Category Archives: Health Policy

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.

Bipartisan Ways and Means leaders unveil measure to stop surprise medical bills

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https://thehill.com/policy/healthcare/481985-bipartisan-ways-and-means-leaders-unveil-measure-to-stop-surprise-medical?utm_source=&utm_medium=email&utm_campaign=27536

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The bipartisan leaders of the House Ways and Means Committee on Friday released their legislation to protect patients from getting massive, surprise medical bills as congressional action on the subject intensifies.

The legislation is backed by the panel’s chairman, Rep. Richard Neal (D-Mass.), and its top Republican, Rep. Kevin Brady (Texas). It would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.

Surprise billing is seen as a rare area of possible bipartisan action this year and has support from President Trump.

But the effort has been slowed by varying approaches and intense lobbying from doctor and hospital groups.

The Ways and Means bill is a rival approach to the bipartisan bill passed out of committee last year by the House Energy and Commerce Committee.

The divide between those two committees will have to be overcome for any bill to move forward.

Neal and Brady said in a statement Friday that their approach “differs” from others because “we create a more balanced negotiation process.”

“Our priority throughout the painstaking process of crafting our legislation has been to get the policy right for patients, and we firmly believe that we have done that,” Neal and Brady said. “We look forward to working with our Democratic and Republican colleagues in Congress, as well as the Administration, to advance this measure swiftly.”

The Ways and Means Committee is planning to vote on the legislation next week.

While all sides in the surprise billing fight agree the patient should be protected, the main dispute has been how much the insurer will pay the doctor once the patient is taken out of the middle. 

Doctors and hospitals have lobbied hard against the Energy and Commerce approach, which they fear would lead to damaging cuts to their payments. That approach sets the payment based on the median rate in that geographic area, with the option of going to arbitration for some high-cost bills.

The Ways and Means approach has generally been seen as more favorable to doctors and hospitals, but industry groups have not yet responded to the details on Friday morning.

The Ways and Means bill gives the decision on how much the insurer should pay the doctor to an outside arbiter, although that arbiter will have to consider the median rate usually paid for that service in making its decision.

The House Education and Labor Committee is also planning to vote on legislation next week, and released a bill on Friday that closely reflects the Energy and Commerce and Senate Health Committee legislation, isolating Ways and Means.

Shawn Gremminger, senior director of federal relations at the liberal health care advocacy group Families USA, said it is “disappointing” that Ways and Means is using an approach that will not lower health costs as much, but he said it is good the process is moving forward.

The Energy and Commerce leaders, along with leaders of the Senate Health Committee, who also back their bill, released a conciliatory statement on Friday about the Ways and Means bill.

“Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority,” said Reps. Frank Pallone Jr. (D-N.J.) and Greg Walden (R-Ore.) and Sens. Lamar Alexnader (R-Tenn.) and Patty Murray (D-Wash.). “We look forward to working together to deliver a bill to the president’s desk that protects patients and lowers health care costs for American consumers.”

 

 

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

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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.

 

 

 

 

Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer

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Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer

After Zoe Friedland became pregnant with her first child, she was picky about choosing a doctor to guide her through delivery.

“With so many unpredictable things that can happen with a pregnancy, I wanted someone I could trust,” Friedland said. That person also had to be in the health insurance network of Cigna, the insurer that covers Friedland through her husband’s employer.

Friedland found an OB-GYN she liked, who told her that she delivered only at Sequoia Hospital in Redwood City, California, a part of San Francisco-based Dignity Health. Friedland and her husband, Bert Kaufman, live in Menlo Park, about 5 miles from the hospital, so that was not a problem for them — until Dec. 12.

That’s the day Friedland and Kaufman received a letter from Cigna informing them their care at Sequoia might not be covered after Jan. 1. The insurance company had not signed a contract for 2020 with the hospital operator, which meant Sequoia and many other Dignity medical facilities around the state would no longer be in Cigna’s network in the new year.

Suddenly, it looked as if having their first baby at Sequoia could cost Friedland and Kaufman tens of thousands of dollars.

“I was honestly shocked that this could even happen because it hadn’t entered my mind as a possibility,” Friedland said.

She and her husband are among an estimated 16,600 people caught in a financial dispute between two gigantic health care companies. Cigna is one of the largest health insurance companies in the nation, and Dignity Health has 31 hospitals in California, as well as seven in Arizona and three in Nevada. The contract fight affects Dignity’s California and Nevada hospitals, but not the ones in Arizona.

