Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) joined a half-dozen of their Senate colleagues to introduce the States Achieve Medicaid Expansion (SAME) Act of 2016. The bill would ensure that states that choose to expand eligibility for Medicaid after 2014 are eligible for the same level of federal matching funds as states that expanded earlier under the terms of the Affordable Care Act.
“States across the country have already expanded Medicaid in a way that meets their needs because it is morally and economically the right thing to do. States that choose not to expand Medicaid – including Virginia – are making the conscious decision to send their tax dollars to other states that have. We’re also allowing health care costs for 400,000 uninsured Virginians to continue to be passed along to taxpayers in the form of emergency room visits and uncompensated care, especially in rural areas of Virginia,” said Sen. Warner. “This legislation is designed to sensibly address one of the concerns we often hear from opponents of expansion in Virginia and the 18 other states that have not yet expanded Medicaid for many of their neediest residents.”
“The States Achieve Medicaid Expansion (SAME) Act of 2016 will preserve the economic incentives for states like Virginia to expand Medicaid under the ACA and promise the Commonwealth that it is not too late to make the humane decision to insure the nearly 400,000 Virginians who fall within the coverage gap,” said Sen. Kaine.
“Access to health care and strong health care systems are crucial economic drivers in every region of Virginia,”said Governor Terry McAuliffe. “I talk to business executives and entrepreneurs every day, and they make it clear that they will not invest in communities that don’t have a solid, sustainable system of medical care. There are other communities and other states, including our neighboring states, embracing rational principles for efficiency and health care access. We must do the same. We must confront this issue with necessary urgency because we are forfeiting $2.4 billion annually in funding directly to families for their medical care. I thank Senators Warner and Kaine for their work to ensure that Virginia families and taxpayers can still have the opportunity to realize the full benefits of expansion.”
The Affordable Care Act provides financial support to states that choose to expand their existing Medicaid programs to provide healthcare coverage to all individuals up to 138 percent of the federal poverty level, with the federal government covering the full cost of expansion for three years, phasing down to a 90 percent match rate for the sixth year of the expansion and in subsequent years. While the Medicaid expansion was intended to be national, the Supreme Court’s holding in National Federation of Independent Business (NFIB) v. Sebeliusmade expansion optional for states. As a result, under existing law, those choosing to expand coverage after 2014 do not receive the same federal matching rates as those that expanded immediately.
The SAME Act would ensure that if Virginia chooses to expand eligibility for Medicaid under the ACA, that it will receive an equal level of federal funding in the first six years as states that expanded on the initial timeline beginning in 2014. Under the bill, a state that expands Medicaid in the future would receive three years of full federal funding, phasing down to a 95 percent Federal Medical Assistance Percentages (FMAP) in Year 4; a 94 percent federal contribution in Year 5; 93 percent in Year 6; and, 90 percent for each year thereafter.
The SAME Act would make the expansion as good a deal for Virginia now as it was for states that already expanded Medicaid eligibility in 2014, and further underscore the federal government’s commitment to funding state expansions of the program.
Thirty-one states and the District of Columbia have already expanded eligibility for Medicaid, while 19 states including Virginia have not yet expanded their programs. In states that have failed to expand Medicaid, nearly 3 million low-income adults – including 400,000 in Virginia – fall into a “coverage gap,” having incomes that are too high to be eligible for Medicaid, but are too low for the limit that would allow them to receive tax credits to purchase affordable coverage in the health care marketplace. Without Medicaid expansion, most of these individuals are likely to remain uninsured, as they have limited access to employer coverage and frequently find the cost of unsubsidized marketplace coverage to be prohibitively expensive.
Numerous studies have shown that expanding Medicaid benefits states both directly and indirectly in the form of jobs and earnings growth, generating additional federal revenue, increasing Gross State Product, increasing state and local revenues, and reducing uncompensated care and hospital costs.
It is estimated that expanding Medicaid in Virginia would save the state $157 million from the general fund while expanding access to 400,000 low-income uninsured Virginians.
The SAME Act has been endorsed by AFSCME, America’s Essential Hospitals, American Cancer Society Cancer Action Network, American Heart Association/American Stroke Association, Association of American Medical Colleges, B’nai B’rith International, Altarum Institute Center for Elder Care and Advanced Illness, Center on Budget and Policy Priorities, Children’s Defense Fund, Families USA, Healthcare for All Virginians, Justice in Aging, March of Dimes, Mental Health America, National Association of Area Agencies on Aging (n4a), National Association of Community Health Centers, National Association of County and City Health Officials, National Consumer Voice for Quality Long-Term Care, National Health Law Program, Planned Parenthood Federation of America, United Methodist Church General Board of Church and Society, Virginia Hospital & Healthcare Association, and Young Invincibles.
Co-sponsors of the SAME Act are Sens. Debbie Stabenow (D-MI), Claire McCaskill (D-MO), Jon Tester (D-MT), Tammy Baldwin (D-WI), Angus King (I-ME), and Gary Peters (D-MI).