U.S. COVID-19 response must expand and federalize Medicaid in all 50 states

Six years before he was outed as the Coronavirus equivalent of a war profiteer, Republican Senator Richard Burr (R-NC) summed up the GOP’s health care plan. “The American system has access to healthcare for everybody,” Burr said, “It's called the emergency room.” Of course, that go-to Republican ER talking point has been a deadly lie since President George W. Bush first regurgitated it in 2007. With many hospitals already overwhelmed with new cases, America’s mushrooming COVID-19 crisis should be the final nail in its coffin.

But the situation is even more dire than that. After all, 27.5 million Americans—some 1.9 million more than in the previous year—had no health insurance at all even before Coronavirus struck. As a tsunami of layoffs sweeps across the nation following last week’s stunning 3.3 million new jobless claims, millions more will lose coverage. Worse still, state budgets will be devastated as the rising demand for services will occur at precisely the same time that tax revenues will be drying up. As a result, the ranks of the uninsured, shuttered rural hospitals and the needlessly dead will grow rapidly, especially in those red states which refused to expand Medicaid under the Affordable Care Act.

All of which is why President Trump and Congress must act to immediately expand Medicaid in all 50 states. As it did when Obamacare was first launched, for the next three years the federal government should fully fund the extension of Medicaid eligibility to 138 percent of the federal poverty level (FPL) in every state. Before the COVID outbreak, that move alone would have provided coverage for 4.8 million Americans. Soon, that figure could easily be twice as high. But that’s not all. Uncle Sam should step in now to take over the $225 billion the states spend annually on their share of the $600 billion Medicaid program.

To help understand why, it’s worth a quick review of how Medicaid worked before and after the passage of the Affordable Care Act (a.k.a. Obamacare). As I documented back in August 2013 on the eve of Obamacare enrollment:

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