Liberal Senate Democrats are pushing to include a new federal health care program in the $3.5 trillion spending package they outlined Monday. It would provide free medical insurance to 4.4 million more people, mostly low-income minorities, in Republican states that have not expanded Medicaid.
To Republicans, it would mean that 4.4 million more Americans would get coverage through the welfare state, increasing government-run health care.
The proposal is part of a summary of the legislation announced by Senate Majority Leader Charles E. Schumer, New York Democrat.
Democrats expect to pass a resolution as soon as Tuesday to begin the process of drafting the massive package they plan to ram through Congress through budget reconciliation, a procedure that allows spending bills to bypass a filibuster in the evenly divided Senate and be passed with a simple 51-vote majority.
“I believe that no one’s access to basic health care should be determined by their income or ZIP code,” Sen. Raphael G. Warnock, Georgia Democrat and a sponsor of the proposal, said in a Twitter post. “Health care is a human right.”
The incentive to expand Medicaid would expire in 10 years, leading to concerns that states would be stuck with the higher cost of insuring more people.
“Ultimately, the whole load would shift to the state, and we simply could not afford it then and we can’t afford that now,” said South Carolina Gov. Henry McMaster, a Republican.
The proposal would require most states to continue contributions to cover those who earn a little too much income to qualify for Medicaid.
That would be unfair to the states still paying, said a Republican aide on the House Energy and Commerce Committee, which handles health care issues. “It’s also unfair they are pushing for another Washington, D.C., command-and-control runaway entitlement that takes away power from the states.”
The proposal by Mr. Warnock, fellow Georgia Democrat Sen. Jon Ossoff and Sen. Tammy Baldwin, Wisconsin Democrat, aims to provide health care coverage to the millions of Americans who have been left out of Obamacare because of partisan squabbling.
Most states have chosen to expand Medicaid, the federal program for low-income people, to residents who otherwise earn too much to qualify. Twelve Republican-controlled states have not expanded Medicaid, leaving out those whose incomes are too high for Medicaid but too low to qualify for Obamacare’s subsidized insurance.
President Biden’s coronavirus relief package in March offered $16.4 billion to the holdout states. The federal government would pick up more of the cost of providing traditional Medicaid if the states expand the program to more people.
None of the states took up the offer.
The senators now want to improve the incentive. Their proposal would increase the federal share of paying for traditional Medicaid, which varies from state to state, by an additional 5 percentage points beyond the 5-point increase in the coronavirus relief bill.
If states still won’t expand the program, the legislation would cover those left out through the new program modeled after Medicaid.
To Democrats, the move is necessary to provide relief to families unable to afford insurance.
Liberal Democrats and their allies are proposing several subsidies in the spending package that would disproportionately help minorities pay for expenses such as child care, community college tuition and health care.
A June study by the liberal Center on Budget and Policy Priorities showed that 60% of those without insurance because of the “coverage gap” in the 12 holdout states were people of color, although they make up only one-third of the population.
“Closing this Medicaid ‘coverage gap’ would be among the most important steps that policymakers can take to reduce racial health disparities,” Judith Solomon, a senior fellow with the group, wrote in a report.
“Our legislation will open the door to those who have been shut out and expand access to affordable health care, including preventive care, that people want and need,” Ms. Baldwin said.
Spokespeople for Mr. Warnock, Mr. Ossoff and Ms. Baldwin did not respond to questions about their proposal. Mr. Warnock has said the measure would cover 275,000 uninsured Georgia residents.
Republicans prefer to encourage the private sector to lower health care costs. Senate Republicans are balking at allocating more tax dollars to increase coverage and passing a $3.5 trillion package. The cost of the bill would lead to corporate tax increases, which would be passed on to consumers through higher prices, further increasing inflation, they say.
Several Republican governors showed no interest in expanding Medicaid, even with the additional federal dollars.
“The governor remains opposed to the expansion of Medicaid in Florida,” said Cody McCloud, a spokesman for Gov. Ron DeSantis.
Govs. Tate Reeves of Mississippi and Kristi Noem of South Dakota also said they continued to oppose Medicaid expansion and prefer to make coverage more affordable by lowering health care costs.
Mr. Reeves “is opposed to the expansion of Obamacare and Medicaid in Mississippi, and the costs associated with doing so, which would ultimately be paid by taxpayers,” spokeswoman Bailey Martin said. “Gov. Reeves continues to support private-sector solutions that ensure Mississippians have access to quality health insurance.”
Ms. Noem “knows that expanding Medicaid is not the answer to accessing quality health care in South Dakota,” said spokesman Ian Fury. “Gov. Noem has promoted consumer-driven alternatives that address the fundamental drivers of rising health care costs.”
With Republicans expected to vociferously oppose the $3.5 trillion measure, Democrats plan to push the package through reconciliation. That would block Republicans from filibustering, but all 50 Senate Democrats would have to agree, and it’s not clear whether moderate Democrats will accept the Medicaid proposal.
Key Democratic lawmakers such as Sens. Joe Manchin III of West Virginia, Kyrsten Sinema of Arizona and Jon Tester of Montana did not return inquiries. Ms. Sinema has said she opposes the $3.5 trillion price tag, which could force Democrats to scale back their plans.
Moderates in the House also could block the Medicaid provision.
In the states that do not expand coverage, the federal government would cover those who do not qualify for Medicaid, with no cost to the state.
Scott Centorino, a senior fellow at the conservative Foundation for Government Accountability, said states that supported Obamacare by paying for Medicaid expansion would be “deeply unhappy” and say, “We stood up for you.”
In South Carolina, which would have the federal government pay to expand Medicaid, Mr. McMaster opposed the federal government’s description of the spending package as human “infrastructure.”
“I think the better thing is to put money into roads, bridges, economic development,” Mr. McMaster said. “The best welfare program is a job.”