Majority Whip James E. Clyburn, U.S. Rep. Robin Kelly and Protect Our Care Call for Federal Action to Close the Medicaid Coverage Gap

WASHINGTON, June 24 -- Protect Our Care issued the following news:

U.S. House Majority Whip James E. Clyburn (D-SC-06) and U.S. Rep. Robin Kelly (D-IL-02) joined Protect Our Care for a press call advocating for a federal solution for closing the Medicaid coverage gap. Republican leaders in 12 states have rejected Medicaid expansion, blocking millions of people from access to coverage. Four million uninsured adults -- including at least 2.4 million people of color, 500,000 people with disabilities and almost a million older Americans -- could gain Medicaid coverage if the remaining states adopted Medicaid expansion.

The call came after leaders of the Congressional Tri-Caucus, which includes the Congressional Asian Pacific American Caucus (CAPAC), Congressional Black Caucus (CBC), and Congressional Hispanic Caucus (CHC), joined more than 60 of their colleagues on a letter advocating for closing the coverage gap through the American Families Plan.

"Even as we welcome the result of last week's Supreme Court decision upholding the ACA, there is something amiss in the 12 states that have not expanded Medicaid, where millions of Americans are left out of this coverage," said Majority Leader James E. Clyburn (D-SC-06). "Of those 12 states, nine of them are in the South, where there are large pockets of poverty. Medicaid expansion would be such a tremendous benefit to South Carolinians who fall into this coverage gap. We must act to close this coverage gap now."

"Over the past year, we have seen just how important it is that everyone has access to quality, affordable health care whenever they need it. And closing the gap is vitally important not only to people without insurance, but to all of us," said U.S. Rep. Robin Kelly (D-IL-02). "Our public health depends on as many people having access to care as possible. Medicaid expansion has played a critical role in reducing racial disparities in access to care, and closing the coverage gap will help families get back on their feet after this pandemic and help to finally address the health disparities that persist in our country."

"There is a stark situation in the states that have not expanded Medicaid, where income eligibility rules are incredibly stringent. In most of these states, if you're a single mother with two children and you make $9,000 per year, you're not eligible for Medicaid," said Yvette Fontenot, Policy and Legislative Affairs Consultant for Protect Our Care. "These states have not been persuaded to change course in the face of generous federal financial incentives, evidence of the health benefits of Medicaid expansion, and the worst pandemic in a century. Waiting for them to act is no longer a viable option."

"Medicaid is a lifeline for millions of Americans, and its importance has never been more clear as it has reached record enrollment during the pandemic," said Protect Our Care Chair Leslie Dach. "Despite the overwhelming benefits of Medicaid expansion, and even with the additional incentives included in the American Rescue Plan, Republicans have put politics over people by continuing to reject the program. Lawmakers must act quickly to provide relief to millions of people who have been locked out of coverage by adopting a federal solution to expand Medicaid in the American Families Plan."

BACKGROUND:

* Six Million People Could Gain Coverage If Remaining Holdout States Expand Medicaid. An estimated four million uninsured adults -- including at least 2.4 million people of color, 640,000 frontline workers, 500,000 people with disabilities, and 926,000 older adults aged 50 to 64 -- could gain coverage if the remaining holdout states adopted expansion. In total, roughly 6 million people could enroll in Medicaid if the remaining states implemented expansion.

* Medicaid Expansion Is Widely Popular. In 2020, the country saw voters in two deeply conservative states, Oklahoma and Missouri, approve expansion. 75 percent of Americans have a favorable view toward the Medicaid program, and 61 percent of Americans in non-expansion states favor expansion.

* Medicaid Expansion Results In Healthier Communities. Research confirms that Medicaid expansion increases access to care, improves financial security, leads to better health outcomes, and even saves lives. Medicaid expansion has played a vital role in reducing racial disparities in health care access and has served as a critical safety net during the pandemic. According to the Kaiser Family Foundation, more than 600 studies confirm the broad benefits of Medicaid expansion.

* * *

To: The Honorable Charles S. Schumer Majority Leader, United States Senate, Washington, D.C. 20510

The Honorable Nancy Pelosi, Speaker, U.S. House of Representatives, Washington, D.C. 20515

Dear Majority Leader Schumer and Madam Speaker Pelosi,

We, the undersigned members of the Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus together write to urge you to close the Medicaid "coverage gap" in the forthcoming American Families Plan. The coverage gap leaves over two million Americans with incomes below the poverty line uninsured and without any pathway to health coverage and almost two million more uninsured people with incomes between 100 and 138 percent of the poverty line who would be eligible if their states expanded./1 Closing this gap is one of the single most important steps we can take to reduce health inequities across the United States, as almost 60 percent of people affected by the coverage gap are Black, Hispanic, Asian, of Pacific Islander./2 Additionally, much of the affected population lives in the South, where state governments have failed to provide basic health coverage for their residents. It is unacceptable for the federal government to continue to allow some states to deny basic health coverage to these uninsured and underinsured Americans.

Medicaid provides comprehensive, affordable, quality health insurance specifically designed for low - income individuals. We urge you to ensure that, regardless of state political decisions or immigration status, everyone eligible for Medicaid expansion is finally able to access the protections of Medicaid. We were pleased that the American Rescue Plan includes a bold new incentive to encourage states to finally do the right thing and expand Medicaid. Numerous researchers have repeatedly established the value of Medicaid expansion. Over 600 studies reviewed by the Kaiser Family Foundation show that Medicaid expansion has wide - ranging benefits, including reducing overall mortality, as well as mortality associated with cancer, cardiovascular disease, and liver disease./3 It has decreased racial disparities in coverage rates, affordability of care, and in some health outcomes - including maternal and infant mortality.

