GOP lawmakers fear Medicaid expansion is straining system

Republicans on the House Energy and Commerce Committee sent letters to Medicaid directors in all 50 states and the District of Columbia on Monday seeking information about the program’s expansion under ObamaCare.

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The letters, signed by committee Chairman Fred Upton (R-Mich.) and Reps. Joe Pitts (R-Pa.) and Tim Murphy (R-Pa.), says Medicaid recipients have experienced increased waiting times to see their doctors in recent years, and argue that those problems are likely to worsen under the Affordable Care Act.

“As scarce resources become even further divided, the most vulnerable Americans could face significant delay in accessing key services and treatments,” the letter reads in part.

The lawmakers also said they were worried that “the program’s existing financial troubles will be exacerbated by the program’s growth.”

Under the Affordable Care Act, the federal government will pay the full cost for a Medicaid expansion that will extend eligibility to those earning less than 138 percent of the federal poverty level for three years. The federal funding drops to 90 percent in the fourth year, requiring the states to pick up the additional 10 percent.

However, the federal dollars can only be used to pay for people who are newly eligible for the subsidized healthcare.

“Expanding the program based on an expectation that the enhanced federal match will alleviate existing financial burdens is misleading to both taxpayers and the millions of Medicaid enrollees who depend on the program today,” the letters say.

“Every state dollar used to cover the costs of a newly eligible enrollee is a dollar that could have been applied to help reduce waiting lists for Medicaid eligible individuals, or improve care for those who already depend on your state’s programs today.”

The Medicaid expansion has been one of the bright spots for ObamaCare so far. The Centers for Medicare and Medicaid Services (CMS) has said Medicaid applications have jumped more than 15 percent over prior months in states that chose to expand the program.



More than 1.46 million people were determined eligible for Medicaid or the Children's Health Insurance Program through state-based agencies and marketplaces in October, the agency said.

Pitts said in a statement that “the president may claim his law is a success for the Medicaid program, but giving Americans coverage without adequate access to doctors is a failure.”

Twenty-five states and the District of Columbia have so far opted into the expanded Medicaid program. But the other 25 states, mostly run by Republican governors or legislatures, have said they would not move forward on the expansion at this time.

Many conservative lawmakers facing reelection or seeking higher office fear there will be blowback from Republican voters, if they accept federal dollars associated with President Obama’s healthcare law. Some conservative governors also argue that the expansion would sink their state budgets.



Democrats have painted governors in those states as unwilling to offer cheap healthcare coverage to low-income residents, noting that the expansion is mostly federally funded.



The Supreme Court ruled last year that the federal government couldn’t force states to participate in the expansion.
 
The Obama administration has said it’s open to working with state Republicans on workarounds for aspects of the Affordable Care Act that they might not be comfortable with.

CMS spokesman Aaron Albright told The Hill in an email that states declining to participate in the Medicaid expansion are the ones responsible for impeding access to healthcare.

“There is a simple solution to dramatically improve access to medical care for millions more uninsured Americans; by expanding Medicaid in the remaining states that have not done so,” he said. “We appreciate the committee’s interest in this issue and hope they will join us in the efforts to extend coverage to an additional 5.4 million Americans who would gain coverage if all states expanded Medicaid.”

— This post was updated at 4:52 p.m.