Democrats Pressure Biden on Medicaid After Voting to End Protections

Democrats on Capitol Hill are pressuring President Joe Biden's administration to take action after reports that states were disenrolling thousands of Medicaid recipients following a recent congressional vote to end protections for Medicaid recipients set during the COVID-19 pandemic.

The calls come amid a rapid unraveling of protections established at the start of the pandemic under former President Donald Trump. At that time, a Democratic-led Congress enacted the Families First Coronavirus Response Act, which included requirements that Medicaid programs keep people continuously enrolled through the end of the public health emergency in exchange for additional federal funding.

But after legislation drawing the public health emergency to a close, a thin Democratic majority in Congress quickly moved to halt the continuous enrollment program under the Consolidated Appropriations Act of 2023, with a scheduled end date of June 1.

The impacts were anticipated to be severe.

According to April estimates by the Kaiser Family Foundation (KFF), Medicaid rolls nationwide could have between 7.8 million and 24.4 million fewer people—many of them children—by the end of May 2024. While many metrics were involved in the projections, most of the losses were anticipated in states that either had flimsy renewal policies or had failed to expand their Medicaid programs after the passage of the Affordable Care Act more than a decade ago.

In recent weeks, the states with some of the biggest reductions in enrollees have been Republican-led states that refused to expand Medicaid.

There is wide variation in disenrollment rates across reporting states, ranging from 72 percent in Texas to 8 percent in Wyoming. But a KFF spokesperson told Newsweek that some states, like Texas and South Carolina, have moved early to target people who state Medicaid officials believe are no longer eligible for Medicaid or failed to respond to renewal requests during the pandemic.

Most of those removed were removed for "procedural" reasons rather than eligibility reasons like missing or incorrect paperwork. This prompted the Centers for Medicare and Medicaid Services (CMS) to issue letters to some 14 states urging them to pause disenrollment until later dates.

Some of this could be the states' own fault.

For example, in Arkansas last week protesters took to the state Capitol following news that 144,000 residents had lost coverage, amid critics' charges that the state's Medicaid program had failed to accurately monitor peoples' income data and contact information. In Texas, an estimated 89 percent of the state's disenrolled population—most of whom were children—still qualified financially, according to estimates that health care advocacy group Every Texan provided to the Public News Service earlier this summer.

But in other states, changing circumstances tied to leaders' failures to expand eligibility requirements under their Medicaid programs have caused some to lose out on health insurance coverage they otherwise might have had.

In Mississippi, a significant campaign issue for Republican Governor Tate Reeves and his Democratic opponent, Brandon Presley, is their state's refusal to expand Medicaid.

In North Carolina, where some 68,000 people have lost coverage, one man reported he lost Medicaid coverage after missing the income requirement by just $7 following the post-COVID reenrollment period. The state's Republican-led Legislature got an admonishment from Governor Roy Cooper, a Democrat, for slow-walking the passage of a state budget that includes Medicaid expansion.

"Republican leaders are ripping health care away from thousands of North Carolinians by failing to do their jobs, pass a budget and start the Medicaid Expansion we've already agreed to in a strong bipartisan vote," Cooper said in an August 22 statement.

In Wisconsin, U.S. Senator Tammy Baldwin, a Democrat, has sought to pressure state leaders to expand Medicaid amid reports of additional purges to the rolls there.

"There's no getting around it—particularly in states like Wisconsin, where the state legislature has refused to accept additional Medicaid dollars—there's a lot of people that get left without coverage," Baldwin said in a recent interview with patient advocate Peter Morley, an activist for Medicaid expansion.

The policy differences are clear. While Texas saw the sharpest increases in disenrollment, other high-population states like New York and California—blue states that have expanded Medicaid—appeared in the top five biggest disenrollment states in KFF's enrollment tracker. Florida, which has refused to expand Medicaid, surpassed both of them, despite having some 17 million fewer residents than California.

Jennifer Tolbert, KFF's director of state health reform, told Newsweek, "Unlike in expansion states where most adults losing coverage are eligible for subsidized coverage in the marketplace, many parents losing coverage in non-expansion states are likely to fall into the coverage gap where their income is too high to continue to qualify for Medicaid but too low to qualify for subsidies in the marketplace."

She continued: "This latter point isn't about the number of people losing coverage in expansion versus non-expansion states but more about the expected increase in the number of people who are uninsured in non-expansion states because of the lack of affordable coverage options for adults being disenrolled from Medicaid."

There is room for the executive branch to act. In a vote last year, Congress moved to give CMS more power to ensure states were not improperly removing Medicaid beneficiaries, with penalties ranging from corrective action plans to a loss of federal funding. And members are threatening to use it.

Already on Capitol Hill, Democrats have been calling on the Biden White House to take more aggressive action against states reporting high disenrollment rates since the start of summer. This includes requests by Democrats urging CMS to withhold funding from state Medicaid programs if they fail to undertake good-faith efforts to remedy the increase in disenrollment.

In an August 22 letter to CMS administrators, the entire Texas Democratic delegation, led by Representative Lloyd Doggett, urged officials to use its power to "prevent the catastrophic loss of coverage occurring in Texas, which already has the disgraceful distinction of the most uninsured people in the country."

Update 8/28/23, 4:20 p.m. ET: This story was updated to include comments from Jennifer Tolbert, the Kaiser Family Foundation's director of state health reform.