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Medicaid Archives — Page 5 of 8 — Protect Our Care

Coverage Roundup: Trump’s Budget Revives Health Care Repeal

As the dust settles around today’s surprise move by President Trump to revive the Graham-Cassidy plan to repeal the Affordable Care Act and gut Medicaid by including it in his annual budget blueprint, here’s a roundup of initial coverage:

Los Angeles Times: “The White House is doubling down on the repeal effort, calling for massive cuts to healthcare assistance in its 2019 budget … Cuts of this magnitude – which parallel repeal legislation pushed unsuccessfully by GOP congressional leaders last year – would likely leave tens of millions more Americans without health coverage, independent analyses have indicated.”

Wall Street Journal: “The budget proposal includes $68.4 billion for the Department of Health and Human Services, a 21% drop from the funding level enacted last year. The proposal would also revive a repeal of the Affordable Care Act and cut spending on Medicare and Medicaid. It calls for enactment of a law to scrap the ACA and instead give block grants to states to establish their own health systems, a plan modeled after GOP legislation that failed to pass last year.”

Washington Post: “On healthcare for low-income Americans, Trump’s budget calls for cutting federal Medicaid funding by $250 billion over the next 10 years, as the administration envisions passing a law ‘modeled closely’ on a Senate Republican proposal that failed last fall to repeal the Affordable Care Act…  Experts say the overall reduction in government spending would cost millions of Americans their health insurance.”

CNBC: The new budget proposal also would seek a rollback of Obamacare’s expansion of Medicaid benefits to poor adults. Medicaid offers health coverage to primarily low-income people. Before Obamacare, most states either denied Medicaid coverage to people who did not have dependent children or set very low limits on how much a person could earn and still qualify for coverage.

Business Insider: “The budget contains cuts to funding for Medicare and other social safety net programs. During the presidential campaign, Trump repeatedly promised not to cut funding to these programs.”

USA Today: “The budget proposes repealing the ACA’s expansion of Medicaid and limiting the amount of money states receive for the jointly-funded health care program for the poor. It would also end after two years the private insurance subsidies for people who don’t get coverage through a government program or an employer, while giving states grants to develop their own programs.”

STAT News: “The proposals are a hodgepodge of relatively narrow policies that take aim at various parts of the Medicare and Medicaid programs. One would reduce the amount of money doctors and hospitals are reimbursed for hospital-administered drugs under Medicare Part B; another would let some states engage in more aggressive negotiation for drugs in their Medicaid programs. Others take aim at a drug discount program for hospitals and at seniors’ out-of-pocket spending.”

New York Times: The budget once again calls for repealing and replacing the Affordable Care Act, an effort that has been tried and failed previously and which Republican leaders have largely abandoned as a priority.”

Trump Administration Continues War on Health Care with FY19 Budget Blueprint

After President Trump released a budget blueprint that would continue his Administration’s assault on the American health care system, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“With today’s budget, the Trump Administration is doubling down on its relentless war on  American health care. By asking Congress to revive the deeply unpopular Graham-Cassidy repeal bill that ended protections for Americans with pre-existing conditions, gutted Medicaid, ripped away coverage from millions, and raised costs for millions more, while also proposing drastic cuts to Medicare, Trump has chosen to ignore the American public’s overwhelming preference for a bipartisan path forward on health care. Instead, the Trump Administration continues its assault on the Affordable Care Act, Medicare, and Medicaid.

“As a deadly flu epidemic continues to sicken people across America, President Trump’s budget today shows that he remains worse than indifferent to our health care. Enough is enough: the sabotage, cuts, and repeal attempts must stop. Congress should declare this budget’s anti-health care proposals dead on arrival.”

BACKGROUND

Today’s Trump budget proposes a $1.7 trillion cut to Medicare and other mandatory programs and pushes Congress to repeal the Affordable Care Act and gut Medicaid by passing legislation modeled on Graham-Cassidy.

Backlash Against Proposed Medicaid Cuts Continues

As national backlash to the Trump Administration’s attacks against Medicaid continued, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“We continue to stand against the Trump Administration’s illegal plan to force people off their coverage. The American people want Congressional Republicans to stop stacking the deck against working Americans and for Congress to preserve Medicaid for generations to come.”

Kentucky Rushes to Remake Medicaid as Other States Prepare to Follow

New York Times // Abby Goodnough // February 10, 2018

LOUISVILLE, Ky. — With approval from the Trump administration fresh in hand, Kentucky is rushing to roll out its first-in-the-nation plan to require many Medicaid recipients to work, volunteer or train for a job — even as critics mount a legal challenge to stop it on the grounds that it violates the basic tenets of the program.

At least eight other Republican-led states are hoping to follow — a ninth, Indiana, has already won permission to do so — and some want to go even further by imposing time limits on coverage.

Such restrictions are central to Republican efforts to profoundly change Medicaid, the safety net program that has provided free health insurance to tens of millions of low-income Americans for more than 50 years. The ballooning deficits created by the budget deal that President Trump signed into law Friday and the recent tax bill are likely to add urgency to the party’s attempts to wring savings from entitlement programs.

House Speaker Paul D. Ryan, Republican of Wisconsin, said Thursday that addressing entitlement spending is “what you need to do to fully deal with this debt crisis,” though Senator Mitch McConnell, the Republican majority leader from Kentucky, said he has ruled out doing so this year.

As Kentucky pushes forward, many who work with the poor are worried that the thicket of new documentation requirements in Medicaid will be daunting for low-income people, who may have little education and struggle with transportation, paying for cellphone minutes and getting access to the internet. Not only that, they note, but the new rules will add the type of administrative costs and governmental burdens that Republicans tend to revile.

On a recent rainy Monday, Bill Wagner, who runs primary care clinics in poor neighborhoods here, listened tensely as a state health official explained how the state would enforce the complex and contentious new rules.

