Instead, he said, Bryant has focused on promoting personal health responsibility, recruiting more doctors and fighting teen pregnancy to reduce low-birth-weight babies.
In neighboring Louisiana, the state House of Representatives and Senate directed the health department last year to prepare a report on how to move from last in the annual health rankings to 35th within the next 10 years. The March 2013 report said the state "should focus on improving those measures weighted most heavily, such as smoking, obesity and the lack of health insurance.
Yet in recent legislative hearings, Louisianas outgoing health secretary, Bruce Greenstein, told lawmakers that broader Medicaid coverage would be a "massive entitlement-program expansion that weakens the private health insurance market."
He said the expansion would swell Medicaid rolls by 467,000 next year, but 187,000 would be people who dropped private coverage.
Experts say all expansion states probably will see their Medicaid rolls grow as working poor adults stop paying for job-based health coverage when they realize they now qualify for Medicaid. States also will incur additional costs due to a likely enrollment spike among adults who are currently eligible for Medicaid but arent signed up.
Overall, Kaiser estimates that if the nine anti-expansion Southern states dropped their opposition, their Medicaid spending would rise 3 to 7 percent from 2013 to 2022. But those spending hikes would be partially offset by savings for hospital indigent care, since more now-uninsured patients would have Medicaid.
Higher state spending on Medicaid also would bring states more than 10 times as many federal dollars, which could bolster the state economy and help create jobs.
By 2022, Kaiser estimates, while Mississippi would spend an additional $1 billion to expand Medicaid coverage, the federal government would pay $14.5 billion of the costs. Other states would enjoy similar windfalls.
Blahous countered that even though the states costs are small, its a fiscal push in the wrong direction right at a time when the states cant very well afford it.
Medicaid has never been an easy political fit in the South. When the program launched in 1966, states such as Alabama, Florida, Mississippi and North Carolina were among the last to opt in. Critics at the time called it socialized medicine.
Over time, as other states used Medicaid waivers and enrollment expansions to cover different groups, such as single adults and childless couples, Southern states largely have chosen to invest in public safety-net hospitals where poor, uninsured patients can get indigent care subsidized by taxpayers.
But most of the issues Southern states are facing obesity, diet, lack of exercise, smoking are things that public hospitals dont do very well, Emorys Thorpe said. They arent designed to provide good primary care and prevention.
Thats what Medicaid is supposed to do.
It might take a Southern state such as Arkansas, with a Democrat in the governors mansion and Republicans controlling the legislature, to make Medicaid expansion palatable in the South and in other pockets of resistance.
Arkansas, which ranked 48th in health outcomes in the United Health Foundation survey, wants to use federal tax credits to pay for private insurance to cover the newly eligible Medicaid population. It would cost the federal government more, but it appeals to Republicans who oppose growing entitlement programs.
The Obama administration supports the general concept, but its waiting for Arkansas to finalize its proposal. Others states, such as Florida, Ohio and Louisiana, are watching with interest. Even Mississippi has left the door open.
If its tax credits that helps grow the economy, Bryant said recently, were willing to look at that.