Why Democrats Dared to Cut Medicaid Eligibility from the Covid Public Health Emergency

“We’re decoupling Medicaid’s continued eligibility policy from the public health emergency. We’re not ending PHE,” said a Capitol Hill source close to the negotiations, who spoke on condition of anonymity to discuss a deal that it’s still moving. “We’re giving states certainty and we’re giving them a gradual flow of funding and protection requirements that protect people. This is something that both Democratic and Republican states asked for so that the 90 million people enrolled in Medicaid can have certainty and protection -se during this massive undertaking.”

Also fueling Democrats’ shift: pressure from state health officials who have been pushing Congress to give them a firm date when their Covid stance will formally end after years of last-minute extensions from the White House .

“The biggest thing that state Medicaid agencies want is certainty about what’s coming,” Jack Rollins, director of federal policy for the National Association of Medicaid Directors, told POLITICO. “This will help us make the concrete plans necessary to make sure this happens in an orderly manner.”

The nonpartisan Congressional Budget Office assumes the public health emergency for Covid will expire in July. Lawmakers have reached an agreement to move the end of their Medicaid rules to April 1, which would allow states to begin weeding out people who no longer qualify, usually because their incomes have increased.

Under the tentative deal, much of the money saved would go toward two Medicaid policies that Democrats have long sought: a year of postpartum coverage for low-income mothers in states that don’t already offer it, and a year of continuous coverage for children at risk. of losing health insurance.

“I was surprised, frankly, that the Dems weren’t more willing to reach a deal sooner,” a health care lobbyist familiar with the negotiations told POLITICO. “No one thought the public health emergency would last forever. And if this happens next week, Congress will basically give states 98 days notice.”

Those involved in the negotiations caution that some details have yet to be ironed out and that the deal could still fall apart as lawmakers and staff rush to finalize the bill’s language, but the interest of ‘both sides increases.

Republicans have long called for an end to the public health emergency for Covid-19 and forced a handful of votes in the Senate that were later blocked in the House. Democrats, on the other hand, have been hesitant to tie the administration’s hands as the virus continues to kill hundreds of people each day and a winter surge in various diseases strains the nation’s medical system.

Republicans who pushed the deal have also reminded Democrats that their original “Build Back Better” legislative package — which eventually became the Inflation Reduction Act and passed this year after being significantly scaled back — included a public health emergency reduction as payment. for

“Democrats are on record as being open to this,” a Senate Republican aide told POLITICO. “But because the Democrats are loath to do this, they’re going to use it to drive a hard bargain. It’s clear that their support and openness to this depends on reinvesting the savings into Medicaid permanently. The question is: Can they get enough gains to remove the political sting that allows states to kick people off the list?

Amid tense arguments over how to spend the savings from the accelerated end to the Medicaid portion of the PHE, lawmakers have also wrestled over whether and how to set up guardrails to protect people who earn a little too much to qualify for Medicaid from staying se without a private health insurance plan they can afford by 2023. Outside GOP advocates working closely with Congress argued that if those barriers are built too high, the policy move could fail to generate the federal revenue that they drive the discussion in the first place.

“It’s just a payment because you would be taking people off Medicaid,” said Brian Blase, president of the conservative think tank Paragon Health and a former Senate Republican aide.Democrats want to make it more difficult, but if they put too many restrictions on states’ ability to do that, I’m not sure how the math will work out. Also, if you funnel people into subsidized Obamacare plans, those are more expensive than Medicaid.”

However, if the guardrails are too weak or non-existent, states could see their uninsured populations rise as government Covid funding dries up, and people will have to rely on health plans to cover tests, vaccines and therapeutics for the virus. A mitigation strategy that insurers and health officials called for: A tweak to the Telephone Consumer Protection Act that would allow health plans and state agencies to call and text residents who will lose Medicaid to guide them through your options

“There’s always a risk” of scams and abuse if that happens, Rollins warned, arguing that the ban on calls and texts should only be lifted during the period of Medicaid redeterminations. “But we have to take advantage of all methods to reach people in the program.”

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