loma Linda University.