(sigh) Tennessee, Texas & Mississippi Republicans latest to tell their constituents to eat a bag of Richards

March 2, 2021:

The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...

Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).

...With that in mind, Congressional Democrats have come up with a simple alternate plan: Bribe the remaining states. From the House Energy & Commerce Committee's summary of their portion of the American Rescue Plan.

...What Is the Estimated Effect on State Spending?

We estimate that the increase in the traditional match rate would more than offset the increased state costs of the expansion in every state. Nationally, the increase in federal support from the 5 percentage point increase in the traditional match rate to the 12 non-expansion states could total $16.4 billion over two years if all states implemented the expansion starting in FY 2022. These new federal funds to states would be offset by new state costs tied to the 10% share of expansion. We estimate that new state costs for expansion could be $6.8 billion over two years across current non-expansion states, assuming all eligible people enroll. The result would be an estimated fiscal benefit to states of $9.6 billion over the two year period (Figure 1).

Yes, that's right: Congressional Democrats got so tired of waitng for Republicans in the remaining non-expansion states to get over their hatred of President Obama that they finally said "to hell with it" and offered them a big fat pile of cash just to do the right thing (which they should've done seven years ago).

Unfortunately, so far it doesn't look like that strategy is going very well:

March 26, 2021:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.

The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.

Let me repeat that: The voters clearly and unequivocally stated that they wanted Medicaid fully expanded to 133% FPL (actually 138% in practice), with no strings attached for the enrollees, to start July 1st, 2021, and for the state to pay for its 10% share of the cost, with no screwing around.

...The "we can't afford it" excuse is even more outrageous considering that the American Rescue Plan includes what amounts to a flat-out bribe of $1.15 BILLION to the state of Missouri just for implementing the legally & constitutionally-binding ballot initiative which WAS ALREADY PASSED BY THE VOTERS LAST SUMMER.

The $130 million for the first year would presumably increase over time due to inflation and increased enrollment, but even at $200 million per year, this means it wouldn't cost the state of Missouri one dime for the first five years or so.

March 31st, 2021:

Senate committee kills Medicaid expansion bill, by Morgan Hughes

Medicaid expansion will not happen in Wyoming this year.

The state’s Senate Labor, Health and Social Services Committee killed a bill Wednesday morning to expand the federal insurance program, which would have insured an estimated 25,000 additional Wyomingites.

Lawmakers have defeated similar proposals for nearly a decade. Advocates hoped this year might be different. Many House Republicans voiced a change of heart after the COVID-19 pandemic and the decline of fossil fuels rocked the state’s economy, leaving many without health coverage. This session was the first in which a bill to expand the program passed a legislative chamber.

The bill, proposed by Rep. John Romero-Martinez, R-Cheyenne, would have expanded the federal program in the state only so long as an improved federal match was maintained. Estimates from the Wyoming Department of Health suggested the state could save $34 million over two years because of a federal increase in the match for the state’s traditional Medicaid program.

Cut to today:

Texas just gave away $5.9 Billion

"Nevertheless, Every Texan is disappointed that Speaker did not include in this announcement any action on Medicaid expansion or a related bipartisan coverage solution, given that is the single policy change that would cover the greatest number of uninsured Texans, while bringing billions of “homesick Texas dollars” back to our communities."

— Jenny Chumbley Hogue (@kgmom219) April 7, 2021

Statement on Speaker Dade Phelan’s Press Conference on Health Coverage for Texans

WATCH: “It makes sense... let’s put politics aside... we can’t keep making an $8 BILLION MISTAKE...”

Despite an even better deal from Biden’s American Rescue Plan, the @TNGOP REJECTS MEDICAID EXPANSION again, leaving 300,000 without coverage

TN is #1 in MEDICAL BANKRUPTCIES pic.twitter.com/5flbRZeCHw

— The Tennessee Holler (@TheTNHoller) April 7, 2021

I don't know if either the Texas or Tennessee developments are the final word on Medicaid expansion in those states this year or not, but it isn't looking good at the moment.

There may be some good news here, however...it sounds like Medicaid expansion may still have a lifeline in Mississippi?

GOP Insurance Chief Mike Chaney discusses benefits of expanding Medicaid

The federal pandemic relief bill contains a big incentive for states that haven’t expanded Medicaid. Mississippi is one of 12 states holding out on the expansion.

Mississippi Insurance Commissioner Mike Chaney says currently the federal government pays about 80 cents on the dollar for Medicaid coverage. If Mississippi were to expand, that amount would increase to 95 cents.

Chaney, a Republican statewide elected official, said Medicaid expansion could provide health care coverage options for those who do not currently qualify under the Affordable Care Act.

“Medicaid expansion is not about putting people on the welfare rolls,” Chaney said. “This is about expanding health care availability to those people that make 138% of the poverty level or less. And that’s about 300,000 to 400,000 people in this state. They’re the poor, those with AIDS, the infants, the disabled, the folks that fall through the cracks that are not able to get on the Affordable Care Act and not able to qualify for Medicaid as it exists now.”

Unfortunately, while I welcome Mike Chaney's views, he's neither a member of the state legislature nor the Governor, who is refusing to budge:

During the pandemic, Mississippi has had the highest COVID-19 death rate of any state outside the Northeast. On Friday, the state’s Republican governor, Tate Reeves, said he remained committed to denying access to Medicaid for constituents near the poverty line, even though expanding eligibility would make money for Mississippi as a result of the new stimulus bill.

“My position has not changed. I am opposed to expanding Medicaid in Mississippi,” Gov. Reeves said during a press conference covered by the Mississippi Free Press. When asked by Vox if the prospect of additional funding might make him reconsider his opposition to Medicaid expansion, Reeves said, “No, sir, it will not."

On the other hand, there's a statewide ballot proposal gearing up in Mississippi to force the state government to expand Medicaid whether they like it or not; I'll write about that separately.

It's my understanding that the GOP Governor of Alabama is still considering pushing for expansion due to the extra cash, and I'm certainly crossing my fingers hoping that something comes of it, but the bottom line is that for the most part none of this has a damned thing to do with whether the states can afford the cost or not. The ACA already covers 90% of the cost, and with the American Rescue Plan offering to drop billions of dollars more on their heads, it would take anywhere from 2 - 7 years before any of these states would have to pay a dime.

The two primary reasons for opposing Medicaid expansion have nothing to do with financial issues:

• Hatred of President Obama to the point of rejecting anything offered by him, even 5 years after he left office; and

• A core ideological opposition of, to put it in one Missouri Republican legislator's words, giving "free health care, government health care to able-bodied adults who can do for themselves."

As a reminder, this mindset is continuing even in the middle of a pandemic which has ravaged the entire country and caused millions to lose their healthcare and employment.

And so it goes.