In the Spirit of Sabotage – Limited Expansions and Other Half-Baked, Harmful Plans
The 2019 legislative sessions for states looking to expand Medicaid have been one attempt at sabotage after another. While the benefits of fully expanding have been made resoundingly clear from one state to another and from one year to the next, states such as Georgia, Idaho, Nebraska, Tennessee and Utah have all decided to not fully realize these benefits by introducing harmful cuts and barriers that will be costly for them to administer and burdensome for their residents.
In Idaho, Nebraska and Utah, elected officials seem hell-bent on defying the will of their voters, who all decided to pass Medicaid expansion without any cuts or barriers in the November 2018 midterm elections. Instead, Idaho is now poised to add a work reporting requirement to its expansion plan, which will cause thousands of residents to lose coverage. Nebraska is planning to delay coverage until almost two years after the ballot initiative passed, along with an unnecessarily complicated and burdensome tiered benefits structure. All of these changes will make it harder for newly-eligible residents to get and keep the health coverage they need, not to mention potentially costing the states millions of dollars in administrative costs, instead of realized savings and revenue gains that would come from expansion.
Utah went even further by deciding to implement a limited, rather than full, expansion, in addition to a work reporting requirement. Rather than expanding eligibility all the way up to 138% of the federal poverty level (FPL), Medicaid eligibility will only go up to 100% FPL, leaving tens of thousands of individuals without access to affordable, comprehensive coverage. Not only that, but Utah also received approval to place an enrollment cap on the expansion population if the cost of expansion exceeds what the state has budgeted for it. An enrollment cap on Medicaid expansion is an exceedingly harmful proposal that sets a dangerous precedent for other states, such as Georgia, where Governor Brian Kemp is considering a limited expansion plan with similar caps.
Last but certainly not least on the list of stealthy sabotage efforts is a bill in Tennessee to change the way their Medicaid programs are financed to a block grant. This mirrors a recent request from Governor Mike Dunleavy of Alaska to President Trump expressing an interest in block granting the state’s Medicaid program. Changing Medicaid’s financing to a block grant is just another Medicaid cut in disguise. By setting the amount of funding at a fixed, blocked amount, states may then be able to limit enrollment if their spending exceeds the blocked amount. Therefore, similar to Utah’s enrollment cap, individuals might be arbitrarily locked out of coverage despite being eligible, and potentially at times they need health care the most.
Overall, by attempting to sabotage the successful program of Medicaid expansion, these states are severely shooting themselves in the foot. While taking a step in the right direction of expanding Medicaid, and seemingly acknowledging the benefits to expansion in the process, these states are then adding new barriers to coverage by introducing proposals that will cause coverage losses, increases costs, and ultimately not reap all of the many benefits that fully expanding Medicaid provides. As legislative sessions continue this year, the country will be watching closely to see what type of half-baked, harmful plans might emerge. After backlash driven by Medicaid advocates in Utah, elected officials should think twice before going against the will of their constituents or otherwise introducing barriers to care rather than fully expanding Medicaid.