Press Releases

Senate Democrats Introduce Legislation to Encourage States to Expand Medicaid

Would ensure equal level of federal matching funds for states expanding Medicaid after 2014

Apr 13 2016

WASHINGTON, D.C. – Today U.S. Sens. Mark R. Warner (D-VA) and Debbie Stabenow (D-MI), both members of the Senate Finance Committee, along with Sens. Claire McCaskill (D-MO), Jon Tester (D-MT), Tammy Baldwin (D-WI), Angus King (I-ME), Tim Kaine (D-VA), and Gary Peters (D-MI), introduced 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.

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 in 2014, the Supreme Court’s holding in National Federation of Independent Business (NFIB) v. Sebelius made expansion optional for states. As a result, those choosing to expand coverage after 2014 do not receive the same federal matching rates as those that expanded immediately.

“States across the country have already expanded Medicaid in a way that works for their needs because it is morally and economically the right thing to do. States that choose not to expand Medicaid – and that includes my own state of Virginia – are making the conscious decision to send their tax dollars to other states that have. They are also allowing health care costs for the uninsured to be passed along to taxpayers in the form of emergency room visits and increased care costs,” said Sen. Warner. “My hope is that this bill will provide an added inducement to Virginia and the 18 other states that haven’t yet expanded Medicaid to make the sensible choice, and expand coverage for millions more Americans.”  

The SAME Act would ensure that all states receive an equal level of federal funding for Medicaid expansion, regardless of when a state chooses to expand coverage. 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 Healthy Michigan Plan has guaranteed health care benefits like maternity care, cancer screenings, and mental health services for nearly 600,000 people across Michigan,” said Sen. Stabenow. “This legislation will ensure Michigan can receive additional federal resources to help families.”

“The failure of legislators in Jefferson City and other state capitals to expand Medicaid is a failure for Missouri families, jobs, and our economy—all in a cynical effort to score political points off of the Affordable Care Act,” said Sen. McCaskill. “This bill allows more breathing room for states and takes off the table any excuse for officials to keep their heads in the sand by continuing to refuse to expand this vital program.”

“Montana’s Medicaid expansion plan is providing health care to folks in every corner of our state and building healthier communities,” Sen. Tester said. “This bill will support low-income families and ensure that all Americans have access to affordable health care.”

“In Wisconsin, Governor Walker has put politics ahead of progress and taken our state in the wrong direction. Instead of accepting a federal investment in our BadgerCare program and expanding Medicaid coverage, he has kicked Wisconsinites off their coverage, created a coverage gap, and exposed Wisconsin taxpayers to higher costs while covering fewer people,” said Sen. Baldwin. “I support this legislation because it is my hope it will point our state in the right direction.”

“States that choose to expand Medicaid for their most vulnerable citizens should not be penalized for making that decision later than others, and this legislation would ensure that all states receive an equal level of federal support moving forward,” Sen. King said. “Ultimately, this decision rests with the states, but our bill should remove one barrier to making a determination that Medicaid expansion will benefit the state and its citizens without threatening the state’s ongoing finances.”

“The States Achieve Medicaid Expansion Act 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.

“Medicaid expansion is helping hundreds of thousands of Michiganders gain access to quality, affordable health insurance for themselves and their families,” said Sen. Peters. “The States Achieve Medicaid Expansion (SAME) Act will continue to encourage expanded coverage, resulting not only in healthier cities in Michigan and across the country, but a stronger national economy.”

Thirty-one states and the District of Columbia have already expanded eligibility for Medicaid, while 19 states have not yet expanded their programs. In states that have failed to expand Medicaid as envisioned under the health care law, nearly 3 million low-income adults 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.  

The SAME Act would make the expansion as good a deal for those states choosing to expand Medicaid late as those that did so in 2014. Seven states that have already expanded since the start of 2014 would also benefit.

The SAME Act has been endorsed by AFSCME, Alliance for Retired Americans, 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 for Medicare Advocacy Inc., Center on Budget and Policy Priorities, Children's Defense Fund, Families USA, Justice in Aging, March of Dimes, Mental Health America, National Association for Home Care & Hospice, National Association of Area Agencies on Aging (n4a), National Association of Community Health Centers, National Association of County and City Health Officials, National Committee to Preserve Social Security and Medicare, 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, and Young Invincibles.