New tip sheet explains ‘partial Medicaid expansion’ – and why it hasn’t happened (yet)

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Map: Kaiser Family Foundation (as of Nov. 15, 2019)

Since the Supreme Court ruling in 2012, states have been warring over whether or not to expand Medicaid.

Now, some states want to pursue a “partial” expansion – under the same generous federal funding rules. So far, no state has been able to do this – but they are trying.

In a new tip sheet, Rachana Pradhan – who had been covering Medicaid deeply at Politico and has moved to Kaiser Health News – explains what you need to know about partial expansion. Politically, it’s a way for conservative states to cover more people with more federal dollars without fully adopting “Obamacare.”   Generally they’d cover people up to the poverty line – while the Affordable Care Act envisioned Medicaid coverage up to 138 percent of the federal poverty line. The states would put people in the 100-138 percent income bracket in the ACA exchanges – where subsidies are fully federally funded, with no state matching contributions.

Rachana Pradhan

Rachana Pradhan

She also notes that both the Obama and Trump administrations have rejected partial expansions but for different reasons. “Democrats shunned partial expansions because they wanted states to fully expand their programs as the ACA intended,” she writes. “The Trump administration has rejected partial expansions because it creates the appearance of a broader state acceptance of the ACA.”

Read more about the policy, the politics, the funding – and the impact on the uninsured – in her tip sheet.

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