There’s been lots of buzz about President Joe Biden’s health care plan and which proposals he’s going to make a priority. But almost nobody is talking publicly about an idea that could do a ton of good: Getting health insurance for the low-income people who are part of what’s come to be known as the “Medicaid gap.”
According to estimates, there are about 4 million of these Americans ― many of them food servers or retail clerks, parts of the child care workforce, or, in some cases, among the ranks of the unemployed. And they were supposed to have health insurance already, thanks to the Affordable Care Act, which gave states extra funding to cover them through Medicaid.
But it hasn’t worked out that way in roughly a dozen states, all places where Republican officials have refused to take the federal money. Those states still have their older Medicaid eligibility guidelines, which restrict enrollment to narrower population groups. With little reason to think GOP officials in these states will change their minds, it’s up to Democrats in Washington to develop an alternative.
A way of insuring these 4 million people through some kind of new federal initiative. A few proposals are already under discussion. And Biden seems interested. He talked about addressing the Medicaid gap during the presidential campaign. On a conference call Tuesday, previewing his new economic plan and address to Congress, a senior administration official alluded to “expanding coverage to those places in the country that have coverage gaps.”
But during the speech itself on Tuesday, Biden included no such references. And although Democrats on Capitol Hill have been agitating on behalf of other health care proposals, like adding benefits to Medicare or making permanent some other, temporary improvements to the Affordable Care Act, none are making a public fuss about policies to close the Medicaid gap. That could be a problem. Nobody in the Democratic Party seems to be against addressing the Medicaid gap. But the feasible policy solutions are expensive, with complex politics, which means they won’t find their way into legislation without vocal champions.