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ashoup
In Administration, News

Polling Roundup: The ACA Has Achieved Lasting Popularity & Republicans Have Been Hurt by Sabotage

Four polls over six weeks have reached the same conclusion: the Affordable Care Act has achieved lasting popularity, the electorate is aware of and angry about Republican health care sabotage, and these factors are making health care voters’ top priority. Here’s what the numbers say:

Last week, Public Policy Polling released its first national poll of the year, contrasting the rising popularity of the Affordable Care Act with the blame being leveled on President Trump’s sabotage:

  • 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.

Also last week, a Priorities USA memo found that President Trump’s handling of health care remains vastly unpopular, especially among independent voters:

  • On the policy of health care, Donald Trump has a 34/46 favorable/unfavorable message.
  • On his handling of drug pricing, 60% of voters have major concerns, including 71% among independents.

These two polls come on the heels of a January Washington Post/ABC News poll which asked Americans about the policies taking precedent during President Trump’s time in office and found that Americans are most united in opposition to the GOP’s health care agenda:

  • Asked if keeping “Obamacare” was a good thing for the country, 57 percent of respondents said yes – a significantly higher percentage than any other policy. Meanwhile, just one policy was underwater: the Republican tax scam, which kicked millions of people off of their insurance and was opposed 46% – 34%.

And all of these polls follow a Hart Research memo which found that health care is the number one issue among voters, far exceeding anything else in terms of driving voting preferences. A majority of those surveyed expressed strong disapproval for the health care policies pushed by the GOP:

  • “Healthcare far exceeds any other issue as an important driver of voting preferences, with over half of all voters identifying healthcare as one of their top priorities in the 2018 congressional elections, with 54% of those surveyed choose health care as one of the two issues that will be the most important to them in deciding how to vote for Congress.”
  • Healthcare is the most frequently cited priority among Democrats (68%), independents (54%), and Republicans (38%). It is particularly important to African-American voters (66%) and to white women voters, whether they are college graduates (62%) or non-college graduates (59%).

One poll can be an outlier, or two a coincidence, but four polls in six weeks independently highlighting the importance of health care and the contrast between the Affordable Care Act’s popularity and the GOP’s sabotage show just how important this issue is to the American people. From coast to coast, constituents are making their view abundantly clear: it’s time for the GOP to stop its war on health care, and there will be significant consequences should President Trump and Congressional Republicans fail to heed this advice.

ashoup
In Administration, News

“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 Administration, News

Idaho Reactions: Will Secretary Azar Uphold His Oath or Allow State to Blatantly Violate Federal Law?

Today, Blue Cross of Idaho announced that it will 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. Blue Cross of Idaho is 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, and it’s now incumbent upon the Trump Administration, specifically Health and Human Services Secretary Alex Azar, to uphold the law of the land – just as he swore to do upon assuming his Cabinet position. How is this announcement being treated so far?

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.” [ACS-CAN, 2/14/18]

Los Angeles Times: “Not A Good Sign For The Rule Of Law.” “If he is serious about his duty to uphold the Affordable Care Act, Azar has no real option other than to nip the Idaho venture in the bud. He could have taken a strong stand during his appearance on Capitol Hill Wednesday, but failed. That’s not a good sign for the rule of law.” [LA Times, 2/14/18]

Business Insider: “HHS Is Required By The ACA To Step In And Take Over Regulation Of Any State That Does Not Meet Regulatory Standards.” “Blue Cross of Idaho announced Wednesday it would take advantage of the state’s new loophole for Affordable Care Act regulations, prompting questions over how the Trump administration will respond… HHS is required by the ACA to step in and take over regulation of any state that does not meet regulatory standards, and the department has done so in four states already.” [Business Insider, 2/14/18]

The Hill: The Proposed Plans Contain Features “Not Allowed.” “[The] proposal is legally questionable and has drawn backlash from Democrats who say he is simply ignoring federal law. The [plans] would charge people with pre-existing conditions more and have a limit of $1 million in claims per year, according to the Idaho Statesman. Both of those features are not allowed under ObamaCare… Democrats have been pressuring Secretary of Health and Human Services Alex Azar to step in to stop Idaho’s plan and enforce the law.” [The Hill, 2/14/18]

Washington Examiner: Proposed Plans “Put Pressure On The Federal Government To Step In And Enforce Rules.” “Many experts have questioned whether this would survive a legal challenge, because Obamacare requires plans sold on the law’s insurance marketplaces, which offer coverage on the individual market, to meet certain benefit requirements… Idaho’s action has put pressure on the federal government to step in and enforce rules that the Trump administration has pushed to repeal.” [Washington Examiner, 2/14/18]

