Tag Archives: Medicaid

Hospitals Attack GOP Health Bill in $1 Million Ad Campaign

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https://www.bloomberg.com/news/articles/2017-06-27/hospitals-attack-gop-health-bill-in-1-million-new-ad-campaign

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Powerful hospital and medical school lobbying groups are spending at least $1 million on television ads opposing Senate Republicans’ plan to repeal and replace Obamacare.

The ads ask viewers to consider whether they’ll be among the millions of Americans projected to lose their health coverage under the Senate proposal, Rick Pollack, chief executive officer of the American Hospital Association, said Tuesday in a conference call with reporters.

The bill, which Republicans have put on hold until after the July 4 recess amid growing opposition within their own party, would leave an additional 22 million people in the U.S. without insurance, the non-partisan Congressional Budget Office estimated. Hospitals have a lot to lose under the current version of the bill, and the AHA, which represents about 5,000 institutions, last week told GOP senators to “go back to the drawing board.”

It’s the second time that the coalition will run ads opposing Republicans’ attempts to replace the Affordable Care Act, often called Obamacare. The group also ran ads opposing the House’s health bill, which passed in May. The House proposal would also increase the number of uninsured by more than 20 million, according to the CBO.

Samantha Dean, a spokeswoman for the AHA, said the campaign’s ads have already begun running and will cost seven figures. She wouldn’t give a precise amount.

The advertisements will continue to run “for as long as needed,” Dean said.

Analysis: Mitch McConnell Plans To Hide Trumpcare’s Pain Until After Midterms

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http://www.healthleadersmedia.com/technology/analysis-mitch-mcconnell-plans-hide-trumpcare%E2%80%99s-pain-until-after-midterms?spMailingID=11361778&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1182449350&spReportId=MTE4MjQ0OTM1MAS2

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The Better Care Reconciliation Act bill may make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal Obamacare.

Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar.

Here are a few key dates in McConnell’s “Better Care Reconciliation Act” (BCRA) that seem aimed more at providing cover for lawmakers than coverage for Americans:

2019: First major changes and cuts to the Affordable Care Act exchanges happen after the 2018 midterm cycle, allowing congressional Republicans to campaign on a “fixed” health system, even though Obamacare is still largely in place next year.

2019: States share $2 billion in grants to apply for waivers under a much looser process through this fiscal year. These waivers could allow insurers to sell skimpy plans that have low price tags but don’t take adequate care of people with preexisting conditions. None of those waivers has to go into effect, however, until after 26 Republican governors face re-election in 2018.

2020: Stabilization cash that makes the markets more predictable and fair for insurers flows through the congressional midterm cycle and the 2020 presidential cycle. Then it disappears. Medicaid expansion funds hold steady through this crucial political window, too.

2024: States enjoy their last few sips of Medicaid expansion cash at the end of 2023 — just as, perhaps, a second Republican presidential term is ending.

2025: The bill changes the formula for the entire Medicaid budget (not just the Obamacare expansion), dramatically reducing federal funding over time. That starts eight years and two presidential election cycles from now.

McConnell insists everything about the bill has been aboveboard and transparent.

“Nobody’s hiding the ball here. You’re free to ask anybody anything,” McConnell said on June 13.

But he and his working group did literally hide the bill from Democrats and most Republicans, crafting it behind closed doors until there was just a week left before his goal to secure a vote on it. (That timing was thrown off Tuesday with the announcement the vote was delayed, but the dealmaking is just beginning.)

Meanwhile, at least two policy details in the bill may obscure the effects for several years and make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

One is a stipulation that compels the federal government, for two years, to pay the cost-sharing reduction payments to insurance companies that President Donald Trump has threatened to end. The payments are part of the Affordable Care Act, and they flow to insurers on behalf of low-income marketplace customers to cover their out-of-pocket health expenses. Republicans had sued to stop the payments, adding considerable instability to ACA marketplaces next year. McConnell ends that uncertainty for two years.

On top of that cash infusion, the BCRA proposes a “Short-Term Stabilization Fund” that would also aim to help lower premium costs and could attract a few more insurers into counties that are sparsely covered now. It would dish out $50 billion to insurers — $15 billion per year in 2018 and 2019 and $10 billion per year in 2020 and 2021.

 

 

 

 

Medicaid, a “broken program that harms its beneficiaries”

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Medicaid, a “broken program that harms its beneficiaries”

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I asked on Twitter for policymakers’ expressions of harm caused by Medicaid.

