This week Senator Reverend Raphael Warnock released a legislative proposal with senators Ossoff and Baldwin to close the Medicaid coverage gap in states that have yet to adopt Medicaid expansion. People with incomes below 138 percent of the poverty line (which is about $17,600 for a single adult) make too much to be eligible for Medicaid in non-expansion states and too little to qualify for premium subsidies to afford a Marketplace plan, leaving them stuck in a coverage gap. Leaders in the 12 non-expansion states, eight of which are in the South, have left 2.2 million people without health coverage. Despite the ongoing efforts of state advocates, community members and people living in the gap to convince state legislators and other key stakeholders in these states to close the coverage gap – backed by hundreds of studies that showcase both the health and economic advantages of doing so and recent federal financial incentives available thanks to the American Rescue Plan – the decisionmakers in these 12 states have yet to act. This hostage-taking – now nearly a decade old – is unacceptable, according to Sen. Warnock and his colleagues. The Medicaid Save Lives Act is a demand to end the stalemate and solve the problem for millions of people, mostly Black and brown, who continue to be harmed by a politically motivated debate that has nothing to do with policy or improving health outcomes.
With a pro-health care majority in Congress for the first time in a decade, federal policymakers have an opportunity to end the stalemate and expand health coverage as the Affordable Care Act (ACA) intended. In doing so, they would help the country move beyond this harmful debate around who deserves access to health coverage toward a discussion around how we improve the health and financial security of all people with low incomes – who are caregivers, parents, essential workers and neighbors – and provide resources to communities in ways that help people to thrive.
The policy solution itself is complex – and is necessary. Closing the gap puts us on a pathway to racial justice and is an important step in reorienting the Medicaid system toward equity. As the president communicated through numerous executive orders, speeches and ongoing agency level work, the work of this administration is to center equity. Closing the Medicaid coverage gap is a critical step in advancing this agenda.
The Medicaid Saves Lives Act is a critical part of this conversation, one that has been going on in non-expansion states for years, and has recently received significant national attention. Before the release of this bill, Sen. Reverend Warnock and Sen. Ossoff sent a letter to Congressional leadership and the President imploring them to take action as a matter of racial justice, as did the Congressional Black Caucus, the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus. Rep. Doggett introduced the COVER Now Act, a partial expansion that illustrates just how desperately a coverage solution is needed. The national drumbeat is critical, and it highlights the importance of supporting this effort broadly, regardless of what policy form it ultimately takes.
While some states did the ‘right thing’ from day one by expanding Medicaid, others still have not. However, the issue at hand is about all of us, one nation, committed to advancing equity. To date, Medicaid access remains an unfinished piece in a quilt of programs meant to support people and communities. Instead, access is dictated by your state of residence. Expansion states are able to support and help drive a federal solution for sistering states and residents stuck without options. If the COVID-19 pandemic brought light to anything, it is that racial inequities are deeply rooted in our policies and systems of care. The racial justice implications are beyond clear: in those states that have yet to expand, 28 percent of residents are Black, 28 percent are Hispanic and 1 percent are Asian or Pacific Islander, according to a recent analysis by the Center on Budget and Policy Priorities, which also includes state-by-state analysis.
There is no more important time for unity than now. There is a unique moment in front of Congress and the voices from non-expansion states are loud and clear. Take action now. Stand together for Medicaid expansion access for all people, regardless of state of residence. If we truly honor all people in all the states that make up this diverse country, then all states – expansion and non-expansion – should have a single voice with a single demand: close the gap with federal action.