Closing the Medicaid coverage gap

After months of doing nothing, Democrats in Congress appear poised to achieve something at last — or rather, multiple somethings, from protections for same-sex marriage to tens of billions of dollars toward computer chips to, finally, an economic package passed through reconciliation. There's still room for the majority to make this last something the best it can be.

The deal Senate Majority Leader Charles E. Schumer (D-N.Y.) seems to have struck with swing-voting Sen. Joe Manchin III (D-W.Va.) primarily involves a popular bill to let Medicare negotiate the prices of a select set of drugs — thereby driving down costs. The legislation is both a political and a policy win for the party. Better yet, it saves money that can be directed into other programs so that, with the blessing of the chamber's parliamentarian, the provisions together can bypass a filibuster. So far, Democrats look likely to extend enhanced Affordable Care Act subsidies for at least two years, preventing a spike in health-insurance premiums that could push millions off the exchanges.

All this is more than welcome: It's essential. The only problem is that, while the extended ACA subsidies will help low-to-middle-income Americans stay insured, the poorest might end up left in the lurch. That's because in 12 states that have refused to adopt the landmark law's Medicaid expansion, an estimated 2.2 million people, mostly of color, languish in the so-called coverage gap: eligible neither for Medicaid nor for subsidies in the ACA marketplace. Build Back Better as originally envisioned sought to fix this fault by letting people in non-expansion states enroll in subsidized plans after all, but the provision has fallen by the wayside. This means that the reconciliation package Democrats are teeing up would continue to assist those above the poverty line in purchasing coverage, but stick those below the poverty line with an impossible bill.

Congress can still solve the issue. The numbers need to add up to satisfy Mr. Manchin, who wants to put much of the savings achieved through the prescription drug plan toward reducing the deficit. Another provision from the former Build Back Better to beef up the Internal Revenue Service's auditing capabilities could raise some revenue without the inflationary blowback that so worries the West Virginian senator by pushing wealthy people to pay legally owed taxes — and is worthwhile on the merits, too. But advocates argue the math could work even without the added dollars from such a reform.

This is likely the last chance lawmakers have to stop what's already a tragedy from causing any more harm and taking any more lives. Democrats, with leadership from a White House that says it's devoted to the country's most vulnerable, can't afford to miss it. The nation's poorest citizens can afford it even less.

An editorial from The Washington Post.