Democrats Must Federalize Medicaid
Now that Democrats have a narrow majority in the Senate, one of their top priorities must be federalizing basic Medicaid. It is the most reasonable way to ensure around two million of the most vulnerable Americans get access to health care during this pandemic. Most importantly, it can legally be included in a budget reconciliation bill, and with some effort it should be able to get 50 votes. Federalizing Medicaid sits at a critical nexus of being actually possible, urgently needed, and politically essential for the party if it wants to hold on to its majority. Yet it risks being overlooked.
Millions of Americans fall into the so-called “Medicaid gap”: people who earn too much to qualify for Medicaid in their Republican-controlled state, and either end up being uninsured because they make too little to qualify for federal exchange subsidies, or need to overpay for private insurance. This situation exists because in National Federation of Independent Business v. Sebelius, the Supreme Court made the Affordable Care Act’s Medicaid expansion optional. Radicalized Republican governments in several states refused to expand Medicaid—even though they were hurting state budgets, public health, low-income residents, and hospitals.
The Democratic Party has only entertained two ways to deal with this legal constraint. One is to offer the remaining holdout Republican states even more money. This is what Speaker Nancy Pelosi proposed in H.R. 1425 last year. But the federal government already pays 90 percent of the Medicaid expansion cost, and Republican states still refuse.
Republican leaders in Georgia, insistent on making sure their Medicaid expansion contains onerous work requirements, turned down millions in federal money. In Tennessee, officials got a last-minute waiver to block-grant Medicaid so they could cut coverage, even though it will almost assuredly be thrown out in court. Right before leaving office, Trump’s Medicaid administrator, Seema Verma, is trying to get Republican-led states to sign on to a Medicaid waiver process that would make it extremely time-consuming for Biden to undo the damage. After more than a decade, it is clear the issue is not cost but ideology and spite. Most of the states that refuse to expand Medicaid are in the South and have large Black populations.
Read more: https://prospect.org/health/democrats-must-federalize-medicaid/
(American Prospect)