HHS is Coercing States to Expand Medicaid, Ten States Tell House Committee Chair


by Danni Ondraskova

Source: The Heartland Institute

A primary provision of Obamacare is Medicaid expansion, but according to the Kaiser Family Foundation, 21 states have yet to expand their coverage as of July 2.        

Holdouts include most Southern states and half of the Midwestern states.

States not expanding Medicaid include Florida, Maine, Texas, and Wisconsin. One sticking point cited by opponents of expansion is the U.S. Department of Health and Human Services (HHS) policy not to require enrollees to be actively seeking employment.

HHS has taken steps to nudge reluctant states, allowing them to use Medicaid funds to pay for private insurance and require some enrollees to make health insurance premium payments. States such as Arkansas, Indiana, and Iowa included such provisions in their Medicaid expansion programs.

On June 23, 10 state attorneys from a variety of states, including Florida, Kansas, and Texas, sent a joint letter to Rep. Fred Upton (R-MI), chairman of the House Committee on Energy and Commerce, asking for an investigation of allegedly coercive actions by HHS to force states to expand Medicaid.

CMS Actions are Coercive

One grievance listed in the letter involves the Center for Medicaid Services (CMS), an agency run by HHS. CMS had announced unless Florida expanded its Medicaid coverage, the state would not receive $1 billion in federal funding to support its Section 1115 program, an initiative supported by the Social Security Act allowing states to fund health care providers serving underserved populations who would otherwise not have access to Medicaid.

According to the letter, CMS put Kansas, Tennessee, and Texas in a similar circumstance.

Devon Herrick, a senior fellow at the National Center for Policy Analysis, says CMS’ actions are indeed coercive.

“The Obama administration’s stated reason, [which is] that health coverage is more efficient than charity care, is meant to effectively deprive states of federal help for charity care unless states expand their Medicaid programs,” Herrick said.

It’s an important issue because expanding Medicaid to cover families above the poverty level moves people from private insurance into Medicaid, which provides inferior coverage, Herrick says.

“Families at the poverty level already have access to subsidized coverage in the [health insurance] exchange,” Herrick said. “States would be foolish to expand Medicaid eligibility above the poverty level because poor individuals at the poverty level would lose access to subsidized coverage in the exchanges.”

States Should Promote Innovation

Matthew Glans, a senior policy analyst at The Heartland Institute, says the Obama administration is sacrificing the best interests of states in favor of an agenda for expanding dependency on federal government programs.

"Since the introduction of Obamacare, the federal government has used Medicaid dollars as a carrot to entice state governments to undergo reforms against their best interests,” Glans said. “States should hold fast against Medicaid expansion and follow Florida’s lead in pushing innovative reforms such as its ‘Medicaid Cure.’”

Danni Ondraskova (Dondraskova@heartland.org) writes from Chicago, Illinois.






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