“The problem is price,” Cigna said in a statement just before the old contract expired on Dec. 31. “Dignity thinks that Cigna customers should pay substantially more than what is normal in the region, and we think that’s just wrong.”

Tammy Wilcox, a senior vice president at Dignity, said, “At a time when many nonprofit community hospitals are struggling, Cigna is making billions of dollars in profits each year. Yet Cigna is demanding that it pay local hospitals even less.”

In 2018, the most recent full year for which earnings data is available, Cigna generated operating income of $3.6 billion on revenue of approximately $48 billion. Dignity Health reported operating income of $529 million on revenue of $14.2 billion in its 2018 fiscal year.

It’s possible Cigna and Dignity can still reach an agreement. Both sides said they will keep trying, though no talks are scheduled.

Disagreements between insurers and health systems that leave patients stranded are a perennial problem in U.S. health care. Glenn Melnick, a professor of health economics at the University of Southern California, said such disputes, which are disruptive to consumers, are often settled.

Melnick believes Dignity is using an “all or nothing” strategy in contract negotiations, meaning either all its facilities are in the insurer’s network or none are.

“This allows them to increase their market power to get higher prices, which is not necessarily good for consumers,” Melnick said.

Dignity replied in an emailed statement: “We do not require payers to contract with all or none of Dignity Health’s providers. We do try to make sure patients have access to the full range of Dignity Health services and facilities in each of our communities.”

Dignity faces a number of legal and financial challenges while it works to implement a February 2019 merger with Englewood, Colorado-based Catholic Health Initiatives that created one of the nation’s largest Catholic hospital systems — known as CommonSpirit Health.

California Attorney General Xavier Becerra approved the deal with conditions, including that Dignity’s California hospitals spend $10 million in the first three years on services for people experiencing homelessness and offer free care to more low-income patients.

The requirement to treat more poor patients at no charge followed a period, from 2011 to 2016, in which Dignity’s charity care declined about 35% while its net income was $3.2 billion.

Last October, CommonSpirit announced an operating loss of $582 million on revenue of nearly $29 billion for the 2019 fiscal year, its first annual financial statement after the merger took effect. Much of the loss was due to merger-related costs and special charges.

The same month, Dignity completed a five-year “corporate integrity agreement” with the U.S. Office of the Inspector General following an investigation into how it billed the government for hospital inpatient stays. Dignity said it “fully complied” with the agreement.

Dignity is also defending itself in a class-action lawsuit alleging that it bills uninsured patients at grossly inflated rates even though it claims to provide “affordable” care at “the lowest possible cost.”

More recently, an appeals court judge ruled Dignity could not charge higher prices — often a lot higher than state-set rates — for treating enrollees of L.A. Care’s Medi-Cal health plan at its Northridge Hospital Medical Center.

Dignity disagreed with the court’s ruling in that case, saying that although the Northridge facility did not have a contract with L.A. Care, many of the health plan’s enrollees who initially sought emergency treatment there stayed in the hospital for additional care after they had been stabilized. The hospital “seeks appropriate reimbursement for providing this care,” Dignity said.

If Dignity does not reach an agreement with Cigna, its hospitals, outpatient surgery centers and medical groups in most of California will soon be out-of-network for many Cigna enrollees. In-network coverage for Open Access (OAP) and Preferred Provider (PPO) ended Feb. 1, and for HMO patients it is set to end April 1.

Peter Welch, president and general manager for Cigna in Northern California and the Pacific Northwest, said Cigna can provide “adequate access” to other hospitals and doctors.

Certain Cigna enrollees can apply to continue visiting Dignity facilities and doctors under California’s Continuity of Care law, enacted in 2014. Eligible enrollees include patients with chronic conditions, those already scheduled for pre-authorized services, people in need of emergency care and pregnant women in their third trimester.

Friedland and Kaufman applied, hoping she would be able to continue seeing her Dignity-affiliated OB-GYN at in-network rates.

On Jan. 22, less than a month from Friedland’s Feb. 15 due date, they received written confirmation that their request had been approved. They wouldn’t have to shop for a new doctor or face stiff medical bills after all.

Early Tuesday evening, Friedland gave birth to a baby girl, Eliza, who entered the world 11 days earlier than expected, weighing in at 7 pounds, 3 ounces.

