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Local governments would be able to bypass conservative heads of state and implement their own Medicaid expansion programs for the working poor in Texas with federal funds, under federal legislation announced by the U.S. representative on Monday. Lloyd Doggett, D-Austin.
Dubbed the “Cover Outstanding Vulnerable Vulnerable Expansion-Eligible Residents Now Act,” the legislation is a “homemade solution” to a decade of resistance from a handful of Red States to allow more people in financial difficulty to access the program. federal health care, said Doggett, chair of the House Ways and Means subcommittee and main sponsor of the bill, which has more than 40 cosponsors.
In Texas, that could represent as many as 1 million new eligible residents – mostly people of color – who currently fall into that gap because they cannot afford private health insurance and cannot claim benefits. grants, but earn too much to qualify for Medicaid.
Sponsors of the bill include all of Texas Congressional Democrats and most Democrats from 12 other states who have refused to extend Medicaid through the Affordable Care Act. This is the first time that local governments have been able to contract directly with the federal government for Medicaid funds.
“For many of our most disadvantaged citizens, this bill provides a pathway to a family doctor, necessary medication and other essential coverage that thirteen states continue to deny,” Doggett said in a statement. . “The COVER Now Act enables local leaders to ensure that obstructionists at the top can no longer harm those most at risk living below. “
The bill allows counties, cities and other political subdivisions to apply directly to the United States Centers for Medicare and Medicaid Services for funds that have been denied by their states, including Texas. States would be required to cooperate and allow access to state Medicaid systems for these entities, with incentives for cooperation and potential penalties for otherwise.
This equates to 100% federal funding for three years and 90% federal funding by year seven and beyond, Doggett said.
The bill will be tabled later on Monday, he said.Other proposals launched in Washington are to do the same as part of a federal program or to expand market access for low-income people, Doggett said.
“All of this has advantages and disadvantages,” he said.
An effort by a bipartisan coalition of state lawmakers to expand Medicaid during the last session of the Texas Legislature bogged down in conservative opposition and was never heard.
Opponents of extending Medicaid to around 1 million Texans who would qualify under the Affordable Care Act of 2010 argue that the program is poorly managed and financially unsustainable, and that the expansion encourages dependence on government, results in poor health outcomes and crowds out children and people with disabilities who need it most.
The new federal legislation would further burden a program that is already “a poorly performing program that leaves millions of low-income and disabled Americans without real access to quality care,” said David Balat, director of the Right on Initiative. Texas Public Healthcare. Policy Foundation, a conservative think tank.
Balat pointed to several measures that were passed by the Texas legislature this year, and championed by Tory leaders, which are “solid steps” to help the uninsured, would serve more people than would be covered by the expansion. of Medicaid and would not threaten funding. for other services like education and public safety, he said.
Some of these measures included programs that reduce the cost of certain prescription drugs, facilitate continuity of Medicaid coverage for children, require transparency in medical billing, expand the availability of telehealth and broadband services, and expand coverage. Medicaid coverage for new mothers; and increased insurance plan options through small businesses, farm associations, and associations, among others.
“Putting millions more into a struggling program will only further harm the current beneficiaries, mainly low-income women and children, the elderly and people with disabilities, and will do nothing to address the existing problems of access to health care, ”he said. “At the end of the day, this is just an effort by some counties and cities to access federal dollars without doing anything to help patients.”
A request for comment from Republican Gov. Greg Abbott, who has resisted calls to expand Medicaid, was not immediately answered Monday morning.
The death of state law left billions of dollars in federal incentives on the table that supporters say not only paid for expansion, but added money to state coffers. and reduced costs for hospitals that care for large numbers of uninsured patients.
“Lack of access to health care during COVID killed people. It killed people. It decimated their finances, it plunged people deeper into poverty. And we’re not talking about the poverty that doesn’t “Only has an immediate impact on the family at some point. I’m talking about generational poverty, and at the border, it’s the most chronic,” said US Representative Veronica Escobar, D-El Paso. “We have to stop hoping that they [state leaders] will open their hearts and get off the culture war train, and we must take care of our people.
Under Doggett’s proposed COVER Now Act, this money would be directly available to local governments through pilot programs approved by CMS without state involvement.
“Health care coverage is as vital to a community as education, roads or reliable food,” said Tom Banning, CEO of the Texas Academy of Family Physicians, which supports the proposed legislation. “Unfortunately, Texas has stubbornly refused federal help to expand Medicaid, leaving millions of our fellow Texans to get their health care by lining up at a free clinic, ignoring a treatable problem, or using the emergency room when it comes down to it. treatable worsens. It’s not just morally wrong, it’s economically stupid.
With more than 5 million of its residents without coverage, Texas has the highest number of uninsured residents in the country, many of whom are working adults who cannot afford private or subsidized insurance but are not eligible for Medicaid. because they earn too much.
About 20% of the state’s population has no health insurance – a number of health officials have risen since more than a million Texans lost their jobs and, in many cases, a health coverage due to the COVID-19 pandemic.
Some 4.2 million people benefit from Medicaid in Texas, including more than 3 million children. The other beneficiaries are people with disabilities, pregnant women and parents living below 14% of the federal poverty line, or about $ 300 per month for a family of four.
Adults without a disability or dependent children are not eligible for Medicaid, and the vast majority of children receiving Medicaid have parents who are not eligible.
The ACA allows states to extend this threshold to 138% of the poverty level, or $ 3,000 per month for a family of four.
In a University of Texas / Texas Tribune poll in April, 55% of voters in Texas said they supported the expansion of Medicaid, while 26% opposed it and 20% said they did not know. no or had no opinion. Two recent polls by other groups show that 70% of Texans support the expansion of Medicaid.
The prospect of Texas rulers pushing for expansion anytime soon is dim. None of the state’s top three Republicans have professed support, and their conservative base has resisted it since the US Supreme Court made it optional for the states in 2012; it was mandatory under the ACA until this provision was challenged in court.
It’s unclear how long the federal incentives will be available, supporters of the Medicaid expansion say, and there’s also the uncertain future of Waiver 1115, a temporary deal to reimburse hospitals for the costs of healthcare. uncompensated health. It was intended to help Texas move on to the Medicaid expansion before the state decides not to.
This waiver is expected to expire in 18 months if Texas fails to persuade federal health officials to extend it.
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