Biden’s Budget Gives States Another Big Reason Not To Expand Medicaid

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If Congress enacts them into law, the legislative concepts outlined in President Biden’s first budget will have far-reaching effects on American debt, deficits, and taxation. One specific policy may have an effect even as a proposal. By suggesting a repeal of the Hyde Amendment, the president gave conservative states another reason not to expand Medicaid.

While coverage of the Biden budget has focused on its support of taxpayer funding for abortion, fewer articles have analyzed where that funding would occur. In practice, eliminating the Hyde Amendment would mean states that have embraced Medicaid expansion would find themselves on the vanguard of a major expansion of abortion coverage. The states that have yet to expand Medicaid—all of which have pro-life tendencies—should take note.

Additional Cash in COVID Spending Spree

Biden has offered new incentives for the 12 states who have yet to embrace Obamacare’s expansion of Medicaid to the able-bodied. Under the aegis of “COVID relief,” Section 9814 of Democrats’ economic legislation offers states that had not expanded as of its March date of enactment a two-year, 5 percent increase in the federal match for their existing Medicaid populations.

Democrats hope that the combination of a temporary increased federal match for current beneficiaries, coupled with a 90 percent enhanced federal match for the new populations covered by Obamacare, would entice the remaining states to take up expansion.

Cutting Hyde Means Forcing States to Cover Abortion

But the administration’s proposal to repeal the Hyde Amendment would have the opposite effect. First enacted in 1976 and named for the late pro-life Rep. Henry Hyde, R-Illinois, the amendment prohibits all federal funds, including Medicaid matching dollars, from being used for abortions, except in the cases of rape, incest, or to save the life of the mother.

Because the Hyde Amendment occurs as a rider to Congress’ annual appropriations bills, lawmakers must re-enact the measure every year. Biden’s budget proposed eliminating the rider for next year’s appropriations measure, in which case the pro-life protections would lapse.

If Congress follows the president’s lead and does not renew the Hyde Amendment, court precedents may require state Medicaid programs to cover abortions in most if not all cases. A 1994 district court ruling in Michigan, and earlier rulings from several federal courts of appeals, suggest that congressional authorization of comprehensive health benefits like those in Medicaid means such programs must cover all medically necessary treatments—including abortion—unless Congress explicitly states otherwise.

Some may argue that, even if the Hyde Amendment represents the only barrier from Medicaid programs being forced to fund abortions, concerns from pro-life Democrats and the Senate’s super-majority requirement for most legislation make it unlikely Congress would let the Hyde language lapse. Those individuals should remember that Biden supported the Hyde Amendment for decades—until quickly reversing himself soon after he announced his presidential campaign.

Another Good Reason to Pass Up Medicaid Expansion

The 12 states that have not adopted Medicaid expansion all have pro-life tendencies. While 16 state Medicaid programs cover abortion despite the Hyde prohibition on the use of federal funding by using state-only dollars, none of the states that have declined the Obamacare expansion do so.

States have many good reasons to eschew Medicaid expansion: The uncertainty of enhanced matching funds from Washington given more than $28 trillion in federal debt, and the need to preserve programs like Medicaid for the most vulnerable patients rather than expanding to able-bodied adults. But for pro-life lawmakers in conservative states, the president’s budget provides another tangible reason to avoid Medicaid expansion, as Biden wants to dragoon states that acquiesce into a massive expansion of abortion coverage.