Inside the Trump Administration’s Debate Over Expanding Obamacare

. . .Preliminary fiscal analyses of partial expansion proposals suggest the policy has few obvious supporters. Liberals will complain that partial expansion could lead to hundreds of thousands of individuals dropping coverage in states that have already expanded Medicaid. By contrast, conservatives will object to the sizable price tag associated with the policy—because government actuaries believe it will encourage more states to expand Medicaid.

The Times reported that some within the administration—including CMS Administrator Seema Verma and White House Domestic Policy Council Chairman Andrew Bremberg—have embraced the proposal. But if the plan overcomes what the Times characterized as a “furious” internal debate, it may face an even tougher reception outside the White House. . .

After the Supreme Court made Medicaid expansion optional for states as part of its 2012 ruling upholding Obamacare’s individual mandate, the Obama administration issued guidance interpreting that ruling. While the court made expansion optional for states, the Obama administration made it an “all-or-nothing” proposition for them.

Under the 2012 guidance—which remains in effect—if states want to receive the enhanced 90 percent federal match associated with expansion, they must cover the entire expansion population—all able-bodied adults with incomes under 138 percent of the federal poverty level (just under $35,000 for a family of four). If states expand only to some portion of the eligible population, they would only receive their regular Medicaid match of 50-76 percent, not the enhanced 90 percent match.

Because individuals with incomes above 100 percent of the poverty level—but only individuals with incomes above 100 percent of the poverty level—qualify for subsidized coverage on insurance exchanges, states like Arkansas and Massachusetts have applied for waivers to implement a partial expansion. If the Trump administration approves such proposals, Arkansas and other states that have already expanded Medicaid would still receive the 90 percent federal match, while shifting the population with income between 100-138 percent of poverty from Medicaid to exchange coverage. (Read more from “Inside the Trump Administration’s Debate Over Expanding Obamacare” HERE)

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