Tagged Medicaid

A Busy Week For Health: Budget Cuts, CBO Scores And Mitch McConnell’s Cryptic Signal

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It was a hectic week for people who follow news about health politics. Kaiser Health News’ veteran reporters Mary Agnes Carey and Julie Rovner sat down to discuss some of the major developments.

MARY AGNES CAREY: Hello, and thanks for joining us. I’m Mary Agnes Carey, partnerships editor and a senior correspondent for Kaiser Health News. Julie Rovner, KHN’s chief Washington correspondent, is here with me to talk about a very busy week in health care: Medicaid cuts in President [Donald] Trump’s budget plan and a new Congressional Budget Office analysis of the House passed ACA overhaul. We’ll also look at what Senate Republicans have in mind for their ACA replacement bill. Julie, let’s get started.

JULIE ROVNER: OK.

MARY AGNES CAREY: First the budget. President Trump released his fiscal 2018 budget plan this week. Federal spending on Medicaid and the Children’s Health Insurance Program would be cut. Can you take us through those changes.

JULIE ROVNER: Yes these Medicaid changes would be on top of what’s in the House-passed health care bill, which would be about $800 billion. What the administration says is that they’re going to let the amount that Medicaid goes up every year go up by less. So that would result in even more cuts. There’s a roughly 20 percent cut to the Children’s Health Insurance Program.

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This budget also includes big cuts to the public health infrastructure. It cuts the Centers for Disease Control and Prevention by about 17 percent. It would cut the National Institutes of Health by nearly 18 percent. It would completely eliminate the Agency for Healthcare Research and Quality and fold that into the NIH. So there’s been a lot of uproar from the medical and scientific community, although we should point out that this budget is unlikely to happen. Presidents’ budgets are mostly wish lists — that goes back decades. Congress basically decides who gets how much money.

MARY AGNES CAREY: Because they control the purse, right.

JULIE ROVNER: Absolutely.

MARY AGNES CAREY: All right. Let’s move on to the ACA. The Congressional Budget Office, or the CBO as we like to call it, released a new score or analysis for the House Republicans’ plan to replace the Affordable Care Act. What were the top takeaways for you?

JULIE ROVNER: Well, a lot of attention was paid to, you know, that sort of top line — that it would result in 23 million more people not having insurance after 10 years and then overall it would save about $119 billion from the deficit.

But what most of us were really looking at is what would happen as a result of that last-minute compromise that actually got the bill passed in the House. That was this amendment that would let states waive some of the requirements in the bill, like having a set of benefits and not charging people with preexisting conditions more. And interestingly, the CBO said that either under the Affordable Care Act or under the original House bill the market for individual insurance would probably be stable. But in those states that decided to take those waivers, it might well become unstable.

And the CBO didn’t say which states that would be, but they estimated that about one-sixth of Americans lived in states where that might happen. In those cases, people with preexisting conditions might be completely priced out of being able to get policies and even people who could get insurance might have to pay many, many thousands of dollars more because some benefits that they might need, like maternity care or mental health care, would no longer be covered. So it was not a ringing endorsement of that last-minute compromise.

MARY AGNES CAREY: And there’s also a big differential between if you’re younger or older, right?

JULIE ROVNER: That’s absolutely right. This is in sort of the original House bill. They would change the way tax credits are provided for people to help pay their premiums. Right now, they’re basically based on your income and how much insurance costs, so it doesn’t matter in different parts of the country if you’re sure insurance costs more. You only have to pay a set percent of your income.

The Republicans would change that, and they would link the tax credits more to age so older people would get more. Younger people would get less, but people would get less help overall. So for older people, premiums would spike dramatically. Sometimes you know more than $10,000 or $12,000. Some younger people, healthy younger people, would see a decrease, but it would not be nearly as large as the increase for older people.

MARY AGNES CAREY: So what does this CBO score mean for Senate Republicans as they try to draft their ACA replacement.