“While the ordeal was stressful, and the communication fraught, we were happy to receive confirmation of continuity of care and that it ended in the best possible way — with the birth of our healthy baby daughter with the provider where we established care,” Kaufman said. “For the sake of those caught in the middle and now having to start relationships with new health care providers, we hope the two sides can come to an agreement.”

 

 

 

Latest boost for Medicare Advantage

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https://www.axios.com/newsletters/axios-vitals-0460cccc-499e-4609-80e6-745311cef1ad.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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The Trump administration yesterday announced more changes designed to make Medicare Advantage more appealing and to lower prescription drug costs for seniors.

Why it matters: Although the proposal mainly tinkers around the edges, it could have a meaningful impact on some seniors’ pocketbooks while furthering the administration’s commitment to Medicare Advantage, a cash cow for insurers.

Details: The proposal aims to create more transparency within Medicare’s prescription drug benefit, and to enhance price competition.

  • Beginning in 2022, plans would be required to give beneficiaries tools to compare the out-of-pocket costs of different drugs, which would allow patients to know their drug costs ahead of time and to shop around for the cheapest medications.
  • The proposal also aims to create more price competition among specialty drugs, which tend to be the most expensive drugs on the market.

It also would allow all seniors with end-stage renal disease to enroll in Medicare Advantage, beginning in 2021.

  • Medicare Advantage beneficiaries this year are gaining access to telehealth benefits that aren’t available to seniors enrolled in traditional fee-for-service Medicare, and the new proposal would build on these benefits.

 

 

 

Failure of Fiduciary Duty?

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https://www.axios.com/newsletters/axios-vitals-0460cccc-499e-4609-80e6-745311cef1ad.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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Sen. Bernie Sanders still may eke out a win in Iowa, and is the consensus front-runner in New Hampshire.

  • But most venture capitalists investing in America’s health care industry — the primary target of Bernie’s ire — have shoved their heads so deep in the sand that they’ve found water, Axios’ Dan Primack writes.

Why it matters: At some point, it could become a failure of fiduciary duty.

Health care accounts for over 20% of all U.S. venture activity.

  • A majority of that is in biotech/pharma, which last year saw 866 deals raise around $16.6 billion.
  • Investors view many of those deals as binary: Either the drug doesn’t work, resulting in a total write-off, or it does work and the financial sky’s the limit. Strike out or grand slam.
  • Sanders pledges to limit the upside, either by limiting drug prices under the current system or (if he gets Medicare for All) by establishing a single, centralized buyer.

Few health care VCs Dan spoke with are working on a Plan B in the event of their risk/reward models being made obsolete. Three main reasons:

  1. They don’t believe Sanders will win.
  2. Even if he does win, they don’t believe Sanders will get Medicare for All.
  3. If Sanders wins and implements his full plan, then it’s such a revolutionary shift that there’s not much health care VCs can do to counter it.

The bottom line: For now, health care venture’s strategy is see no Bernie, hear no Bernie. We’ll see how long that’s viable.

 

 

 

The Recurring Themes of Disease Outbreaks

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The Recurring Themes of Disease Outbreaks

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With news this weekend that the coronavirus is poised to become a global pandemic and that China covered up early evidence of its spread, I was pleased to see an article from Ashley Fuoco Antonelli of the Advisory Board’s Daily Briefing revisiting a four-year-old post of mine. Kristina Daugirdas (my wife) and I had just taught a class on global outbreaks, and we pulled together a list of recurring patterns.

Fuoco Antonelli goes through that list and carefully shows how each of them maps pretty well onto what we’ve seen so far with the coronavirus. Here’s a taste:

Bagley’s 2016 list features several recurring themes that center on governments’ responses to disease outbreaks. For instance, three themes that he highlighted are:

  • “Governments are typically unprepared, disorganized, and resistant to taking steps necessary to contain infectious diseases, especially in their early phases”;
  • “Public officials are reluctant to publicize infections for fear of devastating the economy”; and
  • “Local, state, federal, and global governing bodies are apt to point fingers at one another over who’s responsible for taking action. Clear lines of authority are lacking.”

Each of those themes certainly holds true today. Media outlets have reported that China was slow to report the new coronavirus outbreak and implement measures to contain it. And some observers have questioned whether Chinese officials downplayed the outbreak’s severity.

