"Medicaid Work Requirements" have been in the news a lot over the past two years as the Trump Administration has given states the go-ahead to start imposing increasingly draconian, humiliating and ineffective work requirements for low-income people to avoid losing healthcare coverage.
For the most part, though, the work requirement bills have at the very least been restricted to ACA expansion of the Medicaid program to "able-bodied" adults earning up to 138% of the Federal Poverty Line (roughly $17,000/year for a single adult or $23,300 for a couple without minor children).
Today, Joan Alker of the Georgetown University Health Policy Institute Center for Children & Famlies reports that the Florida House of Representatives is planning on taking the cruelty even further:
URGENT: On Thursday, the Florida House will take up the harshest Medicaid work reporting requirement bill that I’ve EVER seen. As many as 100,000, mostly mothers, could lose their health insurance. https://t.co/64uRz23Puk
(sigh) I wrote about "Farm Bureau Plans" several times last year. They've been widespread in Tennessee for a long time, and are a big part of the reason for the state's high ACA premiums (TN doesn't have the highest premiums, but they're definitely near the top of the list). Here's the description of typical Tennessee "Farm Bureau" plans:
Traditional plans require medical underwriting that may affect eligibility and rates. Medical information will be requested for any person over the age of 40 and children 25 months and under; medical records may also be requested if any health condition on the application is marked “yes.” Any fees for obtaining medical information will be at the applicant’s expense.
Underwriting guidelines regarding particular conditions may necessitate a benefit exclusion rider, a member exclusion rider or an adjusted rate for coverage. There will be a 6-month or 12-month waiting period for pre-existing conditions, depending upon the plan chosen.
Single-payer, I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57.
The government doesn’t administer anything. The first thing they’ve ever tried to administer in social programs was the ACA, and that didn’t go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation.
The Notice for Benefit and Payment Parameters (NBPP) is an annual rule that the Center for Medicare and Medicaid Services (CMS) puts out. NBPP is the operational rule book for the Affordable Care Act. It determines what types of plans can be offered, how pricing is determined, when do things need to be approved, and whether or not Silver Loading is allowed or a Broad Load is required. This is all big stuff for the ACA markets.
The annual NBPP is supposed to be released sometime in November. Last year it wasn't released until December. This year it's mid-January and still no NBPP, although it's supposedly trudging along slowly
The Nevada Senate has passed a bill that would enact state-level health care protections for people with pre-existing conditions.
State Sen. Julia Ratti says the legislation aims to bring about protections that are already in place under the Affordable Care Act. The Democrat told lawmakers last month that people are worried about their health care access.
She says Nevada should make sure these protections are in place at the state level if the federal provisions are rolled back.
State senators approved the measure on Monday in a unanimous vote.
The measure stipulates that insurers cannot deny a person health care coverage due to a pre-existing condition.
I don't know if I'm just asleep at the wheel when it comes to healthcare happenings in Washington State lately, but this one caught me by surprise as well:
Today I signed a bill that protects Affordable Care Act health care insurance practices in WA state. This bill assures Washingtonians that regardless of what happens in D.C., we’re protecting your access to care here here at home. #waleg#ACAhttps://t.co/e3g35Fch68
Combined, the Medicaid and CHIP programs have around 72.5 million Americans enrolled in them as of December 2018. However, the vast majority--over 80% of them--are actually enrolled in privately managed Medicaid programs. Managed Care Organizations (MCOs) are private health insurance companies which states contract with to handle the administration and management. In some cases this works out reasonably well. In others...not so much:
Colorado's Senate advanced another piece of Democratic Gov. Jared Polis' health care agenda on Tuesday by tentatively endorsing a study on creating a state-run health insurance option.
The bill would direct state agencies to recommend a plan that would compete with existing private insurance plans and those offered on Colorado's health care exchange. Another Senate vote sends the study bill to the governor. It's already cleared the House on a bipartisan 46-17 vote.
