Congressional Democrats Try To Go Around Conservative State Leaders To Expand Medicaid In Texas, Elsewhere

Texas rejected expanding medicaid to the working poor again this legislative session. The COVER Now Act will go around those conservative leaders.

Lloyd Doggett (D-TX) announces workaround for states that have not expanded Medicaid.
Courtesy Lloyd Doggett's Office
Lloyd Doggett (D-TX) announces workaround for states that have not expanded Medicaid.

This is a developing story and will be updated throughout the day.

Congressional Democrats have finally found a way to expand Medicaid in the dozen states that haven't yet done so. They will attempt to go around conservative state government leaders who have rejected the prospect for a decade, and instead work with local leaders.

Representatives from 12 states announced outside the U.S. Capital that the Cover Outstanding Vulnerable Expansion-eligible Residents (COVER) Now Act would give dollars directly to local governments and hospitals that want to help expand Medicaid.

Medicaid expansion was rolled out with the Affordable Care Act in 2010 and offers the government health plan to people making up to 138% percent of the national poverty line. Until 2017, 100% of the expansion was paid for by the Federal government. Since then, states that expanded are responsible for 10% of the cost.

Texas rejected expanding Medicaid to the working poor again this legislative session. The COVER Now Act will go around those conservative leaders.

"I think you can’t give the state ideological Republican leaders enough money to do this," said Lloyd Doggett, (D-TX) who authored the bill. "That’s why we just have to go around them and rely on effective local and willing leaders to do the job that we need in Texas."

Texas led the country in uninsured people in 2019 with an estimated 5.2 million lacking basic health coverage, a number likely increased by pandemic job losses. At 18.4%, it is double the national average. According to the Kaiser Family Foundation, expanding Medicaid in Texas could reach more than one-third of those uninsured, more than 1.4 million people.

The bill allows the federal government to directly fund these local hospitals and governments in a "demonstration" program that lasts five years and can be reapplied for. Governments that elect to take the money would qualify for 100% of Medicaid funding for three years and then it would fall to 95%.

"The physical, mental and fiscal wellbeing of our community is inextricably linked to everyone's ability to get covered," said Ron Nirenberg, Mayor of San Antonio. "Medicaid expansion is an issue that's supported across the political spectrum and I'm eager to see the results of the Congressman's bill."

Texas receives around $3.87 billion a year from the federal government to offset uncompensated care hospitals provide to the uninsured. An extension of the program that provides that money, known as the 1115 waiver, was rescinded and the state may lose it after 2022. The move from the Biden administration was intended to pressure state lawmakers like those in Texas to finally expand Medicaid to make up for those costs. That didn't happen though, and Texas hospitals may be hit with the bill.

The move comes as state legislators are preparing for multiple special sessions to address congressional redistricting and a controversial voter law.

Texas Gov. Greg Abbott has defended the state's decision to not expand the health program multiple times. The governor’s office had not responded to TPR by the time of publication, and it wasn't clear how the news would be received.

The bill includes language to penalize states that "withhold or reduce" funding or increase taxes on local governments that participate in the program. It also seeks to prohibit states from barring local governments or health providers from participating.

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