Category Archives: ACA

Trump budget calls for cutting Medicaid, ACA by about $1 trillion

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Trump budget calls for cutting Medicaid, ACA by about $1 trillion

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President Trump’s proposed budget includes about $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, analysts said.

The budget released Monday includes $844 billion over 10 years in cuts from the “President’s health reform vision,” a stand-in for the repeal and replacement of ObamaCare. There are also more than $150 billion in additional cuts from implementing Medicaid work requirements and other changes to the program, which would result in some people losing coverage if they did not meet the requirements.

The cuts drew swift condemnation from Democrats, who pointed out that Trump himself promised not to cut Medicaid, the health insurance program for the poor, during his 2016 campaign.

“I’m not going to cut Medicare or Medicaid,” Trump said in 2015, adding, “Every other Republican is going to cut it.”

“Americans’ quality, affordable health care will never be safe with President Trump,” Speaker Nancy Pelosi (D-Calif.) said in a statement on the budget proposal.

A senior administration official defended the Medicaid cuts, arguing reforms will help preserve the program for people who need it most. “The Budget protects and preserves Medicaid by putting it on a sustainable path, so it can continue to provide vital services to those who need it the most, including children, the disabled, elderly and pregnant women,” the official said.

In contrast to previous years, the budget does not spell out how Trump proposes to repeal and replace ObamaCare. Instead, the budget gives a savings number of $844 billion that could come from any number of possible changes to Medicaid or the health law’s exchanges and subsidies. 

One policy that is specified is that the budget calls for ending the additional federal funding that helped states expand Medicaid to cover more people under the Affordable Care Act, with officials arguing states can step up their spending if they want to expand the program.

The Supreme Court isn’t done with the ACA case yet. Here are the next steps.

Posted on by • Posted in 2020 Election Issues, ACA, Health Policy, Individual Mandate, Severability, Supreme Court, Underinsured, Uninsured • Leave a comment

https://www.healthcaredive.com/news/the-supreme-court-isnt-done-with-the-aca-case-yet-here-are-the-next-steps/570816/

The U.S. Supreme Court is scheduled to review the legal challenge to the Affordable Care Act on Feb. 21 to potentially weigh whether to take the case. However, legal expert Katie Keith from Georgetown University cautioned Healthcare Dive it’s common for the court to reschedule or relist cases for a later conference date.

Tuesday’s one-sentence order from the U.S. Supreme Court denying a request to fast-track the challenge to the Affordable Care Act is not the final word from the high court.

The justices will now decide whether to take up the legal case threatening to overturn the landmark law during their next term, which begins in October.

Essentially, the order returns the case to the typical review process as a group of blue states, led by California’s Democratic Attorney General Xavier Becerra, try to convince the Supreme Court it should hear the case at some point instead of letting it wind its way back through the lower courts.

“The court did not say we’re not reviewing this case at all,” MaryBeth Musumeci, an associate director at Kaiser Family Foundation and graduate of Harvard Law School, told Healthcare Dive.

The blue states sought to expedite the case, which would have resulted in a ruling before the presidential election in November. Some Democrats hoped that would pressure Republicans to come up with a replacement had the law been tossed, or more publicly defend efforts that would kill popular provisions like protections for pre-existing conditions.

The court refused to accelerate its review despite requests from hospitals, insurers, advocacy groups including AARP and a group of bipartisan economic scholars.

“It’s disappointing but it’s not altogether unsurprising. They typically don’t like to grant expedited review,” Katie Keith, a lawyer and health policy expert at Georgetown University​, told Healthcare Dive.

Other legal experts warned against reading too much into Tuesday’s order and what it may mean for the case going forward.

“Expediting was always unlikely. It’s a big ask for little purpose here. I wouldn’t read anything else into it,” Jonathan Adler, a law professor at Case Western Reserve University, told Healthcare Dive​.

Careful observers of the case should expect the justices to vote on whether to take it up by June at the latest, Keith said.

In the meantime, Tuesday’s order sets off another wave of briefs. First, the red states will try to convince the court of its position on whether the legal challenge should be heard in October. Expect that motion in the first few days of February, experts told Healthcare Dive.

