WASHINGTON — U.S. House Democrats are trying again to entice a dozen holdout states to expand Medicaid coverage with the prospect of billions of dollars in federal cash.
And although Missouri has approved a Medicaid expansion, it has not yet rolled it out and would receive the extra money included in the House Democratic proposal.
The new offer, included in a massive $1.9 trillion COVID-19 relief package that House Democrats are pushing through committees this week, could help provide health coverage to more than 2 million Americans. They are falling between the cracks in government programs in the midst of the pandemic and economic downturn.
Most are childless adults who earn some money but still fall below the federal poverty level.
In the vast majority of states, people in that situation could qualify for Medicaid, a public program that provides health insurance to low-income people and people with disabilities.
But in 14 states that have not yet expanded Medicaid, they are still ineligible for that program. Meanwhile, they are still too poor to buy subsidized private coverage through insurance exchanges.
Edwin Park, a research professor with the Center for Children and Families at Georgetown University, said the House proposal could “move the dial” in some states.
“For others, unfortunately, I think they may walk away from this very good deal,” he said.
Supreme Court ruling
The gap that many low-income people fall into was created when the U.S. Supreme Court struck down part of the Affordable Care Act health care law, known as Obamacare. The court said Congress could not make states expand their Medicaid programs.
But states have gradually signed on over the last decade, because Congress provided them with such big financial incentives to do so. At first, the federal government picked up the entire cost of adding childless adults and others to the Medicaid rolls. These days, it still covers 90 percent of the cost.
But throughout much of the South – along with states including Missouri, Kansas, South Dakota, Wyoming and Wisconsin – state officials have resisted calls to expand their Medicaid programs. Republicans in particular have balked at what they see as an overreach by the federal government.
The latest measure, though, would add a new twist. It would give holdout states more money for the patients they are already covering if they agree to expand Medicaid.
“Even though states still pay 10 percent [for the new patients], they would still come out ahead,” said Robin Rudowitz, the co-director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured. “I think that changes the math.”
An analysis by the left-leaning Center on Budget and Policy Priorities shows that states would gain substantially under the Democratic proposal:
- Missouri could receive $1.7 billion.
- Florida could get $3.5 billion.
- North Carolina would be in line for $2.4 billion.
- Georgia could get $1.9 billion.
- Tennessee could collect $1.7 billion.
- Wisconsin could gain $1.3 billion.
- Kansas could receive $330 million.
- Texas could get nearly $6 billion.
The extra money would end after two years.
How Medicaid works
Medicaid is run jointly by states and the federal government. The federal government reimburses states a set amount of the money they spend on the program, and that rate varies by state.
States whose residents have lower average incomes get higher reimbursement rates. In March, Congress increased the reimbursement rate for all states for as long as the COVID-19 emergency remains. President Joe Biden’s administration has said it will extend that emergency until at least the end of 2021.
The House proposal would further increase the reimbursement rates for new expansion states by 5 percentage points.
The new incentives would be part of a larger congressional effort to address the fallout of the COVID-19 pandemic. Democrats’ relief bill covers everything from distributing vaccines to supporting transportation networks to doling out stimulus checks.
That health emergency has also changed how state officials view an expansion of health insurance eligibility, Rudowitz said.
“The pandemic has certainly highlighted the issues around the need for health coverage, and you have more people [in states that haven’t expanded Medicaid] becoming uninsured as related to the economy,” Rudowitz said.
States may resist
Park said that the federal government picks up the costs of the expansion, and people who get health coverage demand fewer state services.
“The fiscal impact of [Medicaid] expansion has always been positive …,” he said. “But some states may resist for ideological reasons rather than looking at the numbers.”
The House Energy and Commerce Committee will hold a hearing on the proposed changes Thursday morning.
Among the other changes that the lawmakers are considering are measures to ensure that women retain their Medicaid coverage for up to a year after giving birth; fully covering the cost of COVID-19 vaccines under Medicaid; and allowing prison inmates to qualify for Medicaid 30 days before they are released.
The full text of this article by Daniel Vock can be read at The Missouri Independent.