Closing the coverage gap would have a significant impact in addressing the Black maternal health crisis, which was the subject of a September 9, 2019 hearing of the House Energy and Commerce Committee, and a May 6, 2021 hearing of the House Committee on Oversight and Reform. To prevent complications and ensure a healthy pregnancy and birth, people need health coverage before they become pregnant and throughout the entirety of their pregnancy and postpartum period. Currently, women in the coverage gap are not eligible to receive care under Medicaid until their pregnancy begins. More than half of people in the coverage gap are women, including large numbers of Black, Hispanic, and Native Hawaiian or other Pacific Islander women, and do not have a pathway to coverage until eligibility is established based on pregnancy./4 This means these women do not have access to vital maternal health care in those critical early weeks and months of pregnancy. This has become even more critical during the COVID - 19 pandemic as Hispanic women make up the largest number of pregnant women with COVID-19 and are at increased risk of adverse pregnancy outcomes./5

The Affordable Care Act (ACA) intended for Medicaid expansion to be available to all people with low incomes regardless of where they live. In fact, the ACA fully accounted for the cost of that expansion, but the Supreme Court decision in NFIB v. Sebelius left decisions of expansion up to the states. Despite the evidence of the lifesaving care provided by Medicaid expansion, 12 state governments still refuse to expand, even with the significant financial incentives provided in the American Rescue Plan. These states additionally lose out on the fiscal benefits of expansion, which research shows produces net budget saving. These states' refusal to expand means residents of those states are denied the far-reaching benefits of expansion. In fact, a landmark study found that in states refusing to expand Medicaid, 15,600 died prematurely from 2014 to 2017, and it is likely that premature deaths are trending upward./6

To advance the goals of Medicaid and the ACA, it is also critical to prioritize the elimination of disparities in Medicaid funding for Puerto Rico and U.S. territories, provide access to Medicaid and the Children's Health Insurance Program (CHIP) to lawfully present immigrants without a five-ear waiting period, and grant access to Medicaid and marketplace coverage to Deferred Action for Childhood Arrivals (DACA) recipients. Specifically, we request that you work with HHS, so the agency will repeal 45 C.F.R. Sec. 152.2(8), which excludes DACA recipients from the definition of "lawfully present" and, consequently from benefits under the ACA. As a result of current regulations and guidance, DACA recipients cannot:

a) Obtain comprehensive health insurance under Medicaid or the Children's Health Insurance Program (CHIP) in most states;

b) Receive federal premium tax credits to make private health insurance affordable in the marketplace (even though DACA recipients still file and pay federal taxes); or

c) Purchase health insurance in the ACA's health insurance marketplace, even at full cost using their own funds;

Recovery legislation presents a unique, historic opportunity to close the gaps in coverage for the millions of people in the Medicaid coverage gap, people who rely on Medicaid in Puerto Rico and the territories, and DACA recipients. We must take advantage of this once - in -a - generation opportunity to bring affordable health care to all Americans. There are various ways to close these gaps and bring lifesaving coverage to millions of Americans--through enrollment in a public option plan offered in the marketplace as set forth in President Biden's campaign plan, a federally-administered Medicaid plan, through enrollment in marketplace plans adjusted to align with Medicaid for those in the 12 non-expansion states, by eliminating disparities in Medicaid funding for Puerto Rico and the territories, and by granting access to ACA benefits for DACA recipients. Regardless, coverage should be as similar as possible to Medicaid to ensure that people in the coverage gap can experience the robust, positive impact of Medicaid.

The coronavirus pandemic has only illuminated the far - reaching, fatal consequences of inadequate access to health care. Addressing the Medicaid coverage gap is critical both i n correcting decades of unacceptable and unjust denial of health care coverage to underserved and minority populations throughout the United States and in protecting our nation from future pandemics. Simply put, it is imperative that Congress and the Biden - Harris Administration enact policies to close the coverage gap to significantly reduce racial health disparities and ensure all Americans have access to basic health care. We look forward to working with you to reduce racial disparities associated with the coverage gap and finally realize the promise of the Affordable Care Act for all Americans, regardless of where they live.

See co-signers here: https://www.dropbox.com/sh/kci68orcrob34b9/AABts_W-T9L2CN8-GsJKvXjBa?dl=0&preview=Tri-Caucus+Letter+to+Close+Medicaid+Coverage+Gap.pdf

Footnotes:

1/ Rachel Garfield, Kendel Orgera , and Anthony Damico, "The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid," Kaiser Family Foundation, January 21, 2021, https://www.kff.org/medicaid/issue - brief/the - coverage - gap - uninsured - poor - adults - in - states - that - do - not - expand - medicaid/

2/ Judith Solomon, "Federal Action Needed to Close Medicaid 'Coverage Gap,' Extend Coverage to 2.2 Millio n People, Center on Budget and Policy Priorities, May 6, 2021, https://www.cbpp.org/research/health/federal - action - needed - to - close - medicaid - coverage - gap - extend - coverage - to - 22 - million

3/ Madeline Guth and Meghana Ammula, "Building on the Evidence Base: St udies on the Effects of Medicaid Expansion, February 2020 to March 2021," Kaiser Family Foundation, May 6, 2021, https://www.kff.org/medicaid/report/building - on - the - evidence - base - studies - on - the - effects - of - medicaid - expansion - february - 2020 - to - march - 2021/

4/ Medicaid Initiatives to Improve Maternal and Infant Health and Address Racial Disparities | KFF

5/ https://covid.cdc.gov/covid - data - tracker/#pregnant - population

6/ Sarah Miller, Norman Johnson, and Laura R. Wherry, "Medicaid and Mortality: New Evidence from Linked Survey and Administrativ e Data," National Bureau of Economic Research working paper, July 2019, https://www.nber.org/papers/w26081.