The 20 hours a week of work, job training or volunteering? Ten regional work force boards will monitor who complies, said the official, Kristi Putnam.

The monthly premiums of $1 to $15 that many will now owe? The managed care companies that contract with the state will collect them.

The “rewards dollars” that many will need to earn to get their teeth cleaned or their vision checked? They’ll be tracked through a new online platform, where Medicaid recipients will also be expected to upload their work, volunteer or training hours.

“I know it sounds a little bit complicated,” Ms. Putnam conceded as the group meeting with her, which has overseen efforts to enroll Louisville residents in health insurance in the Obamacare era, jotted notes. Someone heaved a sigh.

After four years of signing up thousands of people for coverage under the health law’s expansion of the Medicaid program, Mr. Wagner told the room, “We’re shifting our focus from helping people gain coverage to helping people keep it.”

The rationale of Gov. Matt Bevin and other supporters is that Medicaid was created for the most vulnerable citizens — those who aren’t only poor, but pregnant, elderly, children or disabled — and that for everyone else, working or otherwise engaging in their community will provide dignity and better health. About 500,000 Kentuckians have joined the Medicaid rolls under the Obamacare expansion, and the state estimates some 350,000 will be subject to the new work rules.

While the work requirement is unprecedented in the history of Medicaid, Mr. Wagner and others say they’re just as concerned about other new rules that will be confusing and hard to follow. For example, many adults who don’t pay their small premiums can be locked out of Medicaid for six months, unless they complete a financial or health literacy course. Others will lose access to dental and vision care.

Critics of the plan point to Indiana, which dropped about 25,000 adults from its Medicaid program from 2015 through 2017 for failing to pay premiums there. About half found other coverage, according to state surveys, typically through a job.

Mark Lee Coleman, a diabetic who was visiting a busy clinic run by Family Health Centers, the nonprofit network that Mr. Wagner heads, one recent morning, had heard next to nothing about the new rules. He needed refills on his medications; his blood sugar level had climbed so high without them that he risked falling into a diabetic coma. But first Mr. Coleman needed help figuring out why his Medicaid coverage had been canceled late last year, even before the new rules kicked in.

A counselor at the clinic called the state Medicaid office and found out Mr. Coleman, 49, had forgotten to report a change in income last July, when he switched from a higher-paying job at an Amazon warehouse to a less physically demanding job as a parts driver for Pep Boys, the automotive chain. After she helped him email a pay stub to the office, his coverage was set to be reinstated within a few days.

Once Kentucky’s new rules take effect this spring and summer, Mr. Coleman will also have to report a monthly tally of his work hours to keep his coverage.

Matt and Sarah Burress, and their children, at home in Mount Washington, Ky. Mr. Burress, who owns a small lawn care business and doesn’t work all winter, wonders how the new rules would affect seasonal, self-employed workers. Credit Aaron Borton for The New York Times
He now works 20 hours a week, but he has neuropathy, a numbness and tingling in his hands and feet, and sometimes has trouble walking. Should he cut back his hours, he’d either have to try to get classified as “medically frail,” which would exempt him from the work rule, or lose his coverage.

He hasn’t thought all that through yet. In concept, though, he supports work requirements — as do most voters, polls have found.

“That’s not bad, to tell you the truth,” he said. “If you’re working, that’s good for your health.

As he spoke, he gulped water from a bottle he kept refilling — his extreme thirst a sign of his health crisis. Kara Peers, a case worker at Family Health Centers, tried to gauge what other challenges he and his wife and four children might be facing that could interfere with his ability to manage his disease.

“What about food, sir?” she asked.

“Ah, we’re kind of low,” he replied.

“Utilities — are you able to pay the bill?”

“It can be tough.”

He left with a month’s worth of medications — three for diabetes, one for high blood pressure, paid for by the clinic — and the reassurance that his Medicaid would soon be reinstated. Melissa Mather, the communications director at Family Health Centers, said she worried that patients like him, who already stumble over Medicaid’s paperwork requirements, will be more lost under the new rules. She and Mr. Wagner are also worried about their homeless patients, who will be subject to the rules unless they meet the federal definition of “chronically homeless” and get an exemption.

“This is a very, very big concern from my perspective — talking about the complexity of these changes when a lot of the folks we deal with have lives that are in chaos already,” she said.

For now, there are more questions than answers, as state workers like Ms. Putnam hustle to iron out all the details, let alone explain them. Like Mr. Carter, Sarah and Matt Burress got Medicaid under the Affordable Care Act after going uninsured for years. The coverage may have saved Mr. Burress’s eyesight — though only 29, he was diagnosed with advanced glaucoma when he went for a routine eye check shortly after becoming insured in 2015.

Now he’s worried about keeping his coverage because he runs his own small lawn care business, working irregular hours with a hiatus that lasts all winter.

“We haven’t heard how it will work for seasonal self-employed workers,” said Ms. Burress, who works part time as an office manager. “Do his clients have to say, ‘Yeah, he mowed my grass this week?’ Part of it feels like they’re trying to catch you, by burying people in paperwork and making it a huge inconvenience.”

She added that she and her husband plan to remain on Medicaid only until his business starts turning a profit. “This was never meant to be our permanent fix,” she said, not the “dead-end entitlement trap” that Mr. Bevin rails against.

Most people on Medicaid do work, research has found; Those who don’t often are disabled, even though they may not qualify for Social Security Disability Insurance. Sheila Penney, 54, has cycled in and out of jobs for years with chronic depression and anxiety that started when she lost her father at 16. She has worked as a package handler, a boat reservations manager and even a health insurance enrollment counselor, helping patients at Family Health Centers sign up for Medicaid back in 2014.

