2014 Health Reform Session Roundup

With 2014 legislative sessions largely adjourned in statehouses across the nation, this is the first in a series of issue-specific session roundups from Progressive States Network highlighting trends in different policy areas across the fifty states. - See more at:

This year, the moment we have been waiting for finally arrived: the major provisions of the Affordable Care Act (ACA) went into effect on January 1. After a rocky launch, the Affordable Care Act is now in full swing and boasting 8 million signups, the majority of which are newly insured individuals. For 24 states and the District of Columbia, Medicaid expansion went into effect. However, the 2012 U.S. Supreme Court decision meant that states had the option of refusing to expand Medicaid without consequences (other than to its own citizens), and whether to expand Medicaid was an issue hotly debated in the 26 states that did not expand prior to this legislative session.

Progressive States Network’s Working Group of State Legislators for Health Reform provides research, polling, model legislation and everything else legislators need to pursue health reform. If you're a legislator who's interested, join the working group here.


In the 24 states and the District of Columbia that expanded Medicaid prior to the 2014 legislative session, 10,241,000 residents became eligible for the program on January 1 of this year. In the remaining states, many conservative legislative leaders and governors played politics with people's health care by refusing to expand Medicaid to their 12,108,000 constituents even though the cost would be fully covered by the federal government.

Nonetheless, efforts to expand Medicaid were successful in a number of states during the 2014 legislative session.

New Hampshire and Iowa expanded Medicaid making 64,000 New Hampshirites and 148,000 Iowans eligible for health coverage.

Arkansas had implemented a private option Medicaid expansion in the past that requires annual approval to continue. After a contentious political debate, the legislature approved the continuation of the program, preventing the state from having to kick 275,000 Arkansans out of their health plans.

Although they have not yet received final approval, efforts to expand Medicaid are underway in Indiana, Pennsylvania, Utah, and Virginia.

Indiana Governor Pence indicated that the state will develop a Medicaid expansion waiver., which would make 517,000 Indianans eligible for Medicaid

Pennsylvania Governor Corbett submitted a plan to expand Medicaid with a controversial and unnecessary job search requirement, making 682,000 Pennsylvanians eligible.

Virgnia Governor Terry McAulliffe campaigned on expanding Medicaid and after winning, is working to expand Medicaid using his executive authority, making 462,000 Virginians eligible for coverage

Utah Governor Gary Herbert has indicated that he intends to expand Medicaid, saying “doing nothing is not an option,” though his "block grant" approach faces little legislative support despite the fact that it would at least temporarily make 190,000 Utahans eligible for coverage.


Though more than half of the states plus the District of Columbia having expanded Medicaid, there are still 22 states that have dug their heels in and are refusing to expand, denying their 10,045,000 of their constituents health coverage despite vocal support for Medicaid expansion under the ACA from an increasingly ideologically diverse base.

Despite support from many legislators in Alaska, Maine, and Texas, and governors such as Rick Scott (R) in Florida who tried to set the reform in motion, conservatives majorities ultimately won out in preventing legislation from becoming law in these states.

Tennessee Gov. Bill Haslam (R) had an especially difficult time reconciling the needs of multiple competing constituencies in his state while pursuing his own coverage plan for the poor in Tennessee. In the fall of 2013, negotiations with the Obama administration over an alternative potential expansion of the state's Medicaid program, TennCare, fizzled out amidst the administration's battle with online marketplace malfunctions.

For a while in Missouri, it looked like Medicaid expansion might actually come to fruition; the policy enjoyed backing from Gov. Jay Nixon (D) and numerous legislators in both parties. A dramatic protest in early May that temporarily shut down the state Senate clarified citizens' strong feelings on the issue as well. However, the policy was ultimately defeated at the end of the session due to the efforts of a few especially strong Senate opponents.


Nebraska Senator Jeremy Nordquist launched a campaign to expand Medicaid, distributing a petition and organizing the signers to contact the governor and their representatives to urge them to take action. He introduced a strategic messaging bill on the topic of Medicaid expansion. The bill would withhold government-subsidized health insurance from legislators and the Governor until they expanded Medicaid. It is an innovative way to call out the hypocrisy of those who enjoy government-sponsored health insurance for failing to extend it to 110,000 Nebraskans who would be eligible for coverage under Medicaid expansion. In the end, Senator Nordquist came within 5 votes of expanding Medicaid.

Still fighting to ensure that 110,000 Nebraskans get health coverage, Senator NorNovember 2014 ballot. Medicaid expansion may also appear on the November 2014 ballot in Montana.

FamiliesUSA put together a great infographic on the current state of Medicaid expansion. Here's a portion of it: