Do the Right Thing: Incentivize Medicaid Expansion

The health care law expands insurance coverage in two main ways: the law helps women and their families pay for health care premiums when they buy coverage in the private insurance marketplaces and expands who is eligible for Medicaid coverage.  But, as a result of the Supreme Court’s 2012 decision in NFIB v. Sebelius, states can choose whether or not to take federal funds to expand Medicaid.  When a state takes these federal funds in 2014, 2015, or 2016, the federal government pays the entire cost of providing coverage to these newly enrolled people.  Over time, states will only ever pay 10% of the cost to provide coverage.  That’s an excellent deal, and so far 31 states and the District of Columbia have taken it.  And the results speak for themselves: more than 14 million more people are enrolled in Medicaid than before the health care law.

This coverage is particularly important for women because it includes services critical to their health and well-being, like birth control, maternity care, prescription drugs, and hospitalization.  The Medicaid expansion is also key to advancing women’s economic security.  By providing health coverage to women and their families that is not tied to employment, Medicaid allows women to seek positions that may offer higher wages or better opportunities, and it also has improved the economic security of future generations.

But what about the 19 states that haven’t yet taken the federal funds?  How can these recalcitrant states be encouraged to do the right thing?  One way is to extend the period of time that the federal government pays the entire cost of the Medicaid expansion for states that have not yet taken it up.  It’s an idea proposed by President Obama in his budget for Fiscal Year 2017.  And now Congress has introduced a bill to make it happen. The “Incentivizing Medicaid Expansion Act of 2016” (H.R. 4588) and “States Achieve Medicaid Expansion Act of 2016” (S. 2787) encourages the 19 states that have not taken the federal funds for the Medicaid expansion to do so. This means that when a state closes the coverage gap, in 2016 or any other year in the future, for the first three years the federal government will pay the entire cost for enrollees who qualify for expanded Medicaid coverage. 

Expanding Medicaid in these remaining states is critical for women and families. Without coverage, women often forgo important health screenings like Pap smears and mammograms.  A recent study found that women in states that have not yet expanded Medicaid were less likely to have had these screenings before the health care law, and that not expanding Medicaid will further entrench these disparities.  Nearly three million adults don’t have coverage because their state has not expanded Medicaid, and a majority of those adults are women.  Congress should take the first step and pass these bills. Then, the remaining 19 states should take the federal funds to expand Medicaid to do the right thing for women and families.