Robert Henneke, the lawyer representing the individual plaintiffs, told Healthcare Dive his team will argue that the case is still premature for Supreme Court review. “The opinion from the Fifth Circuit was not a complete opinion,” Henneke said.

The appeals court in part affirmed a lower court’s decision, ruling that the individual mandate is unconstitutional because it can no longer be considered a tax. However, it sent the key question of whether the rest of the ACA can stand without the mandate back to the lower court for further analysis.

Becerra has argued that the lower court’s decision is wrong and, without a definitive ruling from the Supreme Court, the challenge only fuels doubt about the future of the ACA — credited with significantly reducing the ranks of the uninsured.

“The health and wellbeing of millions of our loved ones who rely on the ACA for healthcare is too important. We will do everything in our power to keep fighting for them,” Becerra said in a tweet following the order.

Nevertheless, Tuesday’s result likely thrusts the issue of the ACA back in the spotlight for another presidential campaign cycle.

Much of the healthcare debate among Democrats vying to take on President Donald Trump has revolved around a “Medicare for All” idea. One question now is, will Democrats shift to talk about rescuing the ACA, a law in place but remains in jeopardy?

The problem is the outcome is still uncertain, Stephanie Kennan, senior vice president of federal public affairs at McGuireWoods Consulting, told Healthcare Dive. However, it does give Democrats the opportunity to talk about what’s popular in the bill, noting protections for those with pre-existing conditions.

“It certainly gives them a springboard for them to talk about the things they could do to fix it,” Kennan said.

Despite Tuesday’s outcome, there will still be some Democratic contenders who will campaign for Medicare for All, Bill Jordan, chair of Alston and Bird’s healthcare litigation group, told Healthcare Dive. But this ruling gives Democrats another tool against Republicans, he said.

“As time has gone on, the Affordable Care Act has become more popular, not less popular,” Jordan said.

But he cautioned that anything can happen in the next election, which could entirely alter the political landscape and influence whether the case makes it back up to the Supreme Court if the justices pass this time.

 

 

 

 

Public Charge Rule Could Erode Enrollment in Insurance Coverage

Posted on by • Posted in 2020 Election Issues, ACA, Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Block Grants, Medicaid Expansion, Safety-Net Providers • Leave a comment

Public Charge Rule Could Erode Enrollment in Insurance Coverage

Mother and baby at clinic with doctor. Baby is looking directly into the camera.

In a 5-4 vote reflecting the ideological split among the justices, the US Supreme Court on January 27 decided to allow the Trump administration to commence enforcement (PDF) of its “public charge” rule nationwide. Only Illinois, where a statewide injunction is currently in effect, will not begin enforcing the rule. The regulation was slated to take effect last October, but federal judges in California, Illinois, Maryland, New York, and Washington blocked its implementation after states and immigrant rights groups challenged its legality. Federal appeals courts later lifted all but New York’s nationwide injunction and Illinois’ statewide injunction. The Supreme Court has now “stayed,” or put on hold, New York’s injunction, allowing the rule to take effect while the litigation continues.Essential Coverage

The US Citizenship and Immigration Services agency said the new rule will become effective February 24.

The public charge rule sparked controversy because it “would expand the government’s ability to refuse green cards or visas for legal immigrants determined to be a ‘public charge,’ or dependent on public assistance,” Susannah Luthi explained in Politico. “Those using or likely to use Medicaid, food stamps, and other safety-net programs would face greater scrutiny from immigration officials.”

Experts have warned of a “chilling effect” among immigrant communities, meaning that even those who are not subject to the public charge rule could disenroll or avoid public benefits out of fear. The Institute for Community Health estimated that 195,000 to 455,000 California children in need of medical attention could leave Medi-Cal if the rule takes effect. Including adults, this estimate grows to between 317,000 and 741,000 Californians disenrolling from Medi-Cal, according to researchers from UCLA and UC Berkeley (PDF).

The chilling effect has been documented on a national scale. According to the Urban Institute, in 2018, the year when the Trump administration proposed expanding the public charge rule, about 14% of adults in immigrant families reported that fear prompted them or a family member not to apply for a public benefit program or to disenroll from one. Of the adults who experienced chilling effects, 42% said they or their family members did not participate in Medicaid or the Children’s Health Insurance Program.

