Medicaid expansion advocates want more attention from progressives
Advocates from Medicaid expansion holdout states are ratcheting up the pressure. Their latest target: progressives in Congress.
A coalition of over a dozen groups, known as Southerners for Medicaid Expansion, is pushing the Congressional Progressive Caucus (CPC) to prioritize expanding the safety net program in the dozen mostly GOP-led states that have refused it for nearly a decade.
The CPC laid out its priorities for President Biden’s massive social spending bill, in an Oct. 13 letter to House Speaker Nancy Pelosi (D-Calif.) The letter didn’t mention Medicaid expansion — and that struck a nerve with the advocates who say they want progressive caucus leaders to be stronger allies in the fight to close the Medicaid coverage gap.
The gap was created after a 2012 Supreme Court ruling, which said states could rejected Obamacare's offer of expanding Medicaid to those earning up to 133 percent of the federal poverty level. States mostly in the south have rejected the offer, sticking with their narrow eligiblity thresholds and leaving a couple million people ineligible for the program who otherwise would be.
- In a letter sent to CPC leaders yesterday, the coalition wrote it was “disappointed” the progressive caucus didn’t mention extending Medicaid to 2.2 million poor adults in their note to Pelosi.
- “Given our shared commitment to universal health care, economic and justice and racial equity, we urge you to add closing the Medicaid coverage gap to your priorities — it’s one of the most straightforward policies we can adopt to fulfill those commitments,” Southerners for Medicaid Expansion wrote in the letter shared with The Health 202.
The episode is the latest example of the tug-of-war over the health priorities in Democrats’ sweeping economic package as negotiations reach a fever pitch. Biden privately told Democrats yesterday that he believed a deal could be secured on a proposal between $1.75 trillion and $1.9 trillion — far less than what some lawmakers originally wanted, our colleagues report.
The Post's Jeff Stein
Those fighting for the Medicaid policy argue it’s crucial to closing the stark racial inequities in the country’s health care system. Some individual progressive lawmakers are championing a federal fix to the Medicaid coverage gap, said multiple advocates, who added they want more buy-in from the caucus writ large.
In a statement, Rep. Pramila Jayapal (D-Wash.) — CPC’s chair — countered with her caucus’ rationale on its priorities for Biden’s social spending bill.
- In the spring, the Congressional Progressive Caucus surveyed its 96 members, asking them to rank their top five priorities for the upcoming package. (In the health care bucket, the CPC landed on using savings from prescription drug reforms to lower the eligibility age for Medicare and expand the programs’ benefits.)
- That doesn’t preclude the caucus from supporting programs outside those priorities, such as Medicaid expansion. “That's why we have continually called for bold, universal, and robust investments that will deliver funding to communities historically left behind, rather than a narrow bill that will benefit only the few,” Jayapal said in a statement.
The official response: Within a few hours, Jayapal’s staff wrote back to the Southerners for Medicaid Expansion coalition, and asked for a meeting, according to Laura Guerra-Cardus, Texas deputy director for Children’s Defense Fund. A CPC spokesperson confirmed the congresswoman’s team reached out and that CPC staff would join the meeting as well.
Hashing out a deal
But just how the policy — and Democrats’ broader health agenda — will shake out is still up in the air. Biden held a series of meetings with moderate and progressive members yesterday, and all parties appear closer to a deal.
- “Jayapal and other members of her bloc said that there is still hope for a final package to include an expansion to Medicare to cover dental, vision and hearing benefits … Other sources later said that Biden had signaled other critical health care programs, including some money for elder care, extended insurance tax credits and fixes to Medicaid also remain in the mix,” report Tony Romm, Marianna Sotomayor, Seung Min Kim and Jeff Stein.
- But some potential changes have frustrated liberal lawmakers. To some in the room, Biden seemed to underestimate the cost of expanding Medicare, our colleagues report.
Medicaid advocates are pushing for a permanent extension of the safety net program. But the contours of all the policies are getting dialed up and down depending on the topline number.
One potential option that's been on the table for weeks: A fix as short as three years that lets people who fall into the gap get free plans on Obamacare’s insurance marketplaces, according to multiple people familiar, though negotiations are extremely fluid. (Rep. Ro Khanna (D-Calif.), who went to the White House yesterday, told The Health 202 he believes the Medicaid coverage gap will be included in the bill.)
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On the Hill
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The Post's Dan Diamond
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