Medicaid Enrollment Surges to New High

Medicaid Enrollment Surges to New High

Printer-friendly version
Plus, is this finally infrastructure week?
Monday, June 21, 2021

Medicaid Enrollment Surges to New Record Amid Pandemic

A record high of nearly 74 million people were enrolled in Medicaid at the beginning of 2021, the Centers for Medicare and Medicaid Services announced Monday. Including minors enrolled in the Children’s Health Insurance Program, which covers children in families who earn too much to qualify for Medicaid, the total comes to more than 80 million.

Medicaid participation increased sharply as the coronavirus pandemic hit, CMS said, jumping by 9.7 million between February 2020, the month before a public health emergency was declared, and January 2021.

The agency said that a rule change adopted by Congress early in the crisis played a major role in the increase. The Families First Coronavirus Response Act, passed in March 2020, gave states a temporary 6.2% increase in Medicaid funding to cover the expected surge in health care costs, on the condition that they not remove anyone from the rolls until the pandemic is over.

“The increase we are seeing is exactly how Medicaid works: the program steps in to support people and their families when times are tough,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “For the parents that may have lost a job or had another life change during the pandemic, having access to coverage for themselves and their kids is life-changing.”

A change in focus: The increase reversed a trend of declining enrollment in Medicaid, which had been driven in part by the former Trump administration’s efforts to impose new restrictions on participation, The New York Times’s Sarah Kliff notes.

By contrast, says Amy Goldstein of The Washington Post, the Biden administration has focused on expanding federally funded health care, both through Medicaid and the Affordable Care Act. The White House has said that it plans to keep the public health emergency in place at least until the end of the year, which experts will likely keep the enrollment numbers at or near record highs.

The Biden administration is also trying to entice the dozen states that have refused to expand their Medicaid programs as allowed under the Affordable Care Act, to change their minds. The American Rescue Plan, passed in March 2021, includes more generous federal subsidies to cover the state portion of Medicaid costs. So far, though, there are few signs that officials in the non-expansion states are moving toward Medicaid expansion.

Is This, Finally, Infrastructure Week?

This really, finally, could be infrastructure week on Capitol Hill. Or not. The bipartisan group of 21 senators hammering out an infrastructure deal is reportedly hoping to finalize its plan this week. A four-page outline of the proposal is reportedly circulating. But the roughly $1 trillion plan, including $579 billion in new spending, is still being tweaked, with senators reportedly set to meet again Monday night.

"We're continuing to work and flesh it out," said Sen. Susan Collins (R-ME), according to Politico. "There's a sense of growing optimism, that perhaps we can show our country and the world that we can come together on something that makes a real difference in people's lives."

Some details of the bipartisan deal:
Politico reports that, as of now, the bipartisan blueprint includes “$360 billion for roads, bridges and major projects; $48.5 billion for public transit; $66 billion for rail; $55 billion for water infrastructure; $65 billion for broadband and $73 billion for power infrastructure. In addition, the group is proposing spending $47.2 billion on climate resiliency, $25 billion for airports, $10 billion on electric buses and $16 billion for ports.” Of the $360 billion for road and bridges, $110 billion would be new spending.

Pay-fors still a problem:
As is always the case with infrastructure proposals, though, any optimism is clouded by questions about how to pay for new spending. “We’re making progress, particularly on key investments that we need to build out our nation’s infrastructure and prepare for the clean energy economy that is coming,” National Economic Council Director Brian Deese told CNN on Monday. “We still have some sticking points, particularly around how we pay for this.”

White House Press Secretary Jen Psaki told “CBS This Morning” that the administration still needs to see “a few more details” about the plan, “including specifics about how to pay for it.” She added that Biden would not accept an increase in the gas tax, which the White House says would violate Biden’s pledge not to raise taxes on people making less than $400,000 a year. “We’re just not going to stand for that and we’re not going to accept that,” she said.

The White House has also opposed proposals to re-purpose unspent Covid-19 relief funds and a fee on electric vehicles.

Psaki said that Biden would probably be speaking with and hosting some lawmakers at the White House over the next couple of days. At the same time, administration officials emphasized that Biden, while open to continuing discussions about the bipartisan deal, was also pursuing other paths to an infrastructure package.

Congressional Democrats are pressing ahead with a broader package that could be passed by the special budget reconciliation package, meaning it would not necessarily require Republican votes. That package may total as much as $6 trillion, including Biden’s plans for child care, elder care and education, along with a reduction in the Medicare eligibility age to 60 and an expansion of the health care program’s benefits to include vision, hearing and dental services (see more on this below). But getting the necessary Democratic votes to pass such a package will likely be complicated as well.

The bottom line:
Sen. Lindsey Graham (R-SC) said Sunday that a $1 trillion infrastructure deal is “there for the taking,” but the issue of pay-fors could scuttle any deal. Sen. Shelley Moore Capito (R-WV), who negotiated over a separate infrastructure deal with Biden, said Monday that Biden ”really wants the bipartisan deal” but suggested that financing any package will remain a problem. “Pay-fors will be the big issue. As it was with me,” Capito said, according to Politico. And the congressional July 4 recess is rapidly approaching, leaving little time for a compromise to be reached.

Isaac Boltansky, director of policy research at investment bank Compass Point, isn’t buying the optimism: “The bipartisan effort will drive headlines in Washington this week,” he said, according to Politico, “but we remain bearish given the lack of detail, progressive reticence, and persistent divides over both scale and scope.”

Quote of the Day

“The bottom line here is that no matter how all this plays out, and I’m referring to a bipartisan bill versus a reconciliation process, a whole lot of Democratic priorities are going to be left on the cutting room floor. The question is how the left responds.”

– Jim Manley, a strategist and former Senate Democratic leadership aide, as quoted at The Hill in a piece looking at tension between President Biden and the progressive wing of the Democratic Party over the infrastructure package.

Schumer Says He Backs Broader Medicare Coverage

Senate Majority Leader Chuck Schumer (D-NY) said Sunday that he supports an effort led by Sen. Bernie Sanders (I-VT) to expand Medicare coverage to include a more robust set of services.

“There is a gaping hole in Medicare that leaves out dental, vision, and hearing coverage. This is a serious problem,” Schumer tweeted. “I’m working with @SenSanders to push to include dental, vision, and hearing Medicare coverage in the American Jobs and Families Plans.”

A handful of Democratic lawmakers are trying to include an expansion of Medicare coverage in the still-developing infrastructure bill. Schumer told the New York Daily News that doing so will be an “uphill legislative effort.”

Send your feedback to Follow us on Twitter: @yuvalrosenberg, @mdrainey and @TheFiscalTimes. And please tell your friends they can sign up here for their own copy of this newsletter.

Views and Analysis