Doggett: E&C, W&M Working On Different Ways To Fix Medicaid Gap

Inside Health Policy

July 15, 2021 12:03 pm

The House Ways & Means Committee is looking at a proposal to close the so-called Medicaid gap by expanding premium tax subsidies so that those affected could buy an exchange plan, according to health subcommittee Chair Lloyd Doggett (D-TX), but he said the House Energy & Commerce Committee is drafting a plan to close the gap through a new federal Medicaid-like program.

The work comes as congressional leaders lay plans to tackle the Medicaid gap issue as part of Democrats’ upcoming reconciliation package.

Both approaches have advantages and disadvantages, Doggett said during a webinar hosted by the Southerners for Medicaid Expansion coalition Wednesday (July 14). The purported Energy & Commerce proposal would provide more comprehensive coverage and benefits than exchange plans, but it would take time to set up. The Ways & Means proposal could be established quickly but there are questions about how to deal with deductibles and co-pays with exchange plans, the congressman said.

Doggett, who has also introduced a bill that would let local governments expand Medicaid themselves in non-expansion states, said he wouldn’t disparage either approach. But he added that he doesn’t want to see a temporary fix or a solution that switches people between the marketplace and Medicaid.

“That is a false hope and confusion for disadvantaged people that will just mean that they don’t get what they deserve after more than a decade of waiting,” he said.

A spokesperson for Ways & Means did not directly answer questions about the details of the proposal Ways & Means is crafting, but said the committee is working with others, as well as congressional leadership, and details are still being worked out. The spokesperson said the committee wants to find a comprehensive solution that can be implemented quickly.

An Energy & Commerce spokesperson did not respond to questions about Doggett’s assessment of the committee’s plan.

Several Democratic lawmakers, including House Majority Whip Jim Clyburn (D-SC), have said getting these people coverage is a priority in the upcoming reconciliation package, likely to be voted on this fall. Sen. Raphael Warnock (D-GA) already introduced a bill Monday (July 12) that takes the route Energy & Commerce is reported to be exploring by directing CMS to create a federal Medicaid look-alike program available in the states that have not yet expanded Medicaid to people making up to 138% of the federal poverty level.

Senate Majority Leader Chuck Schumer (D-NY) told Inside Health Policy Wednesday morning there is space for legislation to close the so-called Medicaid coverage gap in the $3.5 trillion budget resolution presented Tuesday night (July 13), which provides a framework for the reconciliation package. House Speaker Nancy Pelosi (D-CA) reaffirmed this in a letter sent to House members about the budget deal Wednesday.

Schumer did not give details on how much money could be devoted to closing the Medicaid coverage gap, but a senior Democratic aide said the deal will be offset in part by drug pricing reforms, including a repeal of the Trump administration’s rebate rule.

A press release for Warnock’s bill said the plan requires no additional offsets, since Congress already appropriated funding for Medicaid expansion in the Affordable Care Act. But Doggett disagrees.

“The notion that we already paid for it is not going to work with the Congressional Budget Office,” Doggett said. “We haven’t already paid for it, and in fact, most of the pay-fors for the Affordable Care Act have been subsequently repealed by Congress.”

The Urban Institute put out a report on June 30 estimating how much it would cost to expand eligibility for premium tax credits for exchange plans to people making below 100% of the federal poverty level.

This kind of expansion, using the ACA’s subsidy schedule from before the American Rescue Plan enhancement of the subsidies, would cost the federal government an estimated $181 billion over 10 years. Enhancing all subsidies to match the ARP would cost $270 billion over 10 years, and enhancing premium and cost-sharing subsidies would cost $335 billion over 10 years, the report says.

A follow-up report published Wednesday from some of the same researchers found that a public option that pays providers at Medicare rates and is offered in the exchanges to people in the Medicaid coverage gap would cost the federal government less than using exchange benchmarks. — Maya Goldman