Trump Administration Archives — Page 6 of 7

“Short-Term Insurance Plans Don’t Cover Pre-Existing Conditions, Don’t Cover The ACA’s Essential Benefits, And Can Impose Annual Limits On Coverage”: A Reaction Roundup to the Trump Administration’s Latest Sabotage Attempt

Today, the Trump Administration announced a plan to let insurance companies sell short-term junk insurance year-round, ramping up its sabotage of the Affordable Care Act. These scam insurance plans don’t have to cover people with pre-existing conditions, re-impose lifetime caps, and don’t have to cover the essential medical benefits required by the Affordable Care Act, including maternity care and prescription drug benefits. Today’s proposal would weaken American health coverage, something nearly every major media outlet, health care expert, and stakeholder pointed out.

The coverage of President’s Trump’s latest effort to sabotage American health care is brutal. Take a look:

NBC News: “Trump Pushes Insurance That Doesn’t Cover Pre-Existing Conditions.” “The Trump administration announced Tuesday that it is moving to expand the use of low-budget temporary insurance, which could offer customers a cut-rate alternative to plans on the Affordable Care Act’s exchange, but undermine more comprehensive insurance for others… Unlike the ACA’s plans, they are not required to cover pre-existing conditions, cover specific treatments, or provide unlimited benefits. The plans are normally supposed to cover a brief lapse in coverage, but the order makes it easier to rely on them as primary insurance. Health experts say they’re likely to be cheaper, but they could raise premiums for patients who need comprehensive plans through Obamacare by siphoning away young and healthy customers into a separate market.” [NBC News, 2/20/18]

Washington Post: Short-Term Plans Next Part Of Trump Administration’s Plan To “Dismantle” Affordable Care Act. “The order is part of the administration’s strategy to circumvent parts of the sprawling 2010 health-care law — President Barack Obama’s primary domestic legacy — through executive actions. The moves are an alternate route given the Republican-led Congress’s inability last year to dismantle much of the law — although Trump is still urging lawmakers to try again, despite GOP Senate leaders’ reluctance.” [Washington Post, 2/20/18]

NPR: “Trump Administration Wants To Let Insurers Offer Plans With Fewer Benefits.” “The Trump administration wants to allow insurance companies to offer more policies that have limited health benefits and that can reject customers if they have pre-existing medical conditions.” [NPR, 2/20/18]

Kaiser Health News: Trump Administration Proposes Rule “That Can Reject People With Preexisting Medical Conditions.” “The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law — including plans that can reject people with preexisting medical conditions.” [Kaiser Health News, 2/20/18]

Huffington Post: Plans Would Make “It More Difficult For People Who Need Or Want More Comprehensive Coverage To Get It.” “Taken together, the two steps ― getting rid of the mandate and then changing the rules on short-term plans ― could accelerate an evolution already underway for people buying insurance on their own, rather than through an employer… The new regulations would also render the law’s insurance reforms less effective, making it more difficult for people who need or want more comprehensive coverage to get it.” [Huffington Post, 2/20/18]

Reuters: “Another Trump Administration Move Aimed At Undercutting” The ACA. “The U.S. government on Tuesday proposed extending the availability of skimpy health insurance plans to millions of Americans in another Trump administration move aimed at undercutting the requirements of the Affordable Care Act, often called Obamacare…The plans will not include the benefits that define the insurance created under Democratic former President Barack Obama, including required health benefits such as maternity coverage and the guarantee of insurance regardless of health.” [Reuters, 2/20/18]

Wall Street Journal: Plans “Allow Insurers [To] Charge Higher Premiums Based On A Consumer’s Health Status.” “The plans are often sold only to people who qualify as healthy and they may have annual limits on the amount of care they will cover. The plans don’t have to cover people with pre-existing conditions, for example, and insurers can charge higher premiums based on a consumer’s health status. They also don’t have to include benefits mandated by ACA plans such as prescription-drug coverage… Health analysts say the more extensive short-term plans that would be allowed under the latest proposal could appeal to healthier customers seeking less-expensive alternatives to ACA plans. Higher-risk people would be likely to remain in traditional insurance coverage, however. That would cause their premiums to rise because healthier consumers are needed on the ACA’s exchanges to offset the costs of older and sicker people.” [Wall Street Journal, 2/20/18]

New York Times: Plans “Offer Significantly Less Protection To Consumers.” “Short-term policies are intended for people who are between jobs or need temporary coverage for other reasons. They are generally cheaper than insurance that meets the law’s requirements, but they offer significantly less protection to consumers. Insurers often deny short-term policies to people with pre-existing conditions and can charge higher premiums because of such conditions. Short-term policies do not have to provide the ‘essential health benefits’ that are required by the Affordable Care Act. They may, for example, omit coverage of maternity care, mental health care or addiction treatment. Short-term policies may impose limits on the amount the insurer will pay, but they do not have to cap the patient’s out-of-pocket costs.” [New York Times, 2/20/18]

USA Today: “Trump Proposes 12-month Insurance Plans That Don’t Cover People, Issues Obamacare Requires.” “The Trump administration proposed Tuesday that people be allowed to buy short-term insurance plans that don’t cover the benefits — or people — required to be covered by the Affordable Care Act (ACA)… The ACA was designed to prevent some of the situations the new plans would create, critics said. They could deny coverage based on pre-existing conditions, generally cover few benefits and can cap the benefits provided. The plans could also pull more healthy people out of the pool of people signing up for the ACA, and that could lead to higher premiums for those who remain and aren’t eligible for subsidies.” [USA Today, 2/20/18]

Bloomberg: “Trump Proposes Bigger Role for Skimpy Insurance, Undermining Obamacare.” “The Trump administration is proposing to expand the availability of short-term insurance plans, offering a cheaper health coverage option for consumers, while taking another step to undercut Obamacare… Combined with earlier moves by the Trump administration — such as ending the ACA requirement that all people buy health coverage or pay a fine — the latest proposals could result in higher costs or fewer options for individuals who still want to buy the more comprehensive Obamacare plans.” [Bloomberg, 2/20/18]