Bloomberg: Proposed Policies “Are Specifically Forbidden.” “[The policies proposed] are 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.” [Bloomberg, 2/14/18]

Washington Times: The Trump Administration “Is Responsible For Enforcing [The Law].” “The Idaho situation is a key test for the Trump administration, which still wants to repeal and replace Obamacare but is responsible for enforcing the 2010 law while it remains on the books… Obamacare’s defenders say the Idaho plan skirts the law completely, however, so HHS must act to preserve hard-won consumer protections. ‘It’s cruel, and it’s an illegal attempt to repeal our health care,’ Save My Care, a pro-Obamacare coalition, says in new ads running in Boise, Idaho, and the nation’s capital. ‘Call Health and Human Services Secretary Alex Azar. Tell him to block Governor Otter’s attack on our health care.’” [Washington Times, 2/14/18]

As a reminder, here’s what legal experts are saying about Idaho:

Tim Jost, Washington and Lee University School of Law Emeritus Professor: “What They’re Doing Is Completely Illegal.” “Both in terms of federal penalties and in terms of potential private lawsuits, they are taking on tremendous liabilities here. What they’re doing is completely illegal. It’s kind of jaw-dropping.” [Bloomberg, 2/14/18]

Larry Levitt, Kaiser Family Foundation Senior Vice President: “This Is Simply Not Allowed.” “Idaho is allowing health insurance plans that charge sick people more than healthy people, have an annual limit on coverage, and don’t cover maternity care. That’s simply not allowed under the ACA. If a state like Idaho is not enforcing the ACA’s insurance protections, the federal government is obligated to step in and enforce the rules…. If HHS does not step in and enforce the ACA’s insurance rules in Idaho, it won’t just be about Idaho. Other conservative states will no doubt then start to allow insurance plans that don’t comply with the ACA.” [Twitter, 2/14/18]

Will Secretary Azar follow the oath he swore to uphold just weeks ago? Or will he allow states to violate the very laws he pledged to uphold?

ashoup
In Capitol Hill, Administration, News

3 Facts You Should Know After Sec. Azar’s Ways and Means Hearing

HHS Secretary Alex Azar appeared before the House Ways and Means Committee today and doubled down on the Trump Administration’s war on health care. His language may have been nuanced, but the policy results would be the same. Here are three key facts you should know after his testimony today.

FACT #1: THE TRUMP ADMINISTRATION’S OPIOID FUNDING WILL NOT BE EFFECTIVE IF IT CONTINUES PARTISAN EFFORTS TO REPEAL THE AFFORDABLE CARE ACT AND GUT MEDICAID

WHAT SEC. AZAR SAID: “The President’s Budget recognizes the devastation caused by this [opioid] crisis across America, by providing a historic new investment of $10 billion in HHS funding to address the opioid crisis and serious mental illness…”

THE FACTS: While the additional funding for opioids is welcomed, it will have little to no impact if the Administration continues its partisan push to repeal the Affordable Care Act (ACA) and gut Medicaid.

  • Vox: Trump’s budget could help fight the opioid crisis — if it didn’t try to repeal Obamacare. Vox: “Medicaid is particularly important in this area. A 2014 study by Truven Health Analytics researchers found that Medicaid paid for about 25 percent — $7.9 billion of $31.3 billion — of projected public and private spending for addiction treatment in 2014. That made it the second-biggest payer of addiction treatment after all local and state government programs. Yet not only would Trump’s budget plan end the Obamacare-funded Medicaid expansion, it would also make additional cuts to Medicaid.”

FACT #2: SEC. AZAR DOUBLED DOWN ON THE PARTISAN REPEAL ATTEMPT THAT WILL RIP COVERAGE AWAY FROM TENS OF MILLIONS, RAISE COSTS FOR MILLIONS MORE, AND GUT PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

WHAT SEC. AZAR SAID: “The Budget supports repealing Obamacare and replacing the law with flexibility for states to create free and open healthcare tailored to citizens’ needs. The two-part approach is modeled closely after the Graham-Cassidy-Heller-Johnson amendment to H.R. 1628, the American Health Care Act of 2017, and also includes additional reforms to put healthcare spending on a sustainable fiscal path.”

THE FACTS: The Graham-Cassidy legislation was the worst of all the partisan repeal efforts Congress considered last year that ripped coverage away from tens of millions of people, raised costs on millions more, gutted protections for pre-existing conditions, and slashed Medicaid.

