By skyforbes Should the five territories be subject to maximum Medicaid funding levels, when the states aren’t?
Context
In American Samoa, an infant with cerebral palsy died several weeks after the U.S. territory decided they couldn’t afford to pay for Medicaid treatment. That would have been far less likely in any U.S. state because Medicaid, the government-funded health care program for low income Americans, is funded differently in the five U.S. territories than in the 50 states.
For the states, the federal government lists no pre-set funding cap. Any individual can qualify for Medicaid, if their income is low enough in a certain year. No matter how much Medicaid money a state spends, the federal government will match a certain percentage, varying by the state — from a low of 50.0% in 13 states to a high of 77.7% in Mississippi.
In the territories, though, federal Medicaid funding is capped and annually adjusted for inflation, no matter how much Medicaid need a territory actually has. That funding level is not enough to cover the territories’ Medicaid expenses.
While the territories are also eligible for more federal Medicaid dollars through other sources, primarily the Affordable Care Act (Obamacare), it doesn’t change the fact that the Medicaid funding cap only exists for U.S. territories and not states.
With the territories’ combined population more than 3 million, this gap has been little-noticed in the mainland U.S. But a combination of the covid-19 pandemic and plunging American incomes means the Medicaid rolls are likely about to swell.
What the bill does
The Insular Area Medicaid Parity Act would remove the Medicaid funding caps for the five U.S. territories: Puerto Rico, Guam, Northern Mariana Islands, Virgin Islands, and American Samoa.
It was introduced in the House on April 14 as bill number H.R. 6495, by Rep. Gregorio Sablan (D-MP0), who represents the U.S. territory Northern Mariana Islands in a limited-voting capacity.
What supporters say
Supporters argue the bill creates a parity that could save lives, and is just a matter of basic fairness under any circumstances but particularly given the current covid-19 situation.
“The coronavirus pandemic is exposing the gaps in our national healthcare system like never before,” Rep. Sablan said in a press release. “One of those gaps is that our national Medicaid program does not reach all Americans with full coverage.”
“No matter how many fall ill, no matter how costly or prolonged their treatment, that cap will always limit care in the territories,” Rep. Sablan continued. “Now, as never before, we have to understand that, while some areas of our nation are ill, no area of our nation can be well.”
GovTrack Insider was unable to locate any explicit statements of opposition, but many Republicans oppose increased Medicaid funding at any level, whether a state or a territory. President Trump’s proposed 2020 budget would cut about $1 trillion from Medicaid and the Affordable Care Act over the next decade.
Odds of passage
The bill has attracted 15 bipartisan cosponsors: 14 Democrats and one Republican, Rep. Aumua Amata of American Samoa. The bill has not attracted any Republican cosponsors from the U.S. mainland.
It awaits a potential vote in the House Energy and Commerce Committee. While the relatively partisan cosponsorship implies low odds of passage in the Republican-controlled chamber, you never know. A March law, the Families First Coronavirus Response Act, contained a provision raising the federal percentage for funding Medicaid in every state… and every territory.
This article was written by GovTrack Insider staff writer Jesse Rifkin.
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