Given the sprawling nature of the COVID-19 relief and stimulus measure Joe Biden signed into law on March 11, it’s unsurprisingly taking a while for all its provisions to get the attention they deserve. That’s particularly true of the health-care elements of the bill, which go well beyond f Biden’s campaign promise to shore up and extend Obamacare after four years of Republican efforts to undermine it (absent the power to repeal it).
As Jonathan Chait noted in an analysis before the bill was enacted, the stimulus bill significantly boosted Obamacare’s insurance-purchasing subsidies “across the board,” with especially significant improvements made for middle-class families denied assistance by steep subsidy phase-outs. But another provision depends on subsequent action by the 12 states that have stubbornly refused to take advantage of the Affordable Care Act’s Medicaid expansion, made an option by the U.S. Supreme Court in 2012. It increases the already generous federal share of the cost of expansion from an initial 90 percent to 95 percent. When you add in indirect savings generated by the expansion, as Chait puts it: “[S]tates taking the Medicaid expansion would have more than 100 percent of the cost covered by Washington. They would literally have to pay for the privilege of denying coverage to their poorest citizens.”
Even as Joe Biden begins his travels around the country to promote the stimulus bill’s benefits (today the president will be in Ohio to mark the 11th anniversary of Barack Obama’s signing of the Affordable Care Act), discussions are underway in some deep-red states about the possibility of abandoning resistance to the Medicaid expansion. In Wyoming, which gave a national high of 70 percent of its vote to Donald Trump last November, the state House approved an expansion this week even as the state Senate killed a move in that direction. The ultimate outcome is unclear, but there’s no question the stimulus bill created new momentum for expansion among Republican lawmakers, as the Caspar Star-Tribune reported:
“I voted no multiple times on this issue,” House Speaker Eric Barlow, R-Gillette, said. “I’m going to vote yes this time, because I haven’t seen any other solution. No one has brought anything forward, and I’ve looked myself.”
“I have to admit that although I’ve been one of the ones that have been resisting this, I have really given this some thought and I think it’s time.” Rep. Mark Kinner, R-Sheridan, said.
Meanwhile, there are signs of movement in another deep-red state,
Alabama, as the Associated Press reports:
Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is “open to the discussion” on expansion but that state leaders need additional information about the long-term cost projections.
It has to be tough for conservative Republicans who have demonized Obamacare for all 11 years of its existence to bend now. One Alabama Democrats suggested a cosmetic adjustment:
“I just want to say to Governor Ivey, if not now, when?” Senate Minority Leader Bobby Singleton said in the press conference. “I don’t care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now,” Singleton said.
In the remaining hold-out states, the green eyeshades will be looking at the greater-than-ever advantages of Medicaid expansion, while the pols in both parties examine it as a potential 2022 campaign issue.