Federally finance Medicaid expansion, which provides a mechanism to offer health coverage to low-income adults under the age of 65, is a crucial component of the PPACA. At the heart of the federal Medicaid expansion push is a guarantee from Washington to pick up the entire tab through 2016. In subsequent years, through 2020, the federal reimbursement rate to the states will be tapered to 90 percent.
About 15 million uninsured and underinsured people will have no affordable option to obtain health coverage if their state governments decide not to expand Medicaid, according to a Commonwealth Fund study released last week.
Republicans in several states including Georgia, Missouri, and Texas have staunchly resisted the federal government's offer to fund 100 percent of a straight expansion of existing Medicaid programs. But Arkansas, New Hampshire and a handful of other states have taken an alternative route to Medicaid expansion that many Republican lawmakers across the country find enticing.
A waiver from the federal Medicaid expansion law "allows states to customize their approach to a model that may be more palatable politically," Saloner said.
In New Hampshire, where the Republican-controlled Senate firmly opposed a straight expansion of Medicaid, turning to the state's new public exchange was a solution GOP lawmakers could swallow.
"A straight expansion product would not have gotten past the Republicans," NH Rep. Tom Sherman, a Democrat, said last week in a phone interview after the House approved the Senate's plan to expand Medicaid through the public exchange.