White House offers muddled message to states considering Medicaid expansion

Christopher Wilson
·Senior Writer

The White House didn’t have a clear message for states looking to potentially expand Medicaid in the wake of the American Health Care Act’s (AHCA) failure, implying that the bill would have saved the program for low-income and disabled Americans by cutting nearly a trillion dollars from its funding.

Press secretary Sean Spicer was asked during Tuesday’s briefing about possible expansions of Medicaid coverage in Kansas, Georgia and Virginia. The three states are in varying stages of moving toward joining the 31 states that have already opted in to Obamacare’s expansion of the decades-old program, which covers 74 million Americans. The AHCA would have closed the door on expansion as of March 1.

“I think there’s a reason [President Trump] explained to Congress and especially members who have talked about entitlement expansion why we should have passed this bill last week and why we need to address it now,” said Spicer. “This is a major issue. It’s one of our talking points, so I hope they listen.”

Spicer then went more in-depth, mentioning changes that were made to the AHCA in an attempt to appease more conservative members of the Republican caucus, specifically a work requirement for able-bodied enrollees, and an effort to “push the money and a lot of the authority back to the states.” The bill, he said, “made it a much more states’ rights program and a much more states’ right decision making process in terms of how to care for the populations that they had to address.”

Critics of the Medicaid expansion say that too many able-bodied but low-income Americans are choosing to enroll in the program over working, an issue that would have been addressed by the “able-bodied provision” Spicer mentioned. The last-minute “manager’s amendments” added to make the bill more attractive to right-wing Freedom Caucus members would have set a work requirement for able-bodied Americans without children, a policy that hasn’t produced results in studies at the state level. It also would have cut matching funds to states for anyone making over 133 percent of the poverty line, likely forcing some states to reduce coverage or eliminate people from their rolls.

The proposed legislation would have run counter to one of Trump’s campaign promises. Under the AHCA, the Congressional Budget Office estimated that Medicaid funding would be cut by $880 billion over 10 years, with 14 million recipients losing coverage. Other effects of the legislation, per the CBO:

Roughly 9 million fewer people would enroll in Medicaid in 2020; that figure would rise to 14 million in 2026, as states that expanded eligibility for Medicaid discontinued doing so, as states projected to expand Medicaid in the future chose not to do so, and as the cap on per-enrollee spending took effect.

This is contrast to a statement made by Trump the candidate, who said he would save Medicaid — along with Medicare and Social Security — without cuts. Trump also promised that his program would mean “insurance for everybody,” something the cutting of Medicaid funding would render impossible without a replacement.

Under the Affordable Care Act, the federal government offered a deal to states that offered coverage to anyone making up to 138 percent of the poverty level ($16,400 for a single person): Washington promised to cover a minimum of 90 percent of the states’ costs. Thirty-one states and the District of Columbia have taken the federal government up on that offer, although some states modified programs for their citizens. Medicaid is the main reason that some Republican governors — such as John Kasich of Ohio and Rick Snyder of Michigan — came out against any GOP plan to replace Obamacare that didn’t protect the expansion.

A Supreme Court decision in 2012 gave states the choice to opt out of the program. Currently 19 states haven’t joined, but there is movement. In Maine, there were enough petition signatures to ensure a ballot measure on expansion this November. In Kansas, legislators in the state House and Senate passed a bill to expand the program, although Republican Gov. Sam Brownback could still veto the legislation. The governors of Virginia and Georgia are said to be considering expanding the program.

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