House Speaker Nancy Pelosi suggested that Congress should require states to expand Medicaid to the poor under Obamacare, a mandate that was part of the law before the Supreme Court declared it unconstitutional.
Pelosi made the comments during a town hall on MSNBC Friday after an attendee asked her how Democrats in the House will work to fix the healthcare law, formally known as the Affordable Care Act.
Pelosi told attendees that she would work toward “strengthening the law so that it is required that states will have — expand Medicaid, very, very important.”
Asked to explain the remarks, a senior aide to Pelosi told the Washington Examiner that House Democrats were “looking at a variety of ways to push more states to adopt the Medicaid expansion.”
Obamacare was originally written to have all states expand Medicaid to low-income people making less than roughly $17,000 a year and would have cut off all Medicaid funding from states that didn’t go along with the rule. A 7-2 Supreme Court decision in 2012 made the provision optional, however, and so just over a dozen states haven’t moved to expand.
Congress may consider passing a law to require the federal government, and not states, to pay for the entire cost of expansion.
Under current law, the federal government paid for the full cost of expansion when it first happened in 2014, but will gradually reduce its contribution to 90 percent by 2020, leaving states on the hook to pick up the rest of the costs. In some states, this will lead to billions of dollars in spending, and most states are taxing hospitals and insurers to make up the difference.
Before Obamacare, states varied on who qualified for the program, which is paid for by the government. Generally, however, the program covered pregnant women, people with disabilities, and children. Republicans have opposed Medicaid expansion based on income because they say the most vulnerable groups should remain the sole focus of the program, while Democrats have said low-income people should also qualify because they would otherwise go uninsured and get sicker.
The people that were covered under Medicaid before are still getting coverage under Obamacare, but states pay a larger share, of about 40 percent of costs, for that group.
Pelosi was key to passing the Affordable Care Act when she was House speaker in 2010. She has been sharing ways she would change the law now that she has sworn in as speaker again. On MSNBC, she said she would replace Obamacare’s fine on the uninsured, known as the individual mandate, that was struck down as part of the Republican tax law, and that she would allow more people to receive federal subsidies so they don’t pay as much of their income toward health insurance.
CORRECTION: In a previous version of this story, the Washington Examiner stated that a related Supreme Court case in 2012 made a provision optional in a 7-3 decision, when in reality, the provision was made optional in a 7-2 decision. The Washington Examiner regrets the error.
