Obama wants to extend ACA's Medicaid deal to latecomers

The Affordable Care Act's promise to pay the full cost of expanding state Medicaid programs runs out this year. But as the number of Republican-led holdouts slowly but steadily wanes, the Obama administration wants Congress to extend the offer.

The White House says President Barack Obama's fiscal 2017 budget proposal will include a legislative proposal to cover 100% of cost for three years no matter when a state gets on board.

The 2010 healthcare reform law calls for the 100% matching funds to decline gradually after 2016 to 90% in 2020. The burden of that remaining 10% (and, many Republicans argue, the uncertainty of future funding) has been a primary argument against agreeing to raise eligibility.

The proposal is unlikely to win approval in the Republican-controlled House and Senate. But it highlights Obama's willingness to make concessions to persuade states to expand. The CMS has granted several sweeping Medicaid waivers sought by Republican governors that include unprecedented levels of cost-sharing and conditions of coverage, such as participation in wellness programs.

The announcement came a day after newly sworn-in Democratic Louisiana Gov. John Bel Edwards issued an executive order to expand Medicaid by July 1, potentially extending coverage to 365,000 residents. That will make 31 states plus the District of Columbia that have agreed to raise eligibility under the ACA, which calls for covering most residents making up to 138% of the federal poverty level.

Still, about 3 million uninsured adults who would be eligible are believed to live in one of the 19 states that have yet to expand Medicaid, according to the Kaiser Family Foundation. A significant number of them live in Florida and Texas.

Governors in three additional states—South Dakota, Virginia, and Wyoming— have included Medicaid expansion in their proposed budgets for fiscal 2017.

Virgil Dickson

Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.

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