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White House Offers Incentives To States Holding Out On Expanding Medicaid


Now, we're also following the debate over the future of Obamacare. Many Republicans want to repeal that healthcare law. But some Republican states have taken a more complicated position. This year under Obamacare, more low-wage workers are eligible for Medicaid - that's the government's health insurance for the poor. Some Republican-led states that had refused to add people to Medicaid are rethinking. There are some holdouts, but the White House is looking to change that, as NPR's Debbie Elliott reports.

DEBBIE ELLIOTT, BYLINE: Louisiana got a new Democratic governor this week. And first up, he signed an executive order expanding Medicaid - something the Republican administration before him had rejected.




ELLIOTT: Governor John Bel Edwards has the support of Louisiana's Republican-controlled legislature to broaden Medicaid eligibility to people who make up to 138 percent of the federal poverty level - that's roughly $33,000 a year for a family of four.


EDWARDS: We do not want to continue to send our federal tax dollars to Washington to then be given to 30 other states to help their people who need access to quality healthcare while ours go without.

ELLIOTT: Louisiana is the 31st state to expand Medicaid. Under the Affordable Care Act, the federal government picks up the full tab for the expansion this year. It then tapers to a 90 percent federal contribution by 2020. In Baton Rouge yesterday, President Obama called Governor Edwards' action a bold step.


BARACK OBAMA: It was the right thing to do. And by the way, it will actually help the state's finances.

ELLIOTT: The White House is proposing new financial incentives to convert the remaining 19 states, like Alabama.

At hospital in Mobile, Porsche Blount uses a laptop to help housekeeper Betty Riggins sign up for Obamacare.

PORSCHE BLOUNT: So you're not enrolled in health insurance right now?


ELLIOTT: Blount is a field navigator with Enroll Alabama. There's this moment - she calls it the income dialogue - when she's on edge, hoping clients make at least $1,000 a month. Riggins barely hits the threshold.

BLOUNT: OK, so that's putting us right there at 12675. So we don't hit the Medicaid gap.

ELLIOTT: The Medicaid gap - people who make too much to qualify for Medicaid, but too little to qualify for federal subsidies under Obamacare.

BLOUNT: It's nerve-wracking because it could be potentially heartbreaking. We, a lot of times, leave these appointments friends with these consumers and in tears.

ELLIOTT: She tells people there is hope if Alabama expanded Medicaid. But that's not likely to happen, according to Republican Governor Robert Bentley.


ROBERT BENTLEY: We cannot afford it in Alabama right now.

ELLIOTT: Bentley's position is at odds with his own health care policy task force - board member Jim Carnes.

JIM CARNES: We are already on record as having recommended closing the health-coverage gap in Alabama as our number one priority.

ELLIOTT: Carnes is with the low-income advocacy group Alabama Arise. He blames the continued resistance on the politics of Obamacare - something he hopes will soften as more states expand Medicaid. In South Dakota, Republican Governor Dennis Daugaard included expansion in his budget proposal to the legislature.


DENNIS DAUGAARD: I haven't said never. I've always said, not now. We just didn't have the money.

ELLIOTT: The Obama administration hopes to lure more states by offering money - three years of full funding for Medicaid expansion before the federal match tapers off. But the question is whether a Congress that wants to repeal Obamacare will pay for that plan. Debbie Elliott, NPR News. Transcript provided by NPR, Copyright NPR.

NPR National Correspondent Debbie Elliott can be heard telling stories from her native South. She covers the latest news and politics, and is attuned to the region's rich culture and history.