Politico: Trump Administration Pushing Plans “That Some Deride As ‘Junk Insurance.’” “The Trump administration is proposing to expand the availability of short-term health insurance plans that some deride as ‘junk insurance’ — an effort that could give consumers cheaper coverage options but undermine Obamacare’s marketplaces and popular protections for pre-existing medical conditions… Many health care experts fear expanding the availability of the health plans, which are exempt from Obamacare’s robust consumer protections, could further destabilize the law’s wobbly insurance markets. Critics say the plans offer just the illusion of coverage, and enrollees often don’t realize how limited their benefits are until it’s too late. Short-term plans maintain cheaper prices than traditional insurance by refusing coverage for pre-existing conditions, in some cases, and some medical services. Unlike Obamacare coverage, the short-term plans typically cap payouts, which could leave enrollees with catastrophic illnesses or injuries on the hook for huge medical bills.” [Politico, 2/20/18]

Talking Points Memo: Proposed Plans Represent “Further Gutting O’Care Market.” “Many health care experts and economists say the sale of these skimpy “junk insurance” plans will draw younger and healthier people out of Obamacare’s individual market, making the remaining risk pool older, sicker, less stable, and more expensive.” [Talking Points Memo, 2/20/18]

Vox: “Experts Anticipate [These] Changes Would Damage The Market.” By broadening the definition of short-term insurance, the Trump administration is opening more loopholes for more people to buy insurance outside the health care law’s marketplaces. In the eyes of the administration, this is fulfilling a campaign promise that President Trump made to give people relief from Obamacare… But experts anticipate those changes would damage the market for customers who are left behind. Because younger and healthier people are more likely to leave the markets and buy short-term insurance, leaving an older and sicker pool behind, the ACA markets are likely to face higher premiums. And some insurers might decide to leave the law’s markets altogether if the customers become too unhealthy and therefore too expensive.” [Vox, 2/20/18]

ThinkProgress: Trump Administration’s Latest Attack On Obamacare Would Cost Taxpayers Millions. “The administration is proposing to expand access to short-term health plans, which is intended to fill temporary gaps in coverage and provide some consumers with cheaper options because the plan’s coverage is limited. This is just the latest move to undermine the ACA, and it’ll cost the federal government anywhere between $96 to $168 million more every year.” [ThinkProgress, 2/20/18]

Stephanie Armour, Wall Street Journal: Short-Term Plans Will Mean Higher Premiums. “If the estimated 200,000 people leave exchanges for short term plans, average est. monthly premium goes from $649 to $718 on exchanges based on proposed rule.” [Twitter, 2/20/18]

Catherine Rampell, Washington Post: Short Term-Plans A “Recipe For Siphoning Off Health People And Unraveling The Individual Market.” [Twitter, 2/20/18]

Jonathan Cohn, Huffington Post: “And Now, Another Effort To Undermine Aca Regulations.” [Twitter, 2/20/18]

Ana Marie Cox: “Another Awesome Thing To Be Doing In the Middle Of An Addiction Epidemic.” [Twitter, 2/20/18]

Norm Ornstein, American Enterprise Institute: “Disgraceful.” “Alex Azar at HHS now doing his part to sabotage Obamacare and cost taxpayers hundreds of millions, while taking healthy people out of risk pools and increasing premiums for others. Disgraceful.” [Twitter, 2/20/18]

Health care experts ripped the announcement, and previewed the extensive problems it would cause:

Mike Kreidler, Washington State Insurance Commissioner: “If You Get Sick You May Not Be Able To Renew Your Coverage — There Are No Protections For People With Pre-existing Conditions. Maternity Care And Mental-Health Benefits Often Are Excluded.” [New York Times, 2/20/18]

Larry Levitt, Kaiser Family Foundation Senior Vice President: “Short-Term Insurance Plans Don’t Cover Pre-Existing Conditions, Don’t Cover The ACA’s Essential Benefits, And Can Impose Annual Limits On Coverage.” “Short-term insurance plans don’t cover pre-existing conditions, don’t cover the ACA’s essential benefits, and can impose annual limits on coverage. The expansion of short-term health insurance plans is part of a strategy to create a parallel insurance market that does not comply with the ACA’s rules. Short-term insurance plans will cherry pick healthy people, leaving ACA-compliant plans to cover a sicker pool with higher premiums. With the expansion in short-term insurance plans, low-income people will be protected from higher premiums by subsidies. Middle-class people with pre-existing conditions will feel the full brunt of higher premiums.” [Twitter, 2/20/18]

Rachel Sachs, Health Law Professor: “The Government Will Spend Millions More To Provide Fewer People With Comprehensive Coverage.” “HHS projects this change will cost the government $96-$168 million more every year. So the government will spend millions more to provide fewer people with comprehensive insurance.” [Twitter, 2/20/18]

Loren Adler, Director of USC-Brookings Schaeffer Initiative for Health Policy: “For Middle Class & Above, This Moves Individual Market Away From Providing Insurance, ↓ Costs For The Healthy, ↑ Them For The Sick. This Is A VERY Expensive Rule For Taxpayers.” [Twitter, 2/20/18]

Robert Laszewski, Health Industry Consultant: Plans Will “Woe Unto Those Who Get A Condition And Have To Go Back Into Obamacare.” “If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans…The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.” [Kaiser Health News, 2/20/18]

Robert Laszewski, Health Industry Consultant: “We’re Going To Have Two Different Markets, A Wild West Frontier Called Short-Term Medical…And A High-Risk Pool Called Obamacare.” [Kaiser Health News, 2/20/18]

Kevin Lucia, Georgetown University Health Policy Institute Project Director: “It Will Undermine The Individual Market Risk Pool.” [Kaiser Health News, 2/20/18]

Sarah Lueck, Center On Budget And Policy Priorities Health Policy Expert: Plans Mean “Making People With Pre-Existing Conditions Pay Premiums That Reflect Their Health Status.” “Something I learned from the proposed rule on short-term plans: ‘Actuarially fair’ apparently means, in this Administration, making people with pre-existing conditions pay premiums that reflect their health status.” [Twitter, 2/20/18]