  • Analysts Agree: Every State Loses Under Graham-Cassidy and Many Working and Middle Class Families See Their Costs Increase. Multiple independent analyses agree that the Graham-Cassidy repeal bill would cut federal funding to states. Over time, every state loses because Graham-Cassidy zeroes out its block grants and ratchets down its spending on the Medicaid per capita cap. This means people would not have access to the financial assistance to help lower their health care bills, and federal Medicaid funding would no longer adjust for public health emergencies, prescription drug or other cost spikes, or other unexpected increases in need.
  • 32 Million Would Lose Health Coverage. As a result of zeroing out block grants for Marketplace tax credits and Medicaid expansion and additional cuts to Medicaid, the Graham-Cassidy bill is essentially repealing the Affordable Care Act without replacing it.
  • Graham-Cassidy Would Raise Costs For People With Pre-Existing Conditions. Graham-Cassidy would allow states to let insurance companies once again charge people with pre-existing conditions more, which could raise costs for the more than 134 million Americans that have a pre-existing condition. An individual with asthma, for example, would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320, while it would be $142,650 more for patients with metastatic cancer.

FACT #3: SEC. AZAR DOUBLED DOWN ON THE TRUMP ADMINISTRATION’S WAR ON MEDICAID

WHAT SEC. AZAR SAID: “Our budget proposes a new future for Medicaid that will restructure Medicaid financing, provide states with new flexibilities to better serve our communities, improve the state plan and waiver processes, and provide the right incentives to preserve the program for future generations.”

THE FACTS: The Trump Administration is doubling down on its war on Medicaid by continuing to push for the Graham-Cassidy legislation that ended Medicaid expansion, which has given 15 million people access to care, and by slashing traditional Medicaid, putting the care of millions of seniors, children, and people with disabilities at risk. The Administration’s attempts to impose onerous work requirements are not about work, but about kicking people off their health care. The fact is most people on Medicaid who can work, are working. These requirements are the opposite of what we need to be doing to help people find and keep jobs.

ashoup
In Administration, News

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.”

ashoup
In News, Administration

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.

ashoup
In Administration, News

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]

ashoup
In Stories, Administration, News

“Consumers Really Want Coverage”: Nearly 12 Million Americans Sign Up For Marketplace Plans Despite Rampant Obstacles

Meta Capitol

Despite more than a year of sabotage from President Donald Trump, his Administration, and Congressional Republicans, it was announced today that 11.8 million Americans 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 quality, affordable coverage.

Overall, the open enrollment period this year was a resounding success that proved the skeptics wrong. Don’t believe us? Take a look for yourself…

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

Josh Peck, Former HealthCare.Gov CMO: “Without The Trump Administration’s Efforts To Undermine Enrollment, National Enrollment Would Have Exceeded 12.9 Million Enrollments Or Roughly 1.1 Million Additional People Would Have Enrolled.” [Get America Covered, 2/8/17]

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.” “11,760,418 people signed up for 2018 health insurance coverage on the ACA individual marketplaces, amid steep reductions in federal funding for outreach and navigators, an enrollment period half as long, and a climate of political uncertainty surrounding the law. The federal government also terminated cost-sharing subsidy payments to insurers in advance of the open enrollment period, leading to increases in premiums but also increased premium subsidies for many consumers that in some cases led to reductions in what they had to pay for coverage.” [KHN, 2/7/18]

Los Angeles Times: The Numbers “Suggest Surprising Strength In Many Markets Across The Country.” “Almost 12 million Americans signed up for 2018 health coverage through marketplaces created by the Affordable Care Act, according to a new tally that indicates nationwide enrollment remained virtually unchanged from last year despite President Trump’s persistent attacks on the 2010 health law. The new enrollment numbers — which include totals from California and other states that operate their own marketplaces, as well as states that rely on the federal HealthCare.gov marketplace — offer the most detailed picture to date of the insurance markets. And they suggest surprising strength in many markets across the country, with consumers steadily signing up for health plans even as Trump and his Republican congressional allies derided the markets as crumbling and unaffordable.” [Los Angeles 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.” 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. Enrollment in individual health-insurance plans under the Affordable Care Act fell 3.7 percent in 2018 to 11.8 million, from 12.2 million a year earlier, according to data compiled by the National Academy for State Health Policy, which calls itself a nonprofit, nonpartisan association of state health-policy makers. That’s a far smaller drop than some health-policy watchers had foreseen, after the Trump administration halved the enrollment season and cut marketing and enrollment-assistance efforts. Trump himself declared the law ‘dead.’” [Bloomberg, 2/718]

