Presidential Race Holds Implications for Medicaid, Trump Adviser Says

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By Alex Ruoff

Oct. 5 — The result of the presidential election, more than gubernatorial elections, will decide whether more states expand their Medicaid programs, an adviser on Republican nominee Donald Trump’s presidential transition team said Oct. 5.

Hillary Clinton, if elected president, would push more states to expand Medicaid, Mike Leavitt, who served as secretary of the Department of Health and Human Services under George W. Bush and was named a key adviser to the Trump campaign’s transition team, said. Republican leaders have vowed to repeal the Affordable Care Act, including the added funds for states that expand their Medicaid programs made available under the law.

Under a Clinton administration, governors and lawmakers in states that haven’t expanded their Medicaid programs are likely to take advantage of a little-known ACA provision set to begin in 2017 that allows states to waive many of the law’s requirements—such as individual and employer mandate—if they provide similar coverage, Leavitt said.

Section 1332 waivers offer “tremendous flexibility” that could either provide a boon to Medicaid innovation in many states or offer a loophole for states looking to keep their Medicaid programs running as is, he said at a health policy forum hosted by the National Institute for Health Care Management (NIHCM) Foundation.

Leavitt told Bloomberg BNA he wouldn’t comment on whether Trump would seek to alter the 1332 waivers or if he would support Medicaid expansion, which is unlikely considering Republican opposition to it.

Medicaid Changes

Trump has vowed to turn Medicaid into a block grant program, while Clinton has vowed to expand upon the ACA. Her platform includes offering new incentives for states to expand Medicaid.

Health policy observers have been looking toward upcoming gubernatorial elections to gauge how many more states will expand their Medicaid programs. Of the 19 states that haven’t expanded their Medicaid programs, three—Missouri, North Carolina and Utah—will elect a governor in November, possibly bringing a shift in health policy along with a change in administration.

Expansion is intended to provide health insurance to those in the “coverage gap,” a crack people fall into when they earn too much to qualify for Medicaid but not enough to purchase private insurance through the marketplace. Expansion reduces the coverage gap by increasing Medicaid eligibility for people earning up to 138 percent of the federal poverty level.

In the first three years of expansion, ending in 2016, coverage for newly eligible adults was fully funded by the federal government. That federal funding phases down to a 90 percent federal match by 2020, according to the HHS.

However, on Jan. 1, the ACA’s 1332 waiver program begins. Under that section of the law, states can make broad changes to the ACA as long as the coverage is at least as comprehensive and affordable as would be provided absent the waiver; provides coverage to a comparable number of residents of the state; and doesn't increase the federal deficit.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

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