Soon after the rule was finalized last year, Eisner Health, a community clinic in Los Angeles, started getting phone calls from patients enrolled in Medi-Cal and CalFresh who wanted to end their families’ coverage, Claudia Boyd-Barrett reported in California Health Report. Many of those patients were not yet permanent residents or were members of mixed immigration status families who feared being penalized for using public benefits.

New Rule Doesn’t Apply to Many Immigrants

It is important to note that many immigrants are not subject to the new public charge rule. “It is urgent that all of us working with immigrant communities — via government, legal aid, health care, and more — have accurate and accessible information for families,” Sandra R. Hernández, president and CEO of CHCF, wrote on Twitter.

Mark Ghaly, California Health and Human Services Agency secretary, released a statement emphasizing that immigrant families should learn their rights. “You can find a list of nonprofit organizations providing free legal immigration services on the California Department of Social Services (CDSS) website, here,” Ghaly said.

CDSS offers a list of legal services providers across California who can assist with public charge questions. Protecting Immigrant Families (a partnership of the National Immigration Law Center and The Center for Law and Social Policy) also has resources on the public charge rule.

Following the Supreme Court’s order to stay the nationwide injunction, California Attorney General Xavier Becerra reiterated his commitment to fighting the rule. “We are a nation of immigrants, so we will lean forward in the face of heartless attacks on working families,” Becerra said in a statement. “Together, we’ll continue our fight to stand up for the right of each and every person who calls the United States their home.”

The legal challenges to the public charge rule will continue to move forward in courts around the nation — including in California — the New York Times’s Adam Liptak reported.

Medicaid Block Grants Could Reduce Access for Many

The Trump administration has announced its plan to let states volunteer to convert a portion of their Medicaid funding into block grants. The program, which has been branded a “Healthy Adult Opportunity,” represents a radical change in financing for Medicaid. Medicaid programs, which are operated by states with significant federal funding and oversight, constitute the nation’s health insurance program for Americans with low incomes. Covering over 75 million people, or one in five Americans, Medicaid programs provide services to 83% of children from low-income families, 48% of children with special health care needs, and 45% of nonelderly adults with disabilities.

On January 30, the administrator of the US Centers for Medicare & Medicaid Services, Seema Verma, sent to state Medicaid directors a letter (PDF) about the new block grant program. Verma gave states “the possibility of trading away an entitlement program that expands and contracts depending on how many poor people need the government health coverage,” Amy Goldstein wrote in the Washington Post. “In exchange, for able-bodied adults in the program, states could apply to receive a fixed federal payment and freedom from many of the program’s rules.”

Additionally, participating states would be allowed to limit the health benefits and drugs offered by their Medicaid programs, Rachel Roubein and Dan Diamond reported for Politico. According to one official, patients with behavioral health needs or HIV would be protected under the new plan.

Criticism from Medicaid advocates was swift. Twenty-seven patient and consumer groups, including the American Lung Association, American Cancer Society, and National Alliance on Mental Illness, issued a statement expressing strong opposition to the new guidance. “Block grants and per capita caps will reduce access to quality and affordable health care for patients with serious and chronic health conditions and are therefore unacceptable to our organizations,” they wrote.

“Worst Medicaid Idea Ever”

Frederick Isasi, executive director of Families USA, said in a statement, “Having spent many years working with governors and Medicaid programs, block grants are possibly the worst Medicaid idea ever presented to states by a federal administration. They would allow the federal government to off-load shared Medicaid responsibility at the expense of deep cuts to state budgets, vital programs supported by states, and the people who rely on those programs.”

Joan Alker, executive director and a cofounder of Georgetown University’s Center for Children and Families, warned in a statement that “if states accept a fixed cap on federal funding to meet their health care needs, they may be able to get by in the short term, but they put the health of their citizens and future state budgets at serious risk down the road.”

The block grant program is unlikely to affect California, which has invested heavily in expanding Medi-Cal access and is not expected to apply to participate.