On the surface, this sounds pretty much like the state-level Public Option bill which has quietly been rushed through the Washington State legislature over the past few weeks. Unlike the Washington bill, however, it looks like the Colorado legislature is covering a few more bases...particularly funding:
I've written several times over the past few months about the confusion regarding how much of an impact on the private insurance industry the move to a universal, 100% publicly-financed single payer healthcare system would have.
The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act.
...The proposal would have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange, according to a summary of the proposal.
The tagline for ACASignups.net is "healthcare policy data, analysis & snark", so naturally many of my blog posts have tongue-in-cheek, sarcastic headlines.
This is not one of those times. The headline above is absolutely, sickeningly true.
On a couple of days ago, both houses of the Ohio state legislature--the House and Senate alike--voted to ban abortion outright six weeks after conception. There's no exception for rape. There's no exception for incest. There is an exception for the life of the mother (not her health, mind you...just her actual ability to keep breathing)...but that's it. Yesterday this bill was signed into law by GOP Governor Mike DeWine.
The six-week abortion ban known as the "heartbeat bill" is now law in Ohio. That makes Ohio the sixth state in the nation to attempt to outlaw abortions at the point a fetal heartbeat can be detected.
The Tennessee House of Representatives passed a bill on Thursday that would ban abortion after a fetal heartbeat is detected, mimicking laws in other states that have been struck down by the courts and drawing the criticism of both advocates and opponents of abortion rights.
The measure, House Bill 77, would tightly restrict the window of time within which a woman could seek an abortion, because a fetal heartbeat can be detected as early as six weeks into a pregnancy. That is before many women even realize they are pregnant.
My main point was that while most MFA activists have long insisted that eliminating (or virtually eliminating) private health insurance companies is not only a feature but the entire point of moving to single payer, ever since Kamala Harris walked back her “get rid of all that!” comment in a CNN Town Hall the next day, I’ve seen some MFA activists fall all over themselves to suddenly insist that “no, no...there’d still be plenty of room for private insurance, really!”
The #TexasFoldEm case uses the World's Flimsiest Excuse to try and eliminate the Affordable Care Act's critical health insurance coverage protections for the 130 million Americans who have pre-existing conditions.
In response, Republican Senators Tillis, Alexander, Grassley, Ernst, Murkowski, Cassidy, Wicker, Graham, Heller and Barrasso have introduced a new bill which they claim would ensure pre-existing coverage protections. Unfortunately, it...doesn't.
The [Idaho] Senate Health and Welfare Committee voted 7-2 to hold in committee a House bill that would create a work requirement for Medicaid expansion beneficiaries — after lawmakers found out during the hearing that a federal judge had just struck down Medicaid work requirements in Kentucky and Arkansas.
Meanwhile, a Senate bill that would create a voluntary job training requirement for Medicaid expansion beneficiaries is still in that chamber’s amending order and could come up soon. The Medicaid budget for 2019-2020 is still being held in the full House. And Gov. Brad Little has said he won’t let lawmakers adjourn for the year until Medicaid expansion and funding is resolved.
OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler’s proposal to end the harmful practice of surprise medical billing passed the Senate today on a vote of 47 to 0. It now goes back to the House of Representatives for a concurrence vote before heading to the governor’s desk.
Second Substitute House Bill 1065 (www.leg.wa.gov) prevents consumers from getting a surprise bill when they seek either emergency treatment at an out-of-network emergency room or medical services at an in-network hospital or facility but are treated by an out-of-network provider.
In September 2017, Sen. Bernie Sanders introduced his "official" Medicare for All, universal single payer bill to much fanfare. At the time, it garnered a lot of attention, but it also had some gaping holes...most notably the lack of any actual funding mechanism or specifics, as well as a big coverage gap which could be found in both the "Medicare for America" bill which I'm a big fan of as well as the House MFA version.
Today, Sanders launched a revised version of the bill which supposedly addresses both of those issues along with others. Let's take a look.
