Expanding Medicaid
New CMS chief highlights program's role in first interview
In one of her first public interviews, the new head of the Centers for Medicare and Medicaid Services said she will she will look primarily to existing programs — the Affordable Care Act and Medicaid chief among them — to move the U.S. closer to universal coverage.
In an interview with Kaiser Health News’ Julie Rovner, Chiquita Brooks-Lasure pointed to the additional funding in the American Rescue Plan for states that still haven’t expanded Medicaid to include the near poor. During the Trump administration, CMS chief Seema Verma did little to encourage states to raise Medicaid’s income eligibility ceiling to 125% of poverty. She also allowed states to attach work requirements before allowing their low-income residents to participate in the public program, a policy rescinded by the Biden administration.
“Ideally states are able to craft policies in their own states; they’re closest to the ground,” she said. But if states fail to take up the offer to expand Medicaid, “the public option or other coverage certainly would be a strategy to make sure people in those states have coverage.”
Hospitals and other providers are opposed to a public option on the exchanges because they fear a government-run plan would impose Medicare payment rates, which studies show range from 30% to 83% of commercial insurance rates for various services. Yet they don’t oppose Medicaid expansion, even though its rates are even lower. Given that people without any form of insurance account for the lion’s share of uncompensated care, providers no doubt figure something is better than nothing.
There’s a fairly close correlation between states with the highest uninsured rates and their failure to expand Medicaid. Below is a list of the 19 states with uninsured rates above the national average. The data is from 2019, the last year available on the Kaiser Family Foundation website.
The states that failed to expand Medicaid are highlighted in red. States that have expanded Medicaid since 2019 include Oklahoma, Idaho, Missouri and Utah.
A few facts about Medicaid that are little to known to the general public: Though the joint federal-state program accounts for just 17% of total health care spending, it now covers nearly half of all children under 6 and more than a third of children between 6 and 18. Children represented 38% of all participants in the program in 2019.
The elderly poor and disabled individuals represent anothe 21% of the nearly 85 million people in the program. Able-bodied adults made up the remaining 41%, but accounted for only 28% of program expenditures.
More than half of them worked enough hours to put them above the poverty line. They qualified for Medicaid in states that expanded the program to include the working poor.