Dania Palanker, Former National Women’s Law Center Senior Counsel For Health And Reproductive Rights: “Mental Health Crisis? Short-Term Plans Exclude Mental Health. Opioid Crisis? Short-Term Plans Exclude Substance Use Treatment. Maternal Mortality Crisis? Short-Term Plans Exclude Maternity Coverage.” [Twitter, 2/20/18]

Center On Budget And Policy Priorities: Short-Term Health Plans Would Raise Premiums In Individual Market, Undermine Market Reforms, And Expose More Consumers To Gaps And High Costs. “This would let a parallel market for skimpy plans operate alongside the market for comprehensive individual health insurance, exposing consumers to new risks and raising premiums for people seeking comprehensive coverage, especially middle-income consumers with pre-existing conditions.” [Center on Budget and Policy Priorities, 2/20/18]

The announcement was also criticized by stakeholders, who know first-hand what such a proposal will mean for Americans’ health:

American Cancer Society Cancer Action Network, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Consumers Union, Crohn’s & Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Leukemia And Lymphoma Society, Lutheran Services In America, March Of Dimes, National Health Council, National Ms Society, National Organization For Rare Disorders, United Way, World Wide Volunteers Of America: “The Proposed Rule Released Today Would Permit Insurance Companies To Offer Substandard Insurance Policies To Millions Of Americans… As Organizations Committed To Ensuring That Coverage Remains Affordable, Accessible, And Adequate For All Americans, We Cannot Support This Proposal. “The proposed rule released today would permit insurance companies to offer substandard insurance policies to millions of Americans. As drafted, the rule could result in the proliferation of lower-premium plans, known as ‘short-term limited duration’ plans that could exclude coverage for critically important health care services, charge individuals with pre-existing health conditions higher rates, increase deductibles, and place strict limits on benefits. These lower-premium plans are designed to draw younger and healthier individuals away from the individual marketplace – leaving them with inadequate coverage if they become ill or injured. Older and less healthy individuals that remain in more comprehensive plans will likely see their insurance premiums increase dramatically, making it even more challenging to secure the care they need and deserve. It will also create confusion for the American public about which types of plans will cover the services they need – creating an opportunity for consumers to purchase plans that would leave them unknowingly underinsured. As organizations committed to ensuring that coverage remains affordable, accessible, and adequate for all Americans, we cannot support this proposal.” [Consumers Union, 2/20/18]

America’s Health Insurance Plans: “We Remain Concerned The Expanded Use Of Short-Term Plans Could Further Fragment The Individual Market, Which Would Lead To Higher Premiums For Many Consumers, Particularly Those With Pre-Existing Conditions.”While we are reviewing the proposed rule to understand its impact on the people we serve, we remain concerned that expanded use of short-term policies could further fragment the individual market, which would lead to higher premiums for many consumers, particularly those with pre-existing conditions.” [Twitter, 2/20/18]

American Cancer Society-Cancer Action Network: Plans Represent A Roll Back of Critical Patient Protections. “Short-term plans can deny coverage based on pre-existing conditions, often cover very few benefits and can set caps on what limited benefits are provided. While these exemptions make these policies inexpensive, they also create plans with potentially inadequate coverage. Short-term plans are meant to be a bridge, not a substitute, for long-term meaningful coverage. Permitting plans to be renewed indefinitely would likely result in more people struggling with unexpected health care bills and insufficient insurance.” [ACS-CAN, 2/20/18]

Community Catalyst: Short-Term Plans Proposed by Trump Administration Would Roll Back Consumer Protections Enshrined in Affordable Care Act. “By giving insurance companies more leeway to sell plans that can skirt protections the ACA put in place specifically to ensure people with preexisting conditions such as cancer, asthma or diabetes wouldn’t be denied or priced out of coverage, President Trump is once again prioritizing politics over peoples’ health.” [Community Catalyst, 2/20/18]

Wisconsin Cancer Council: “Bottom Line: These Plans Do Not Have Protections Guaranteed.” “Bottom line: these plans do not have protections like guaranteed issue and bans on coverage limits, and may contribute to rising premiums for full coverage #ACA plans in the individual market, especially after the tax penalty goes away in 2019.” [Twitter, 2/20/18]

Today’s announcement represents the Administration’s latest salvo in their war on health care, and yet again it is the American people who will be the victims. These junk insurance plans would be another way for the Trump Administration and insurance companies to dismantle the Affordable Care Act and the benefits that millions of Americans have come to rely on. Enough is enough – it’s time for the Trump Administration to end its war on our health care.

ashoup In News

This Week in the War on Health Care — February 12-16, 2018

This week, as the President announced his budget and the Senate debated various immigration proposals, the Trump Administration continued its unprecedented assault on the American health care system. Here’s what happened this week in Republicans’ war on health care, and why the American people stood up to this Administration – and the prominent GOP legislator who joined them:

ABOUT THAT BUDGET

On Monday, President Trump released his 2019 fiscal year budget blueprint, and its most prominent feature was a series of draconian cuts to the nation’s health care programs.

The Trump budget doubled down on Congressional Republicans’ previous failed repeal attempts, calling for the implementation of Graham-Cassidy, the GOP’s worst repeal bill, which would take away health insurance from 32 million Americans, raise costs, remove protections for pre-existing conditions, and end Medicaid as we know it. The budget also called for drastic cuts to Medicare and ending funding for Planned Parenthood, continuing to target everyday Americans in an attempt to balance costs after cutting taxes for the wealthiest and corporations.

President Trump and his Administration should be ashamed – and Congress should declare the budget dead on arrival.

THE ATTACKS ON WOMEN’S HEALTH CARE CONTINUE

The Administration also ratcheted up its war on women’s health care this week. In addition to a budget defunding Planned Parenthood and slashing Medicaid, denying millions of women access to basic health care, it came out that President Trump’s Health and Human Services Department last month instructed a Southern Poverty Law Center-designated hate group to write an official government letter providing a roadmap for state Medicaid programs to restrict women’s access to the health care provider of their choice.

