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Lawmakers back extending coverage where states refuse Move would be major shift in Medicaid’s federal-state dynamic May 10, 2021 5:16 AM By Alex Ruoff With no states jumping on the offer of added federal money to expand their Medicaid programs, Democrats are mulling changing the federal-state partnership to cover millions of people left ineligible for government-funded insurance. Congressional Democrats in the 12 states that haven’t expanded their Medicaid programs under the Affordable Care Act say their state legislatures remain hostile to growing their public health insurance programs, and have left too many Americans uninsured. Some in the holdout states are proposing a new tier of the ACA marketplace plan, or government-run insurance available to people who make too much to qualify for Medicaid—but too little to qualify for subsidies for private insurance. Others are suggesting allowing counties or cities to expand access within their boundaries,

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