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The Supreme Court ruled in 2012 that Medicaid expansion was optional, but 38 states and Washington, D.C., have capitalized on significant federal financial incentives and expanded their programs. Now, with the end of the public health emergency looming, advocates in the remaining states argue that expansion is a moral imperative with significant financial incentives.
“There are going to be a lot of low-income folks in the coverage gap after the public health emergency ends,” said Jane Adams, campaign director at the Cover Alabama Coalition, a group advocating for expansion in Alabama. “And it doesn’t have to be this way… It’s just bad governance not to expand.”
Opposition remains stiff.
“It’s about the state having autonomy over its money,” said Justin Bogie, senior director of fiscal policy at the Alabama Policy Institute, a conservative Birmingham-based think tank that opposes expansion. “It’s really the federalism principle – having that division of power, letting states choose how they allocate their resources without strings attached.”
The scope of loss
It’s not immediately clear when the unwinding will begin, though it could be as soon as mid-January. The Biden administration has promised to give 60 days notice before ending the public health emergency, which means they would likely alert the public by mid-November about their plans. Worries about a winter COVID-19 surge could spur the administration to renew the public health emergency.
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