First of all, who's co-sponsoring it? In 2017, it was cosponsored by 16 Democratic Senators:
Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mr. Franken, Mrs. Gillibrand, Ms. Harris, Mr. Heinrich, Ms. Hirono, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr.Schatz, Mrs. Shaheen, Mr. Udall, Ms. Warren, and Mr. Whitehouse) introduced the following bill; which was read twice and referred to the Committee on Finance
Sorry, I'm a little behind the 8-ball today...a few hours ago, the House Education & Labor Committee voted on and approved H.R.1010, which would reverse the Trump Administration's executive order which removed restrictions placed on so-called "short-term, limited duration" (STLD) healthcare policies, commonly known as "junk plans" since most ACA regulations/requirements don't apply.
Again, the short version (no pun intended) is this: Under the Obama Administration, STLDs were restricted to no more than 3 months at a time, and forbid them from being renewed within the same calendar year. They were always intended to be just that: Short-term only, and of limited duration, for certain people in special circumstances only.
A couple of weeks ago I reported that the Colorado legislature was moving on an ACA reinsurance bill which, on the surface would seem to be similar to other reinsurance programs implemented in over a half-dozen other states to cut down on individual market premiums. The Colorado bill, however, had an unusual funding mechanism:
While similar programs have gone into effect in a number of states, Colorado’s funding mechanism for reinsurance would be an innovative approach. This mechanism utilizes Medicare reference-based pricing to bring down health care costs (what is paid to hospitals and doctors). Medicare-reference-based pricing means that the hospitals, doctors and other healthcare providers would be paid a percentage of what Medicare would pay. For example, the program may pay 150 percent (or 1.5 times) of what Medicare would pay for services, which would be less than what is currently paid to healthcare providers. That savings is then passed on to consumers in the form of lower premiums.
Because of the recent ruling by a Federal judge in the Northern District of Texas, the ACA is back on uncertain ground. No one is surprised. Trump is swerving all over the place first into the total, immediate destruction of the ACA and then veering back to say that his incredible new plan will come out right after he is re-elected. Even McConnell isn’t humoring Trump this time, which should be your first clue. But don’t worry, “preexisting conditions will be covered.” Of course, insurance companies will be able to charge whatever they feel like in order to issue the coverage but Trump is positive that will work for everyone. Well, at least all the billionaires. The rest of us can just use the hospital emergency room, right?
CHUCK TODD: Let me move to health care because to me, it's an even more trickier situation, given that you won re-election I believe, excuse me, you won election in Utah on the same ballot that a majority of -- of your constituents wanted to see Medicaid expanded. So what would you do now with health care? Would you scrap the system we have and build from scratch? Or do you take the Obamacare infrastructure, which many will note was modeled in some ways off of what you did in Massachusetts, and try to reform from there?
Arthur Childs, DO, FACOI is an internist specializing in critical care medicine in Cape May Court House*, New Jersey. About a year ago, as part of a project for the Jefferson School of Population Health, he put together his own Strategic Roadmap for Healthcare Delivery in the United States as a potential alternative to the various universal coverage proposals being tossed around on the left side of the aisle these days. He asked me to read it over and wanted my feedback.
I've done so, and while I'm still a strong proponent of going the Medicare for America route, he makes a lot of useful points and provides much food for thought. It's also very well-researched and cited, and I felt it deserved a wider audience. And so, with the permission of both him and the Jefferson School of Population Health, I'm presenting his full paper with a few of my own thoughts interspersed.
Back in January I reported that the state of Colorado is joining several other states in cracking down on non-ACA compliant so-called "Short-Term, Limited Duration" healthcare policies. As of April 1st, STLDs:
Can last no longer than 6 months/year (still longer than the 3-mo limit under Obama)
Have to stick to the ACA's 3:1 age band limit on premiums
Must be guaranteed issue (no more medical underwriting)
They can still exclude coverage of pre-existing conditions, but there's a limit of 12 months on the lookback timeframe
Must cover all 10 of the ACA's Essential Health Benefits
Must follow other ACA community rating requirements (limiting variances to age, tobacco use and geographic area)
A minimum Medical Loss Ratio of 80% to match the ACA's MLR (currently CO only requires a 60% MLF)
In other words, Colorado just made STLDs follow most of the same rules as ACA-compliant policies.
