Almost immediately after taking office last year, Louisiana Gov. John Bel Edwards (D) adopted Medicaid expansion under the Affordable Care Act, making his state the 31st in the nation to embrace the policy. To date, Louisiana's policy has worked very well, and hundreds of thousands of low-income Louisianans have been able to receive affordable coverage.In light of the results of the presidential election, the question now is whether there will be a 32nd state to do the same thing.South Dakota Gov. Dennis Daugaard (R) wanted his state to embrace the policy, but he faced resistance from his own party, and in mid-November, following a conversation with Vice President-elect Mike Pence, Daugaard gave up on the idea.But with time running out on the Obama administration, one more state may be able to take advantage of one of the ACA's most important opportunities. WRAL in Raleigh reported:
North Carolina's new Democratic governor on Friday formally started his effort to expand Medicaid to more of the poor and middle class lacking insurance, even as Republicans in Washington bear down on repealing the federal health care law that offers this coverage option.[Roy] Cooper's office said he sent a letter to federal regulators alerting them of his intentions to seek changes that could provide health care to more than 500,000 people starting in January 2018.
It's an unexpected turn of events in one of the nation's most politically volatile states. In fact, Roy Cooper, who was narrowly elected by North Carolinians two months ago, is well aware of the fact that the Republican-run state legislature -- which recently scurried to gut the powers of the governor's office -- has prohibited North Carolina from adopting Medicaid expansion.Cooper, however, is moving forward anyway, telling a group of business leaders last week that the state's 2013 law blocking Medicaid expansion was an unlawful infringement on the authority of the governor's office -- and so he's going behind legislators' backs to help the state, whether Republicans like it or not.The Obama administration will have to move quickly to approve North Carolina's application before Jan. 20, but with the health security of 500,000 Americans on the line, something tells me federal officials at HHS will move this to the top of their to-do list.A court fight will inevitably follow.But while we wait for this process to unfold, this reminds me of an uncertainty on the horizon: if states wanted to pursue Medicaid expansion after Jan. 20, would the Trump administration approve their requests?At this point, there's no reason to believe such a scenario will play out, and the 19 states that continue to reject arithmetic and common sense will likely continue to do so. But let's say for the sake of conversation that Maine Gov. Paul LePage (R), for example, the sole impediment to Medicaid expansion in his state, resigned this year, and the state decided soon after to let HHS know Maine is finally ready for Medicaid expansion.Would HHS Secretary Tom Price, a fierce opponent of the policy, approve the application? Would the Trump White House tell the remaining states, "Tough luck, the door is now closed"?