Medicaid Expansion

via Greg Bluestein & Ariel Hart of the Atlanta Journal-Constitution:

Gov. Brian Kemp will ask the Georgia Legislature and the federal government for flexibility to improve access to government-funded health insurance for the state’s poor and middle class.

His administration told The Atlanta Journal-Constitution on Thursday that it will back a measure that seeks two separate federal “waivers” to Medicaid and the Affordable Care Act to tailor new programs to Georgia’s needs.

This sounds potentially promising, but...

...The ACA waiver, which he outlined on the campaign trail, aims to stop premiums on the health insurance exchange market from rising so fast. A second push, which emerged after his election, would raise the possibility of a partial expansion of Medicaid to some of Georgia’s poorest residents.

Hmmmm...

I wrote about this a week ago...

The full expansion initiative passed last fall, of course, is supposed to cover Utah residents earning up to 138% of the poverty line, or around 150,000 people...without any work requirements.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

 

Light posting for the next two weeks as I'm dealing with my kid's upcoming bar mitzvah and some other personal stuff, but this one literally hits home.

You may recall that last spring, Republicans in the Michigan legislature attempted to push through a bill to change the state's current ACA Medicaid expansion program (which is close to "vanilla" Medicaid with a few minor tweaks) by tacking on pointless, ineffective and (in an earlier draft) blatantly racist work requirement provisions:

White, Rural GOP Counties Get Exempted from Medicaid Legislation

Republicans in the legislature are working to change Medicaid in Michigan, but only for certain people, as they have tailored the language of pending legislation to exempt some of their constituents from being affected.

I'm rather late to the game on this issue, but it looks like the story is already making major headlines elsewhere so I don't feel too bad; via Robert Pear of the NY Times:

In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved

The voters of Utah and Idaho, two deeply Republican states, defied the will of their political leaders in November and voted to expand Medicaid under the Affordable Care Act. Now those leaders are striking back, moving to roll back the expansions — with encouragement, they say, from the Trump administration.

Utah’s ballot measure, approved with support from 53 percent of voters, would expand Medicaid to cover people with incomes up to 138 percent of the poverty level — up to about $16,750 a year for an individual — and pay the state’s share with a small increase of the sales tax. Under the ballot initiative, 150,000 people are expected to gain coverage, starting April 1.

Back in April 2017, I compiled a 20-itme "ACA 2.0 wish list" which I titled "If I Ran the Zoo", which gained some amount of attention from the healthcare policy wonk community. To be clear, I wasn't the first one to come up with most of these ideas; it was mainly just pulling together a bunch of proposals to protect, repair and strengthen the ACA from various sources into a single, comprehensive collection.

Since then, several bills have been introduced by Democrats in either the House or the Senate which addressed one or more of these recommendations, and last spring there were two bills (one in the House, one in the Senate) which tackled over a half-dozen of them in a package deal. None of these bills have gone anywhere since then, of course; with the Dems having retaken the House, it's a lot more viable that one or more will do so this year, although getting any of them through the Senate is obviously a much tougher climb.

However, some of the items on the list haven't even made it that far, including #5 on my list:

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

This happened while I was out of town, but it's welcome news nonetheless...

Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year

RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.

“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”

This Just In...

Governor Northam Announces Over 182,000 Virginians Enrolled in New Health Coverage

  • SNAP recipients and parents of children with Medicaid coverage can use three-question application until January 4

The new coverage is available to men and women ages 19 through 64 who are not eligible for Medicare and who meet income requirements, which vary by family size. For example, a single adult with an annual income at or below $16,754 may be eligible for coverage. An adult in a three-person family with a total household annual income at or below $28,677 may be eligible.

SNAP recipients and parents whose children are currently receiving Medicaid coverage have the opportunity to use a short-form application to sign up if they do so by January 4, 2019. These individuals were notified by letter earlier this fall, and a follow-up postcard was recently mailed to potentially eligible adults in these categories.

