WASHINGTON—U.S. House Democrats are trying again to entice a dozen holdout states—many of them in the South—to expand Medicaid coverage with the prospect of billions of dollars in federal cash.
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 get 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.
Holdout states include Florida, Georgia, North Carolina, Kansas, Tennessee and Wisconsin. Among many other benefits, North Carolina would realize an extra $2.4 billion over two years from the proposal.
Missouri has approved a Medicaid expansion but has not yet rolled it out; it would receive the extra money included in the House Democratic proposal.
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 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 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.
Throughout much of the South, along with places like Kansas, South Dakota, Wyoming and Wisconsin, though, 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:
- Florida could receive $3.5 billion.
- North Carolina would be in line for $2.4 billion.
- Georgia could bring in $1.9 billion.
- Tennessee could collect $1.7 billion.
- Wisconsin could gain $1.3 billion.
- Missouri could receive $1.7 billion.
- Kansas could bring in $330 million.
Texas stands to gain the most, with a potential of bringing in nearly $6 billion. The extra money would end after two years.
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