Democrats are working on a ‘Plan A’ for finally getting full Medicaid expansion

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A new plan from Dems would bypass the state nature of Medicaid entirely.

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with Alexandra Ellerbeck

Republicans’ long effort to ditch Obamacare seems finally in the rearview mirror, now that the Supreme Court has thrice upheld it.

The road ahead will look very different for the law, as it enters what many view as a new phase of life.

“The ‘Repeal and Replace’ Era Is Over; The ‘ACA Expansion’ Era Begins,” Chris Condeluci, a health policy consultant, wrote in an email to clients this week.

First up: Medicaid expansion.

Democrats have been devising several different strategies for getting health insurance to people in the “coverage gap” — a population that would have otherwise been eligible for expanded Medicaid except for the fact that their states refused to expand the program. This includes roughly 4.3 million Americans in a dozen states.

Their first approach — incentivizing states to expand by giving them extra federal money to do so — hasn’t seemed to work, at least so far. A second approach rolled out by Rep. Lloyd Doggett (D-Tex.) is creative but could be logistically difficult to implement and perhaps even impossible under persistent state resistance (we wrote about Doggett’s bill here).

© Sergio Flores/Getty Images Rep. Lloyd Doggett speaks at a rally in Austin. (Sergio Flores/Getty Images)

So Democrats are working on a third approach.

The legislation — which two health policy experts described to me as Democrats’ “Plan A” for Medicaid expansion — is being crafted by staff members on the House Energy and Commerce Committee. 

The main thrust of the pending legislation is to circumvent the GOP-led states still refusing to expand Medicaid, and find a way to get the free or low-cost coverage to people in the coverage gap, who typically earn at or below the federal poverty level. The bill could take two basic routes to get there — and it’s unclear which one staffers have settled on.

  • One approach would be to allow the coverage gap population to buy fully subsidized plans on or the state-run marketplaces. As Judy Solomon writes at the Center on Budget and Policy Priorities, this would require policymakers to make changes in benefits, cost-sharing and enrollment processes.
  • Another approach would be to set up a federalized Medicaid program. It probably would involve direct contracts between the Centers for Medicare and Medicaid Services and managed-care companies to administer Medicaid benefits to people in the coverage gap.

The first method — using the marketplace — could raise some cost concerns, considering it’s far more expensive to insure people through private plans than through Medicaid, which pays providers lower rates. There’s also a worry that both approaches could incentivize states that already expanded Medicaid to drop the coverage, if the federal government starts fully funding the expansion population through a new route.

Democrats are keeping their plans close to the vest.

An Energy and Commerce Committee spokesman declined to offer any details about the legislation, offering only a generic statement about the committee’s work.

“The committee is continuing to work on a comprehensive solution to provide coverage to Americans who are trapped in the Medicaid coverage gap through no fault of their own,” the statement said. “Our priority is crafting a policy fix that provides coverage and access to care to everyone in the states that have not expanded and not limited to certain counties.”

Whatever the bill ends up looking like, Democrats are hoping to include it in any budget reconciliation package Congress tries to pass this year. But those plans are still up in the air, as a bipartisan group of senators tries to negotiate an infrastructure deal with the White House, which would allow Democrats to wait on passing a partisan reconciliation bill until later in the year.

The Post’s Jeff Stein, who has been covering the negotiations:

Ahh, oof and ouch

AHH: The White House said the United States will miss Biden’s July 4 vaccination goal.

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