Politico: “A conservative legal organization worked with the Trump administration to make it easier for states to defund Planned Parenthood.”

CNN: “The Trump administration relied on a right-wing anti-abortion rights group to draft the letter it sent to states reversing Obama-era guidance that it’s against the law to terminate Planned Parenthood as a Medicaid provider … the Alliance Defending Freedom calls itself a conservative Christian nonprofit organization … but the Southern Poverty Law Center has labeled it a hate group for its attacks on LGBT rights.”

A BLATANT VIOLATION OF FEDERAL LAW? MEH, SAYS ALEX AZAR

On Wednesday, Blue Cross of Idaho announced that it would follow Republican Governor Butch Otter’s lead and violate federal law by offering insurance plans that don’t conform to the consumer protections mandated by the Affordable Care Act, leading the charge to take people back to a time when insurance companies could decide whether they were taken care of when they got sick. In response, newly-confirmed HHS Secretary Alex Azar refused to say he will stop the measure, despite it being a blatant violation of federal law. Secretary Azar should read the letter fifteen patients’ rights groups sent him:

American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Cystic Fibrosis Foundation, Epilepsy Foundation, Hemophilia Federation of America, Leukemia & Lymphoma Society, Lutheran Services in America, March of Dimes, Mended Little Hearts, Muscular Dystrophy Association, National MS Society, National Organization for Rare Disorders: “The Federal Government Must Uphold The Requirements Of Federal Law.” “Idaho’s insurance bulletin would allow insurers to sell individual market plans that do not comply with federal law. Because the Idaho Bulletin purports to authorize the issuance of insurance coverage that is prohibited by federal law, it is legally invalid… The federal government must uphold the requirements of federal law that protect patients, their families, and the health system against these consequences. On behalf of our patients, and all Americans, we urge you to make clear that Idaho cannot authorize the issuance of health insurance coverage that violates federal law, and that any insurer that issues such plans risks enforcement action and serious penalties.” [American Cancer Society-Cancer Action Network, 2/14/18]

JOB OR NO JOB, REPUBLICANS CONTINUE SECRETLY ATTEMPTING TO REPEAL THE ACA

The Hill this week reported that Congressional Republicans, in a backdoor manner, are seeking to repeal yet another component of the Affordable Care Act: its requirement that employers with over 50 workers offer health insurance. The hypocrisy of encouraging states to cut working-age people off Medicaid, saying they should find a job if they want coverage, to telling employers they shouldn’t have to offer health coverage to their workers, is breathtaking. 151 million Americans are covered through employer-sponsored insurance, and such a move would be devastating. Unfortunately for the GOP, voters are on to their secret sabotage strategy…

POLLS CONFIRM AMERICANS ARE FED UP WITH GOP’S WAR ON HEALTH CARE

Two major polls were released this week, and both came to the same conclusion: voters are fed up with the GOP’s war on health care.

Public Policy Polling released its first national poll of the year, and offered some key findings about the state of health care:

Approval for the Affordable Care Act is 12 points above water (47% approval to 35% disapproval), a dramatic reversal from trends before Trump took office.
Over half of voters know Republicans are sabotaging health care, with 51% believing the Trump Administration is actively taking steps that will raise people’s health care costs.

Additionally, a Priorities USA memo found that independent voters continue to hold major concerns about President Trump’s war on health care, confirming that voters realize Republican sabotage is driving up insurance premiums and exacerbating the high health care costs burdening working families.

All in all, the results are clear: voters are fed up with the GOP’s posturing on health care and want real solutions that can expand coverage and lower premiums, and what they’re telling the GOP is simple: enough is enough, stop your war on our health care.

ashoup In News, Roundup

REACTION ROUNDUP: States Face Wave of Resistance to Trump-Inspired Medicaid Cuts

As states start to take advantage of the Trump Administration’s invitation to strip Medicaid coverage away from millions by imposing restrictions such as ‘work’ requirements designed to reduce access to coverage, these proposals face a wave of backlash from local editorial boards, lawmakers, health care providers, hospitals, and advocates:

Iowa (legislation to impose work requirements introduced in Feb. 2018)

Des Moines Register editorial: Medicaid bill demonizes low-income Iowans with delays, drug tests, work requirements. Iowa state Sen. Tom Greene, R-Burlington, is sponsoring Senate File 2158, a measure which “directs the Iowa Department of Human Services to seek federal approval to impose work requirements on Medicaid recipients.” The paper adds, “One would think Greene, who worked as a pharmacist for four decades, would understand the importance of ensuring Iowans get care needed to be productive members of society. Then again, the part-time lawmaker was not required to pee in a cup or wait six months to enjoy his taxpayer-subsidized family coverage.” [Des Moines Register, 2/14/18]

Louisiana (expected to propose work requirements in mid-Feb. 2018)

Republican state lawmaker skeptical: “Medicaid work requirements probably would not save much money as the state tries to close a looming $1 billion budget shortfall, he added. Louisiana legislators have expressed similar concerns. ‘I’m skeptical that it’s going to be any real savings,’ said Rep. Kirk Talbot, R-River Ridge.” [Louisiana Daily Comet, 2/6/18]

West Virginia (considering Medicaid work requirements as of Feb. 2018)

Charleston Gazette-Mail editorial: Work requirements don’t help people work. “Helping people achieve gainful employment and self-sufficiency is exactly the right goal. Disrupting people’s health coverage will not accomplish it. Medicaid recipients already struggle to maintain employment and support themselves. Otherwise, they wouldn’t qualify for Medicaid…A smarter, not to mention more humane, approach would be to remove as many barriers to health care access as possible for the state’s most challenged residents. The smarter approach would be to err on the side of inclusion. Cover more West Virginians, and don’t hassle them off of Medicaid month after month as their work status fluctuates.” [Charleston Gazette-Mail, 1/25/18]

Missouri (state has called for legislation to pursue work requirement)

