WASHINGTON, D.C – U.S. Senator Angus King (I-Maine) has cosponsored legislation to incentivize Medicaid expansion nationwide, bring needed federal dollars to states, and promote healthcare access for low-income Americans amid the current health and economic crisis. The States Achieve Medicaid Expansion (SAME) Act of 2021 would allow states that expanded Medicaid after 2014, or who expand Medicaid in the years ahead, to receive the same full federal matching funds as states that expanded Medicaid earlier under the terms of the Affordable Care Act.

“The coronavirus pandemic has exacerbated the challenges of our healthcare system, as millions of Americans lost their jobs through no fault of their own – and their employer-sponsored health insurance in a historically difficult period,” said Senator King. “To make matters worse, the economic fallout has hit budgets of state and local governments hard, creating increased difficulties as they work to meet the heightened need. These states need additional help, and the federal government can provide it by passing the SAME Act and ensuring that all states can access the full benefits of the Affordable Care Act, even if they chose to expand Medicaid after 2014. This is critical legislation that can help states like Maine extend life-saving healthcare coverage to its citizens; the Senate should pass this legislation immediately.”

The SAME Act would ensure that the fourteen states that chose to expand Medicaid after January 1, 2014 are eligible for the same level of federal matching funds as those that expanded earlier under the terms of the Affordable Care Act. Maine was among these states, where Medicaid expansion went into effect on January 1, 2019, allowing more than 400,000 Mainers to access low-cost or no-cost healthcare coverage under Medicaid.

The Affordable Care Act provides financial support from the federal government to states that have expanded their existing Medicaid programs to provide health care coverage to all individuals up to 138 percent of the federal poverty level. The federal government covers the full cost of expansion for three years, phasing down to a 90 percent match rate for the sixth year of the expansion and in subsequent years. In passing the Affordable Care Act, Congress intended for all states to expand Medicaid in 2014. However, the Supreme Court’s holding in National Federation of Independent Business (NFIB) v. Sebelius made expansion optional for states. As a result, states choosing to expand coverage after 2014 do not receive the same federal matching rates as those that expanded immediately.

The SAME Act would address this discrepancy by ensuring that any states that expand Medicaid receive an equal level of federal funding for the expansion, regardless of when they chose to expand. Under the bill, a state would receive three years of full federal funding, phasing down to a 95 percent Federal Medical Assistance Percentages (FMAP) in Year 4; a 94 percent federal contribution in Year 5; 93 percent in Year 6; and, 90 percent for each year thereafter. Currently, 39 states and the District of Columbia have adopted Medicaid expansion, including Oklahoma and Missouri which passed ballot initiatives to expand Medicaid in 2021.

Numerous studies have shown that expanding Medicaid benefits states directly and indirectly, in the form of jobs and earnings growth, additional federal revenue, increased Gross State Product, increased state and local revenues and reduced uncompensated care and hospital costs. 

In addition to Senator King, the legislation is supported by Senators Mark Warner (D-Va.), Raphael Warnock (D-Ga.), Tim Kaine (D-Va.), Tom Carper (D-Del.), Debbie Stabenow (D-Mich.), Bob Casey (D-Penn.), Tammy Baldwin (D-Wis.), Gary Peters (D-Mich.), Jon Ossoff (D-Ga.), and Chris Coons (D-Del.).