Congress, three weeks ago, passed the One Big Beautiful Bill.
And in that bill, [there] was a modest cost-sharing requirement for able-bodied Medicaid expansion adults that were making more than 100 percent of poverty.
The cost-sharing requirements would not apply to primary, prenatal, pediatric, mental, substance abuse disorder, emergency room care or care provided by community health centers, certified behavioral health clinics or rural health clinics.
Now, under the One Big Beautiful Bill, this cost-sharing that is required for able-bodied Medicaid adults, can’t exceed $35 per visit, and there is an annual maximum limit of no more than five percent of an individual’s income.
Well, you might ask, “Why cost-sharing?”
Having a modest cost-sharing ensures consumers have “skin in the game” and thus in turn, be responsible health care consumers.
Adults in [Medicaid] earning between 100 and 133 percent of poverty are most likely to gain health insurance through the federal marketplace or through an employer where cost-sharing is common.
Despite fear mongering about cost-share requirements, establishing modest cost-sharing requirements in Medicaid is not anything brand new.
It’s been around for quite a while.
So, let me give you a little bit of history.
The Obama administration approved a half-dozen Medicaid waivers, including my home state of Iowa, to establish modest cost-sharing for able-bodied Medicaid adults.
Congress, in addition, has enabled cost-sharing before. Obama made that move.
In the 2005 Deficit Reduction Act, which included my Family Opportunity Act, we expanded state flexibility in Medicaid to let states establish cost-sharing up to 10 percent of the cost of services for those making over the poverty limit.
The law also lets hospitals impose cost-sharing for non-emergency services provided in the emergency department.
The cost-sharing policies had support from governors of both parties from a National Governors Association work group.
At a 2005 Finance Committee hearing that I chaired, governors said modest Medicaid [cost-]sharing “[utilizes] market forces and personal responsibility to improve health care delivery.”
Another example is in the 1990s. Congress enabled cost-sharing in the Children’s Health Insurance Program.
To this day, states are allowed, and do, impose cost-sharing in that program.
Even socialist proposals like Medicare for All have also included cost-sharing.
So, I want to make very clear: this is nothing new.
Modest cost-sharing is a commonsense policy for those benefiting from a government program and who have the means to pay for it.
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