St. Louis Post-Dispatch editorial: Job requirements for Medicaid recipients won’t work and might actually backfire. “Tracking down these people will require state governments to expand their staffing to police the work requirement and administer the paperwork. If the work requirement is similar to that required for coverage under the Temporary Assistance for Needy Families program, child care and transportation will have to be subsidized if it’s available. The cost savings for taxpayers is starting to look a little hazy…Ironically, researchers say that taking health insurance away from people makes it less likely they will be able to get and keep a job. This will be particularly true if, as expected, the burden of the work requirement falls most heavily on those with physical or mental impairments not yet certified as permanent disabilities.” [St. Louis Post-Dispatch, 1/15/18]

Missouri family medicine physician: Rolling back Medicaid will worsen Missouri’s opioid crisis. “For Missourians struggling with opioid addiction, Medicaid is the difference between life and death. The medications I prescribe can help 50 percent of patients begin recovery and stay healthy in the long term. With access to these medications, I see many of my patients rebuilding their lives, advancing in their careers and enjoying life with their families. But without Medicaid, many will lose access to the treatment and medications that we know are effective. Even for those with full-time jobs, many Missourians simply don’t make enough to afford private health insurance, and Medicaid is their only option to afford health care.” [Columbia Missourian, 1/31/18]

Maine (work requirement submitted for approval on 8/2/2017)

Portland Press-Herald editorial: Medicaid limits are not what Maine voters want. “MaineCare is health care, not welfare. People on the program don’t get a check every month that discourages them from working. But they do get a chance to go to see a doctor when they are sick, or fill prescriptions that keep chronic diseases at bay. Adding more hurdles to applying for benefits will inevitably result in eligible people failing to be enrolled. The bureaucratic nightmare of trying to figure out who has received how much coverage during their lifetimes would slow the process for everyone … Cutting off someone’s health care is not going to make them more likely to work — just the opposite is true. Illness is one of the main barriers that prevents people from working.” [Portland Press Herald, 2/8/18]

Bangor Daily News editorial: The contorted logic of allowing states to require work as a condition for Medicaid. “If work requirements in a food assistance program are likely to lead to a diminished state of health for thousands of low-income adults, it’s not hard to imagine the damaging health effects of imposing work requirements in a benefit program designed explicitly to ensure that the poorest among us can access health care.” [Bangor Daily News, 1/19/18]

South Dakota (Gov. Dennis Daugaard has called for Medicaid work requirements)

Yankton Daily Press & Dakotan editorial: Be wary of what’s lurking in the details of Medicaid work requirements. “The statement also feeds the long-held generalization embraced by some people that many of those receiving some form of low-income assistance are basically living off the government dole instead of working. However, a lot of low-income people who receive Medicaid are already working but aren’t able to make ends meet or afford basic health care, which Medicaid helps provide…If handled properly, the work requirement for Medicaid proposed by Daugaard — and pushed by the White House — may impact only a small segment of recipients. If this move becomes something more than that — which, unfortunately, could be vaguely implied by Verma’s blunt remarks — then the idea may be little more than subterfuge for something else.” [Yankton Daily Press & Dakotan, 1/20/18]

Kansas (work requirement submitted for approval on 12/20/2017)

Health execs: Don’t equate work requirements with job stability. “‘If the state is going to make further changes to the KanCare program, it will put a greater burden on the state’s general fund, hospitals and providers, said Brenda Sharpe, CEO of the REACH Healthcare Foundation. ‘The misconception of who is on Medicaid is rampant.’ Sharpe also said the proposed changes fail to account for the type of jobs most low-income workers hold. For example, a construction job may be seasonal, and a retail worker’s schedule may very week by week — then throw in the need for child care. ‘If they lose their job for three months because they work in an outdoor setting, are you going to kick them off benefits for three months?… The best thing you can do to get someone to keep a job is to give them health insurance.’” [Kansas City Business Journal, 1/24/18]

Arizona (work requirement submitted for approval on 1/4/2018)

Arizona Alliance for Healthcare Security: “They have no evidence of anyone taking advantage of the system, so this just becomes another obstacle for people to overcome in order to get Medicaid benefits.” [Inside Tucson Business, 1/19/18]

Arkansas (work requirement submitted for approval on 6/30/2017)

Arkansas Advocates for Children and Families: “Arkansas Works, the state’s Medicaid expansion program, has successfully provided hundreds of thousands of Arkansans with affordable health care coverage and has saved the state money in charity payments to providers for uncompensated care. But the proposed changes are designed to remove people from coverage without giving them a comparable alternative. This is not just bad policy – it runs counter to Medicaid’s core mission of providing health care coverage to low-income people.” [AACF report, 1/4/18]

Kentucky (work requirement approved on 1/12/2018)

Lexington Herald-Leader editorial: Cutting unemployment benefits won’t strengthen Ky. workforce. “The best hope for addiction treatment is Medicaid, but the state is getting ready to impose new work requirements and other hurdles to treatment and the chance at a responsible life.” [Lexington Herald-Leader, 2/14/18]

Policy analyst: “You’re spending more money to cover fewer people.” “Cost savings come from the assumption that nearly 100,000 people will drop out of Medicaid by the end of the five-year project recently approved by the federal government. For those who remain, the monthly cost of care increases faster than it would have had the state made no changes, according to the administration’s projections. ‘You’re spending more money to cover fewer people,’ said Dustin Pugel, a policy analyst for the Kentucky Center for Economic Policy in Berea and a critic of the Bevin plan. I’m not crazy about the idea of us spending more money to cover fewer people.'” [Louisville Courier Journal, 2/14/18]

Indiana Daily Student editorial: Kentucky’s Medicaid requirements hurt more than help. “There are patients on Medicaid who are disabled, need cancer treatment and have other situations that would make working impossible or incredibly difficult.” [Indiana Daily Student, 2/5/18]

Utah (work requirement submitted for approval on 8/16/2017)

Op-ed: Medicaid ‘work mandate’ is misguided policy. “The 1115 waiver’s “work requirement” is a fancy term for ‘work mandate’; it is in fact designed to provide less coverage overall. Utah children and parents will be caught in a poverty cycle. Utahns will be far less healthy than they would be with full Medicaid expansion through the Utah Decides ballot initiative.” [Utah Policy, 1/11/18]

