Democrats Eye Time Limit on Medicaid Expansion in Quest for Cuts

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The proposed fallback plan to force expansion on non-expansion states is starting to be trimmed back in cost negotiations.



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Congressional Democrats from Republican strongholds say they expect legislation to create a federal Medicaid program for many of their states to be limited to as few as three years.

The battle now, they say, is getting funding for the program for as many years as possible.

Right now it’s pretty clear it won’t be made permanent,” Sen. Tammy Baldwin (D-Wis.) said in a hallway interview.

Democrats Hold Tight to Obamacare, Medicaid in Funding Wish List


Photo: Kevin Dietsch/Getty Images

House Majority Whip Jim Clyburn (D-S.C.) speaks on Medicaid expansion and the reconciliation package during a press conference at the U.S. Capitol on Sept. 23, 2021. He was joined by Democratic Sens. Tammy Baldwin (Wis.), Raphael Warnock (Ga.), Jon Ossoff (Ga.), Elizabeth Warren (Mass.), and Rep. Carolyn Bourdeaux (Ga.).

Democrats are debating how to shrink a once-$3.5 trillion domestic spending agenda that has so far included creating a permanent federally run Medicaid program to cover Americans in states that haven’t grown their public health insurance programs under the Affordable Care Act.

A House committee approved a bill earlier this month that would immediately give no-cost insurance through the ACA marketplace to people in non-Medicaid expansion states under a certain income level, then transition them starting in 2025 to a new, federal Medicaid-like program.

Democrats’ Expansion of Medicaid in Hold-Out States Clears Panel

That plan, coupled with provisions to lower ACA premiums overall, could cost as much as $300 billion, House leaders have said. With moderates in both the House and Senate pushing to lower the price tag of the domestic spending bill, supporters of the so-called “Medicaid gap” fix say party leaders have signaled they’ll have to accept cuts.

Two senior Democratic aides, one of from the House and another from the Senate, said to cut costs the new Medicaid program could be shortened to as few as three years. However, both cautioned that Democratic leaders haven’t settled on the overall size of the package so it’s unclear what changes, if any, will be needed.

‘Big Deal’

Democrats from states such as Texas — where more than 1 million people could benefit from the proposed federal program for those who make too much money to qualify for Medicaid and too little to benefit from ACA subsidies — said they’re willing to compromise as long as their constituents get quality, no-cost health insurance coverage.

“It’s a really big deal for us and I know it’s a big number associated with it,” Rep. Colin Allred (D-Texas) said. “Any time the overall number gets adjusted you know it’s the big ticket items are going to get adjusted first.”

Baldwin said she’s working with her colleagues to get funding for as many years of Medicaid expansion as possible.

“We’re fighting for as long as we can,” Baldwin said

Others say the health care items in their domestic policy package don’t have to shrink if the party stays united.

“We have no shortage of potential revenue sources for Medicaid or any other policy we are seeking to enact in Build Back Better, only a question of the political will to move forward,” Rep. Lloyd Doggett (D-Texas) said.

House Backing

However, Doggett acknowledges that the policy has much more support in the House, where there are dozens of Democrats from non-expansion states, than the Senate, where there are only three: Baldwin and Sens. Jon Ossoff and Raphael Warnock of Georgia. Non-expansion states have little to gain from this policy.

“There’s much more stronger support here in the House for closing the Medicaid gap than there is in the Senate,” Doggett said.

That dynamic is partly why House Democrats have been pushing hard to make the issue about equity and helping the poorest Americans. Lawmakers say policies like expanding Medicare’s benefits are also pricey but aren’t focused on those most in need of government assistance.

“I’ve been pushing to target the resources to the needy,” said Rep. Jim Clyburn (D-S.C.), who also represents a state that hasn’t expanded its Medicaid program.

To contact the reporter on this story: Alex Ruoff in Washington at



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