Nonetheless, the block grant proposal shows that the Trump administration continues to prioritize changes that weaken the foundation of the nation’s health care safety net and could dramatically reduce health coverage for millions of Americans with low incomes.

 

 

 

We’re going to our primary care doctors less

Posted on by • Posted in 2020 Election Issues, ACA, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, Out of Pocket Expenses, Primary Care, Underinsured, Uninsured • Leave a comment

https://www.axios.com/newsletters/axios-vitals-ded63eb6-2431-48d0-a186-2f3b52417f2f.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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Adults in the U.S. are visiting primary care doctors less often, according to a new study in the Annals of Internal Medicine, which could foreshadow worse health outcomes and higher costs.

By the numbers: The study focused on adults enrolled with a large commercial insurer.

  • Between 2008 and 2016, visits to primary care physicians declined by 24.2%, and nearly half of adults didn’t visit one in any given year by the end of the time frame.
  • Groups with the largest declines were young adults, adults without chronic conditions, and those living in the lowest-income areas.

Meanwhile, visits to alternative facilities like urgent care clinics increased by 46.9%.

The big picture: Primary care doctors are there to keep people healthy. The less often we go to them, the more likely we are to get or remain sick, which ultimately costs the health care system more money.

 

 

Health care is Iowa’s only winner right now

Posted on by • Posted in 2020 Election Issues, ACA, Essential Health Benefits, Health Policy, Medicaid, Medicare, Medicare for All, Preexisting Conditions, Public Option, Single Payer Health System, Single Payer Healthcare System, Underinsured, Uninsured • Leave a comment

https://www.axios.com/newsletters/axios-vitals-ded63eb6-2431-48d0-a186-2f3b52417f2f.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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Iowa Democrats reported last night that their biggest priorities were beating President Trump and health care — but the meltdown of their election reporting systems left their presidential choices unresolved.

Why it matters: We’ve been writing for months that Democrats have a major choice ahead, either picking an advocate of Medicare for All — and siding with the plan that’s less popular with the rest of the country — or a public option advocate.

  • The Iowa debacle means the path the party will take won’t be clear for a while longer.

By the numbers: Several polls — including ones by NBC News, the National Exit Poll and AP Votecast — found that around four in 10 caucus voters said health care was their top issue.

  • Previous polling has found that Medicare for All is less popular overall than a public option, but both were popular among Democratic caucus-goers last night.
  • Seven in 10 said they back a single-payer plan, and almost nine in 10 said they support a public option, per AP Votecast, which was conducted by NORC at the University of Chicago for The Associated Press and Fox News.

Yes, but: Caucus-goers said they prefer a Democratic candidate who can beat Trump over one that agrees with them on issues, CNN reports.

The big picture: Republicans are more than happy to talk about Medicare for All — and its subsequent tax increases and expanded government role in health care — instead of protecting and building on the Affordable Care Act.

  • Whereas the former gives them an opportunity to go on offense, the latter puts the GOP on defense against its 2017 repeal-and-replace efforts and ongoing lawsuit that would strike down the whole health care law, including its protections for pre-existing conditions.

 

Supreme Court denies blue states’ effort to expedite ObamaCare challenge

Posted on by • Posted in 2020 Election Issues, ACA, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, Individual Mandate, Preexisting Conditions, Supreme Court, Texas v. United States, Uncertainty, Underinsured, Uninsured • Leave a comment

Supreme Court denies blue states’ effort to expedite ObamaCare challenge

Supreme Court denies blue states' effort to expedite ObamaCare challenge

The Supreme Court on Tuesday rejected an effort by Democrats to expedite a challenge to a lower court’s ruling striking down a key tenet of ObamaCare, narrowing the possibility that the court takes up the contentious case this year.

The House of Representatives and a group of blue states had asked the court to fast-track their appeal after the 5th Circuit Court of Appeals ruled that the Affordable Care Act’s individual mandate is unconstitutional.

“Under the current state of affairs, there is considerable doubt over whether millions of individuals will continue to be able to afford vitally important care,” the House wrote in a court filing earlier this month.

