In-Depth: Rep. Marc Veasey (D-TX) reintroduced this bill from the 115th Congress to encourage the 14 states that have yet to expand Medicaid under the Affordable Care Act (ACA) to do so by giving them extra funds for the expansion:
“The bill will create an incentive for all eligible States to provide affordable health care coverage for all of their citizens. In Texas, approximately 638,000 people would gain coverage if Medicaid were expanded. This is a no-brainer for the state of Texas and for the fourteen states across the country who haven’t adopted this program.”
Original cosponsoring Rep. Terri Sewell (D-AL) adds that the "writing is on the wall" for states that have yet to expand Medicaid:
"The writing is on the wall and the facts are clear: premiums and health care costs are higher in states that have not expanded Medicaid. And over 90% of rural hospital closures have been in states that did not expand Medicaid before the closure. In my state, approximately 314,000 more Alabamians would be covered under Medicaid expansion. Not doing so is a poor decision. And while I can’t force Alabama’s governor to expand Medicaid, I can continue to promote legislation that provides more incentives for her to do so. T[his] legislation is a step in the right direction."
Last Congress — and in the years before it — Rep. Gene Green (D-TX) introduced this bill to incentivize states that haven’t yet expanded Medicaid to do so:
Medicaid is as much of a good deal for states as it is for patients. In
our District alone, 55,000 residents would gain coverage if Texas
expanded Medicaid, and 1 million people would gain coverage statewide.
Under the ACA, this would happen at minimal cost to the state with the
federal government financing 100 percent of expansion costs for the
first three years and after that, no less than 90 percent on a permanent
basis. Rather than letting the 90 percent match rate take effect in
2017 as originally written into the ACA, this bill would allow all
states who expand now or in the future to receive 100 percent backing
for 3 years from the date of expansion.”
Those who oppose
states expanding their Medicaid programs argue that federal assistance
will decline over time and that even without the expansion, many states
struggle to balance their budget each year. Not only that, but Medicaid
is the largest expenditure for most states and its costs increase faster
than tax revenue can be brought in to keep pace.
In the current session of Congress, there are 18 Democratic cosponsors of this bill. Last Congress, this bill had four Democratic cosponsors and didn't receive a subcommittee vote. In the 114th Congress, it had 18 Democratic cosponsors in the House and didn't receive a subcommittee vote.
Note: Following a 2012 ruling by the U.S. Supreme Court that states
weren’t required to expand their Medicaid programs to accommodate the
Affordable Care Act, 19 states opted not to expand
their program. As of this bill's reintroduction in mid-January 2019, 14 states — Alabama, Georgia, Florida, Kansas Mississippi, Missouri, North Carolina, Oklahoma, Tennessee, Texas, South Carolina, South Dakota, Wisconsin, and Wyoming — had yet to expand their Medicaid programs under the ACA.
Rep. Veasey's office estimates that states that opt out of the Medicaid expansion are missing out on $305 billion over the 2013-2022 period. Medicaid expansion under the ACA allows states to receive 100 percent Federal Medical Assistance Percentages for the first three years a newly-eligible individual is enrolled in the Medicaid program, 95 percent for the fourth year, 94 percent for the fifth year, 93 percent for the sixth year, and 90 percent each year thereafter — in short, a significant cost reduction for states.
Summary by Eric Revell(Photo Credit: Ragesoss / Creative Commons)