Austin Frakt 

✔@afrakt

Seen a *policymaker* justify BCRA Medicaid changes because “Medicaid causes harm”? Send me the link. cc @aaronecarroll

By email, Andrew Goodman-Bacon came through in a huge way. The bullets below are a lightly edited version of what he sent me, shared with his permission. (For the record, Medicaid does not cause harm. More about that soon.)

  • The Sommers/Epstein paper surveyed governors and found that five of those who opposed expansion felt that Medicaid was a “broken program that harms its beneficiaries.”
  • Senator Ted Cruz has said that Medicaid hurts health care access
  • In one of Tom Price’s recent testimonies he said ,“Medicaid is a program that has, by and large, decreased people’s ability to access care.”
  • Speaker Paul Ryan comes close on pg 24 of “A Better Way
  • A Healthy Indiana report (notably produced by the Pence administration) cites Roy and LaPar, but doesn’t go all in on the “harms” claim
  • Here is the American Action Forum saying “harm”
  • See also, this brief from a policy shop in MI, this brief from a policy shop in NC, and this brief from a policy shop in PA
  • Here is ALEC citing that study, although not going so far as to say patients will be “harmed”

To these, I will add this quote of Representative Bill Cassidy (via Aaron) and this op-ed by Seema Verma (via Adrianna). Note: I have not looked through everything in the above list. If you find errors or have more contributions, let me know.

Medicaid: Welfare or Health Insurance?

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https://www.axios.com/the-great-medicaid-divide-2445011303.html

Image result for Republicans see Medicaid as welfare. Most Americans don't

Republicans want to roll back the Medicaid expansion, cap federal Medicaid spending increases, and add work requirements, drug testing, time limits, copays and premiums to some state Medicaid programs. But almost no one else wants to do these things. One poll finding goes a long way toward explaining why: Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program.

Why it matters: Welfare remains unpopular in our country; it’s always popular to limit or cut “welfare”. Whether it should be, and what this says about us, is a different question.

What the poll found: As the chart shows, Democrats (73%) and independents (62%) view Medicaid as an insurance program similar to others that help people pay for health care. But a slight majority of Republicans (52%), see it as more similar to welfare programs like food stamps.

Between the lines: One reason Medicaid limits are no slam dunk for Republicans in the Senate may be that not all Republicans view it as welfare: 46% see it as insurance, just as most Democrats and Independents do. Republicans who are more moderate are worried about the practical effects on citizens and states of rolling back the expansion or cutting federal Medicaid spending. One assumes they wouldn’t worry as much unless they viewed Medicaid as valuable health insurance coverage.

Perceptions of Medicaid as welfare don’t seem bothered much by facts, such as, for example, that two thirds of Medicaid spending goes for the low income elderly and disabled who don’t fit the Ronald Reagan era image of the welfare king or queen. But it’s not the majority view in any case. A little less than a third of voters identify as Republicans today, and about half of them see Medicaid as welfare.

It’s this group and their perceptions of the program, and elected officials who share their views, that seem to be driving debate about Medicaid today.

Explaining Medicaid’s Starring Role in the U.S. Health Debate

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https://www.bloomberg.com/news/articles/2017-06-27/medicaid-s-starring-role-in-u-s-health-care-flap-quicktake-q-a

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The biggest single change called for by the Republican health-care bill that may be voted on by the U.S. Senate this week is its reduction in federal spending on Medicaid, the program for poor and disabled Americans. The bill is being championed by Majority Leader Mitch McConnell and backed by U.S. President Donald Trump as a way to “repeal and replace” the Affordable Care Act, also known as Obamacare. The Senate bill, like one passed in May by the House of Representatives, would roll back Obamacare’s expansion of Medicaid and make other far-reaching changes to the program as well.

1. Who does Medicaid serve?

It’s the biggest health insurer in the U.S., providing benefits to about one in fourAmericans. It covers almost half of all births, almost two-thirds of people in nursing homes, almost 40 percent of all children and almost a third of adults with disabilities. Total Medicaid spending was $552 billion in the 2015 fiscal year, 17 percent of overall health spending. Along with education, Medicaid is one of the two largest components of spending by state governments, which administer the program and fund it in partnership with the federal government.

2. How did Obamacare change Medicaid?

It expanded Medicaid to cover those who were unable to afford private insurance but didn’t have incomes low enough to qualify for Medicaid before. After a Supreme Court ruling made the expansion optional, 31 states and the District of Columbia used the financial incentives offered under the Obamacare law to add about 12 million people to the Medicaid rolls. To congressional Republicans’ ire, the expansion was funded in part by tax increases on higher-income people. The federal government pays more than 90 percent of the cost of the Medicaid expansion.

Reverse the expansion of Medicaid, at different paces. The House bill would wind down funding for the expansion starting in 2020. The Senate bill would phase out the expansion’s funding between 2021 and 2024.

