Jones Introduces Bill Requiring Reports on Money Forfeited When States Bypassed Medicaid Expansion

Doug Jones

Sen. Doug Jones, D-Alabama, has introduced a bill that would require a federal agency to show how much states such as Alabama have left on the table by refusing to expand Medicaid.

The Smart Choices Act would mandate that the Medicaid and CHIP Payment and Access Commission, or MACPAC, annually publish reports showing how much states receive under expanded Medicaid. In particular, the reports would show how much the states that refused expansion under the Affordable Care Act would have gotten if they had joined the program.

The bill has five co-sponsors — four Democrats and an independent. Although Jones in his weekly telephone press conference Thursday called the bill a bipartisan effort, he admitted that no Republicans had expressed support so far and that it faces an uphill battle to be considered by the full Senate.

“It’s up to Majority Leader Mitch McConnell (R-Kentucky). He has control over what makes it to the floor,” Jones said.

Medicaid expansion originally was mandatory for all states under the ACA. But opponents filed a lawsuit to block that part of the law, and the U.S. Supreme Court ruled in 2012 that states could opt out of the requirement. In doing so, those states left federal funds on the table. The program initially paid 100 percent of the expansion costs but reduced that percentage on a sliding scale over time.

Twenty-seven states expanded their Medicaid coverage through the ACA, and seven others did so with alternative plans. That left 17 states that opted out altogether, including every state in the Deep South except Arkansas and Louisiana. Arkansas has since switched to a Republican governor, who filed a request to scale back its expansion last year. Louisiana did the opposite; it refused in 2013 to expand under Republican Gov. Bobby Jindal, but after Democratic Gov. John Bel Edwards replaced term-limited Jindal in 2015, the new governor signed an expansion law on his second day in office.

Since replacing Robert Bentley as governor, Kay Ivey has declined to change the state’s stance on expanded Medicaid. The Alabama House Democratic Caucus passed a resolution in February asking Ivey to reconsider, saying that more than 235,000 additional Alabamians would have access to health coverage.

In his press conference, Jones also cited the lack of expansion as a reason numerous rural hospitals have had to close their doors or soon will. That’s a position supported by the Alabama Hospital Association, which says that dozens of hospitals have closed or will soon.

Jones also announced that he supports another Senate bill called States Achieve Medicaid Expansion, or SAME, which would allow states like Alabama to approve expanded Medicaid and still get full federal funding, just as if those states had approved the move before the 2014 deadline.

“It’s a second chance for us to get full funding. Right now if we opted in, we would still be covered for only 90 percent,” Jones said.

Talks With North Korea

In a separate issue, Jones told reporters he is optimistic about President Donald Trump’s recent summit in Singapore with North Korean leader Kim Jong Un, but he is waiting for something more concrete to develop than what he’s seen so far.

“I’m like everybody in this country and everybody in the world in that I am hopeful,” Jones said. “I think it is a historic breakthrough, although it’s probably not as historic as people make it out to be because I think the leaders of North Korea have been dying to meet with the president of the United States for decades. … The fact is that it took place and there’s hope coming out of it, but I want to make sure people understand that North Korea has never been a country we can trust. They have a history of going back on their word.”