But she has not worked at all for the last two years, focusing instead on getting her mental health problems under control and relying on her mother to pay her rent. Now she’s a plaintiff in a lawsuit filed last month to stop Kentucky’s new requirements from taking effect. With Medicaid, she is able to go weekly to a therapist and monthly to a psychiatric nurse practitioner who adjusts her medication, she said.

“I’m wanting to go back to work, but if I was told, ‘You have to go back,’ I do think that would step up my anxiety,” Ms. Penney said. “Volunteering would be less pressure, but you would still want to be consistent and reliable.”

Caring full time for a child or other family member can also count toward the work requirement, as can going to school full time, though neither will apply to Ms. Penney.

She expects she will find a way to pay the new premiums she’ll owe under the plan — $4 a month — but predicts it will mean going without other necessities at times. (She is poor enough under the new rules that if she fails to pay them, she will lose access to dental and vision coverage but not be dropped from coverage altogether.)

“I was at the store yesterday, looking in my wallet and going, ‘Do I have enough money for dog food?” she said. “The thought of taking on even one more expense feels overwhelming.”

For Kimberly Dandridge, who overcame breast cancer and addiction to crack cocaine earlier in her life, Medicaid is a bridge while she works toward a job that comes with benefits. Ms. Dandridge, 53, works 30 hours a week as an administrative assistant, and said she would have no trouble meeting the premium and work requirements — but could relate to those who might.

“I remember there was a time I was just down, in the gutter, so low and broken,” she said. “If people like that need medical attention, just let them get it.”

 

Momentum Builds Against Lifetime Limits on Medicaid Coverage

As critics speak out against the Trump Administration’s consideration of lifetime limits for people covered through Medicaid, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“One in five Americans has Medicaid coverage, most of them seniors, children, and people with disabilities. Every step the Trump Administration takes to roll back Medicaid coverage reveals that its true intention is to take away health insurance from Americans. But reactions to this week’s news about lifetime limits on Medicaid coverage make clear that this is an approach our nation rejects.

“The Affordable Care Act made it illegal for insurance companies to cut off care, preventing those going through extensive treatment like chemotherapy from having their coverage stopped. Allowing lifetime limits again would cast aside vulnerable Americans for no reason and under false pretenses – because despite the rhetoric coming from this Administration, studies show these proposals don’t incentivize people to work, they merely punish them for getting sick or having a disability and losing their job, or for working for a business that does not offer insurance.

“Implementing lifetime limits for those receiving coverage under Medicaid would work against the foundational goals of the program, which is why Americans are speaking up and fighting back.”

Another day, another stealth attack on Medicaid

Washington Post // Helaine Olen // February 8

Another day, another attack on Medicaid — and on the poor and working class.

According to a little-noticed McClatchy report this week, Arizona, Kansas, Utah, Maine and Wisconsin have appealed to the Trump administration to seek permission to put lifetime limits on Medicaid coverage for recipients they deem able-bodied. In other words, those five states want to time-limit or cap the total period of time an individual could receive Medicaid benefits over his or her lifetime.

There is no word on whether the administration will agree to this, but it is worth noting that it comes on the heels of its decision to allow Kentucky and Indiana to mandate that many of their able-bodied Medicaid recipients meet work requirements.

If successful, this push for lifetime limits will constitute another way to try to undermine the overall Medicaid program, including the Affordable Care Act’s coverage expansion. Arizona opted into the ACA’s Medicaid expansion, and voters in Maine approved a referendum to do the same, though that’s still up in the air. If the Trump administration signals that it will approve lifetime caps, other states that expanded Medicaid could follow. As a result, this could end up being a way to cut back on Medicaid both in states that didn’t expand the program as part of the ACA, and in states that did — further undermining the ACA’s historic coverage gains, just as work requirements will inevitably do.

As Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, put it, the latest proposed change, when taken along with the work requirements, suggests the administration is “hell-bent on trying to keep people out of coverage.”

Direct attacks on Medicaid are not popular, as President Trump and Republicans learned last year during their efforts to repeal the Affordable Care Act. Polls have also found broad opposition to cutting Medicaid.

But that doesn’t mean Republicans are giving up. Both the work requirements and the proposed lifetime limits should be understood as using bureaucracy to facilitate a backdoor attack on Medicaid. As Rebecca Vallas, a vice president at the Center for American Progress, told me, work requirements ultimately are really about putting up “roadblocks and red-tape obstacles” in the way of access to health coverage. They discourage applicants from completing the process of getting benefits, usually to reduce spending by the states.

Work requirements — which have been championed by Seema Verma, the head of the Centers for Medicare and Medicaid Services — rest on a false premise.  It’s not true — despite myths claiming otherwise — that there are well-paying jobs out there for everyone who is willing and able to do them. Workers in the gig economy find temporary positions that come and go. Other low-wage workers can find their hours fluctuating enormously and with little notice. Medicaid is not simply there for people who are unemployed, or not a part of the workforce, but also as a support for people who are working, but not earning an adequate wage to afford health insurance.

Lifetime limits impose another hurdle on those who need Medicaid. Each state is proposing doing this in a different way. Utah’s proposed lifetime limit would be a total of five years. Wisconsinites would hit the limit at four years. In Kansas, at three years. Three of the states would count time working and not working while receiving Medicaid toward the limit, while two would only subject those receiving Medicaid while unemployed to the limit. Utah would only subject childless adults to it. All of these changes would be complex to navigate and, if they are green-lit, will not only push people out of the program when they hit the limits, but possibly discourage them from applying at all.

Medicaid lifetime limits and work requirements also function as cloaked attacks on the concept of universal health coverage. Medicaid functions as a guarantee of health coverage for people who do not have employer provided insurance, as well as the poor and working class. Lifetime limits — such as work requirements — throw more obstacles in the path of that idea, since they will, at some point, likely leave many without even that baseline access to health coverage.

If you believe universal health care is a right, lifetime limits are not the way to go. Caps on the time people can receive coverage would ultimately have the same effect as work requirements — a certain percentage of people who are ill, or will become ill, will not be able to easily access medical services when they need them.

