Though the "private option" is likely to cost the feds hundreds of millions more per year, it remains a much more popular idea among Republican lawmakers than traditional Medicaid expansion, which appeared dead in the water just a few weeks ago. The "private option" seems fishy and we still think the political optics of the executive power grab are awful, but all systems appear to be go from a legal perspective. DHS has sent a letter to the feds to make it official and once DHS releases their projections next week, the Ledge should have most of the details they need to proceed.
If there's a risk here, it's probably that The Four Privateers (Sen. David Sanders, Sen. Jonathan Dismang, Rep. John Burris, and Rep. Bruce Westerman) will try to squeeze even more demands out and could possibly walk away if they don't get what they want. They want more "flexibility" than the law currently allows and their urge to chip away at the existing program burns on. Hard to believe that Republicans would back out over details or subsidiary fights now that private insurance companies have a stake too, but you never know with true believers.
Meanwhile, the conservative wing of the General Assembly still has doubts about expansion even with the "private option." Anti-Obamacare lost causers are bringing in a big gun next week to fan the flames.
Still, the Four Privateers have a lot of conservative cred and should be able to sell the deal. They'll even argue that it won't cost more due to the magic of free markets, even though that's not so. Should be all sorts of twisting and turning since many of the arguments for the new deal are awfully similar to those for the old deal. We'll hear from Republicans about "cuts" that aren't really cuts in service. Maybe we'll even hear that the feds can afford to pay a little more because the ACA is revenue positive. Romneycare-style premium assistance, once a conservative idea, then socialism, now arrives full circle into the waiting arms of the Four Privateers.
And for the folks that are desperate for healthcare in this state, that's welcome news. The Expand-o-meter is holding course, remaining at 75 percent.