Getting Medicaid expansion to red states that have turned it down has been a major Biden campaign promise, but keeping that promise won't be easy, or cheap, and like everything else the Dems are trying to do, they're running out of time before they potentially lose the House, Senate, or both.
Democratic lawmakers are rallying around an effort to extend health insurance in states that have refused to expand Medicaid, believing they have a limited window to help millions who’ve been unable to get coverage because of intractable GOP opposition to the Obamacare program.
Democrats had hoped that President Joe Biden’s election, along with the promise of new federal cash from the recent Covid relief package for states to expand Medicaid, would move at least some of the dozen remaining holdout states. But there’s little indication those states are budging, which is energizing a push among Democratic lawmakers for a new federal program guaranteeing coverage for low-income adults long shut out of Medicaid expansion.
“I think in most of them, like Texas, it's not a question of dollars, it’s a question of wanting to be ideologically opposed to any additional role for government in helping impoverished people,” said Rep. Lloyd Doggett (D-Texas), the House Ways and Means health subcommittee chairman, who’s working on a coverage proposal. “The only way we overcome that is through a federal initiative.”
Expanding coverage to the estimated 2.2 million people lacking affordable health insurance options in the Medicaid expansion holdout states would fulfill a Biden campaign pledge while his other key health care promises, like government drug price negotiations and a public option, face tough odds in Congress. Democrats also believe it would deliver a major win for their party heading into tightly contested midterm elections next year, given that Medicaid expansion has polled well — including in states where Republican leaders have blocked it for years.
However, the new effort carries risks that Democratic lawmakers, White House officials and health care advocates have been struggling to resolve in behind-the-scenes discussions over the past few months, say people involved in those talks. One challenge is designing a program that won’t invite backlash from a health care industry ready to battle Democrats on other sweeping changes. Another concern is inadvertently rewarding states that blocked Medicaid expansion for years. Any plan would also come with a steep price tag.
"There is pretty universal acknowledgment that action is needed to address the population,” said Henry Connelly, spokesperson for House Speaker Nancy Pelosi. “Everyone is exploring ways to get it done.”
Democratic lawmakers are weighing a few options that could potentially get wrapped into a major economic package they hope to pass along party lines this year. But they haven’t yet agreed on an approach, and Democratic leaders are facing competing demands to use upcoming infrastructure legislation to expand Medicare eligibility and benefits, mandate drug price negotiations and bolster Obamacare subsidies.
Health care advocates caution that Democrats have limited time to address stalled progress on Medicaid expansion — seen as the biggest unfinished piece of the Affordable Care Act — while the party controls Washington for the first time since the law’s passage a decade ago.
“This is the moment,” said Judy Solomon, a senior fellow at the left-leaning Center for Budget and Policy Priorities. “This is probably the only moment that we’ll have for years.”
Maybe I'm being fatalistic but my entire life has been "Democrats with a limited 2-year window of doing the right thing, making limited progress, then seeing a lot of that progress destroyed by Republicans" and yeah, I want to see things improve dramatically, for once.
In a lot of ways it has already.