HEALTH CARE BRIEFING: Medicaid Expansion Push Gains New Momentum

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Billions of dollars in new incentives to boost Medicaid programs are re-energizing advocates in the dozen U.S. states that have turned down the federal assistance so far—and potentially aiding Democrats in future elections.

Republican-controlled legislatures or governors in 12 states declined to take advantage of the 2010 Affordable Care Act’s broadening of Medicaid. Now, Medicaid expansion advocates have something new to offer: extra money from Washington.

“For so many years it’s kind of felt like banging your head against the wall,” Hyun Namkoong, a policy advocate for the North Carolina Justice Center, a group pushing to expand Medicaid, said. “This is changing that feeling.”

Democrats who’ve pushed for expanding Medicaid in Republican-controlled states may also benefit if voters see this offer as too good to pass up. The federal-state health insurance for low-income people traditionally focused on children, pregnant women, seniors, and people with disabilities. Obamacare had allowed states to expand eligibility to adults earning up to 138% of the poverty level.

The sweeping $1.9 trillion Covid-19 relief package (Public Law 117-2) enacted earlier this month boosted the federal government’s share of Medicaid costs in states that newly expand their public health insurance. Millions of Americans could gain health insurance coverage if all the holdout states grow their Medicaid programs, President Joe Biden said.

Under the ACA, the federal government pays 90% of expansion costs, a share that’s gradually fallen since states began building on the program. The new law offers a two-year increase in the federal government’s portion for traditional Medicaid, the larger section of the program. Read more from Alex Ruoff.

Division on Medicaid Work Rules Seen on High Court: Also in Medicaid policy, the Supreme Court canceled plans to hear arguments on work requirements for Medicaid beneficiaries, but it didn’t dump the cases entirely, signaling that the court may be divided over what to do with the dispute. The parties in the case are waiting for justices to rule on an unusual request from Biden’s White House. The Justice Department asked the court to toss two lower court verdicts invalidating work rules in Arkansas and New Hampshire. Lydia Wheeler has more.

  • That move comes as Biden’s Health and Human Services Department actively works to withdraw those proposals. HHS yesterday took its first formal step towards rolling back work requirements in Medicaid, telling Arkansas and New Hampshire that it’s revoking the must-work provisions approved under Trump. Christopher Brown has more.

House to Vote on Waiver for Medicare Cuts

House lawmakers plan to vote today on a measure that would waive a requirement for $36 billion in cuts to Medicare in 2022, a bill that hasn’t garnered support from Republicans, who blame Democrats for spending too much in their $1.9 trillion stimulus.

The bill (H.R. 1868) would waive the need for automatic spending cuts known as sequestration, triggered under statutory “pay-as-you-go” requirements because Democrats didn’t offset the cost of their stimulus bill. No Republicans joined Democrats in voting in favor of the rule for consideration of the bill to waive those cuts, a motion that was approved 216-204 on Tuesday.

Many bills are subject to a “PAYGO” requirement under the Statutory Pay as You Go Act of 2010, which requires that legislation be offset with revenue increases or spending cuts, or else enactment would trigger automatic cuts to mandatory programs. Medicare cuts, the largest sequestration requirement, would be limited to $36 billion in 2022, according to the Congressional Budget Office. Lawmakers have frequently waived the need for those cuts, but not without tense political maneuvering, because a waiver would require 60 votes in the Senate.

Republicans have said they don’t want to allow the cuts to take place, but they’ve opposed this measure. Rep. Jeff Duncan (R-S.C.) offered an amendment that would have waived the sequestration requirement, but also rescinded $494 billion in funds from the stimulus. Democrats rejected that measure, imposing a closed rule for consideration without any amendment votes on the floor.

“While Republicans and Democrats alike agree that it’s important to ensure cuts to mandatory spending like Medicare do not take place, it’s disappointing Democrats have chosen not to work with Republicans in putting together a bipartisan bill,” Rep. Tom Cole (R-Okla.) said at a House Rules Committee meeting on Tuesday, Jack Fitzpatrick reports.

