Senators introduce bill allowing Virginia, other states, to further benefit from expanding Medicaid

healthcareU.S. Sen. Mark Warner (D-VA) and Sen. Doug Jones (D-AL) were joined by Sen. Tim Kaine (D-VA) and six other senators in introducing legislation that would allow states that expanded Medicaid after 2014 or expand in the years ahead to receive the same full federal matching funds as states that expanded earlier under the terms of the Affordable Care Act.

The States Achieve Medicaid Expansion (SAME) Act of 2019 is also co-sponsored by Sens. Tammy Baldwin (D-WI), Tom Carper (D-DE), Chris Coons (D-DE), Angus King (I-ME), Gary Peters (D-MI), and Debbie Stabenow (D-MI).

“It’s crazy that for so many years, Virginia taxpayers were footing the bill for states that had already expanded Medicaid. Today, Medicaid expansion is bringing billions of tax dollars back home to Virginia, and more than 400,000 Virginians have gained access to quality, low-cost or no-cost Medicaid coverage,” said Sen. Warner, a former Governor of Virginia. “This bill will bring even more federal dollars back to Virginia by making sure that we get the same deal from the federal government as states that expanded back in 2014. It also encourages the states that have yet to take the same step to expand Medicaid as Congress intended.”

The bill would ensure that the twelve states that chose to expand Medicaid after January 1, 2014 are eligible for the same level of federal matching funds as those that expanded earlier under the terms of the Affordable Care Act. These states are Alaska, Idaho, Indiana, Louisiana, Maine, Michigan, Montana, Nebraska, New Hampshire, Pennsylvania, Utah and Virginia, where Medicaid expansion went into effect on January 1, 2019, finally allowing more than 400,000 Virginians to access low-cost or no-cost healthcare coverage under Medicaid. The bill would also provide a financial incentive to the 14 states that have not yet expanded Medicaid to do so.

The Affordable Care Act provides financial support to states that have expanded their existing Medicaid programs to provide healthcare coverage to all individuals up to 138 percent of the federal poverty level. The federal government covers 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. Currently, states choosing to expand coverage after 2014 do not receive the same federal matching rates as those that expanded immediately. This is due to the Supreme Court’s holding in National Federation of Independent Business (NFIB) v. Sebelius, which made expansion optional for states, despite intentions to make Medicaid expansion national in 2014.

The SAME Act would ensure that any states that expand Medicaid receive an equal level of federal funding for the expansion, regardless of when they chose to expand. Under the bill, a state 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 save Virginia’s hospitals an estimated $300 million per year in the first three years of implementation, according to the Virginia Hospital & Healthcare Association. That increased federal funding under the SAME Act will be especially meaningful in medically underserved areas, where patients are more likely to be uninsured and hospitals have struggled to stay afloat financially and keep their doors open. In Virginia, two rural hospitals – in Patrick County and Lee County – have closed since 2013.

“Virginia hospitals support Medicaid expansion as a means to improve access to care for thousands of uninsured Virginians. To achieve that, the Commonwealth’s hospitals voluntarily committed the financial resources necessary to cover Virginia’s 10 percent share of program costs not funded by the federal government,” said Virginia Hospital & Healthcare Association President and CEO Sean T. Connaughton. “Senator Warner’s legislation to ensure that states which expand Medicaid eligibility under the Affordable Care Act receive equivalent funding, regardless of their expansion date, is a welcome proposal that promotes funding equity among the states.”

“This legislation will finally return money that Virginia taxpayers have been sending to the federal government for health coverage since 2010. It will also provide the financial wherewithal for the 14 states that have an expanded Medicaid eligibility to do so,” said Deborah Oswalt, Executive Director of the Virginia Health Care Foundation.

Thirty-three states and the District of Columbia have already expanded eligibility for Medicaid, and three more states – Idaho, Utah and Nebraska – have passed ballot initiatives to expand Medicaid soon. Fourteen states have not yet expanded their programs. In states that have failed to expand Medicaid as envisioned under the health care law, more than 2 million low-income adults fall into a “coverage gap,” due to incomes that are too high to be eligible for Medicaid, but are too low to meet 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 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.

