Senators Call on State Governors to Expand Medicaid Under Affordable Care Act

WASHINGTON, D.C.— U.S. Sen. Tom Harkin (D-IA), Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, today joined a group of 20 senators in calling on state governors to expand Medicaid in their states under the Affordable Care Act. In a letter to the 18 governors who have yet to undertake the expansion, the senators urged the governors to put aside their political differences and expand the Medicaid program. The letter asserts that by refusing to do so these governors are denying millions of individuals access to life-saving health care and preventive health services. To date, approximately 6 million Americans are not getting the coverage they are eligible for under the Affordable Care Act because of these governors’ refusal to expand Medicaid.

Under the Affordable Care Act, the federal government provides funding to states that wish to expand their Medicaid programs. This funding is then used to pay local hospitals, doctors and other health care providers to administer care. By forgoing federal funding and choosing not to cover millions of eligible individuals, these 18 states stand to lose billions in new revenue.

The letter was signed by Harkin along with U.S. Senators Chris Murphy (D-CT), Mark Begich (D-AK), Tim Johnson (D-SD), Jay Rockefeller (D-WV), Mary Landrieu (D-LA), Brian Schatz (D-HI), Sheldon Whitehouse (D-RI), Barbara Boxer (D-CA), Kay Hagan (D-NC), Claire McCaskill (D-MO), Ben Cardin (D-MD), Bernie Sanders (I-VT), Richard Blumenthal (D-CT), Tammy Baldwin (D-WI), Charles Schumer (D-NY), Kirsten Gillibrand (D- NY), Patty Murray (D-WA), Debbie Stabenow (D-MI), and Martin Heinrich (D-NM).

The letter was sent to Governors Robert Bentley (R-AL), Sean Parnell (R-AK), Rick Scott (R-FL), Nathan Deal (R-GA), Butch Otter (R-ID), Sam Brownback (R-KS), Bobby Jindal (R-LA), Paul LePage (R-ME), Phil Bryant (R-MS), Dave Heineman (R-NE), Pat McCroy (R-NC), Mary Fallin (R-OK), Nikki Haley (R-SC), Dennis Daugaard (R-SD), Bill Haslam (R-TN), Rick Perry (R-TX), Scott Walker (R-WI), and Matt Mead (R-WY).

“While the Affordable Care Act has expanded access to health care dramatically over the last year, there is a fundamental inequity playing out in states that have chosen to not expand the Medicaid program,” the Senators wrote. “Denying Medicaid coverage—an incredibly important program that covers millions of Americans, including in your state—to millions of people who could be eligible is short-sighted. Your state’s decision not to expand health coverage is creating two Americas: one where millions are benefiting from preventive care and covered treatments while local economies get stronger and healthier by the day; and another where patients continue to show up to emergency rooms without a way to pay and local economies fall further and further behind.”

Full text of the Senators’ letter is below.

June 4, 2014

Dear Governor,

We write today to call your attention to the recent announcement that nearly 5 million Americans enrolled in Medicaid over the past six months and another 1 million individuals gained coverage in states that expanded earlier than January 1, 2014. While this is a major step forward for our health care system, there is a fundamental inequity playing out in your state and others that have chosen to not expand this basic health care coverage. A political difference should not result in almost 6 million Americans falling into a coverage gap because their income is too high for Medicaid coverage, but below the level for a premium tax credit for coverage through a Marketplace plan.  We urge you to fix this inherently unfair situation by working with the Department of Health and Human Services (HHS) to expand the program in a way that would work for your state.

Denying Medicaid coverage — an incredibly important program that covers millions of Americans, including in your state — to millions of people who could be eligible is short-sighted. Studies have shown that Medicaid has been effective at reducing the financial strain for low-income families and improving health and mental health outcomes. Without access to medical care, these individuals will forego preventative measures or medications that could lead to costly complications in the future.

Beyond the obvious health benefits of covering these individuals, there are  strong economic arguments for expansion for states, health care providers, and employers. The Affordable Care Act established a new minimum Medicaid eligibility level of 138 percent of the federal poverty level, with the federal government funding the entire cost of a state’s expansion for the first three years, and never declining support below 90 percent – the highest federal match your state has ever received. An independent analysis found that in all but 8 states the amount of funding a state would receive for expanding eligibility would exceed the amount it receives through the federal highway program. The same study found that for most states the costs of expanding Medicaid would be less than one-sixth the amount they pay to attract businesses.

New federal dollars coming to the state for expansion could be injected into local economies in the form of payments to local hospitals, doctors, and others healthcare providers to create new jobs and spur economic growth. One recent study found that community health centers in states that are electing to not expand Medicaid will lose nearly $570 million in extra federal funding while centers in states that have expanded will gain up to $2.1 billion in new revenue. Adding to that disparity is the fact that 1 million patients who use community health centers will remain uninsured if they live in a state that has not expanded.  In addition, as a result of your state’s decision not to expand this basic health coverage, hospitals in states like yours across the country are collectively losing out on $130 billion in additional revenue. 

Expanding basic health care to the millions currently in the coverage gap also means a healthier, more productive workforce that enhances competitiveness. For business owners, health coverage provides comfort in knowing their employees have a doctor to see when they get sick, cutting down on absenteeism, and improving productivity while employees are at work. Small businesses with low-wage workers, especially many of those with minimum wage jobs, may not always be able to afford to offer their employees health insurance.  With expansion of this basic health coverage, many of these employers would benefit from having a healthier, stronger workforce to better compete with big businesses that can afford health insurance. 

Recently, Sylvia Mathews Burwell, the nominee to lead HHS, testified before the Senate Health, Education, Labor and Pensions Committee that she would work with states to be flexible in how they choose to expand Medicaid as long as the approach respects the principles set forth under the law. This was a reaffirmation of HHS’s commitment to work with states and we would encourage you to begin discussions about how best to provide coverage for the people who fall into this coverage gap.

Your state’s decision not to expand health coverage is creating two Americas: one where millions are benefiting from preventive care and covered treatments while local economies get stronger and healthier by the day; and another where patients continue to show up to emergency rooms without a way to pay and the local economies are falling further and further behind. Again, we urge that you put politics aside and do the right thing in helping to expand Medicaid coverage to the millions of Americans who desperately need it.

Sincerely,
 
TOM HARKIN
United States Senator

CHRISTOPHER S. MURPHY
United States Senator

MARK BEGICH
United States Senator

TIM JOHNSON
United States Senator
 
JAY ROCKEFELLER
United States Senator

MARY LANDRIEU
United States Senator

BRIAN SCHATZ
United States Senator

SHELDON WHITEHOUSE
United States Senator

BARBARA BOXER
United States Senator

KAY HAGAN
United States Senator
 
KIRSTEN GILLIBRAND
United States Senator

DEBBIE STABENOW
United States Senator

RICHARD BLUMENTHAL
United States Senator

CHARLES SCHUMER
United States Senator

BEN CARDIN
United States Senator

BERNIE SANDERS
United States Senator

CLAIRE MCCASKILL
United States Senator

TAMMY BALDWIN
United States Senator

PATTY MURRAY
United States Senator

MARTIN HEINRICH
United States Senator

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