State Legislatures Quarrel Over Whether To Expand Medicaid : Shots - Health News Medicaid expansion was a big deal in a handful of state legislatures this year. Wyoming said no. Tennessee said no. But Montana said yes, and three more states are coming down to the wire.
NPR logo

State Legislatures Quarrel Over Whether To Expand Medicaid

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
State Legislatures Quarrel Over Whether To Expand Medicaid

State Legislatures Quarrel Over Whether To Expand Medicaid

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


We're about to listen to the still-evolving debate over Obamacare. That debate is changing, at least on the state level. It's become a bottom-line question.


Many Republicans have vowed total opposition to the Affordable Care Act, but a slowly increasing number of states have decided to accept the law's federal help to expand Medicaid, the health insurance program for the poor. Five states with Republican-dominated legislatures have faced that question this year.

INSKEEP: In a moment, we'll hear the debate in Alaska. We start with the first state to pass a form of Medicaid expansion this year. Here's Eric Whitney of Montana Public Radio.

ERIC WHITNEY, BYLINE: Montana's legislature has been stewing over Medicaid expansion since lawmakers said no to it in 2013, when they last convened. When the session started this January, the Koch brothers group, Americans for Prosperity, staffed up here and targeted moderate Republicans, organizing anti-expansion town hall meetings in their districts.


UNIDENTIFIED MAN #1: Well, that vote is a bellwether for Medicaid expansion forms. And so Rep. Gardner's on that vote on that to side with liberals...

WHITNEY: But AFP didn't invite targeted lawmakers themselves and that backfired. Many voters called AFP's tactics, meddling by outsiders, and some AFP meetings were disrupted. A reporter from the Flathead Beacon took this video.



UNIDENTIFIED MAN #3: Hey, hey, guys - hey.

WHITNEY: Tea Party lawmakers in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans felt politically safe enough to cross party lines and vote with all the Democrats to pass it. But at the bill signing ceremony, Republican Senator Ed Buttrey, who sponsored the bill, said...


SENATOR ED BUTTREY: This is not Medicaid expansion.

WHITNEY: Buttrey says Republicans won important concessions from Democrats. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn't just doing the White House's bidding.


BUTTREY: I'll say it again, and I hope the media will report this exciting and unique story. This is not Medicaid expansion.

WHITNEY: Montana's proposal is now on its way to the federal government, who will have the last word on whether it's legitimate under the Affordable Care Act. For NPR News, I'm Eric Whitney.

ANNIE FEIDT, BYLINE: And I'm Annie Feidt in Alaska, where Governor Bill Walker, a former Republican who is independent, has made Medicaid expansion one of his top priorities. But Republicans leading the state House and Senate blocked expansion during the legislative session that just wrapped up. One of those opposed was Senator Pete Kelly.


SENATOR PETE KELLY: I think everyone agrees that Medicaid is broken. Now, to put more money into it, to bring more people into it, that's certainly not going to help its brokenness.

FEIDT: Most Alaskans, though, favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies like this one, organized by an interfaith church group.


PASTOR JULIA SEYMOUR: Is your light shining?


SEYMOUR: Are you willing to sing about it?

FEIDT: Lutheran Pastor Julia Seymour turned the crowd into a choir.


SEYMOUR: For Medicaid expansion.

(Singing) For Medicaid expansion, I'm going to let it shine.

FEIDT: Even though it didn't pass this session, Seymour's more determined than ever to make sure all Alaskans have access to health insurance.

SEYMOUR: The Bible tells us that faith, hope and love go on and do not end. And I'm keeping the faith and I'm hopeful, but my love for some of the leaders is waning now and then.

FEIDT: Those leaders have another shot at passing Medicaid expansion. As soon as the regular session ended, Governor Walker called lawmakers into special session, but legislative leaders decided to take a recess. The state is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says even in better financial times, Alaska usually jumps at the chance to accept more than a billion federal dollars.

GOVERNOR BILL WALKER: If that was a road project or if that was some, you know, infrastructure project, we'd be all over that. So this is health care.

FEIDT: Walker has proposed expanding on his own if lawmakers don't act, but it's not clear he has the authority. About 40,000 would qualify for Medicaid if the state expands. For NPR News, I'm Annie Feidt in Anchorage.

INSKEEP: That story is part of a reporting partnership with NPR News, local member stations and Kaiser Health News.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.