Trish RIley, National Academy For State Health Policy Executive Director: “This Shows Consumers Really Want And Need Coverage.” “‘This shows that consumers really want and need coverage,’ said Trish Riley, executive director of the National Academy for State Health Policy, which compiled the nationwide enrollment tally. ‘These are stable markets and a stable program,’ she said.”  [Los Angeles Times, 2/7/18]

Allison O’Toole, MNSure Chief Executive: “We Had The Best Open Enrollment Period We Have Ever Had.” “‘We had the best open enrollment period we have ever had,’ said Allison O’Toole, chief executive of Minnesota’s insurance marketplace, known as MNsure, which saw enrollment surge nearly 6% this year. Elected officials in Minnesota developed their own reinsurance system to help control premiums this year.” [Los Angeles Times, 2/7/18]

Washington Post: “Enrollment Was Surprisingly Resilient.” “With the Trump administration taking steps to undercut these marketplaces and congressional Republicans having spent much of last year trying unsuccessfully to dismantle large parts of the ACA, leaders of state insurance exchanges and other health-policy experts said that enrollment was surprisingly resilient.” [Washington Post, 2/7/18]

The Hill: The Numbers “Show The Obamacare Remains Stable In The Face Of ‘National Uncertainty.’” “Experts and advocates of ObamaCare had expected a bigger drop in enrollment, mainly due to attacks on the system from the Trump White House. The administration slashed the advertising budget for open enrollment by 90 percent and also cut funds for local groups that help people sign up for coverage.  Experts also worried that multiple attempts by congressional Republicans to repeal and replace the law could cause confusion and deter consumers from signing up… The final numbers released Wednesday, however, show the ObamaCare remains stable in the face of ‘national uncertainty,’ says the National Academy for State Health Policy (NASHP), the group that released the numbers. ‘For the first time we now have the full national picture of how the individual marketplaces did this year and it is a picture of remarkable stability,’ said Trish Riley, executive director of NASHP.” [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.” “Enrollment remained remarkably stable despite President Donald Trump’s disdain for ‘Obamacare,’ and repeated efforts by the Republican-led Congress to repeal the program. The Trump administration also cut the sign-up window in half, slashed the ad budget, and suddenly stopped a major subsidy to insurers, which triggered a jump in premiums.” [AP, 2/7/18]

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.” “‘If you had asked me a year ago whether enrollment for 2018 would be almost equal to 2017, I would have laughed at you,’ said Larry Levitt, who follows health law for the nonpartisan Kaiser Family Foundation. ‘So long as lots of people are still getting insurance it becomes much harder to take that away.’” [AP, 2/7/18]

Washington Times: “Interest In The Exchanges Outpaced Last Year On A Day-To-Day Basis.” “Based on its figures, the 11 states — plus D.C. — that ran their own exchanges matched last year’s signups. In fact, there was a tiny increase of 0.09 percent, compared to a 5.3-percent drop among the 34 states that solely relied on HealthCare.gov. Five states that run their own exchanges, yet use the federal website, saw a minuscule increase of 0.2 percent, according to the academy. Mr. Trump slashed the enrollment season in half this year, meaning consumers in HealthCare.gov states had to sign up by mid-December, though hurricane-battered areas got extra time. Interest in the exchanges outpaced last year on a day-to-day basis.” [Washington Times, 2/7/18]

San Diego Union Tribune: States “Generally Attributed The Reduction To The Trump Administration’s [Actions].” “States with larger enrollment declines have generally attributed the reduction to the Trump administration’s decision to cut back on marketing efforts and shorten the 2017 open-enrollment period which ended more than a month earlier than it did in California. Double-digit premium increases in many states are also blamed for decreasing enrollment in many locations. The president’s late 2017 executive order to eliminate special “cost sharing reduction” payments directly to health insurance companies are blamed for the price hikes.” [San Diego Union Tribune, 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.” “Mark Hall, a professor of law and public health at Wake Forest University, said the report ‘shows that, despite the Trump administration’s effort to undermine the Affordable Care Act, its basic structure remains solid. This is a testament to its fundamental soundness. In North Carolina, enrollment dipped, but not as much as some people feared.’” [Winston-Salem Journal, 2/7/18]

ashoup
In Administration, News

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.

ashoup
In Administration, News

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

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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.

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