Wisconsin (work requirement submitted for approval on 6/15/2017)

Policy analyst: “Requiring you to work to get healthy — there’s something backwards there.” “‘If you’re not healthy, it’s difficult to work,’ said Mike Bare, research director for Community Advocates’ Public Policy Institute in Milwaukee. ‘Requiring you to work to get healthy — there’s something backwards there.’” [Wisconsin State Journal, 1/11/18]

Madison nonprofit: Work requirements only make lives harder. “‘This is targeted at the lowest-income folks that we have out there, people who have difficult lives already,’ said Bobby Peterson, executive director of ABC for Health, a nonprofit public interest law firm in Madison. ‘We’re just making it harder for them.’” [Wisconsin State Journal, 1/11/18]

Illinois (Rauner administration developing Medicaid work requirement)

Shriver National Center on Poverty Law: A Medicaid work requirement would be cruel — and costly. “Medicaid work requirements will largely be used to punish people in dire need for forces beyond their control…Ironically, by taking crucial medical assistance away from people who are already struggling, work requirements will make finding or maintaining employment much more difficult. The fact of the matter is that Medicaid, like most other major anti-poverty programs, serves as a work support.” [Chicago Tribune, 1/23/18]

Ohio (Kasich administration preparing to submit application)

Ohio Center for Community Solutions: “To suddenly remove these resources not only dis-benefits this huge area of employment and this huge area of economic impact for providers and others, it would have drastic impacts on things like the opioid epidemic, on chronic-disease management.” [Cleveland Scene, 2/12/18]

South Carolina (McMaster administration has directed Medicaid agency to submit application)

South Carolina Hospital Association VP: “If anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” “After all, most Medicaid beneficiaries in South Carolina are already working. Among those who are not, 52 percent are disabled or too sick, while another 32 percent act as caregivers. Community-engagement requirements shouldn’t punish the sick or discriminate against those with disabilities; if anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” [The State, 2/7/18]

Tennessee (House speaker has filed Medicaid work requirements bill)

TennCare Work Plan Would Affect 86K, Cost $18.7M. “A state analysis says legislation seeking to require certain able-bodied TennCare recipients to work, volunteer or attend school would affect 86,400 people and cost the state $18.7 million annually…The $18.7 million net cost notably includes $22.3 million more in anticipated case management state costs and $3.7 million in estimated state savings from disenrollments, assuming a 2020 program start.” [U.S. News & World Report, 2/14/18]

Chattanooga Times Free Press: Nearly 87,000 adult TennCare enrollees could be affected under work requirement plan. “As many as 86,400 able-bodied adult enrollees on Tennessee’s Medicaid program could be affected by a bill that seeks to require they work, attend school, volunteer or face losing their health benefits, according to a legislative analysis … Rep. John Ray Clemmons, D-Nashville, said ‘the data is clear’ with proponents’ ‘ultimate’ goal being ‘to kick people off’ of TennCare, the state’s Medicaid program.” [Chattanooga Times Free Press, 2/14/18]

… and 160 National, State, and Local Organizations Oppose Work Requirements in Letter to Secretary Azar: “CMS’s Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis .. and will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders.” [2/15/18]

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Protect Our Care Calls On Azar to Stand Up for Idahoans’ Coverage

After HHS Secretary Alex Azar dodged questions posed by the House Ways and Means Committee about an Idaho insurance company that intends to sell plans that violate Affordable Care Act minimum quality standards and protections for people with pre-existing conditions, saying “I’m not aware that our opinions or views have been solicited,” Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Dodging the question won’t cut it: Secretary Azar needs to stand up and protect health care for the people of Idaho by stopping the state’s illegal plan to allow pre-Affordable Care Act coverage. This morning we learned that Blue Cross Idaho is trying to take Idahoans back to the days of coverage caps, when people with insurance still lived one illness or injury away from bankruptcy. Even worse, the company is planning to charge people higher premiums based on their medical history, bringing Idaho back to the days when insurers could discriminate against people with pre-existing conditions like asthma or cancer. Medical bankruptcy and coverage denials are exactly the kind of insurance company abuses the Affordable Care Act was designed to stop, and it has done so with popular provisions that most Republicans claim to support. Now, it’s time for Secretary Azar to stand up for the people of Idaho and enforce the law that’s designed to protect their care.”

Ignoring Obamacare Rules, Idaho ‘Freedom’ Plans Come With Limits

Bloomberg // Zachary Tracer // February 14, 2018

After Idaho’s Republican governor promised to find creative ways to get around Obamacare, one health plan in the state plans to offer skimpy coverage that may violate many of the law’s protections for patients.

Blue Cross of Idaho said Wednesday that it will offer insurance plans that don’t comply with some Affordable Care Act requirements. The plans, branded as “Freedom Blue” coverage, have limits on annual medical spending and will charge sicker people higher premiums or deny them coverage in some cases — policies specifically forbidden by the 2010 law.

The move sets up a potential conflict with the federal government. While President Donald Trump has said he opposes the law and has taken steps to undermine it, the administration will have to decide whether to enforce legal requirements that remain on the books.

“Both in terms of federal penalties and in terms of potential private lawsuits, they are taking on tremendous liabilities here,” said Tim Jost, an emeritus professor at the Washington and Lee University School of Law who has been critical of efforts to unwind the law. “What they’re doing is completely illegal. It’s kind of jaw-dropping.”

Trump’s Secretary of Health and Human Services, Alex Azar, said during a Senate hearing last year that he’d uphold the ACA as long as it remains law. Azar is testifying before Congress Wednesday. The department didn’t immediately respond to a request for comment.

Ways Around Law

In early January, Idaho Governor Butch Otter directed the state’s insurance regulator to find “creative ways” for health insurers in the state to offer more affordable coverage. Otter said the state planned to use flexibility offered by the Trump administration in an executive order, and that it had authority to do so. The insurance regulator issued guidelines for the plans later that month.

“The door is open for states to pursue our own reasonable solutions,” Otter said. “We believe Idaho will lead the way in states taking back control of their insurance markets.”