“Many thanks to Senator Warner for reintroducing the SAME Act! By ‘leveling the playing field’ for all states adopting Medicaid expansion, the legislation would provide a huge financial benefit to many states, including Virginia as the Commonwealth continues to implement new health coverage for up to 400,000 low income adults. It also provides a compelling incentive for the remaining states to adopt expansion without further delay. It’s time to fully close the Medicaid Gap nationwide, which still leaves millions of Americans uninsured and without any coverage options,” said the Virginia Poverty Law Center in a statement.

The SAME Act has endorsements from the Alliance for Retired Americans, American Cancer Society Cancer Action Network, American Federation of State, County and Municipal Employees (AFSCME), American Heart Association/American Stroke Association, Association of Medical Colleges, Center for Medicare Advocacy Inc., Center on Budget and Policy Priorities, Children’s Defense Fund, Justice in Aging, Mental Health America, National Association of Area Agencies on Aging (n4a), National Association of Community Health Centers, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Health Law Program, Protect Our Care, and Young Invincibles. A copy of the bill text is available here.

“By refusing to expand Medicaid, Alabama has turned away $14 billion of our own taxpayer dollars. For years, those dollars could have been helping to keep our hospitals open, supporting good jobs in our communities, and providing health coverage for hundreds of thousands of Alabamians. This isn’t a partisan issue – expanding Medicaid is the right thing to do. Alabama can no longer afford not to expand, and our SAME Act legislation would ensure that states will get a fair deal when they do. I urge my colleagues on both sides of the aisle, and on both sides of Capitol Hill, to support this common sense bill,” said Sen. Jones.

“I served as Governor of Delaware for eight years, and I know a good deal when I see one,” said Sen. Carper. “Thanks to the Affordable Care Act, Medicaid expansion ensured that over 11 million Americans – including 25,000 Delawareans – gained access to health care, many for the first time in their lives. The expansion of this vital program also helped to ensure that higher health care costs and expensive emergency room visits are not shouldered by American taxpayers. This is an obvious win-win, and tens of thousands of Delawareans have seen the clear benefits of Medicaid expansion in the First State. This bill will help to ensure more states – and more low-income Americans living in those states – can similarly benefit from Medicaid expansion while also keeping costs down for taxpayers. We must uphold our moral obligation to protect the most vulnerable members of our communities, while also avoiding placing increased financial burdens on state budgets.”

“Last year, Medicaid expansion in Virginia made 400,000 more people eligible for coverage,” Sen. Kaine said. “By guaranteeing states the same federal Medicaid funding incentives regardless of when they expand, this bill will help Virginia with its expansion program and encourage states that have not yet expanded Medicaid to make the same smart move.”

“Medicaid expansion has been a proven success in Michigan. It has helped provide access to quality, affordable health care for hundreds of thousands of Michiganders – including many for the first time in their lives,” Sen. Peters said. “This legislation is important because it will allow families in Michigan and across the country to access affordable health care, strengthening our communities as well as our economy.”

“Because of Healthy Michigan, more than 690,000 people in our state have access to quality health care, including cancer screenings, mental health services, and maternity care,” said Sen. Stabenow. “Our bill ensures that Michigan can receive additional federal resources to help families.”

“The people of Maine have made their wishes perfectly clear: they want Medicaid expansion,” said Sen. King. “Our state’s legislators voted six times to expand Medicaid under the Affordable Care Act, and each of these proposals was vetoed – so the voters of Maine took the issue into their own hands and decisively passed a referendum to expand Medicaid access to tens of thousands of Maine people. Our state government is in the process of fulfilling this responsibility, but due to delayed implementation, Maine stands to lose a significant portion of the federal funds that should go towards our most vulnerable citizens. The people of Maine don’t deserve to be punished for this delay – so while this expansion proceeds at the state level, I will continue fighting at the federal level to make sure our state receives the same benefits as those who expanded Medicaid earlier.”



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