The rapidly approaching end of pandemic-related Medicaid coverage protections and growing GOP attacks on the program at the state and federal levels have left millions of vulnerable people worried about being thrown off their insurance—and potentially losing access to lifesaving care.
Beginning on the first day of April, states will be allowed to resume Medicaid eligibility screenings and disenrollments that have largely been paused during the coronavirus pandemic to ensure coverage stability.
As part of a government funding package passed in December, Democrats and Republicans in Congress agreed to begin unwinding so-called "continuous coverage" requirements for Medicaid recipients in April—though some provisions were included to help children maintain health coverage.
Estimates from outside analysts and the Biden administration indicate that the unwinding of coverage protections enacted in the early stages of the Covid-19 pandemic could throw upwards of 14 million people off Medicaid over the course of 12 months, which is how long states have to resume eligibility screenings.
Some Republican governors, such as Sarah Huckabee Sanders of Arkansas, are working to accelerate the screening process with the goal of booting as many people from the program as possible. The results could be disastrous: more than a third of Arkansas residents are on Medicaid.
Experts have warned that even people who are still qualified for the program could be kicked off in the coming weeks given the confusion and administrative barriers associated with income verifications and other eligibility tests that states typically require on an annual basis.
Alice Wong, founder of the Disability Visibility Project and a Medicaid recipient based in California, described the stress of the program's redetermination process in a column for Teen Vogue earlier this week.
Even though I've been through this process seemingly countless times, when that thick packet from the county comes in the mail, it still creates a pit of dread in my stomach. One small error can be disastrous, resulting in what's called 'churn,' the gap in coverage that can lead to delays in care while people re-enroll—or people can fall through the cracks altogether. Administrative and procedural barriers can also lead to someone being disenrolled, with low-income people and people of color disproportionately at higher risk due to structural inequities.
It is a lot of work to be poor and disabled. In a country where healthcare is not a right, the Medicaid redeterminations reinforce the precarious state of marginalized communities in relationship to the state. When I go through this process, I am angered as I think of all the people who need assistance trying to understand the form, collecting information, and physically completing it on time. The administrative burden, access barriers, and emotional toll it takes to jump through these hoops for survival is cruel and counterproductive.
"Medicaid expansion saves lives," Wong added. "But perhaps we should question whether we are considered human in the eyes of the GOP. If we don't fight back, the 'great unwinding' could become the great unraveling of the safety net as we know it."
In recent years, disability rights advocates and others have fought tirelessly—and often successfully—against Republican attacks on Medicaid, including efforts to repeal the Affordable Care Act and impose punitive work requirements.
But GOP lawmakers have signaled that they intend to continue targeting the popular program in the coming months, using the need to raise the debt ceiling as leverage to pursue steep spending cuts. Democrats, the minority in the House but retaining a narrow majority in the Senate, have vowed to oppose any proposal to diminish Medicaid.
"We're going to resist them completely," Rep. Frank Pallone, Jr. (D-N.J.) said earlier this month.
The Washington Postreported last month that congressional Republicans have been taking advice from right-wing ideologue Russ Vought, who served as budget director under the Trump administration.
One of the ideas Vought has privately pitched to GOP lawmakers is $2 trillion in cuts to Medicaid.
According toPolitico, some Republicans "want to revive a 2017 plan to phase out the enhanced federal match for Medicaid and cap spending for the program—an approach the Congressional Budget Office estimated would save $880 billion over 10 years and increase the number of uninsured people by 21 million."
"Many other Republicans are also pushing for Medicaid work requirements," the outlet added, "though the one state that implemented them saw thousands of people who should have qualified lose coverage."
As congressional Republicans and GOP-led states attempt to weaken the critical healthcare program, North Carolina lawmakers on Thursday granted final approval to legislation that would expand Medicaid, a step that could provide coverage to 600,000 residents.
The move, which brought to an end more than a decade of obstruction by state Republicans, came on the 13th anniversary of the Affordable Care Act.
"This is a victory for North Carolinians and a victory for the 600,000 individuals and their families who will now have access to lifesaving care," Brad Woodhouse, executive director of the advocacy group Protect Our Care, said in a statement. "Even as Republicans in Washington try to gut the Affordable Care Act and Medicaid, this bipartisan action shows what can happen in the states after years of gridlock because the people demanded it."