4. How else would they change Medicaid?

Currently, the federal government generally reimburses states for a fixed percentage of Medicaid expenditures, regardless of total spending or number of people enrolled. The Republican bills would impose a per-person limit on Medicaid reimbursement that would increase over time at a rate linked to inflation. The Congressional Budget Office said that under the House bill, which uses the rate of medical inflation to set the pace of spending, federal Medicaid spending would decrease by $834 billion between 2017 and 2026. The Senate bill would set a lower growth rate starting in 2025 by using the general inflation rate as a benchmark for much of Medicaid’s spending, rather than the medical inflation rate.

5. What would the impact be?

The Congressional Budget Office estimates that between 2017 and 2026, 15 million fewer people would be covered by Medicaid under the Senate bill, and 14 million fewer under the House bill, than under Obamacare. In both cases, Medicaid would account for about two-thirds of the increase in the number of uninsured projected by the CBO.

6. How else could poor people get coverage?

The House and Senate bills would make them eligible for subsidies for individual insurance policies, meaning people who are dropped from Medicaid could use the subsidies to buy their own coverage. Critics say the bill would make those policies unaffordable to low-income people by increasing deductibles.

7. What’s the debate about the bills like?

8. What’s Trump’s position?

During the 2016 campaign, Trump said that unlike other Republican candidates he would not cut Medicaid, Medicare or Social Security. But he did support the House health-care bill. After McConnell introduced a draft version of his bill, Sean Spicer, the White House spokesman, said that Trump was “very supportive” of the bill but was “committed” to making sure that people currently on Medicaid didn’t lose their coverage.

From Birth To Death, Medicaid Affects The Lives Of Millions

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http://www.npr.org/sections/health-shots/2017/06/27/534436521/from-birth-to-death-medicaid-affects-the-lives-of-millions

Medicaid pays the costs for about 62 percent of seniors who are living in nursing homes, some of the priciest health care available.

Medicaid is the government health care program for the poor.

That’s the shorthand explanation. But Medicaid is so much more than that — which is why it has become the focal point of the battle in Washington to repeal and replace the Affordable Care Act, also known as Obamacare.

President Barack Obama expanded Medicaid under his signature health care law to cover 11 million more people, bringing the total number of people covered up to 69 million.

Now Republicans want to reverse that expansion, and they want to go much further in cutting back on the number of people covered and federal dollars spent. The legislation they’re contemplating in both the House and Senate shrinks and fundamentally restructures the program.

The report issued by the Congressional Budget Office on Monday estimates that 15 million people would lose coverage through Medicaid by 2026 under the proposed Senate bill.

Here are five key things to know about Medicaid as the debate moves forward.

Medicaid Makes Up Almost 10 Percent Of The Federal Budget

Medicaid is a joint federal/state program under which both costs and regulations are divided. Currently, it’s an open-ended program, where the governments pay for any covered medical costs that beneficiaries need.

Federal spending on Medicaid in 2015 was about $350 billion, almost one-tenth of the $3.7 trillion federal budget. That money is supplemented by the states, so total spending on Medicaid services was $545 billion that year. Those numbers have been increasing as health costs rise and the number of people who are eligible for the program expands.

That’s what makes Medicaid a rich target for Republicans who want to put a lid on its growth. The Senate and House health plans would cap the amount Medicaid will spend per person, and then give states that amount of money to administer the program largely as they please.

Medicaid Pays For Half Of All Births In The United States

Medicaid was established in 1965 as a program to help poor single parents on welfare, along with their children. Two decades after that, the federal government required states to cover poor women who were pregnant for the first time. And in the early 1990s, Congress expanded coverage for pregnant women further to ensure that all pregnant women and mothers of children under age 6 with incomes up to 133 percent of poverty — or $21,599 for a family of two — are covered. According to the Kaiser Family Foundation, about half of all births are now paid for by Medicaid, ranging from 72 percent in New Mexico in 2015 to 27 percent in New Hampshire

Medicaid Pays For Most People In Nursing Homes

Medicaid pays the costs for about 62 percent of seniors who are living in nursing homes. The reason? Many seniors enter retirement with low incomes and few assets. And over time, many middle-income people who saved for retirement spend down their assets on health care.

Inpatient nursing care is some of the priciest health care out there, so even though seniors accounted for only 9 percent of Medicaid beneficiaries in 2014, they used 21 percent of Medicaid dollars, according to the Kaiser Family Foundation.