“Millions of individuals will live with the insecurity of not knowing that they have access to affordable health care, and will be forced to make important life decisions without knowing how those decisions will affect their continued access to such care.”

“If the Court does not hear the case this Term, that uncertainty will likely persist through next year’s open enrollment period,” the House wrote.

Tuesday’s order makes it unlikely that the high court will rule on the health care law before the November presidential election, where health insurance policy is sure to play a prominent role.

The 5th Circuit’s ruling delivered a victory for the coalition of conservative state attorneys general challenging the Obama administration’s signature achievement.

The Trump administration has declined to defend the Affordable Care Act in court, and the president has cheered on legal efforts to dismantle it.

“This decision will not alter the current healthcare system,” President Trump said in a statement last month. “My Administration continues to work to provide access to high-quality healthcare at a price you can afford, while strongly protecting those with pre-existing conditions. The radical healthcare changes being proposed by the far left would strip Americans of their current coverage. I will not let this happen.”

It’s still unclear whether the Supreme Court will decide to hear the challenge to the 5th Circuit ruling. Now that the justices have chosen to adhere to a normal briefing schedule, that decision will likely not come until March at the earliest.

 

 

 

Supreme Court to take up Trump appeal in ObamaCare birth control case

Posted on by • Posted in 2020 Election Issues, ACA, Birth Control, Birth Control Coverage, Roe v. Wade, Supreme Court, Womens Health • Leave a comment

https://thehill.com/regulation/court-battles/478838-supreme-court-to-take-up-trump-appeal-in-obamacare-birth-control

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The Supreme Court on Friday agreed to hear the Trump administration’s appeal in a legal fight over religious exemptions for ObamaCare’s requirement that employer-based health plans cover birth control.

The administration is seeking to expand exemptions for religious objectors to the Affordable Care Act’s so-called “contraceptive mandate.”

It will mark the third time the Supreme Court has heard a case regarding the mandate, a controversial provision of ObamaCare that has been fiercely opposed by conservatives and religious groups for years.

The Trump administration is asking the Supreme Court to overturn a nationwide injunction issued by a lower court blocking the rule from taking effect.

The rule would allow most businesses to claim a religious exemption to the mandate and opt out of covering contraception for their employees. 

Rules issued by the Obama administration already provided exemptions for religiously-affiliated organizations. But the Trump rule would also allow exemptions for almost all other businesses, including nonprofits, for-profit companies, higher education institutions and other non-government employers.

Civil rights groups argue the rules would essentially let employers discriminate against employees who use birth control. 

“Allowing employers and universities to use their religious beliefs to block employees’ and students’  birth control coverage isn’t religious liberty — it’s discrimination,” said Brigitte Amiri, deputy director at the ACLU Reproductive Freedom Project.

 

 

 

 

Hospitals, insurers urge Supreme Court to hear ACA case to avert havoc

Posted on by • Posted in 2020 Election Issues, ACA, Essential Health Benefits, Health Policy, Individual Mandate, Preexisting Conditions, Severability, Supreme Court, Texas v. United States, Underinsured, Uninsured • Leave a comment

https://www.healthcaredive.com/news/hospitals-insurers-urge-supreme-court-to-hear-aca-case-to-avert-havoc/570525/

Dive Brief:

  • The main lobbying groups for both the hospital and insurance industries filed amicus briefs Wednesday urging the Supreme Court to take on the controversial case seeking to overturn the Affordable Care Act.
  • By sending the key question in the case back down to the lower court for a “do-over,” the appellate court’s ruling “casts a long shadow of uncertainty over ACA-based investments,” America’s Health Insurance Plans said in its brief.
  • Various hospital lobbying groups argued the case creates enormous uncertainty for industry, raising questions about whether they should continue to invest in the provisions that are so closely intertwined with the ACA, according to their brief.

Dive Insight:

Two courts have so far ruled against the landmark health law, finding that the individual mandate is unconstitutional because Congress stripped away the financial penalty for forgoing insurance coverage.

Without the financial penalty attached, the so-called individual mandate can no longer be considered a tax and is therefore unconstitutional, according to the courts. A lower court went even further than the appellate court and found that the entire law must fall because the mandate cannot be severed from the remainder of the ACA.