“Our Freedom Blue plans bring more choices and lower prices to consumers,” Blue Cross Idaho Chief Executive Officer Charlene Maher said in a statement.

The plans have a $1 million annual per-person limit to how much care the insurer will pay for. Some also don’t have to cover services like maternity care, and can charge more to people who are sicker after asking them extensive questions about their health.

While such policies were banned by the Affordable Care Act, Idaho plans to use the law as a backstop. If individuals end up with medical expenses that exceed the $1 million limit in the non-Obamacare plans, Idaho will require insurers to help them move into ACA plans, which don’t have limits on medical spending.

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Trump Administration Targets Women in its War on Health Care

After yesterday’s revelations about the Trump Administration’s continuing attacks on women’s health care, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“The past 24 hours confirm that the Trump Administration’s war on health care is specifically targeting American women. Not only did President Trump release a budget that would defund Planned Parenthood and slash Medicaid, denying millions of women access to basic health care, but we also learned that Trump’s HHS last month instructed a Southern Poverty Law Center-designated hate group to write an official government letter that provides a roadmap for state Medicaid programs to restrict women’s access to the health care provider of their choice. These blatant attacks on women’s health care remain front and center in the Trump Administration’s ongoing war against the Affordable Care Act, Medicaid, and the entire American health care system.”

POLITICO, 2/12/18: “A conservative legal organization worked with the Trump administration to make it easier for states to defund Planned Parenthood.”

CNN, 2/12/18: “The Trump administration relied on a right-wing anti-abortion rights group to draft the letter it sent to states reversing Obama-era guidance that it’s against the law to terminate Planned Parenthood as a Medicaid provider … the Alliance Defending Freedom calls itself a conservative Christian nonprofit organization … but the Southern Poverty Law Center has labeled it a hate group for its attacks on LGBT rights.”

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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.

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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.”

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Protect Our Care Outlines Market Stabilization Must-Haves

As Congress begins to shape an omnibus after passing this morning’s spending bill, Protect Our Care Campaign Director Brad Woodhouse released the following statement outlining provisions that bill must include to stabilize the Affordable Care Act’s marketplaces and counteract cost increases caused by the Trump Administration and its Republican allies in Congress’s ongoing sabotage:

“If Congressional Republicans are serious about addressing the mounting mess they have created in the individual insurance market, they need to do far more than they are currently proposing. And the scale of those solutions must match the scope of the problems that Republican sabotage has created.

“While the Affordable Care Act marketplaces have shown remarkable stability in the face of this relentless sabotage, President Trump’s actions have already raised premiums this year, and the Republican tax bill will make things even worse next year by pushing premiums up double digits.

“A truly bipartisan market stabilization plan means making coverage more affordable, not punishing people with pre-existing conditions, and not including anti-choice restrictions. The American people want affordable, high-quality health care, not even more restrictions on women’s health. And Republicans should not seek to revive high risk pools, failed experiments of the the past which would reverse the Affordable Care Act’s guarantees and once again allow states to segregate people with pre-existing conditions.

“The American people keep saying it loud and clear: enough is enough. It’s time for Republican lawmakers to do the right thing, leave politics at the door, reject their party’s war on health care, and develop real solutions to make coverage more affordable and accessible for more Americans.”

Policymakers Should Craft Reinsurance Proposals to Lower Premiums, Help More People
Center on Budget and Policy Priorities // Sarah Lueck // 2.8.18

The idea of reimbursing health insurers for some costs associated with their highest-cost enrollees, known as reinsurance, is gaining traction as policymakers seek ways to make states’ individual insurance markets more stable and reduce premiums. But some federal reinsurance proposals are likelier than others to reduce premiums, and reinsurance alone won’t help individual market consumers who qualify for subsidized coverage.

Reinsurance defrays insurers’ costs and reduces their risk, so insurers can reduce overall premiums compared to what they’d otherwise charge.

In the House, a bipartisan reinsurance bill from Reps. Ryan Costello and Collin Peterson is reportedly gaining support, including among insurers. It would provide up to $30 billion over three years for the Secretary of Health and Human Services (HHS) to allocate at his discretion. Meanwhile, Sen. Susan Collins is continuing to craft her bipartisan reinsurance bill (co-sponsored by Sen. Bill Nelson), which Senate Majority Leader Mitch McConnell promised to bring to the Senate floor. She’s proposing to make up to $10 billion over two years available to states, which they could then use to secure additional federal funding through waivers that HHS approves to let states experiment with new ways to deliver health care to their residents.

With reinsurance efforts potentially moving forward, policymakers should keep the following in mind:

Reinsurance funds should be targeted at reducing premiums, not diluted by other purposes. The Costello bill would let states use federal reinsurance for a number of purposes, not all of which focus on the individual market or on reducing premiums. For example, states could use the funding for “promoting participation” and “increasing health insurance options” in both the individual and small-group markets, or for promoting access to preventive services (especially dental and vision care) and maternity and newborn care, and preventing and treating mental or substance use disorders. While increasing access to these health services is important, it isn’t directly related to reducing premiums or stabilizing insurance markets. These provisions would probably also let states use federal funds to replace their own spending on activities they would have undertaken anyway — which would have no impact on individual-market premiums at all. The Costello bill also seems to let states create high-risk pools, an idea that House Speaker Paul Ryan has continued to talk up. But past high-risk pools worked by separating people with high-cost health needs into a different pool from less costly people. That approach has been tried and failed, and it shouldn’t be replicated. The Costello bill also includes new, unrelated policy dealing with abortion.