BGOV Bill Summary: H.R. 1868, Medicare PAYGO Waiver

Also Happening on the Hill

Nomination Schedule: Senate Majority Leader Chuck Schumer (D-N.Y.) yesterday filed cloture on the next tier of nominees after Cabinet nominations, Nancy Ognanovich reports. The Senate is expected to vote on the nominees in the order of the cloture filings, likely beginning next week:

  • Shalanda Young to be deputy director of the White House Office of Management and Budget;
  • Vivek H. Murthy to be surgeon general of the Public Health Service;
  • Rachel Levine to be an assistant secretary at Health and Human Services;

Walensky Pressed to Change School Guidelines: Senate Republicans grilled health leaders, particularly CDC Director Rochelle Walensky, to change agency guidelines and make it easier for America’s schools to reopen during a Health, Education, Labor and Pensions Committee hearing yesterday. “When we discussed this issue recently, I really detected a lack of a sense of urgency on your part to reopen schools,” said Sen. Collins, adding that guidance from the CDC to space desks six feet apart have been at odds with recommendations from groups like the American Academy of Pediatrics.

A Massachusetts study found three feet was adequate distance if everyone wore masks, and Walensky said her agency is actively looking to update the guidance as more studies publish. “Our guidance was intended to lean in,” so that schools that have been shut can implement the necessary mitigation strategies needed to reopen,” Walensky said.

Ranking member Richard Burr (R-N.C.) called for clearer CDC guidance in general. “The guidance documents coming out of the CDC have been two steps behind the data. All that I’m asking is for the CDC’s communication to be fast and transparent. Tell the American people what we know, when we know it, and when we don’t, so that they can make the best decisions for themselves and their families,” he said, Jeannie Baumann reports.

Democrats Pressed on Drug Pricing in Reconciliation: Lower Drug Prices Now—a customer advocacy group fighting high prescription drug prices—urged Speaker Nancy Pelosi (D-Calif.) and Schumer in a letter to pass a stronger version of H.R. 3 “to make prescription drugs more affordable and hold the pharmaceutical industry accountable for price gouging and pandemic profiteering.” Read the letter here.

Panel Probes Trump-Era N95 Awards: House Select Subcommittee on the Coronavirus Crisis Chair James Clyburn (D-S.C.) sent a letter to counsel for Robert S. Stewart, CEO of Federal Government Experts, to inquire about a”failed $35 million contract” to provide N95 masks to the Veterans Affairs Department during the Trump administration, according to a statement. The contract was canceled after the company failed to deliver any N95s, he added. The probe signals that House Democrats aren’t dropping investigations of coronavirus contracts struck during Trump’s presidency. Read the letter here.

Banking Access for Pot Business Sought: Rep. Ed Perlmutter (D-Colo.) introduced a bipartisan bill granting marijuana-related businesses in states with some forms of cannabis legalization and strict regulations access to the banking system, according to a statement. His measure has garnered bipartisan support, with Ohio Republican Reps. Steve Stivers and Warren Davidson named as co-sponsors, Peyton Forte reports.

Ways and Means To Examine Private Equity: The House Ways and Means Oversight Subcommittee announced a March 25 hearing to look at private equity’s role in heath care, which will likely touch on health prices and surprise billing practices, Alex Ruoff reports.

The Coronavirus Pandemic

Biden Marks 100 Million Shots: President Joe Biden announced that today, the U.S. will clinch his goal of administering 100 million Covid-19 vaccine shots in the first 100 days of his presidency, hitting the milestone six weeks ahead of time. The U.S. recorded 2.7 million more doses yesterday, pushing the cumulative total to 115.7 million shots injected, according to the CDC. As of data reported on Jan. 20, the U.S. had given roughly 16.5 million doses. Read more from Josh Wingrove and Nancy Cook have more.

Dozen States Throw Open Vaccine Eligibility Ahead of May 1: A dozen U.S. states are expanding access to Covid-19 vaccinations earlier than planned for every adult, accelerating the biggest such campaign in the country’s history and making long strides toward Biden’s May 1 deadline for eligibility. Read more from Jill Shah.

Biden to Send AstraZeneca Doses to Mexico, Canada: Biden’s administration plans to send around 4 million doses of AstraZeneca’s Covid-19 vaccine to Mexico and Canada, White House Press Secretary Jen Psaki said. The deal emerged alongside an announcement by Mexico that it will crack down on the flow of migrants across the U.S. border. The export plan is still under assessment, Psaki said, and would see the U.S. send Mexico 2.5 million doses and Canada 1.5 million doses. Read more from Josh Wingrove.