For example, the New York Times‘s Li Yuan writes that, as the first cases of the virus emerged, officials “insisted that it was controlled and treatable,” and “the [Chinese] government took pains to keep up appearances.” For example, she notes, “[T]wo days before Wuhan told the world about the severity of the outbreak, it hosted a potluck banquet attended by more than 40,000 families so the city could apply for a world record for most dishes served at an event.”

Media reports also have highlighted complications and conflict between local and central officials in China regarding what information could be shared with the public. For instance, the Wall Street Journal‘s Josh Chin writes that Wuhan Mayor Zhou Xianwang has cited rules set by leaders in Beijing for “limit[ing] what he could disclose about the threat posed by the pathogen.”

As I told Fuoco Antonelli, there’s a sense that we’ve seen this movie before, and history offers us resources for thinking about how this is likely to play out. That may explain why some of the best writing on the virus has come from historians of infectious disease—including in particular my colleague Howard Markel, who has criticized the Chinese authorities for their heavy-handed quarantine.

I wanted to close by flagging Ashish Jha’s recent post at the Health Affairs Blog. Ashish takes an early look at the American response and closes with a look toward the future:

Here is the bottom line: we need to be doing more. This outbreak, under the best of circumstances, is going to cost countries around the world tens of billions of U.S. dollars and American businesses possibly many billions more. Yet we spend a fraction of that each year on vaccine platforms, research on viruses, and capacity-building for rapid vaccine production.  Firefighting is always more expensive than fire prevention. In a highly connected world, with climate change upon us, novel disease outbreaks that become global is the new normal.

Indeed, if history teaches us anything, it’s that outbreaks of novel infectious diseases have always been normal. Even so, we’re almost never ready. History teaches us that too.

 

Payers, providers urge CMS to scrap rule targeting supplemental Medicaid payments

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https://www.healthcaredive.com/news/payers-providers-urge-cms-to-scrap-rule-targeting-supplemental-medicaid-pa/571573/

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Dive Brief:

  • Payer and provider lobbying groups are urging CMS to pull back a proposed rule that aims to clamp down on supplemental Medicaid payments in order to contain spending growth.
  • The American Hospital Association wants CMS to withdraw the rule, warning it would “severely curtail the availability of health care services to millions of individuals,” according to comments it submitted in response to the proposal.
  • The insurance lobby wants CMS to start with a “more limited initial step” and focus on gathering data so it can “fully assess the current landscape of state Medicaid funding and payment mechanisms,” America’s Health Insurance Plans said in its comments. The Association for Community Affiliated Plans also asked the agency to withdraw the rule.

Dive Insight:

A sharp rise in these supplemental Medicaid payments caught the attention of CMS as spending has continued to increase and much of the growth has come from the federal share of the program, according to the agency.

These supplemental payments from the federal government to the states have risen from 9.4% of all other payments in fiscal year 2010 to 17.5% in 2017. This growth comes with “an urgent responsibility to ensure sound stewardship and oversight of the Medicaid program,” CMS said in November as it rolled out the proposed rule called Medicaid Fiscal Accountability Regulation.

A 2015 Government Accountability Office report found that states are increasingly relying on providers to help them finance the state’s portion of Medicaid funding. “A small number of providers supplied funds to the state for the nonfederal share, generally through intergovernmental fund transfers or provider taxes, and in turn received large supplemental payments, enabling states to obtain billions of dollars in additional federal matching funds,” according to the report.

CMS argues the proposed rule, which calls for states to provide more detailed information on these supplemental payments, including provider-specific payment data, would help beef up its oversight of the program.

AHA warned, however, the rule could cut Medicaid payments to hospitals by up to $31 billion annually, or nearly 17% of total hospital program payments. The group also argued the changes violate the Administrative Procedures Act and due process protections in the Constitution.

The Association of American Medical Colleges also opposed the rule, saying it would “limit the federal government’s congressionally mandated responsibility to the Medicaid program and could result in reductions in coverage, access, and quality care for the millions of vulnerable patients who rely on this critical program.”

CMS and the GAO report have noted a lack of data about these payments once they reach the states, making it hard to do any sort of analysis. In fact, GAO complained that the state of California did not have data on these payments for the agency to do an assessment.

 

Public Charge Rule Could Erode Enrollment in Insurance Coverage

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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.