The pandemic and the economic calamity it has unleashed have exposed two harsh realities: Our welfare state is woefully insufficient to meet human needs at a moment of crisis, and the degree to which people’s health insurance is tied to their jobs is a key cause of that problem.
But how can we quickly scale up a fix to that problem in a way that could also lay the groundwork for more ambitious future reforms?
The liberal Center for American Progress is rolling out a new plan that seeks to answer this question.
The plan would expand Medicaid in a manner that’s both straightforward in policy terms, at a time when speed is very much of the essence, and ambitious at a time when public need is widespread and urgent.
The basic aim of the proposal is to expand Medicaid to as many unemployed people as possible.
Under the CAP’s plan, all 36 states that have expanded Medicaid under the Affordable Care Act could avail themselves of federal funding to cover the enrollment in Medicaid of everyone who is unemployed and/or has gotten unemployment insurance or food stamps during the pandemic. Crucially, in those states, this enrollment would be automatic.
Meanwhile, any individual in a similar situation in the 14 states that haven’t expanded Medicaid could themselves opt in to Medicaid on the federal level. The result would theoretically be that all unemployed Americans could quickly get health coverage via Medicaid.
After the public health emergency has passed, the CAP proposal envisions that this category of automatic enrollment in Medicaid would end. But it would be replaced: Unemployment assistance that people continue to receive would not count toward income in determining eligibility for Medicaid, which would allow many on unemployment insurance to get it.
“Medicaid is a proven, popular program that we know works,” Larry Levitt, executive vice president at the Kaiser Family Foundation, told me. “Expanding it would cost money, but it’s by far the most efficient way to cover people.”
The idea behind a proposal like this is to be ambitious while uniting the Democratic Party, which is divided between those who want Medicare-for-all and those who want to retain but expand the Affordable Care Act.
As Levitt pointed out, the ACA exists as a safety net for the first time during a recession but could also reveal “the vulnerability of relying so heavily on health insurance tied to work,” especially amid the “double whammy of a public health crisis and an economic crisis.”
Scaling up Medicaid would provide a foundation that Democrats might unify behind for the time being. Those who want single-payer could later use this as a foundation to argue in that direction, while those who want to expand the ACA could do the same.
The need is urgent. More than 45 million people have filed jobless claims at some point during the pandemic, and the unemployment rate is just above 13 percent. That sudden unemployment shock is also a health-care shock: As of mid-May, the Kaiser Family Foundation had estimated that nearly 27 million newly unemployed people could lose job-linked health insurance. That number may be higher now.
This week, House Democrats plan to unveil their own bill that would expand the ACA. An aide tells me it will include a measure to pressure those 14 Medicaid-expansion-holdout states to expand it, by reducing funds for the operation of their own Medicaid programs. It will also include an expansion of subsidies to lower-income people who get coverage on the individual market. That could lower costs for up to 13 million people.
Democrats appear unlikely to incorporate ideas like this one from the Center for American Progress. But it’s worth keeping them in the mix.
That’s in part because President Trump is running for reelection on the insulting argument that he built the greatest economy in history and that he’ll now do it all over again. But that debate will unfold in a context where Trump actually inherited most of the good pre-coronavirus trends from his predecessor, and then signed a massive corporate tax giveaway while trying to gut the ACA, an effort that continues today.
That record won’t make it easier for Trump to cast himself as the person to best rebuild our coronavirus-shattered economy or to reform it to protect those who are vulnerable in the best of times and those who stand to get severely pummeled in future crises.
Democrats can draw a sharp contrast in this regard by putting forth real health-care proposals that both unite the party and are ambitious enough for the times, while contrasting them with the Trump/GOP efforts to roll back health care for millions.