A federal reinsurance program is likely the fastest, most efficient way to mitigate premium increases in 2019. Insurers will have to finalize their decisions about individual-market premiums and about where they will offer plans by this fall, and they’ll begin making decisions well before that. And 2019 is shaping up to be a tough year in the individual market, particularly because the new tax law’s repeal of the Affordable Care Act’s (ACA) individual mandate to have health coverage or pay a penalty will take effect and because plans that don’t meet ACA standards are expected to proliferate under proposed Trump Administration regulatory changes. While a temporary reinsurance program is only a partial fix at best for the premium increases and other harmful effects of these changes, a federal reinsurance program could be implemented more quickly and efficiently than multiple state-level programs. The Collins-Nelson bill relies entirely on states to apply for funding. In a better approach, the Costello bill gives states the option to apply for funding and administer their own programs but includes a safeguard — to establish a federal program if states don’t act fast enough. The Costello bill, however, would also leave the amount that each state would receive up to the HHS Secretary’s discretion, creating unnecessary uncertainty and risk, particularly because the Trump Administration has been more focused on sabotaging the ACA-compliant insurance markets than shoring them up.

Provisions intended to offset reinsurance costs shouldn’t make people worse off. If policymakers seek to offset the federal cost of a reinsurance program through spending cuts or tax increases, those measures should not threaten the health of individuals. They should not, for instance, include cuts in other health care programs or changes that hurt modest-income people or those with pre-existing conditions.

Even well-designed reinsurance doesn’t make health care more affordable for low- or moderate-income people. Reinsurance reduces the sticker price of health insurance — i. e., the overall premiums that insurers charge. That means it benefits individuals and families who don’t qualify for premium tax credits that help low- and moderate-income people afford their insurance through the ACA health insurance marketplaces. That’s because the premium credits limit eligible people’s cost to no more than a given percentage of their incomes, so they pay about the same amount for coverage regardless of the sticker price. Most Americans who are uninsured and eligible for marketplace coverage could qualify for tax credits under current law. But some people who get tax credit — those with incomes up to four times the poverty level, or about $48,000 a year for an individual — also have trouble affording their premiums and out-of-pocket costs. Researchers estimate that modest improvements in the tax credits could meaningfully expand coverage. Increasing the tax credits or cost-sharing reductions (CSRs) for those already receiving them would also help shore up insurance markets and, if paired with reinsurance, broaden the benefits to all individuals and families buying health insurance on their own.

A bill that includes reinsurance funding and would reinstate CSR payments to insurers, such as the Costello bill, also should increase the tax credits or increase cost-sharing subsidies for people. Here’s why: As we and others have explained, the Trump Administration’s decision to halt CSR payments has had the effect of substantially raising tax credits, making coverage more affordable for many moderate-income consumers. (That’s because insurers raised premiums to account for the loss of CSR payments, which boosted the amount of federal premium tax credits available to eligible people.) Restoring CSR payments would reverse the tax credit increases and make coverage more expensive for this group. Thus, a bill funding reinsurance, restoring CSRs, and failing to increase tax credits or cost-sharing subsidies would make coverage more affordable for middle-income consumers but less affordable for many people at lower income levels.

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

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.

ashoup In Statement, News

Protect Our Care Statement on 11.8 Million Final Open Enrollment Total

After final confirmation that 11.8 million people nationwide purchased 2018 health insurance through the individual insurance marketplaces created by the Affordable Care Act, meaning that despite a year of aggressive sabotage by the Trump Administration, overall enrollment equaled 96% of last year’s total, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“The American people are our own best health care advocates, and today’s enrollment total shows that we keep on beating the odds. This year’s open enrollment succeeded thanks to an untold number of enrollment assisters, community activists, health care professionals, and volunteers who did what their government refused to and helped their fellow Americans get covered.

“Despite everything the Trump Administration threw in their way, the high number of people who bought comprehensive insurance through the individual insurance marketplaces this year, 11.8 million, shows that the marketplaces are an essential component of the American health care system. Enrollment could have been even higher this year, but unfortunately, the cumulative effect of Trump’s year of sabotage was that too many Americans faced higher prices or fewer choices, as well as new hurdles to enrollment.

“The millions of people who bought coverage deserve a Congress that will protect and improve their access to care, but instead, their own Republican elected officials continue to sabotage the Affordable Care Act. They have already spiked next year’s premiums double digits by repealing the individual mandate and will do even more damage if they refuse to address and fix President Trump’s administrative sabotage.

“Along with Medicaid expansion, the marketplaces are how the Affordable Care Act succeeded in driving the American uninsured rate down to historic lows. Clearly Americans want and need to shop on their own for coverage in a marketplace where they can’t be denied for having a pre-existing condition or priced out based on their age, gender, or medical history.

“Despite the odds, this year’s enrollment total was 96% of last year’s. When you look at the numbers, it’s clear that with nurturing instead of sabotage, these marketplaces could keep expanding access to coverage and help reverse the increase in the uninsured rate that’s being caused by President Trump and his Republican allies’ war on our care.”

Trump Administration

The coverage of President’s Trump’s latest effort to sabotage American health care is brutal. Take a look:

ABOUT THAT BUDGET

THE ATTACKS ON WOMEN’S HEALTH CARE CONTINUE

A BLATANT VIOLATION OF FEDERAL LAW? MEH, SAYS ALEX AZAR

JOB OR NO JOB, REPUBLICANS CONTINUE SECRETLY ATTEMPTING TO REPEAL THE ACA

POLLS CONFIRM AMERICANS ARE FED UP WITH GOP’S WAR ON HEALTH CARE

Iowa (legislation to impose work requirements introduced in Feb. 2018)

Louisiana (expected to propose work requirements in mid-Feb. 2018)

West Virginia (considering Medicaid work requirements as of Feb. 2018)

Missouri (state has called for legislation to pursue work requirement)

Maine (work requirement submitted for approval on 8/2/2017)

South Dakota (Gov. Dennis Daugaard has called for Medicaid work requirements)

Kansas (work requirement submitted for approval on 12/20/2017)

Arizona (work requirement submitted for approval on 1/4/2018)

Arkansas (work requirement submitted for approval on 6/30/2017)

Kentucky (work requirement approved on 1/12/2018)

Utah (work requirement submitted for approval on 8/16/2017)

Illinois (Rauner administration developing Medicaid work requirement)

Ohio (Kasich administration preparing to submit application)

South Carolina (McMaster administration has directed Medicaid agency to submit application)

Tennessee (House speaker has filed Medicaid work requirements bill)

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