Medicaid

Various healthcare wonks, including myself, have been warning for years that imposing work requirements on Medicaid enrollees would be pointless, ineffective, wasteful, expensive and cruel.

Several studies, including this one from just the other day, have driven home this point clearly: Adding work requirements to Medicaid expansion enrollees serves no useful purpose other than to kick tens of thousands of people off of their healthcare coverage (which, of course, is the whole point from the POV of those who add the requirements).

As for the one positive-sounding goal (increasing employment) which supporters always use to try and justify them, that's a complete joke:

The first major study on the nation’s first Medicaid work requirements finds that people fell off of the Medicaid rolls but didn’t seem to find more work.

Some Guy, 2015:

In other words, only about 10% (at most) of those still in the Medicaid Gap could even remotely match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.

Yesterday I noted that both houses of the California state legislature (Assembly and Senate) voted to expand Medi-Cal (the state's Medicaid program) to anywhere between 147,000 - 175,000 undocumented immigrants (young adults age 19 - 25 and seniors over 65), entirely funded using state dollars.

It turns out that this was only part of a marathon voting session yesterday over the past few weeks. Either the state Senate, Assembly or both have also voted to pass three a bunch of other healthcare-related bills (I've included simple descriptions of each):

BREAKING: California Assembly passes our #AB1246(@Limon) to align consumer protections for all Californians, including those in large group coverage. #Care4AllCA

Back in 2016, California passed an important bill which allowed undocumented children to enroll in the state's Medicaid program (called Medi-Cal). The costs are borne entirely by the state, since federal law currently doesn't allow federal taxpayer dollars to be used to pay for Medicaid...although, I should note, this isn't entirely true:

Federal law generally bars illegal immigrants from being covered by Medicaid. But a little-known part of the state-federal health insurance program for the poor has long paid about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants.

The lion’s share goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.

Last week, Joan Alker of the Georgetown University Center for Children and Families noted that a whopping 840,000 children lost Medicaid or CHIP coverage in 2018:

We've taken a closer look at these #'s - check out your state below.
The net national # is 840k kids losing Medicaid/CHIP in 2018 not 860k as we said initially
But in the 39 states losing kids on Medicaid the net total # is worse -- 920,000

https://t.co/dOOD4gyAOw https://t.co/jhs22mNc0w

— Joan Alker (@JoanAlker1) April 26, 2019

There's a link to a whole analysis which breaks the numbers out by state:

We’ve been anxiously awaiting the release of final Medicaid and CHIP enrollment data for 2018, which was expected to be posted almost a month ago. The wait is finally over but not our concerns about what’s happening.

"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

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:

UnitedHealthcare is pulling out of Iowa's private Medicaid management program

More than 425,000 poor or disabled Iowans will soon have to switch health insurance carriers. 

UnitedHealthcare, which manages health care for more than two-thirds of Iowans on Medicaid, is leaving the market, Gov. Kim Reynolds’ office announced late Friday afternoon.

I'm lumping together three Tennessee-based stories here from the past month or so, but they're perfectly connected to each other:

March 7th, 2019:

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.

So much crazy healthcare policy/legal news is happening this week I'm having trouble keeping up.

This happened yesterday:

BREAKING: federal judge strikes down Kentucky's Medicaid work requirements. Again. Remands them back to HHS

— Nathaniel Weixel (@NateWeixel) March 27, 2019

Same judge also strikes down work requirements in Arkansas

— Nathaniel Weixel (@NateWeixel) March 27, 2019

And since I was too swamped with other stuff, I didn't have a chance to write about it until now. A bunch of other outlets have already posted the details, so here's Dylan Scott of Vox.com to save me the trouble:

A federal district judge has blocked Medicaid work requirements approved by the Trump administration in Arkansas and Kentucky.

Ugh:

CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

No, it won't go anywhere with the House held by Democrats, but even so:

President Trump is releasing a $4.7 trillion budget plan Monday that stands as a sharp challenge to Congress and the Democrats trying to unseat him, the first act in a multi-front struggle that could consume Washington for the next 18 months.

The budget proposal dramatically raises the possibility of another government shutdown in October, and Trump used to the budget to notify Congress he is seeking an additional $8.6 billion to build sections of a wall along the U. S.-Mexico border.

Here we go again...

Trump’s “Budget for a Better America” also includes dozens of spending cuts and policy overhauls that frame the early stages of the debate for the 2020 election. For example, Trump for the first time calls for cutting $845 billion from Medicare, the popular health care program for the elderly that in the past he had largely said he would protect.

Amidst all the depressing news about various GOP states moving backwards on healthcare policy by gunking up Medicaid programs to add draconian work requirements, lowering the eligibility thresholds, stripping benefits and so forth, there were two positive developments in deep red territory last week, both relating to Medicaid work requirements:

First, in West Virginia:

A bill that sought to place work or other requirements on Medicaid recipients in West Virginia has died in the House of Delegates.

A House committee put the bill on its inactive calendar Wednesday, Feb. 27, the final day that legislation could be passed in their chamber of origin. The full House earlier Wednesday debated the bill but stopped short of voting on it, and did not take up the bill during a late evening session before adjourning.

The bill would have required able-bodied adults to work, participate in workforce training or community service, or attend a drug treatment or recovery program for at least 20 hours per week.

(sigh) via Joan Alker of the Georgetown University Health Policy Institute:

Last week, the state of Arkansas released its latest round of data on implementation of its Medicaid work reporting requirement – the first in the country to be implemented. As readers of SayAhhh! know, over 18,000 lost coverage in 2018 as a result of not complying with the new reporting rules. And the policy is clearly failing to achieve its purported goal – incentivizing work – with less than 1% of those subject to the new policy newly reporting work or community engagement activities.

The contrast in how a completely Republican-held state government like Utah and a completely Democratic-held state government like New Mexico deal with Medicaid is pretty astonishing.

In Utah, just four months ago the public voted, clearly and unequivocally, to enact a full expansion of Medicaid to all adults earning up to 138% of the Federal Poverty Line...but the GOP state House, Senate and Governor decided to ignore the voters and override their will by cutting the expansion down to a 100% FPL cap, including work requirements, which will cover tens of thousands fewer people while costing the state $50 million more.

In New Mexico, meanwhile, a newly-enabled Democratic trifecta (I believe both houses of the state legislature were already held by Dems, but the Governorship flipped from Republican Susana Martinez to Democrat Michelle Lujan Grisham) has been on a tear in their first month and a half:

 

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.

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