Lifetime limits on Medicaid eligibility, like work requirements, take us backwards: they reestablish a principle that the ACA tried to abolish, albeit incompletely: that healthcare is not a right, but a privilege.

This Week in the War on Health Care — February 5-9, 2018

While the budget showdown took up most of the oxygen this week in Washington, the Trump Administration continued its unprecedented assault on the American health care system.

Meanwhile, despite the relentless sabotage, 11.8 million people nationwide signed up for coverage through the Affordable Care Act marketplaces during this year’s open enrollment. Experts estimate that 1.1 million more could have signed up if Trump’s HHS hadn’t attacked outreach funding.

While most of us were focused on cars in space and the stock market, here’s a summary of what happened this week in sabotage – and how Americans are fighting back:

A NEW LOW IN THE WAR ON MEDICAID

On Monday reports emerged that the Trump Administration is considering a new low in their war on Medicaid: lifetime limits on coverage. The Affordable Care Act stopped insurance companies from imposing lifetime limits on coverage, freeing Americans from arbitrary limits on their care. The re-institution of these limits could punish Medicaid enrollees simply because their longtime employer doesn’t offer insurance or because they got sick or have a disability and lost their job, threatening the health and well-being of millions of Americans and leaving large swaths of the population with nowhere to turn.

And with Medicaid covering one-fifth of substance abuse treatment nationwide and playing a “central role,” in attempts to combat this crisis, this proposal could make things even worse.

MEANWHILE, SUPPORT FOR MEDICAID EXPANSION GROWS IN STATES

In stark contrast to the Administration’s near-constant attacks on Medicaid, medical professionals continue to assert the benefits of the popular program and states from coast to coast are moving forward with attempts to expand it.

In North Carolina, a children’s advocacy organization released a new report arguing that Medicaid expansion could reduce the state’s fetal and infant mortality rates, endorsing the bipartisan expansion proposal currently under consideration in the state legislature. Grassroots movements are underway in Nebraska, Utah, Missouri, and Idaho to put Medicaid expansion on state ballots in 2018. Just three weeks ago, Oregon voters supported a legislative package funding the state’s Medicaid program. And back in November, Maine voters overwhelmingly approved Medicaid expansion in the state.

All of which is to stay: people want expanded access to coverage. And if there were any doubts …

OPEN ENROLLMENT BLOWS EXPECTATIONS OUT OF THE WATER

Despite more than a year of sabotage from President Donald Trump, his Administration, and Congressional Republicans, 11.8 million Americans, including 2.5 million new enrollees, purchased 2018 health insurance through Affordable Care Act marketplaces – 96% of last year’s total. These Americans did so in the face of rampant obstacles put in their way, from a shortened sign-up period to the President declaring the law ‘dead,’ and did so for one reason: they want and need the quality, affordable coverage they can get from the Affordable Care Act . Here’s how health care experts and media outlets described this year’s open enrollment period:

NBC News: “Despite Trump, Obamacare Records Strong Enrollment.” [NBC News, 2/7/18]

Kaiser Family Foundation: 11.8 Million People Signed Up “Amid Steep Reductions In Federal Funding For Outreach In Navigators, An Enrollment Period Half As Long, And A Climate Of Political Uncertainty Surrounding The Law.” [KHN, 2/7/18]

Los Angeles Times: The Numbers “Suggest Surprising Strength In Many Markets Across The Country.” [Los Angeles Times, 2/7/18]

The Hill: The Numbers “Show The Obamacare Remains Stable In The Face Of ‘National Uncertainty.’” [The Hill, 2/7/18]

Associated Press: “Enrollment Remained Remarkably Stable Despite President Donald Trump’s Disdain For ‘Obamacare,’ And Repeated Efforts By The Republican-led Congress To Repeal The Program.” [AP, 2/7/18]

Washington Post: “Enrollment Was Surprisingly Resilient.” [Washington Post, 2/7/18]

Washington Times: “Interest In The Exchanges Outpaced Last Year On A Day-To-Day Basis.” [Washington Times, 2/7/18]

Bloomberg: “President Donald Trump Has Frequently Been Accused Of Trying To Undermine Obamacare, His Predecessor’s Signature Health Law. New Data Show That By At Least One Measure He Didn’t Do A Particularly Good Job Of It.” [Bloomberg, 2/718]

Larry Levitt, Kaiser Family Foundation: “If You Had Asked Me A Year Ago Whether Enrollment For 2018 Would Be Almost Equal To 2017, I Would Have Laughed At You.”  [AP, 2/7/18]

Mark Hall, Wake Forest University Professor Of Law And Public Health: “Despite The Trump Administration’s Effort To Undermine The Affordable Care Act, Its Basic Structure Remains Solid.” [Winston-Salem Journal, 2/7/18]

Trish Riley, National Academy For State Health Policy Executive Director: “This Shows Consumers Really Want And Need Coverage.”[Los Angeles Times, 2/7/18]

Allison O’Toole, MNSure Chief Executive: “We Had The Best Open Enrollment Period We Have Ever Had.” [Los Angeles Times, 2/7/18]

As Trump Administration Undermines Medicaid, Some States Attempt to Expand It

Meta Capitol

It was revealed yesterday that the Trump Administration may allow lifetime coverage caps for people covered by Medicaid, an illegal move that would threaten the health and well-being of millions of Americans. But beyond the nation’s capital, states are instead looking at ways to expand Medicaid coverage.

Just today, a children’s advocacy organization in North Carolina released a new report arguing that Medicaid expansion could reduce the state’s fetal and infant mortality rates, bolstering the case for the bipartisan expansion proposal the state is currently considering.