The appellate court avoided answering this key question regarding severability and sent it back to the lower court for additional analysis. The appellate court ruling generated outcry from industry, which argues the case will take years to wind its way through the courts leaving a cloud of uncertainty in its wake.

The ACA fundamentally reshaped the nation’s healthcare system and is credited with lowering the ranks of the uninsured by millions.

A coalition of blue states that stepped in to defend the law petitioned the Supreme Court to hear the case and asked for an expedited review. Meanwhile, a group of red states looking to overturn the law has argued the case does not merit intervention from the high court.

After failed attempts by Republicans in Congress to kill the law entirely, in 2017 Congress cut the penalty for not having insurance coverage to zero in a unrelated tax bill. The red states and two individual plaintiffs from Texas have argued the move renders the law unconstitutional.

AHIP argues that the ACA can stand without the penalty (and has) since Congress’ changes in 2017.

“Congress has unmistakably indicated through its actions: that the ACA should continue in operation even in the absence of the individual mandate,” AHIP said in its brief, arguing a repeal of the law would “wreak havoc” on the nation’s healthcare system.

Other advocacy groups, including AARP, American Cancer Society and Small Business Majority filed separate briefs urging the Supreme Court to take on the case. A group of bipartisan economic scholars also submitted a brief in support of the Supreme Court taking on the case.

 

 

 

 

How the Health Insurance Industry (and I) Invented the ‘Choice’ Talking Point

Posted on by • Posted in 2020 Election Issues, ACA, Choice, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Out of Network, Out of Pocket Expenses, Status Quo • Leave a comment

It was always misleading. Now Democrats are repeating it.

There’s a dangerous talking point being repeated in the Democratic primary for president that could affect the survival of millions of people, and the finances of even more. This is partly my fault.

When the candidates discuss health care, you’re bound to hear some of them talk about consumer “choice.” If the nation adopts systemic health reform, this idea goes, it would restrict the ability of Americans to choose their plans or doctors, or have a say in their care.

It’s a good little talking point, in that it makes the idea of changing the current system sound scary and limiting. The problem? It’s a P.R. concoction. And right now, somewhere in their plush corporate offices, some health care industry executives are probably beside themselves with glee, drinking a toast to their public relations triumph.

I should know: I was one of them.

To my everlasting regret, I played a hand in devising this deceptive talking point about choice when I worked in various communications roles for a leading health insurer between 1993 and 2008, ultimately serving as vice president for corporate communications. Now I want to come clean by explaining its origin story, and why it’s both factually inaccurate and a political ploy.

Those of us in the insurance industry constantly hustled to prevent significant reforms because changes threatened to eat into our companies’ enormous profits. We were told by our opinion research firms and messaging consultants that when we promoted the purported benefits of the status quo that we should talk about the concept of “choice”: It polled well in focus groups of average Americans (and was encouraged by the work of Frank Luntz, the P.R. guru who literally wrote the book on how the Republican Party should communicate with Americans). As instructed, I used the word “choice” frequently when drafting talking points.

But those of us who held senior positions for the big insurers knew that one of the huge vulnerabilities of the system is its lack of choice. In the current system, Americans cannot, in fact, pick their own doctors, specialists or hospitals — at least, not without incurring huge “out of network” bills.

Not only does the current health care system deny you choice within the details of your plans, it also fails to provide many options for the plan itself. Most working Americans must select from a limited list made by their company’s chosen insurance provider (usually a high-deductible plan or a higher-deductible plan). What’s more, once that choice is made, there are many restrictions around keeping it. You can lose coverage if your company changes its plan, or if you change jobs, or if you turn 26 and leave your parents’ plan, among other scenarios.

This presented a real problem for us in the industry. Well aware that we were losing the “choice” argument, my industry colleagues spent millions on lobbying, advertising and spin doctors — all intended to muddy the issue so Americans might believe that reform would somehow provide “less choice.” Recently, the industry launched a campaign called “My Care, My Choice” aimed in part at convincing Americans that they have choice now — and that government reform would restrict their freedom. That group has been spending large sums on advertising in Iowa during this presidential race.

