Clyburn: ‘UnAmerican’ not to prioritize Medicaid expansion in spending package

House Majority Whip James Clyburn (D-S.C.) on Wednesday said it would be “unAmerican” not to prioritize Medicaid expansion in the Democrats’s social spending package amid an intra-party clash over health care priorities.  

Clyburn is a leading advocate of including in President Biden’s Build Back Better plan a provision for the federal government to step in and provide Medicaid coverage in the 12 GOP-led states that have so far declined the coverage under the Affordable Care Act.  

But with a limited amount of funds for a slew of health care priorities, there is tension with progressives, led by Sen. Bernie Sanders (I-Vt.), who are pushing for expanding Medicare to include dental, vision, and hearing coverage.  

Clyburn on Wednesday made the case for prioritizing Medicaid over adding to Medicare, noting that Medicaid serves low-income people while Medicare serves seniors regardless of income, meaning it includes even “billionaires.” 

“I think it would be unAmerican of us to continue to do the things that are necessary to get our economy back going and leave these 200,000 South Carolinians out, leave the Americans, the citizens in these 12 states, leave them behind as we go on to improve other parts of health care services in our country,” Clyburn said on a press call hosted by the group Protect Our Care.  

Clyburn said Medicaid expansion in the 12 holdout states should not be “sacrificed as we add on to services for billionaires,” in Medicare.  

The House package as it was released earlier this month came down on Clyburn’s side. It included a permanent expansion of Medicaid in those 12 states, while not starting Medicare dental benefits until 2028, to help save money in the short-term. 

Sanders criticized the House measure for being too “drawn out” in starting the Medicare dental benefits. 

Some progressives argue that both the Medicare and Medicaid provisions could be fully funded. But that might not be possible given the limited number of dollars, and especially given that demands from moderates like Sen. Joe Machin (D-W.Va.) appear to be shrinking the overall size of the package. 

Manchin last week also raised concerns about adding Medicare benefits before shoring up the program’s existing finances.

“I want to make sure we are stabilizing what we have before we start going down this expansion role,” he told reporters.  

Further complicating the competing priorities is the push to extend enhanced financial assistance under ObamaCare that helps people afford their premiums, a priority for Speaker Nancy Pelosi (D-Calif.), who counts the Affordable Care Act as a major part of her legacy. 

To squeeze priorities in with a limited amount of money, one potential option is shortening the duration of priorities like the Medicaid expansion, so the provision would be scheduled to phase out after a certain number of years unless Congress acted in the future. 

Rep. Lauren Underwood (D-Ill.) pushed back on that idea on Wednesday’s press call, though, noting that Republicans might be in control of Congress then and allow the program to expire. 

“Congressional Republicans have not embraced Medicaid expansion, I’ll say that,” she said.