3 States Counter Obama's Proposal For Medicaid Expansion

STEVE INSKEEP, HOST:

Some Republicans are quietly coming to terms with a key part of Obamacare. You wouldn't know this from the headlines. The new Congress is expected to challenge the law again.

LINDA WERTHEIMER, HOST:

But on the state level, the debate has shifted. Some Republicans are negotiating terms under which they could live with part of the Affordable Care Act.

INSKEEP: It's the part of the law that offers states' federal money to expand Medicaid. The question is no longer how to reject this Medicaid deal but under what terms to make it happen. Montana Public Radio's Eric Whitney reports.

ERIC WHITNEY, BYLINE: Montana's got a Democratic governor, but Republicans have long dominated the legislature. The legislature said no to Medicaid expansion in 2013. And the modified proposal the governor's pitching this year isn't getting much support either. Republic senators like Fred Thomas say it's too generous, extending benefits to anyone making less than about $16,600 a year. He wants to...

SENATOR FRED THOMAS: Keep it targeted towards what's intended to do - is to take care of our most vulnerable citizens - disabled persons, low-income seniors, low-income parents, children.

WHITNEY: More Montanans in those categories would get Medicaid under the Republican counterproposal to the governor's deal with the White House. But, Thomas says, adults without kids who aren't disabled and don't have much income...

THOMAS: Anyone that's in that predicament - we're going to encourage them to get another job, get the extra hours and qualify for the exchange by bumping their income up a little bit.

WHITNEY: Qualifying for the exchange means making more than the federal poverty threshold of about $1,000-a-month income. People who make less than that don't qualify for subsidies to buy coverage on healthcare.gov or state exchanges. Thomas says it also might make sense to use tax credits to boost poor people's incomes high enough to qualify for subsidies. Heather O'Loughlin, with the Montana Budget and Policy Center, says it makes more sense to just give Medicaid to more people since the federal government is picking up most of the tab.

HEATHER O'LOUGHLIN: We believe that this plan will not provide the coverage to all those that are eligible. And therefore Montana loses out on the higher federal match and billions in federal dollars that Montanans really deserve.

WHITNEY: O'Loughlin backs Governor Steve Bullock's plan, and he's still optimistic that support from outside the legislature will get his plan across the finish line.

GOVERNOR STEVE BULLOCK: We'll walk into this legislative session - everybody from AARP, the Chamber of Commerce to the hospital association, saying we need to do something.

WHITNEY: Montana's state lawmakers may agree that something needs to be done, but like their counterparts in Wyoming and Utah, they're not sure the deal their governor's worked out with the White House is it. All three Republican state Houses are working on their own Medicaid proposals that may or may not pass muster in Washington. For NPR News, I'm Eric Whitney in Missoula, Montana.

INSKEEP: That story's part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.