This isn’t the first time the industry has made “choice” a big talking point as it fights health reform. Soon after the Affordable Care Act was passed a decade ago, insurers formed the Choice and Competition Coalition and pushed states not to create insurance exchanges with better plans.

What’s different now is that it’s the Democrats parroting the misleading “choice” talking point — and even using it as a weapon against one another. Back in my days working in insurance P.R., this would have stunned me. It’s why I believe my former colleagues are celebrating today.

The truth, of course, is that Americans now have little “choice” when it comes to managing their health care. Most can’t choose their own plan or how long they retain it, or even use it to select the doctor or hospital they prefer. But some reforms being discussed this election, such as “Medicare for all,” would provide these basic freedoms to users. In other words, the proposed reforms offer more choice than the status quo, not less.

My advice to voters is that if politicians tell you they oppose reforming the health care system because they want to preserve your “choice” as a consumer, they don’t know what they’re talking about or they’re willfully ignoring the truth. Either way, the insurance industry is delighted.

I would know.

 

 

Kansas has reached a deal to expand Medicaid, covering 150,000 people

Posted on by • Posted in 2020 Election Issues, ACA, Health Policy, Medicaid, Medicaid Expansion, Underinsured, Uninsured • Leave a comment

https://www.vox.com/policy-and-politics/2020/1/9/21058531/kansas-medicaid-expansion-obamacare-trump

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It looks like Kansas will become the 37th state to expand Medicaid through the Affordable Care Act, the latest breakthrough in more conservative territory for the health care law.

Democratic Gov. Laura Kelly, a moderate elected in 2018 in the anti-Trump wave driven largely by health care, and Sen. Jim Denning, the Republican leader of the state Senate announced Thursday that they had reached a deal on Medicaid expansion.

Under Obamacare, states can expand coverage to anybody with an income 138 percent of the federal poverty level or less (about $17,000 for an individual or $29,000 for a family of three) and receive a generous federal funding match.

Between 130,000 and 150,000 people are expected to be covered by Medicaid expansion in Kansas, mostly adults without children or parents currently ineligible for benefits despite living in or near poverty. Roughly 9 percent of Kansans are uninsured.

According to the AP, the agreement between Kelly and Denning includes a provision for state support to reduce private insurance premiums, to prevent people eligible for Medicaid expansion from leaving their current private plan (if they have one) to join the public program:

Denning had proposed financing his new program by increasing tobacco taxes, including a $1-per-pack increase in the state’s cigarette tax, to $2.29. His compromise with Kelly gives the state a year to develop the premium-reduction program and drops the tax increase, which Kelly and many lawmakers thought wasn’t likely to pass anyway.

It’s a relatively small concession for Republican support. An estimated 50,000 people would be expected to make the switch. The compromise notably does not include work requirements, which some other GOP-led states have sought (though they are on hold in the courts) as a condition of expansion. There will also be small premiums (about $25 a month), a provision approved in other Republican-leaning states looking to expand.

In some ways, Medicaid expansion has proven the most important part of Obamacare, covering 20 million or so people, but it has yet to reach its full potential. That’s because the Supreme Court ruled in 2012 that states must have the option to refuse to expand the program, and many Republican-led states have. About 2.5 million people, half of them in Texas and Florida, don’t have health coverage because their state has blocked Medicaid expansion.

But the number of non-expanding states has shrunk over the years, with a number of Republican states unable to refuse the ACA’s deal of more federal funding and more people with insurance. Even Vice President Mike Pence had cut a deal as governor with President Obama to expand Medicaid in Indiana. Voters in Idaho, Nebraska, and Utah have approved Medicaid expansion at the ballot box in the last few years.

Now Kansas looks like it will join the expansion ranks. Previous attempts to expand Medicaid ran up against the veto pen of a GOP governor. But Kelly’s election changed the situation.

Its decision is also a small act of defiance: Even as 20 red states and the Trump administration fight to overturn Obamacare in the courts, government leaders in Kansas are pushing to expand the law’s reach in their state to cover more people. Though the ideological battle over the law isn’t totally over, in practice, its reach is only growing.