If You Or Your Loved One Is Disabled, You May Qualify

Medicaid spends almost $200 billion a year caring for people with physical and intellectual disabilities. That’s about one-third of its budget, even though, according to the Center for Budget and Policy Priorities, only about 13 percent of those enrolled in Medicaid are disabled. The services offered to people with disabilities vary by state and can include inpatient care, home-based services including personal care such as bathing and feeding, school-based services for children and job coaching for adults who opt to live independently.

People Who Need Treatment For Opioid Addiction

For people who are addicted to opioids, the expansion of Medicaid has proved to be one of the only paths to treatment. The expansion, in 31 states and the District of Columbia, opened up coverage to adults without children who have incomes up to 138 percent of the federal poverty level. In 2015, the program spent nearly half a billion dollars on Suboxone, a drug used to help those addicted to opioids control their cravings and stop using. Several studies have credited the expansion of Medicaid to better access to medication-assisted treatment, which is the most successful treatment for substance abuse.

Other Adults

About 11 million people got new health coverage through the expansion of Medicaid under the Affordable Care Act. Almost two-thirds of those fall into the category of the working poor, and another 12 percent are looking for work, according to an article published by Health Affairs in March. Many low-wage jobs don’t come with health benefits, and insurance premiums are often too high for people living on the edge of poverty to buy coverage.

Under the House bill and proposed Senate bill, the people who gained coverage under Medicaid expansion would be among the first to lose insurance.

 

Numbers of uninsured changes little from House version of healthcare bill, CBO score estimates

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http://www.healthcarefinancenews.com/news/numbers-uninsured-changes-little-house-version-healthcare-bill-cbo-score-estimates?mkt_tok=eyJpIjoiTldabVl6TmhaV1kyWm1RNSIsInQiOiJKTFFBemgxZnhNOXhNUHVWMnY1Wmt6U2JLaTlURnZ6SDM0ZVRcL2M0Mjd1NW1LTW16SmkxekpiSk1adnJodDI1T0hjdnRvUmRKTnJ2XC82ZWNXVGRHWkVlMEtZRnhEdFwvM1pBQ1wvSFVHQ0ZZZ3RQcWljeUthK0UrVU9FY3Arc05ST28ifQ%3D%3D

The number of uninsured by 2026 would increase by 22 million, 1 million less than what was estimated under the House bill.

Under the new Senate bill, the number of people who would be uninsured by 2026 would increase by 22 million as compared to the number under the current Affordable Care Act and 1 million less than what was estimated under the House bill’s American Health Care Act, according to a score of the bill released Monday afternoon by the Congressional Budget Office and the staff of the Joint Committee on Taxation.

By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under the current Affordable Care Act, the CBO said.

In 2018, 15 million more people would be uninsured under this legislation than under current law–primarily because the penalty for individuals and employers for not having insurance would be eliminated.

In later years, other changes in the legislation–lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market–would also lead to increases in the number of people without health insurance, the CBO said.

By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent.

Senate Majority Leader Mitch McConnell reportedly wants a vote prior to the July 4 recess but it’s unknown whether he’ll have the votes necessary among his own party members.

Democrats were quick to denounce the bill because of the CBO findings.

“Today’s CBO score has pulled back the curtain of Senate Republicans’ healthcare bill: it’s about giving huge tax cuts to millionaires and billionaires and dismantling important middle class programs like Medicaid and Medicare, all in the name of ‘health care reform,’ said Ways and Means Committee Ranking Member Richard Neal, a Democrat from Massachusetts.

Providers also find little to like in a bill that takes away coverage in both the individual market and through Medicaid.

“The Senate’s Better Care Reconciliation Act would be as damaging to the country as its deeply unpopular House counterpart, the American Health Care Act,” said Bruce Siegel, MD, president and CEO America’s Essential Hospitals.

The score reflects a last-minute amendment by McConnell to stabilize the insurance market through a continuous coverage provision giving a penalty for a lapse in insurance.

The Senate’s Better Care Reconciliation Act of 2017 is the Senate’s answer to H.R. 1628 put forward by House Majority Leader Paul Ryan in May.

The CBO forecasts stability for the nongroup market in most areas of the country under the new bill, including in states that obtain waivers for coverage of essential benefits.

This is because there would be substantial federal funding to directly reduce premiums available through 2021. Premium tax credits would continue to provide insulation from changes in premiums through 2021 and in later years, the CBO said.

Lower premiums will help attract enough relatively healthy people for the market in most areas of the country.

That stability would continue even when cost-sharing reduction payments to insurers are eliminated starting in 2020, a move payers have said would drive up the price of premiums.

A small fraction of the population resides in areas in which — because of this legislation — no insurers would participate in the nongroup market or insurance would be offered only with very high premiums.

