PHOENIX (AP) -
Former Arizona Gov. Jan Brewer fought her own Republican party in the state
Legislature for months to push through a Medicaid expansion under the
Affordable Care Act.
That was three
years ago. Now, as an early Donald Trump supporter who has his ear, Brewer
hopes one of the pillars of President Barack Obama’s health care law can be
saved as Trump pushes to dump much of the overhaul.
“I don’t know how
much of that, and I mean it sincerely, is going to be affected,” she told
The Associated Press in an interview. She said she’s encouraging Trump’s
administration to look at Arizona’s model because it is so cost-effective.
Brewer said the
low-income population that the Medicaid expansion was designed to cover was
one of the main drivers of the law, and she’s not prepared to see that group
go without care. Nearly 400,000 Arizonans have gained Medicaid insurance
since Brewer’s proposal took effect in 2014.
Arizona is one of
31 states that expanded Medicaid, many of them run by Democrats. Republicans
have blocked expansion in the remaining 19 states.
Among the GOP-led
states that expanded Medicaid, many officials are like Brewer, strong
proponents of the program that has brought insurance to about 9 million
low-income Americans who can’t possibly afford to buy it themselves. Before
the expansion, those people had little access to regular health care, and
when they got sick, hospitals were forced to treat them without
strongly oppose Medicaid expansion, however, continue to do so.
top Republican leaders have said consistently for years that they believe
the state cannot afford expansion, as have Idaho’s GOP leaders.
Florida Gov. Rick
Scott called for a complete repeal of Obama’s overhaul a week after the Nov.
8 election. Scott has been vague, however, about what should be done about
the 20 million Americans who got health insurance through the overhaul,
nearly half of them through Medicaid expansion his state rejected.
If he doesn’t
completely dump the program, Trump will be under pressure to allow changes
to it to give states more control.
Gov. Doug Ducey last year proposed a work requirement for healthy Medicaid
recipients, premiums and co-pays and a five-year limit on coverage. The
Obama administration approved limited co-pays but nixed the work requirement
and the five-year limit. Michigan, Indiana and Iowa also have been allowed
to charge premiums or fees, but broader changes requested by some states
have been rejected.
president-elect Mike Pence told Republican governors meeting in Florida on
Nov. 14 that Trump would replace traditional Medicaid funding to states with
block grants that “encourage innovation that better delivers health care to
eligible residents,” according to a statement from the Trump transition
governor, expanded Medicaid in his state but got waivers from the Obama
administration to implement plans that kick healthy people off the program
for six months if they fail to pay premiums.
Arkansas Gov. Asa
Hutchinson said he hopes Trump’s election means the state will have more
flexibility in how it spends Medicaid money. More than 300,000 people are
enrolled in the state’s hybrid Medicaid expansion, which uses federal
expansion money to buy private insurance for low-income residents.
means we’re going to have an administration that wants to give more
flexibility to the states,” Hutchinson, a Republican, said recently. “So
this is good news in our ability to get waivers to implement the reform we
want in terms of work requirements, in terms of cost-sharing, in terms of
other elements of reform that encourages employer-based insurance.”
short of saying whether he’d like some form of coverage for those on the
expanded Medicaid program to continue if Trump and congressional Republicans
repeal the Affordable Care Act.
Arizona’s governor, said recently the discussion is “not only about repeal
“We want to see all
of our citizens have access to affordable health care,” Ducey told reporters
in response to a question about the future of Medicaid expansion. “That was
the objective. That’s not where we are. We’ve got a new president and a new
Congress, and a fresh start.”
A spokesman for
Republican Michigan Gov. Rick Snyder said he plans to work with the new
administration to tout the successes and advantages of his state’s Medicaid
“How we continue
that success is important, and he’s willing to discuss how to do that with
anyone who has other ideas to consider,” Ari Adler said.
As for Arizona’s
former governor, she said her state’s Medicaid program is among the nation’s
best in terms of costs and provider choice. The program contracts with
private insurers to provide care on a per-patient basis.
“I don’t know how
you could deliver that population any more services better, more cheaply,
than what we’ve already done here,” Brewer said.