Democrats plan to force states to expand Medicaid in filibuster-proof budget bill

Democrats in Congress are planning to force states to expand Medicaid as part of a forthcoming filibuster-proof budget reconciliation bill.

According to the Centers for Medicare & Medicaid Services, a record 80 million people are currently on Medicaid, but Democrats are seeking to expand it further. 

The federal government pays the majority of the costs to expand Medicaid on the state level, and state governments pick up the rest of the tab. Under the Affordable Care Act, known as Obamacare, states had the option to opt out of expanding Medicaid. 

According to Kaiser Family Foundation, total Medicaid spending in FY2019 was $604 billion, not including administrative costs.

House Majority Whip James Clyburn said on Wednesday that there are 12 states, including 9 southern states, that have not expanded Medicaid, despite the federal incentives included in the $1.9 trillion American Rescue Plan Act that President Biden signed in March to entice states to participate.

"When you see the states refusing to expand Medicaid, then that's a big, big problem for us," Clyburn said during a press briefing with the organization Protect Our Care. "We cannot wait anymore for the states who don't do it. We in the Congress have got to move to do it. And I'm pleased that the Biden administration has decided to support our efforts to give everybody the benefit of Medicaid expansion."

South Carolina Republican Gov. Henry McMaster is one of the governors opposing Medicaid expansion.

"Gov. McMaster isn't for sale, regardless of whatever ill-conceived 'incentives' congressional Democrats may come up with," said McMaster spokesman Brian Symmes. "What the federal spending plan does is attempt to offer a short term solution for a long term problem."

Clyburn was asked to respond to governors in states such as South Carolina who have cited long-term cost concerns as the reason for not expanding Medicaid.

"I don't buy that the state cannot afford it," said the South Carolina Democrat. "We look at the growth in the economy, the job creation, and the kind of people who would go to work, people paying taxes, I think the whole thing would pay for itself in the long run.

"So often we think about the immediate outlay, and do not equate that to what is the cost for not doing something. If you look at the cost of not doing it, then I'm sure that this is a very good investment in South Carolinians, and in their health and in their productivity, and it will all add up to growing the state's economy." 

When asked if the rest of the Democratic leadership is committed to including Medicaid expansion in the reconciliation package, Clyburn replied, "The Speaker of the House is very committed to this."

Leslie Dach of Protect Our Care argued that Medicaid expansion "has played a critical role in reducing racial disparities in access to care" and said his organization supports Democrats closing the Medicaid coverage gap.