Governor Janet Mills announced today that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved Maine’s State Plan Amendments to expand Medicaid (MaineCare) under the Affordable Care Act. CMS notified the Maine Department of Health and Human Services (DHHS) of the approval today.
CMS approved the state’s plan retroactive to July 2, 2018, which was the date indicated in the 2017 ballot initiative supported by nearly 60 percent of Maine voters. MaineCare expansion is projected to provide coverage to approximately 70,000 people throughout the state. With today’s approval, the federal government will finance more than $800 million in estimated costs for those who enroll under expansion from July 2, 2018 through state fiscal year 2021. Maine is among 36 states plus the District of Columbia that have expanded Medicaid.
Late last night, the E&C committee was burning the midnight oil (seriously...they were working on it past midnight) during the "markup langage" part of the process...and ended up voting to approve all 12 bills:
E&C CHAIRMAN PALLONE ON PASSAGE OF 12 BILLS TO LOWER HEALTH CARE AND PRESCRIPTION DRUG COSTS FOR CONSUMERS
Apr 4, 2019
Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) released the following statement today after 12 bills to lower health care and prescription drug costs for consumers were favorably reported to the full House of Representatives:
Last week, after Donald Trump dropped another massive turd in the punchbowl by telling his Justice Dept. to ask for the entire ACA to be ruled unconstitutional (as opposed to "only" the pre-existing condition protection provisions, as if that wasn't bad enough), Congressional Republicans were caught completely blindsided and at first, couldn't distance themselves from him fast enough:
Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.
McConnell said he made clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court.
However, this report was released amidst a gusher of other major ACA/healthcare news stories over the course of the week, and I never really got around to a deep dive. I'm still swamped, but I figured I should at least go back and do a little more analysis today.
OK, first of all, I need to clean up the discrepancies between the OE6 enrollment data I had and what's in the official CMS report. Every year there are always slight variations in a few states, usually when it comes to the state-based exchanges, and this year is no exception. There were differences reported in six states; in five of them, CMS reported lower enrollment numbers; in one the CMS tally is higher:
Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans.....
Yes, I'm still fiddling around with the 3-Legged Stool metaphor. I wasn't gonna mess with it any further, but gvien that Donald Trump has decided that making healthcare the biggest topic of the 2020 election cycle (again) is a brilliant strategy for the Republican Party, I figured it was time for an update.
The version below includes a bunch of changes; some are corrections; others are enhancements:
Moved "Maximum Out-of-Pocket Costs" to the Blue Leg, since that's really a carrier covrerage requirement.
Added "Stay on Parents Plan until Age 26" to the Blue Leg. I never had it listed before, not sure why.
Added "Health Insurance Exchanges" to the Green Leg. I never had them actually listed on the graphic, but they're an important Government Responsibility, after all.
Governor Andrew M. Cuomo, Senate Majority Leader Andrea Stewart-Cousins and Assembly Speaker Carl Heastie today announced an agreement on the FY 2020 Budget. The Budget holds spending growth at 2%for the ninth consecutive year and cuts taxes for the middle class.
The Budget includes several landmark policies that will bring sweeping transformation and social justice reform to the state with the passage of the permanent 2% property tax cap that has already saved New Yorkers $25 billion since it was first implemented in 2012; a strategic MTA reform plan and steady revenue stream to fund the next capital plan through Central Business District Tolling; an additional $1 billion to support education, bringing total education funding to $27.9 billion; and landmark criminal justice reforms, including reforming the cash bail system, speedy trial, and the discovery process for a more fair and just New York for all.