Insurance covering certain services would become more expensive–in some cases, extremely expensive–in some areas because the scope of coverage for essential health benefits would be narrowed through waivers affecting close to half the population, CBO and JCT said.

The CBO and JCT estimate that enacting this legislation would reduce the federal deficit over the 2017-2026 period by $321 billion. This is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House.

The largest savings would come from reductions in Medicaid. Spending on the program would decline by 26 percent in 2026 compared with what CBO projects under current law.

Spending would be reduced because of the elimination of federal spending for Medicaid expansion under the ACA’s subsidies for nongroup health insurance.

Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage including additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.

The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers, the CBO said.

What the Senate healthcare bill could mean for Californians

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http://www.latimes.com/local/lanow/la-me-ln-senate-healthcare-bill-calif-20170623-htmlstory.html?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=53556425&_hsenc=p2ANqtz-_hPx1HfAdYE1P-TUg2uSAZhzRObBW1gNiZE5LA54kKyb8YsTq2NfZcYDzf9ZbJqqw2CN0F7uk5g9kdOQXlj_KSKRTUow&_hsmi=53556425

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Senate leaders have released their Obamacare repeal bill, which would slash federal funding for healthcare and could leave millions of Americans uninsured.

Though the plan has not yet been analyzed by the Congressional Budget Office, it isn’t too different from the one passed by the House last month. The CBO projected the House bill would save the federal government $119 billion over the next decade, raise insurance deductibles and leave 23 million fewer Americans with health coverage.

Both bills would also undo several taxes on high-income Americans that are used to fund Obamacare.

The Affordable Care Act has had a huge impact on California, where roughly 4 million people have gained insurance and the percentage of uninsured residents has dropped more than half.

Below is a breakdown of some of the ways the Senate bill could affect healthcare coverage in California if it becomes law.

How Medicaid Works, and Who It Covers

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One of the biggest flash points in the debate over Republican legislation to repeal and replace the Affordable Care Act is the future of Medicaid. Here are some basic facts about the 52-year-old program.

What is Medicaid?

It’s a public health insurance program largely for low-income people, though some middle-class disabled and elderly people also qualify. States and the federal government share the cost.

Whom does Medicaid cover?

■ Nearly one in five Americans, 74 million people, are on Medicaid.

■ Federal law guarantees Medicaid coverage to pregnant women, children, elderly and disabled people under certain income levels.

■ It covers more than a third of the nation’s children and pays for half of all births.

■ It also covers almost two-thirds of nursing home residents, including many who are middle class and spent of all their savings on care before becoming eligible.

States also have the option of covering other groups, like children and pregnant women whose household incomes are higher than the federal thresholds, or young adults up to age 26 who were once in foster care.

■ The Affordable Care Act allowed a new optional group: any adults with income up to 138 percent of the poverty level, which would be $16,643 for an individual this year. Thirty-one states now offer Medicaid to this group.

When was it created?

■ In 1965, as part of President Lyndon B. Johnson’s “Great Society.”

■ There was little political debate; the bigger fight was over creating Medicare, the program to cover the elderly, which Medicaid is often confused with.

Is Medicaid an entitlement
program?

Yes. Anyone who meets the eligibility rules has a right to Medicaid coverage, and for now, states are guaranteed open-ended financial support from the federal government.

How much does it cost?

■ Medicaid cost $553 billion in fiscal year 2016. Of that amount, $348.9 billion came from the federal government; the states paid $204.5 billion.

■ Medicaid accounts for 9 percent of federal domestic spending. For states, it is the biggest source of federal funding and the second-largest budget item, behind education.

The biggest costs in Medicaid are for the elderly and the disabled, often because of long-term care in nursing homes.

■ Washington pays 50 to 75 percent of Medicaid costs for most eligible groups, with poor states receiving more money.

■ Under the Affordable Care Act, the federal government initially covered all of the costs for the roughly 11 million people insured under the law’s expansion of Medicaid, who are largely adults without disabilities.

■ Under the law, Washington picks up 95 percent of state costs for the expansion of Medicaid this year, whittling down to 90 percent in 2020.

What changes are in store?

■ Both the House and Senate health bills would fundamentally change the way the federal government pays its share of Medicaid costs, setting a per-person limit on spending that would adjust annually for inflation.

■ The bills would also effectively end the Medicaid expansion, by sharply reducing how much the federal government pays for that population starting in 2020.

■ The result of these changes, according to independent analyses, would be major reductions in federal Medicaid spending over time.

■ Enrollment would drop, too, according to the nonpartisan Congressional Budget Office, with states making it harder to qualify for the program and getting rid of certain benefits to make up for tightened federal spending.