Outside of North Carolina, grassroots movements are underway in Nebraska, Utah, Missouri and Idaho to put Medicaid expansion on state ballots in 2018. And just three weeks ago, Oregon voters supported a legislative tax package funding the state’s Medicaid program. Back in November, Maine voters overwhelmingly approved Medicaid expansion in the state.

“The Trump Administration and Congressional Republicans are doing the exact opposite of what the American people want, which is expanded access to coverage. It’s time for this Administration and its sabotage partners in Congress to get the message being sent to D.C. by countless states and take ACA repeal, Medicaid block grants, and administrative actions that diminish access off the table. Enough is enough: it’s time for the GOP to end its war on our health care,” said Protect Our Care Campaign Director Brad Woodhouse.

Groups: Medicaid expansion could lower baby-death rates

Winston-Salem Journal // Richard Craver // February 7, 2018

A state child advocacy group has added its voice to those urging the Republican-controlled legislature to expand Medicaid to more than 500,000 North Carolinians

States that have expanded Medicaid have a lower infant mortality rate than those who haven’t, NC Child said in a 2016 report.

An update of that report, which was scheduled to be released today, focuses on fetal mortality, which is defined as the death of a fetus that occurs at 20 or more weeks of gestation.

Both rates are affected by a wide range of factors, including tobacco use and substance use disorders, obesity, domestic violence, poverty, racism, education and access to pre-conception and prenatal healthcare.

In North Carolina, 58 percent of women between the ages of 18 and 44 are considered to be overweight or obese, while 16 percent have been diagnosed with hypertension and 20 percent are smokers.

In 2016, North Carolina had almost as many fetal deaths (818) as infant deaths (873).

From 2012 to 2016, there were 6.9 fetal deaths per 1,000 live births in North Carolina, compared with an infant mortality rate of 7.2 per 1,000 live births.

In Forsyth County, the rate of fetal deaths was 6.4 during that time span, while the infant mortality was 8.3. Forsyth’s highest infant mortality rate was 14.7 in 1997.

“By utilizing available federal funding to expand access to affordable health care for women of childbearing age, the state can influence both fetal and infant mortality simultaneously, effectively doubling the positive impact for North Carolina families,” said Whitney Tucker, research director at NC Child.

Statewide, premature birth and low birthweight are the leading causes of death for infants under 1 year old, causing 20.6 percent.

“These chronic conditions and risk factors can be addressed most effectively when women have access to health insurance,” NC Child said. “Unfortunately, 20 percent of North Carolina women of childbearing age (18 to 44) lacked health insurance in 2016.”

NC Child said 20.5 percent of Forsyth women of childbearing age do not have health insurance, while 31 percent do not receive prenatal care in their first trimester of their pregnancy.

“Newborns of mothers with no prenatal care are three times more likely to have a low birthweight and five times more likely to die than children born to mothers who do receive prenatal care,” according to the report.

NC Child spokesman Rob Thompson said “certain groups of non-citizens are eligible for Medicaid and Obamacare, but not undocumented immigrants.”

“I don’t know exactly what portion of the 20 percent is composed of undocumented immigrants. With children in N.C., 96 percent are insured and the general thinking is that somewhere between one-third and one-half of the remaining uninsured are undocumented.”

Most Republican legislative leaders argue that the federal government, first under the Obama administration and now under the Trump administration, may not be able to keep its pledge of covering 90 percent of the administrative costs of Medicaid expansion.

The advocacy group supports House Bill 662, titled “Carolina Cares,” that represents a bipartisan effort to expand Medicaid. The bill has Rep. Donny Lambeth, R-Forsyth, as its main sponsor.

The bill would require some people who get Medicaid to work, which has proven controversial. North Carolina is one of 10 states with federal regulatory permission to move forward with a work requirement, if legislatively approved.

However, HB 662 has not appeared on either chamber’s agenda for the current special session after not advancing out of committee during the regular 2017 session.

“While the proposal includes elements that will negatively impact enrollment — premiums and work requirements — it has the potential to provide currently unavailable health care options for women of childbearing age at high risk of experiencing fetal or infant mortality,” NC Child said.

“Whether it’s Carolina Cares or a different bill, the legislature should act quickly to close the health insurance coverage gap and support healthy pregnancies and healthy babies,” Tucker said.

Marlon Hunter, Forsyth’s health director, has said the county health department, along with its community and agency partners, encourage women of child-bearing age “to achieve optimal health before they become pregnant in order to improve birth outcomes.”

“Almost half of all pregnancies in our community are not planned.”

The county health department and county Infant Mortality Reduction Coalition are focusing on reducing pre-term birth, supporting and improving mental health services for women, and stressing the importance of women and men of reproductive ages to develop reproductive life plans.

The Kate B. Reynolds Charitable Trust and Novant Health Inc. launched Forsyth Connects in May 2016. Their initiative provides free in-home nurse visits to all mothers with newborn babies who are born and reside in Forsyth. The baby doesn’t have to be the mother’s first.

3 Questions Secretary Azar Must Answer After Today’s Meeting With President Trump

Trump Header Background

This morning, as news breaks that almost 12 million people enrolled through the Marketplaces despite Republican sabotage, Health and Human Services Secretary Alex Azar will meet with President Trump to discuss the Administration’s path forward. Will they continue their unpopular, partisan war on our care, or listen to the American people, who want an end to sabotage and repeal?

Here are three questions Secretary Azar must answer following his meeting with the President:

1. Will the Trump Administration Stop its War on Medicaid?

Yesterday, the Trump Administration announced it might allow states to impose lifetime limits for people with Medicaid, a direct affront to Medicaid’s mission. This proposal puts care for roughly 1 in 5 Americans, or 77 million people, in danger most of whom are seniors living in nursing homes or receive other long-term care, children, and people with disabilities. The reality is the majority of Americans with Medicaid coverage live in working households, and now the Trump Administration is considering punishing people just because their employer doesn’t offer insurance or because they got sick or have a disability and lost their job. The Affordable Care Act stopped insurance companies from imposing dollar lifetime limits on coverage, and as a result, 105 million Americans are now free from arbitrary limits on care. But the Trump Administration wants to take us back to the days of lifetime coverage caps, and they’re targeting our most vulnerable citizens as guinea pigs. The Administration has also just started allowing states to impose onerous work requirements for people with Medicaid, which will not help people find or keep a job, but will just take away their health care.

