The article “Biden to reopen ACA marketplace, revisit work requirements” was helpful in understanding the ongoing threats to Medicaid coverage through work requirement waivers. The Trump administration tried to kill the program through “death by a thousand cuts.”
Hopefully, the Biden administration will turn this situation around by expanding enrollment opportunities and eliminating work requirements, which were not part of the ACA law.
Medicaid expansion should have been a no-brainer for every state more than a decade ago when the ACA was signed into law. It’s past time for the 12 states that haven’t expanded the program to stop playing politics with the health of their citizens and approve simple expansion. Congress can help speed the process.
As part of the original ACA legislation, the feds were going to pay 100% of expansion costs for three years. After that, the state was to pay 10% of the cost, a great deal for any matching grant. Plus, the original ACA legislation stated that if a state did not expand Medicaid, it would lose all Medicaid funds. That poison pill was intended to ensure that all states fully participated. And it would have worked.
However, in a split decision, the Supreme Court struck down that clause. Thus, some of the poorest states opted out and many of their neediest citizens lost coverage.
If the House and Senate (now controlled by Democrats) care to do so, they can work to abolish the 10% state matching requirement for Medicaid expansion. Maybe that could entice some of the holdouts to finally opt in, giving their neediest residents access to coverage. States that have already expanded could use their matching funds (which would no longer go to Washington) for other pressing needs, like COVID vaccinations.
This legislation would benefit both red and blue states. All it takes is the political will.
Peachtree City, Ga.