Perspective: The case for expanding Medicaid in the time of coronavirus

Expanding Medicaid in the 14 states that have not done so yet would provide health insurance for millions at a time when they desperately need it without hurting state budgets, according to a new Perspective piece in the New England Journal of Medicine.

Co-authors Benjamin Sommers, professor of health policy and economics at Harvard T.H. Chan School of Public Health, and economist Jonathan Gruber of the Massachusetts Institute of Technology, argued that “the case for Medicaid expansion in the remaining 14 states has never been stronger.”

In an April 7, 2020 article in the Miami Herald, Sommers called the lack of expansion in states like Florida “pretty galling.”

Most states that haven’t expanded Medicaid have done so due to budgetary concerns, according to Sommers and Gruber. The Affordable Care Act stipulated that, in states that expand Medicaid, newly eligible adults would be covered with 100% federal funding from 2014 to 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% thereafter.

But even though the percentage of federal funding for Medicaid expansion states dropped after 2016, Sommers and Gruber found in recent research that there haven’t been adverse effects on budgets in states that chose the expansion, and that states have not been forced to cut back on spending for other priorities such as education and transportation. The authors said that the lack of impact on state budgets is likely because states have been able to use federal dollars from the expansion to offset other areas of state spending. “Medicaid expansion appears to be a win-win from the states’ perspective,” they wrote.

They argued against proposed changes to the way Medicaid is paid for, such as shifting to a fixed federal contribution. Given current realities—that the COVID-19 pandemic threatens to overwhelm health care providers and hospitals, that a recession is likely over the coming months, and that Medicaid will be called on to pay for COVID-19 treatments and any potential vaccine—“it would be hard to imagine a worse policy approach in Medicaid than to cap federal contributions,” they wrote. “There is no moment in recent memory more critical than now to bolster Medicaid.”

Read the NEJM article: Paying for Medicaid — State Budgets and the Case for Expansion in the Time of Coronavirus

Read the Miami Herald article: Florida argues Medicaid expansion hurts state. Experts say right now, it could help.