JULIE ROVNER: Well it certainly doesn’t help. The Senate had to wait for the Congressional Budget Office to deliver this score. That’s one of the requirements of the budget process that they’re using. But Senate Majority Leader Mitch McConnell did a couple of interviews this week where he basically said that they’re working hard on health care, but he doesn’t see a path to 50 votes, which is what they need to get this bill passed. That’s assuming Vice President [Mike] Pence could break a tie.

What we’re starting to see are conservatives saying they need to have these waivers — the ones that the CBO just said might destabilize the insurance market. Then you’ve got more moderates saying no we want fewer or no waivers. It’s hard to see where they’re going to come together. We’re told that staff is going to try to draft something next week while Congress is out for the Memorial Day break. But there’s no real anticipated timeline for this yet.

MARY AGNES CAREY: So Julie, why do you think Mitch McConnell would send such a public signal that he’s having a problem getting to 50 votes?

JULIE ROVNER: I really don’t know. I thought it was kind of curious. One of the things that it might be is that he wants to, you know, light a fire under his caucus, who are having all this disagreement, saying you know this whole thing could, you know, just dissolve if you don’t actually start coming to the table and compromising. Why else do you think he might do it?

MARY AGNES CAREY: Well you talk about how the calendar is working against him if he wants to get to tax reform. We’re at Memorial Day, and typically tax reform takes a lot of work, a heavy lift, maybe he just wants to move onto that.

JULIE ROVNER: So basically abandon the whole health reform idea?

MARY AGNES CAREY: I mean it sounds a little nutty. And obviously it’s a campaign promise they’ve all made. But also, as we’ve seen, there are problems in the marketplace. You do see insurers leaving over uncertainty. Perhaps they want to let that play out. I’m not sure.

JULIE ROVNER: Neither am I.

MARY AGNES CAREY: All right, well there you go. Thank you, Julie Rovner of Kaiser Health News.

Categories: Health Industry, Insurance, Medicaid, Public Health, Repeal And Replace Watch, The Health Law, Uninsured

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Perspectives On The Trump Budget: Examining The Charged Language Used To Respond To It; And What Does That Budget Say About Trump And His Voters?

Opinion writers take on a variety of fiscal issues advanced by President Donald Trump’s budget proposal, including how it treats Medicaid and Social Security’s disability program.

The New York Times: It’s All About Trump’s Contempt
For journalists covering domestic policy, this past week poses some hard choices. Should we focus on the Trump budget’s fraudulence — not only does it invoke $2 trillion in phony savings, it counts them twice — or on its cruelty? Or should we talk instead about the Congressional Budget Office assessment of Trumpcare, which would be devastating for older, poorer and sicker Americans? There is, however, a unifying theme to all these developments. And that theme is contempt — Donald Trump’s contempt for the voters who put him in office. (Paul Krugman, 5/26)

Boston Globe: Baby Boomers Beware: GOP’s Medicaid Cuts Could Hurt You Later
But there’s a giant hole in Medicare coverage, a hole that many aging American seniors eventually fall into: Nursing home care isn’t generally covered, and neither is full-time assistance at home. But if you live to 65, there’s a 40 percent chance you’ll enter a nursing home in the future. And it’ll cost you $80,000 to $90,000 a year on average. So where does that money come from if Medicare won’t pay? The answer is Medicaid, the other government insurance program, the one more often associated with the poor than the elderly. About 60 percent of nursing home residents rely on Medicaid. Which means that if the Republican plan to slash $834 billion from Medicaid goes forward, it could have a devastating impact on seniors with critical health needs. (Evan Horowitz, 5/25)

