House Democrats hope to push all states to expand Medicaid

Les Masterson

Jan. 8, 2019

Dive Brief:

• House Speaker Nancy Pelosi said Democrats may nudge non-Medicaid expansion states to open up their programs and possibly vote for more federal dollars to pay for expansion.
• The Affordable Care Act initially demanded that all states expand Medicaid for people up to 138% of the federal poverty level or forfeit Medicaid funding. However, the U.S. Supreme Court in 2012 ruled that expansion had to be optional. In comments Friday, Pelosi said Democratic leaders were looking at various ways of pursuing more expansion.
• Meanwhile, some Republicans in Washington support a partial Medicaid expansion for non-expansion states. Supporters say the option won't cost as much, but critics say that move would still leave many without coverage.

Dive Insight:

Three-dozen states and the District of Columbia have expanded Medicaid. That piece of the ACA is the major reason for millions of newly insured individuals. Medicaid expansion alone covers about 15 million people.

Medicaid expansion proponents say covering more people is helping improve care and reducing long-term healthcare costs for the country. Expansion has also been a boon for health insurers, including Centene and Molina.

With Democrats back in control of the House of Representatives and Pelosi returning to the top spot in the chamber, the party is looking to strengthen the ACA and protect the law against Republican efforts to undermine it. President Donald Trump and Republicans on Capitol Hill have taken aim at the ACA but failed to get enough votes in the Senate to overturn the law in 2017.

Republicans have worked in the courts to throw out the law. In the most recent ruling, Judge Reed O'Connor of the Federal District Court for the Northern District of Texas ruled the ACA unconstitutional without its individual mandate penalty. Democratic attorneys general appealed the decision.

The ACA is also much more than the exchanges. It touches numerous parts of healthcare, including Medicaid expansion. If the ACA is ruled unconstitutional, the decision could reverse the entire expansion, too.

With that in mind, the Democratic-controlled House is exploring ways to further expand Medicaid. One of those measures is attempting to get all states to expand the program with the promise of more federal funds.

More states, including traditionally Republican ones, have increasingly looked at expanding Medicaid coverage. Last fall, voters in Utah, Nebraska and Idaho all voted to extend the program. Virginia legislators also expanded Medicaid, which began this month.

Meanwhile, Maine, which approved expansion in 2016, will finally get a larger Medicaid program. Republican Gov. Paul LePage refused any expansion that raised taxes or tapped into reserve funds. Now, with LePage out of office and a new governor, Maine is expected to broaden the rolls this year. Gov. Janet Mills wants a quick expansion to get at least 70,000 additional Mainers onto Medicaid.

That still leaves 14 states that haven't expanded: Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. There are efforts in some of those states to expand the program though. Over the past week, leaders in Kansas and Oklahoma have spoken in favor of expansion.

https://www.healthcaredive.com/news/house-democrats-hope-to-push-all-states-to-expand-medicaid/545440/