These are the latest salvos in their war on Medicaid. Last year, the House of Representatives passed a health repeal bill that cut Medicaid by $839 billion, or 25 percent, and converted the program into a “per capita cap”, thus ending the guaranteed coverage for everyone who has it.

2. Will the Trump Administration Stop Pushing Junk Health Care Plans that Roll Back Key Protections for People with Pre-Existing Conditions?

The Trump Administration is taking steps to gut key protections and expose people to discrimination based on pre-existing conditions through their so-called “association health plans” and short-term plans. These efforts allow insurance companies to once again sell plans that do not meet the requirements of the Affordable Care Act. These skimpy plans could refuse to cover essential health benefits such as cancer treatments, maternity care, and addiction treatment, forcing people who actually want or need comprehensive coverage or have a pre-existing condition to pay more.

3. Will the Administration Start Walking the Walk on Fighting the Opioid Crisis?

Yesterday, Politico reported that White House Counselor Kellyanne Conway was “quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day.” Sen. Shelley Moore Capito of West Virginia said, “I haven’t talked to Kellyanne at all and I’m from the worst state for this…I’m uncertain of her role.”

To date, the Administration has completely failed to address  the nation’s raging opioid crisis. The window-dressing public health emergency declaration the President made freed up a fund worth only $57,000, falling pathetically short of the billions that experts say are desperately needed to combat the crisis. The House repeal bill that President Trump supported would make the opioid crisis worse by eliminating coverage requirements for mental health and addiction treatment, and through drastic Medicaid cuts that put states on the hook for the huge cost of dealing with the epidemic. The Trump Administration has relentlessly attacked and sabotaged Medicaid, which helps people with opioid addiction receive care, paying for one-fifth of all substance abuse treatment nationwide. And, the Trump Administration proposed a 95% cut to the Office of National Drug Control Policy, which is charged with coordinating the federal response to the nation’s raging opioid crisis – for the second year in a row.

Protect Our Care Blasts Consideration of Medicaid Lifetime Limits

Washington, D.C. – In response to the news that the Trump Administration may allow states to impose arbitrary lifetime limits on Medicaid coverage, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“The appalling concept of lifetime Medicaid limits represents a new low for the Trump Administration, and it threatens the health and well-being of the millions of Americans who get their coverage through Medicaid. Allowing states to impose arbitrary time limits on access to health care would leave innocent Americans with nowhere to turn and fundamentally change and weaken the popular Medicaid program, which serves millions of American seniors, children, and people with disabilities.  

“The Affordable Care Act stopped insurance companies from imposing dollar lifetime limits on coverage, and as a result, 105 million Americans are now free from arbitrary limits on care. But the Trump Administration wants to take us back to the days of lifetime coverage caps, and they’re targeting our most vulnerable citizens as guinea pigs. The majority of Americans with Medicaid coverage live in working households, but the Trump Administration is now considering punishing people just because their longtime employer doesn’t offer insurance or because they got sick or have a disability and lost their job.

“Today’s news makes it clear that threats to the Affordable Care Act, Medicaid, and the health of millions of Americans will remain very much alive for as long as the Trump Administration and Congressional Republicans continue their war on Americans’ health care. The idea of arbitrary time limits on Medicaid eligibility is not only illegal, it is immoral, and the Trump Administration should be ashamed. Enough is enough – it’s time for the GOP to stop trying to kick Americans off their coverage and end its war on our health care once and for all.”

Trump’s Opioid Mess Keeps Getting Worse

New Report: Congressional Republicans Fed Up With Inaction

After new POLITICO reporting reveals mounting frustration among even Congressional Republicans about the Trump Administration’s failure to confront the national opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“When Republican Members of Congress are willing to go on record about your Administration’s continuing failure to confront a massive public health crisis, you have a problem. President Trump needs to wake up to reality and get serious about this out-of-control crisis instead of continuing his harmful efforts to gut the agency charged with fighting it and to sabotage Medicaid, which funds one-fifth of all substance abuse treatment nationwide.”

Kellyanne Conway’s ‘opioid cabinet’ sidelines drug czar’s experts

POLITICO // BRIANNA EHLEY and SARAH KARLIN-SMITH // 02/06/2018

President Donald Trump’s war on opioids is beginning to look more like a war on his drug policy office.

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a “just say no” campaign.

Trump is expected to propose massive cuts this month to the “drug czar” office, just as he attempted in last year’s budget before backing off. He hasn’t named a permanent director for the office, and the chief of staff was sacked in December. For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.

“It’s fair to say the ONDCP has pretty much been systematically excluded from key decisions about opioids and the strategy moving forward,” said a former Trump administration staffer, using shorthand for the Office of National Drug Control Policy, which has steered federal drug policy since the Reagan years.

The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings, according to his close associates. His schedule, obtained under a Freedom of Information Act request, included no mention of the meetings. Two political appointees from Baum’s office, neither of whom are drug policy experts, attend on the office’s behalf, alongside officials from across the federal government, from HHS to Defense. A White House spokesperson declined to disclose who attends the meetings, and Baum did not respond to a request for comment, although the White House later forwarded an email in which Baum stressed the office’s central role in developing national drug strategy.

The upheaval in the drug policy office illustrates the Trump administration’s inconsistency in creating a real vision on the opioids crisis. Trump declared a public health emergency at a televised White House event and talked frequently about the devastating human toll of overdoses and addiction. But critics say he hasn’t followed through with a consistent, comprehensive response.