  • The European Union’s medicines regulator said AstraZeneca’s vaccine is safe to use, but warned it can’t rule out a link with blood clots in a review that may perpetuate confusion over the shot’s perceived safety. At a briefing yesterday, the European Medicines Agency emphasized repeatedly the vaccine is “safe and effective,” and the benefits outweigh the risks. Read more from Suzi Ring and Marthe Fourcade.

Elderly Face Higher Risk of Reinfection: Older people are more at risk of catching Covid-19 again after recovering from a previous bout of the disease, new research shows. While most people are unlikely to be infected again for at least six months, older people are more prone to reinfection, according to the study published yesterday in the Lancet medical journal. The Danish study showed that those under 65 who had Covid-19 were about 80% protected from getting it again, but only 47% for those 65 and older. Read more from Anne Pollak.

Biden Eyes Relaxing Travel Limits: The Biden administration is looking at the middle of May to start to relax Covid-19 restrictions on travel with Mexico, Canada, and inbound travel from the U.K., Europe, and Brazil, CNBC reports, citing two sources familiar with the matter. There is no policy memo or any formal codification of that time frame, and the White House did not respond to requests for comment, CNBC added. Read more.

Democrats Want Prison Employees Vaccinated: Democrats on the House Appropriations Financial Services Subcommittee are frustrated and confused by the low rate of vaccinations among Federal Bureau of Prisons employees, members said yesterday, Jack Fitzpatrick reports.

All employees have been offered a vaccine, but only 49% have gotten one, bureau Director Michael Carvajal, who was appointed by the Trump administration, told the panel yesterday. Reps. Charlie Crist (D-Fla.), Ed Case (D-Hawaii), and Dutch Ruppersberger (D-Md.) pressed Carbajal for an explanation. “It is a public health matter that so many declined to take it,” Case said. “Something’s wrong there.”

Carvajal said he can’t require employees to get the vaccine because it’s approved under an emergency-use authorization by the Food and Drug Administration, rather than a full approval. Carvajal cited the bureau’s lawyers on the issue, but added, “I don’t fully understand it myself.”

More Headlines:

What Else to Know Today

Becerra Confirmed, Taking Lead Role Facing ACA: Xavier Becerra will become the public face of the administration’s health agenda after the White House and fellow Democrats spent two months putting Biden’s stamp on the country’s coronavirus response without him. The Senate confirmed him as Health and Human Services Secretary on a 50-49 vote yesterday. Becerra joins the HHS less than a week after Biden signed legislation to expand the Affordable Care Act for the first time, and now those provisions are largely up to HHS to implement.

The administration meanwhile has held almost-daily briefings with key members of the Covid-19 response team. Becerra will have a role in that effort, though what form it takes will evolve over time. Those two factors make it clear Becerra will be a central player in the White House and focal point for his opponents. He was confirmed with the support of only one Republican, Sen. Susan Collins (Maine). Read more from Alex Ruoff, Shira Stein, and Jacquie Lee.

LGBTQ Groups Oppose Delay of Health Anti-Bias Case: Groups representing LGBTQ people are asking a federal court in Massachusetts to deny a government agency’s request to delay a lawsuit opposing changes the Trump administration made to a regulation intended to protect their members from discrimination in health-care services. Granting HHS an open-ended stay will let provisions of the “rollback rule” that have not been blocked by other courts take effect, potentially exposing LGBT people to bias, groups told the U.S. District Court for the District of Massachusetts. Read more from Mary Anne Pazanowski.

HHS Delays Trump-Era Drug Rebate Rule: The HHS yesterday delayed until 2023 a Trump administration rule that would have changed payments from drug companies to pharmacy middlemen. The HHS delay follows a court order that also holds litigation about the rule in abeyance pending a review by the department. A pharmacy liaison group had claimed that the changes would significantly disrupt negotiations with drugmakers. Jacquie Lee and Ian Lopez have more.

More Headlines:

With assistance from Jeannie Baumann, Brianna Jackson, and Nancy Ognanovich

To contact the reporter on this story: Brandon Lee in Washington at

To contact the editors responsible for this story: Zachary Sherwood at; Giuseppe Macri at; Michaela Ross at

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