A bill that would be a back-door way to expand Medicaid in Kansas and eleven other states that have so far declined to do so was introduced by Rep. Lloyd Doggett (D-Texas) earlier this month.
The bill, H.R.3961, entitled “To amend title XIX of the Social Security Act to provide for a demonstration project under the Medicaid program for political subdivisions of States to provide medical assistance for the expansion population under such program, and for other purposes,” introduced on June 17, so far has no text, but has already attracted 44 co-sponsors — including such far-left luminaries as Sheila Jackson Lee (D-Texas), Hank Johnson, (D-Georgia), Debbie Wasserman Schultz (D-Florida) and House Majority Whip James Clyburn (D-South Carolina.)
Twelve states, including Kansas, have declined to expand the Medicaid income cap, mostly citing the negative impact on state budgets where expansion has occurred.
According to a statement from Doggett’s office, “states would be required to cooperate and authorize access to State Medicaid systems for participating entities, with additional federal administrative Medicaid funding for cooperation and subject to federal penalties for non-cooperation (emphasis added).”
“Nearly six million Americans, primarily from communities of color, remain uninsured due to Republican ideological obstruction and indifference,” Doggett said in a release on his official website. “Our homegrown solution, the COVER Now Act, enables willing local leaders to accept directly federal resources to achieve both the public health and financial benefits of Medicaid expansion.”
In other words, the federal government will go around state legislatures and give incentives to cities and counties to expand Medicaid in local areas.
And expansion costs not covered by the incentives would lead to large increases in property tax and sales tax.
Disingenuous rationale for Medicaid expansion
The claim that Republican-led legislatures are obstructing based on “ideology,” or “indifference,” is disingenuous at best. Legislators repeatedly cite severe budget challenges in other states as the reason for their opposition.
As Kansas Rep. Ron Estes points out, the costs are always shifted onto the states.
“Kansans will be left on the hook to pay for this expansion,” Estes said in an emailed statement. “States that choose to do so have seen the cost far exceed estimates; Ohio’s Medicaid program came in 50% over budget in the first half of the first year they expanded. We need to consider solutions to support uninsured Kansans, like emphasizing community health centers, that don’t endanger our current health system and budget.”
The Foundation for Government Accountability reports: “In states that expand Medicaid, enrollment numbers consistently shatter projections. Some states have enrolled twice as many — sometimes even four times as many people — as they ever said they would enroll.
“The natural consequence of this is that Medicaid costs also shatter projections and crowd out other budget priorities. California, for example, enrolled 278 percent more people than planned. Because of this, they ran into a $54 billion deficit that forced them to cut money from education to foot the bill.
“This is a common occurrence in expansion states: Massive budget shortfalls result in fewer resources available for priorities like education, transportation, law enforcement, and other programs that benefit the truly needy.”
FGA also points out that over 54 percent of those who would qualify for Medicaid if their state expanded already have private health coverage and in some states the number is as high as 71 percent.
“Currently, people who are between 100 and 150 percent of the FPL can get private, silver-level plans on the ObamaCare exchange at no cost to themselves,” FGA writes. However, when states choose to expand Medicaid, able-bodied adults with income between 100 and 138 percent of the FPL become eligible for Medicaid and automatically lose access to the free, private health insurance plans.
Rather than make up for the oft-touted “coverage gap”— expansion forces able-bodied adults off private insurance with better coverage and onto Medicaid.
False claim of saving rural hospitals
Advocates of expansion — and bills like this — often argue that expansion will “save rural hospitals.”
Indeed, in October 2018 after the Fort Scott hospital closed, Governor Laura Kelly couldn’t wait to get to a mic to decry the death of another rural hospital.
“This should not have happened,” Gov. Laura Kelly said in October 2018 after Fort Scott’s Mercy Hospital closed. “Simply put: if Kansas had expanded Medicaid, Fort Scott would still have a hospital.”
Except that wasn’t true.
“In Fort Scott, the figure that was given to me was around $14 million that the hospital had lost and that expansion of Medicaid would have only brought in around two million,” Collins (R-Mulberry) wrote in an emailed response to questions from the Morning Sun in April of 2019. “That would not have saved that hospital.”
Again, FGA: “Studies show ‘no significant difference’ in improved financial status of hospitals in expansion states compared to states that rejected ObamaCare expansion.”
Biden wants to force expansion
According to the Topeka Capital-Journal, Doggett hopes to use the budget reconciliation process — and it’s notable the bill was referred to the Committee on Energy and Commerce — to shove the proposal past Republican opposition, and the Biden administration is continuing to put pressure on states — and use the coercive power of the federal government to do so.
“Even if it doesn’t move forward, however, there will likely continue to be an interest from Congress and President Joe Biden‘s administration to induce the holdout states to pursue expansion,” the Cap-Journal’s Andrew Bahl wrote. “The Biden administration, for instance, is threatening not to renew a key Medicaid waiver for Texas — potentially costing the state billions of dollars — in an effort to force it to expand.”