He has endorsed anti-drug messaging and tougher law enforcement. But he ignored many of the recommendations from former New Jersey Gov. Chris Christie’s presidential commission about public health approaches to addiction, access to treatment, and education for doctors who prescribe opioids. And he hasn’t maintained a public focus. In Ohio just this week, it was first lady Melania Trump who attended an opioid event at a children’s hospital. The president toured a manufacturing plant and gave a speech on tax cuts.

Much of the White House messaging bolsters the president’s call for a border wall, depicting the opioid epidemic as an imported crisis, not one that is largely home-grown and complex, fueled by both legal but addictive painkillers and lethal street drugs like heroin and fentanyl.

“I don’t know what the agency is doing. I really don’t,” said Regina LaBelle, who was the drug office’s chief of staff in the Obama administration. “They aren’t at the level of visibility you’d think they’d be at by now.”

Conway touts her opioids effort as policy-driven, telling POLITICO recently that her circle of advisers help “formalize and centralize strategy, coordinate policy, scheduling and public awareness” across government agencies.

That’s exactly what the drug czar has traditionally done.

Conway’s role has also caused confusion on the Hill. For instance, the Senate HELP Committee’s staff has been in touch with both Conway and the White House domestic policy officials, according to chairman Lamar Alexander’s office. But lawmakers who have been leaders on opioid policy and who are accustomed to working with the drug czar office, haven’t seen outreach from Conway or her cabinet.

“I haven’t talked to Kellyanne at all and I’m from the worst state for this,” said Sen. Shelley Moore Capito, a Republican from West Virginia, which has the country’s highest overdose death rate. “I’m uncertain of her role.” The office of Sen. Rob Portman (R-Ohio,) another leader on opioid policy, echoed that – although Portman’s wife, Jane, and Conway were both at the event with Melania Trump this week.

Some drug abuse experts and Hill allies find a silver lining, noting that Conway’s high-rank brings White House muscle and attention.

“If I want technical advice, I’m going to work with Baum,” said Rep. Tom MacArthur (R-NJ), a co-chair of the Bipartisan Heroin Task Force. “If I want to get a message to the president, Kellyanne is somebody that I know I can talk to.”

“It’s a really good sign that one of the president’s top advisers has been assigned to such an important topic,” said Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum.

Baum’s email called the drug office the “lead Federal entity in charge of crafting, publishing and overseeing the implementation of President Trump’s National Drug Control Strategy,” which multiple agencies review. He called Conway’s opioids cabinet an “interagency coordinating apparatus for public-facing opioids-related initiatives” and said that it was not overseeing national policy. But several administration officials did say her cabinet was indeed focused on a variety of policies.

Whatever Conway’s ties to the president, her career has been in polling and politics, not public health, substance abuse, or law enforcement.

Some of her “cabinet” participants do have a broad, general health policy background. But they don’t match the experience and expertise of the drug office’s professional staff. In her circle is Lance Leggitt, the deputy director of the White House’s Domestic Policy Council who was also chief of staff to former HHS Secretary Tom Price. Another top Price aide, Nina Schaefer, recently returned to the Heritage Foundation. The conservative think tank then touted her as having managed “the development of the HHS response to the opioid abuse crisis,” but when POLITICO recently tried to contact her, she said through a spokesperson she was not an expert on the topic.

Among the people working on the public education campaign that Trump promised is Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy, multiple administration sources told POLITICO. Nor has Conway spent her career in the anti-opioid trenches.

“Kellyanne Conway is not an expert in this field,” said Andrew Kessler, the founder of Slingshot Solutions, a consulting group that’s worked on substance abuse with many federal agencies.“She may be a political operative and a good political operative,” he added. “But look. When you appoint a secretary of Labor, you want someone with a labor background. When you appoint a secretary of Defense, you want someone with a defense background. The opioid epidemic needs leadership that ‘speaks’ the language of drug policy.”

The set-up befuddles other experts who’ve worked on substance abuse for prior administrations. Fresh ideas are fine, they say. But the drug office has a purpose.

“The whole reason we created ONDCP in 1988 was to be a coordinating force with power in the government and to bring together 20 agencies, many reluctant to be involved in drug control,” said Bob Weiner, who served in that office in both the George W. Bush and Clinton White Houses. “This is exactly when the agency should get maximum support from the White House,” he added.

An ONDCP spokesperson told POLITICO the office “works closely with other federal agencies and White House offices, including Kellyanne Conway’s office, to combat the opioid crisis” but declined to say whether the office’s career experts have attended any of her “opioids cabinet” sessions. The drug office is still crafting the annual drug control strategy, outside the Conway group, administration officials said.

A senior White House official confirmed that officials considered kicking off the media campaign with a big splash during the Super Bowl, but that fell through. Beyond that, many experts on drug policy and substance abuse say messaging alone won’t solve the problem anyway. People with addiction need treatment, and many people get addicted in the first place to painkillers their doctors have prescribed. An ad campaign won’t solve that.

One big test for the drug office will come when Trump releases his budget Monday, which is expected to slash the office’s budget, turning much of its work over to HHS and the Department of Justice. Both departments are developing their own opioid approaches; in past administrations, the drug czar would have coordinated. Lawmakers are already sounding the alarms over the budget plan.

A bipartisan group of senators last week wrote a letter to White House budget director Mick Mulvaney, urging him to reconsider and maintain the office’s programs that “prevent and fight against the scourge of drug abuse.”

Pushback to a similar proposal last year led the Trump administration to reverse the decision and maintain the office’s budget. Lawmakers hope that there will be a similar outcome this time — along with a smarter utilization of the drug policy office.

“What we haven’t seen is the kind of coordination of critical programs that ONDCP has traditionally done,” said Sen. Maggie Hassan, a Democrat from New Hampshire, another state with one of the highest overdose death rates in the country.

