STATES: Leaders Call Senate Reform Bill Unfair
States that already have expanded health coverage to allow more people to enroll in Medicaid say the Senate’s health reform bill (HR 3590) would force them to subsidize states that have failed to extend Medicaid benefits, the New York Times reports. The Senate bill would extend Medicaid coverage to U.S. residents whose incomes are 133% of the federal poverty level beginning in 2014. In comparison, the House reform bill (HR 3962) would expand coverage to U.S. residents whose incomes are up to 150% of FPL beginning in 2013.
Under the Senate bill, states that have not expanded coverage would be reimbursed at a higher rate than states that have expanded their coverage. Generally, states without expanded coverage would be reimbursed 95% of their Medicaid costs by the federal government, compared with between 80% to 95% for states that already have expanded coverage.
About 20 states already have expanded Medicaid coverage for their residents beyond federal requirements. Officials from those states have said that the Senate bill would force their states to pay a larger proportion of new Medicaid costs than states that cover fewer low-income residents. Those states — which include Arizona, California, New Jersey, New York and Wisconsin — say they cannot afford to subsidize other states’ Medicaid programs, especially at a time when they are already facing their own budgetary pressure. Massachusetts and Vermont, which provide the broadest health coverage, already have received some relief, but other states are still pushing for more equitable rules.
In Arizona — which expanded Medicaid coverage in 2000 — its share of Medicaid is projected to be $17 billion under the first seven years of the Senate bill, but it would only have been $1.4 billion if it had not expanded coverage, according to state estimates. Some states also are expected to take a financial hit from a massive influx of participants in the program. Some residents are eligible for Medicaid but have not yet enrolled. However, they are expected to join as a result of the mandate that all U.S. residents have insurance. States with expanded coverage would not receive matching federal funds for those beneficiaries because such reimbursements cover only newly eligible participants (Zernike, New York Times, 12/27/09).
– compiled by Ryan Holeywell
