Expanding Medicaid for the Uninsured Working Poor

Expanding Medicaid for the Uninsured Working Poor


About 4 million Americans are uninsured because the politicians in their states (18 at the moment and shrinking) refuse to implement the Medicaid expansion component of the Affordable Care Act for the working poor. The ACA allows states to cover their uninsured citizens and legal permanent residents with incomes up to 138% of the Federal Poverty Level, regardless of their categorical linkage to the initial Medicaid program, which was enacted in 1965 to cover the poor elderly, disabled and single parent families. For the first three years (through 2016), the federal match was 100%; it is slowly being phased down to 90/10 by 2020 and thereafter.

The Maine legislature voted five times to expand Medicaid; each time the Governor vetoed it. Finally last year Maine voters passed a ballot initiative with a 59% majority to expand Medicaid as authorized by the Affordable Care Act. The state’s Governor, Paul LePage, is refusing to implement the people’s will. So finally, advocates have had to sue the Governor to get about 80,000 Maine residents covered. https://www.politico.com/story/2018/04/30/lepage-sued-medicaid-expansion-ballot-measure-559952Across the country, groups in states such as Idaho and Nebraska are looking to put Medicaid expansion on the ballot. Advocates in Utah have already garnered enough signatures to do so.” http://thehill.com/policy/healthcare/385501-medicaid-expansion-advocates-expected-to-sue-in-maine

In Virginia the state’s legislature and Governor are about to agree on a Medicaid expansion with a work requirement. About 400,000 uninsured Virginians would be covered.  https://www.huffingtonpost.com/entry/virginia-is-on-the-verge-of-expanding-health-coverage-to-400000-but-theres-a-catch_us_5ae0f225e4b055fd7fc79c7d In last fall’s elections, Virginia Republicans got clobbered at the polls due in part to their adamant refusal to help the state’s uninsured by expanding Medicaid for the working poor. The state’s current eligibility levels are 39% of the Federal Poverty Level and are limited to aged, disabled, children and parents with very low incomes. The compromise saves face for Republicans and moves forward a very important Medicaid expansion. The work requirement appears to me to be illegal as there is no authorization for such a requirement anywhere in the Medicaid statute. However the Trump Administration has encouraged states to apply for a §1115 waiver to impose work requirements for Medicaid patients; nearly 10 states have lined up to seek such requirements. “Arkansas, Indiana and Kentucky have already received approval for work requirements. Utah, Arizona, Kansas, Maine, Mississippi, New Hampshire and Wisconsin have also applied for them, and other states are sure to follow.”

It took Arizona until 1983 to implement the Medicaid program for low-income Arizona residents because they were concerned about covering poor Native American residents. The Trump Administration was not successful last year in repealing the Affordable Care Act and block granting Medicaid to the states.


Prepared by: Lucien Wulsin Jr.

Dated: May 1, 2018


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