(sigh) Just nine hours ago I posted the following about Kentucky's Medicaid expansion work requirement waiver:

A waiver was approved for Kentucky last spring, but has been (temporarily?) invalidated by court order.

I guess it's a good thing I included the "temporarily" caveat, because just moments ago...

.@CMSGov just re-approved Kentucky’s #Medicaid waiver. https://t.co/2Q16AKQoLS

— Dustin Pugel (@Dpugel) November 21, 2018

Sure enough, here it is:

With all the attention being paid to the midterm elections causing ACA Medicaid expansion to be passed in Utah, Nebraska and Idaho (while also now being at risk in Alaska and Montana), I've kind of lost track of the situation in Virginia, where it was expanded last May to over 400,000 Virginians.

Thankfully, Esther F. linked me to this article from the Virginia Mercury, which brings me up to speed on the actual implementation of the VA expansion program:

Less than two weeks after Virginia opened registration for its expanded Medicaid program, officials say they’ve already drawn thousands more applicants than initially anticipated.

The state had expected the new program to enroll 300,000 over the next year and a half. They now expect that number to reach 375,000. The new estimates won’t alter the total expansion population, which the state has said will be about 400,000.

Over at the Washington Post, Catherine Rampell has an article which confirms EVERYTHING that I and other healthcare wonks have been warning about for months (or years) regarding the real-world impact of imposing work requirements for Medicaid expansion recipients:

...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.

...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.

...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

I just realized that while I've written quite a bit about the potential loss of Medicaid coverage for thousands of residents of Michigan, Kentucky and Arkansas over the past few months due to the new work requirement laws in those states, It's been far too long since I've given a shout-out to the four states which are hoping to add Medicaid expansion (or at least continue it, in one case) exactly one week from today.

Bloomberg News has a pretty good overview:

For years, elected leaders in conservative states have resisted expanding Medicaid, the government health program for low-income Americans. Now voters in four of those states will decide the question directly.

 

As I've written about many times before, my home state of Michigan is, unfortunately, among the states which are trying to institute work requirements for ACA Medicaid expansion for 680,000 Michiganders. As I've also written about many times before, work requirements for Medicaid are not only burdensome and cruel, they're counterproductive in terms of efficiency, economics and even in the stated goal of such programs, which is supposedly to "inspire" low-income people to get a job.

Michigan’s Medicaid Proposal Would Harm Low-Income Workers — And Can’t Be Fixed

Specifically, the Michigan bill, or any similar proposal, would:

“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

--Douglas Adams, The Hitchhiker's Guide to the Galaxy

Yesterday CMS Administrator Seema Verma posted this on Twitter...

I’m excited by the partnerships that Arkansas has fostered to connect Medicaid beneficiaries to work and educational opportunities, and I look forward to our continued collaboration as we thoroughly evaluate the results of their innovative reforms. #TransformingMedicaid

— Administrator Seema Verma (@SeemaCMS) September 13, 2018

Breaking News via the Lincoln Journal Star...

A Lancaster County District judge has dismissed a challenge to the Medicaid expansion petition initiative, allowing the initiative to be placed on the November ballot.

The lawsuit was brought by former state Sen. Mark Christensen and Sen. Lydia Brasch. They alleged the initiative was an unconstitutional delegation of legislative authority, contained more than one subject, which the state Constitution prohibits, and that it failed to identify Nebraska Appleseed as a sworn sponsor.

Last week, Secretary of State John Gale confirmed that enough signatures were gathered by petition circulators to put the question of whether to expand Medicaid to about 90,000 uninsured adult Nebraskans on the Nov. 6 ballot. 

...The campaign has said Medicaid expansion will create and sustain 10,000 new jobs, reduce medical bankruptcies, bring $1.1 billion of Nebraskans’ tax dollars back from Washington, D.C., and produce savings by reducing uncompensated care for those who lack health coverage.

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