Republicans seek political cover to accept Medicaid expansion money

In the bitterly partisan debate over the Affordable Care Act, few House members criticized the proposed legislation as harshly or as often as then-Rep. Mike Pence. But now, nearly four years after the measure passed on a party-line vote, Pence, now Indiana’s governor, is asking the federal government for ACA money to expand a program that provides coverage to low-income Hoosiers. But he wants to do it outside the confines of the health-care law.

Pence is among a small but growing number of GOP governors and lawmakers looking for alternatives to expanding Medicaid. They don’t want to be seen embracing a law that is almost universally loathed in their party, but the hundreds of millions of dollars available to their states through the law’s provisions are too enticing to pass up.

“Obamacare was a mistake. It was, to borrow a phrase, a bad idea poorly executed,” Pence said in an interview. “But where I work, it’s about solutions. People are looking for results.”

On Friday, Pence met with Health and Human Services Secretary Kathleen Sebelius to ask for a waiver for the Healthy Indiana Plan, which helps about 45,000 low-income residents with personal health funds linked to insurance plans with high deductibles. Pence wants to use the federal money earmarked for Indiana’s Medicaid expansion to grow that program instead.

“I’ve made it very clear that I have no interest in expanding traditional Medicaid in Indiana,” he said. “I think Medicaid is a deeply flawed system. I think it’s broke, and broken, and it ill serves the people that are covered. We’re currently in negotiations with the administration about using the resources that are available for Medicaid expansion to expand the Healthy Indiana Plan.”

Republican governors in other states are using the same technique, seeking waivers to use Medicaid expansion money to fund alternative programs that would accomplish many of the same goals, but under a different name.

“There’s a lot of trying to say they’re not doing Obamacare so that they can call it something different,” said Diane Rowland, a health policy expert and executive vice president at the Kaiser Family Foundation. “They’re trying to put some distance between the straight concept of a Medicaid expansion so they can build a coalition in the legislature.”

Pennsylvania Gov. Tom Corbett (R) has sought a waiver to include work requirements in Medicaid expansion, while Utah Gov. Gary R. Herbert (R) said last month that he will push to expand Medicaid in some form during this year’s legislative session.

Wisconsin Gov. Scott Walker (R) has performed his own version of this political jujitsu: His state has curtailed Medicaid to the point at which it covers only those who make up to 100 percent of the federal poverty level — $23,550 for a family of four. Those who earn more and who don’t have dependent children are covered under BadgerCare, a program that receives Medicaid funding.

The Healthy Indiana Plan, meanwhile, creates an individual account similar to a health savings account, linked to a high-deductible health plan. Low-income residents pay a percentage of their income into the account, and the state has preventive-care incentives that have saved money. Pence has asked HHS for a long-term waiver, extending a temporary waiver his state received for the first time in 2008.

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