COVER Now Act: Empowering Local Governments to Overcome Obstruction to Medicaid Expansion

Press Release

Today, U.S. Representative Lloyd Doggett (D-TX), Chair of the House Ways and Means Health Subcommittee, led over 40 Democratic House Members from States which have refused to expand Medicaid coverage in introducing the Cover Outstanding Vulnerable Expansion-Eligible Residents Now (COVER Now) Act. This landmark legislation authorizes the Centers for Medicare and Medicaid Services (CMS) to work directly with counties, cities, and other political subdivisions to expand Medicaid coverage. It would, for the first time, allow local leaders to help their vulnerable residents in States which have declined to accept federal resources for Medicaid expansion. Standing together in front of the U.S. Capitol, cosponsors held a press conference this morning.

"Nearly six million Americans, primarily from communities of color, remain uninsured due to Republican ideological obstruction and indifference. Our homegrown solution, the COVER Now Act, enables willing local leaders to accept directly federal resources to achieve both the public health and financial benefits of Medicaid expansion," said Congressman Doggett. "For many of our most disadvantaged citizens this bill offers a pathway to access a family physician, necessary medicine, and other essential coverage that thirteen States continue to deny. The COVER Now Act empowers local leaders to assure that the obstructionists at the top can no longer harm the most at-risk living at the bottom."
The COVER Now Act would:

Authorize CMS to contract directly with counties and other political subdivisions to establish demonstration projects expanding Medicaid coverage to their residents
Participating entities will receive the same deal previously made available to States: 100% federal funding for the first 3 years and a gradual reduction to 90% federal funding by year 7 and thereafter
Participating entities may apply individually or jointly if they wish to establish a regional expansion project
Existing Medicaid rules and systems would remain in place and apply to the local expansion programs
States would be required to cooperate and authorize access to State Medicaid systems for participating entities, with additional federal administrative Medicaid funding for cooperation and subject to federal penalties for non-cooperation
Should a State expand, eligible beneficiaries enrolled in a local expansion program would be automatically enrolled into the State Medicaid program

The COVER Now Act is based on previous successful demonstration projects in Cuyahoga County, Ohio, Cook County, Illinois, and several counties in California. These demonstration projects were established by State application through 1115 waivers and served as the glidepath to statewide expansion. Under the COVER Now Act, local entities would be empowered to apply directly to CMS without the State's involvement.

Endorsing organizations: UnidosUS, American Diabetes Association, National Alliance on Mental Illness, National Multiple Sclerosis Society, Texas Academy of Family Physicians, Every Texan, Texas Children's Defense Fund, Texans Care for Children, CommuniCare Health Centers

"UnidosUS is deeply committed to ensuring all Americans have access to quality, affordable health coverage and care. Latinos and their children have long been overrepresented among the uninsured and the pandemic has only exacerbated such long-standing inequities in our health care system, especially in nonexpansion states like Texas and Florida," said Eric Rodriguez, Senior Vice President of Policy and Advocacy with UnidosUS. "As we continue to push for Medicaid expansion for all residents in the remaining states, we applaud Congressman Doggett and the other sponsors of this bill for their leadership in addressing coverage gaps, and for their commitment to reduce racial and ethnic health disparities. Making sure each and every American has access to coverage under the Affordable Care Act protects public health and is morally the right thing to do."

"Millions of people have gained access to health care, thanks to the Affordable Care Act. But despite these advancements there are still 2.2 million people who have been shut out due in large part to 12 states refusing to expand Medicaid. The majority of those impacted are people of color. In order to fix this, the American Rescue Plan provided a sizable financial incentive to states to finally take up Medicaid expansion. Still, these states ---many with a deep legacy of racism and racist health policies -- will likely continue to refuse these incentives at great detriment to the health outcomes, lives, and maternal health of their residents. The National Partnership commends Rep. Doggett for working to find ways to address the coverage gap in states that have not expanded Medicaid coverage, and we urge Congress to work towards a solution," said Debra L. Ness, President, National Partnership for Women & Families.

American Diabetes Association's CEO Tracey Brown said, "The American Diabetes Association strongly supports the COVER Now Act to expand access to Medicaid coverage for uninsured and under-insured Americans, especially the 122 million people living with diabetes and prediabetes. Health insurance coverage through Medicaid can empower individuals and families to be more proactive in seeking preventive care, early diagnosis and diabetes management through affordable prescription drugs and devices. Health care costs for the diabetes community are 2.5 times higher than those for Americans without diabetes, and the COVER Now Act is an important step toward addressing cost barriers to life-saving health care."

"People living with mental illness living in the 12 states that have yet to expand Medicaid deserve the opportunity to access mental health treatment and services. They should not be disadvantaged because of their states' inaction. Congressman Doggett's legislation gives them a fair chance to access coverage and treatment" said Angela Kimball, Director of Public Policy at the National Alliance on Mental Illness (NAMI).

"Catholic values affirm that health care is a sacred human right for every person. Already more than 600,000 people in the U.S. have died from COVID-19, with the pandemic revealing long-standing health disparities particularly for Black, brown, and Native American communities. These disparities are the result of a long history of systemic racism and racial exclusion often manifested in our country's laws. Closing the Medicaid gap for people living in non-Medicaid expansion states is an important step towards eliminating these unjust and immoral racial health disparities. We are grateful to Congressman Doggett for his leadership and urge all Members of Congress to heed the call to prioritize health equity for all," said Mary J. Novak, Executive Director of NETWORK Lobby for Catholic Social Justice.

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