Trump officials say it was the Obama administration that began undermining the drug policy office, demoting the director from the Cabinet, shrinking the staff and stressing the health aspects more than a law enforcement-focused “war on drugs.” They say the emergency requires a new approach.

Bob Dupont, who served as the second White House drug czar under President Gerald Ford, before the formal drug policy office was created, and still informally advises the Justice Department on drug policy, believes the White House will eventually realize it needs the expertise that ONDCP has to offer.

The West Wing doesn’t “have the staff or capability” to carry out drug policy work like ONDCP does, Dupont told POLITICO. “I don’t think swashbuckling your approach is going to last very long.”

 

PHOTOS: Health Care Protests at GOP Retreat in West Virginia

As Congressional Republicans retreated to West Virginia to discuss their plans for 2018, they were greeted by protesters who are furious about the GOP’s ongoing war on health care. Hundreds of protesters greeted Vice President Pence at the airport, lined up along the President’s motorcade route, and made sure every Member of Congress in attendance knew just how furious voters are about their party’s health care sabotage:

[Beckley Register-Herald]

The protesters made clear just how devastating the GOP’s health care attacks would be to West Virginia:

“An issue on the minds — and signs — of many of the protesters was health care. Hanno Kirk, 78, of Lewisburg, said his main concern as a health care provider is the 230,000 people in West Virginia who are in danger of losing health insurance if the GOP succeeds in dismantling the Affordable Care Act. ‘It’s totally misguided to attempt to do away with the ACA simply because it’s called ‘Obamacare,’ Kirk said, noting he used to be a ‘liberal Republican in Washington, D.C., back when there was such a thing as a liberal Republican.’ Stephen Josephine Fritsch of Harrisburg, Pa., the daughter of a combat veteran, said it appears the values her father fought for are slipping away. ‘This is America,’ she said. ‘It should be we the America, not me the America.’ Fritsch expressed concern about the state of U.S. health care under GOP leadership.”

“‘Well, we have a lot of issues in West Virginia,’ said psychotherapist and protester Hanno Kirk. ‘As a healthcare provider, I am acutely aware how many of my patients are reliant on Medicaid and Medicare and CHIPS. And if those two are eliminated, as there is a threat to that, we would have a huge number of uninsured people.’” [WVVA, 1/31]

[Beckley Register-Herald]

Protesters gathered at Senator Moore-Capito’s office ahead of Congressional Republicans’ arrival:

Protesters are hitting the streets in Charleston, a day ahead of the GOP retreat at The Greenbrier, to voice their concerns about cuts to health care and Medicaid. A rally Wednesday evening included people from all over the eastern U.S. gathering in Charleston, including one woman from as far away as Vermont. It is a test run for a bigger demonstration on Thursday in Greenbrier County. By the end of the night Wednesday, the group is expecting about 500 advocates in town — standing together against Medicaid and health care cuts. [WSAZ, 1/31]

They met Vice President Pence at the Charleston airport:

“‘We’re just ready for that change,’ Debbie Naeter says. She’s right outside the Greenbrier Valley Airport gates with protestors prepared to welcome Vice President Pence with their concerns. ‘It’s health care, and fracking, and equality, and being nice again,’ she says.” [WDBJ, 1/31]

Engaged activists traveled from all over the country to make their voices heard:

“Protesters came from all over the United States. WDBJ7’s Sara Machi spoke with protesters from West Virginia, New York City, Charlotte, and Arkansas. Many protesters present Thursday said they have decided to protest because of issues important to them. These issues include immigration, healthcare, the recent tax bill, clean water, and other issues.” [WDBJ, 2/1]

[Beckley Register-Herald]

As Paul Ryan raised the specter of “entitlement reform” inside, protesters at the gates of the five-star resort raised awareness about the GOP’s proposed cuts to Medicare and Medicaid:

“President Donald Trump’s address to Republican congressmen at The Greenbrier resort in southern West Virginia has drawn several hundred protesters with signs and chants criticizing him and calling for living wages, protecting Medicaid and Medicare, defending immigrants and decrying hate speech.” [AP, 2/1]

[Twitter]

The bottom line from protesters: Enough is enough. It’s time to stop the Republican war on our care.

“While President Donald Trump and Vice President Mike Pence plan to attend a GOP congressional retreat in West Virginia, some health care advocates plan to attend rallies to protest Medicaid and health care cuts… Organizers said in a news release that West Virginia health care advocates would join more than 500 people gathering to protest and send a message ‘that any cuts to health care — the issue expected to top the GOP’s agenda — will be met with a fierce nationwide fight.’” [WCHS, 1/31]

[Beckley Register-Herald]

Lest anyone be confused, they made clear what the protests were really about:

“Sammi Brown, the federal campaigns director for Our Children, Our Future, said this started after activists in Greenbrier County reached out to individual groups, and word of the action reached organizations in West Virginia and other states shortly afterward. ‘It is folks all along the East Coast that are standing in solidarity with West Virginia. We are expecting upwards of 600 people tomorrow to march with us,’ she said. Brown said the protest was not about Trump but rather the agenda of what she called ‘attacking health care.’” [West Virginia Metro News, 1/31]

And Vice President Pence found one special health care protester – West Virginia Senator Joe Manchin. After Pence chided him for not voting for the GOP tax scam, which kicked millions of Americans off of their coverage, Manchin hit back:

[Twitter]

As President Trump, Vice President Pence and GOP Members of Congress were shown upon their arrival in West Virginia, Americans, from local organizers to United States senators are furious about their repeal and sabotage memo. They’re furious over their weakening of the Affordable Care Act; they’re furious over their attempts to gut Medicare and Medicaid; and they’re furious over their unnecessary attacks on America’s health care system. And if they don’t stop, it’s only going to get worse.

Enough is enough – it’s time for the GOP to end their war on health care.