Chicago Tribune: Social Security’s Disabling Disability Program
Whhen the White House unveiled its 2018 budget on Tuesday, plenty of Democrats were quick to characterize it as stingy and cruel. Among the exhibits for the prosecution was the plan for Social Security Disability Insurance, whose projected outlays the administration would cut by 5 percent by 2027. White House budget director Mick Mulvaney started the argument in March. “It’s the fastest growing program,” he asserted. “It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.” He was promptly accused of factual sloppiness and heartlessness, and some of the criticism was justified. But Mulvaney is onto a real problem that demands attention. (5/25)

The Kansas City Star: Truth From Mick Mulvaney
Cutting health care for the poor is a dream come true for many congressional Republicans. And that’s not an exaggeration, but a direct quote: “So Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this” since college, House Speaker Paul Ryan said in March. So, what are food stamp recipients who do work but don’t earn enough to feed their families to do? Get “the right mind-set,” says HUD head Ben Carson, since poverty is largely “a state of mind.” (Melinda Henneberger, 5/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes: The Politics Of Repeal, Replace And Reform

Editorial pages across the country include thoughts about the political risks in play as Congress and states confront efforts to dismantle Obamacare.

Bloomberg: Exposing The Obvious About The GOP Health-Care Bill
The gory details of the Congressional Budget Office’s report on the House legislation to “repeal and replace” Obamacare are, in many ways, superfluous. The bill’s flaws, substantive and otherwise, have long been evident. Less clearly understood, though equally disturbing, is the larger political context. (5/25)

Roll Call: A GOP Guide To Running For Cover On Health Care
Most of the news coverage highlighted the CBO’s estimate that 23 million fewer Americans would have health coverage in 2026 under the bill. But in 2026, most current House Republicans will be lobbyists and strategic consultants — and some future Congress would get the blame. In political terms, the scariest CBO number was that 14 million fewer Americans would be without health insurance next year. And many of these suddenly uninsured people just might remember whom to blame when they cast their 2018 ballots. (Walter Shapiro, 5/26)

Los Angeles Times: Die Hard: Republican Healthcare Bill Has No Problem Throwing You Off A Building
Glendale resident David Cannizzaro has had asthma since he was 7. Prior to Obamacare, his healthcare strategy was to see the doctor as little as possible so his insurer wouldn’t notice his preexisting condition and decide to raise his rates or drop his coverage. Now that Republican lawmakers are advancing a bill that would repeal the Affordable Care Act and potentially allow insurers to jack up premiums for people with preexisting conditions, Cannizzaro, 49, said he’s once again living in fear. “It’s very, very scary,” he told me. (David Lazarus, 5/26)

The Washington Post: Senate Republicans Who Are Gunning For Obamacare Are Caught In A Trap
Republican senators who are being asked today about the brutal Congressional Budget Office score of the health-care plan that passed the House have a ready answer: That doesn’t have anything to do with us. Numerous senators released statements saying that the CBO score just shows that the American Health Care Act (AHCA) is a radioactive fungus, which is why they’re starting over on their own bill. (Paul Waldman, 5/25)

The Washington Post: Don’t Blame The CBO For Problems In The House Health-Care Bill
The new Congressional Budget Office score of the American Health Care Act is devastating. In 2026, 23 million fewer Americans would be insured with it than without it. The response of the secretary of health and human services and other defenders of the Republican bill? Attack the Congressional Budget Office. I had the honor of running the CBO a decade ago and will be the first to admit it’s not perfect. But it’s also far better than the alternatives, and most of the critiques are off base. (Peter Orszag, 5/25)

Los Angeles Times: If You Plan On Having A Baby Under Trumpcare, You Better Start Saving Now
Seventeenth century playwright William Congreve famously wrote that hell has no fury like a woman scorned. House Republicans may feel some of that heat once their constituents find out the healthcare bill they passed could make maternity coverage vastly more expensive and harder to obtain. It’s widely known that the House GOP’s proposed American Health Care Act would bar federal funding for Planned Parenthood, which provides many reproductive and maternal health services to lower-income women across the country. Less well understood is that an amendment to the AHCA would also allow states to lift the mandate that insurers include maternity coverage in all the policies they sell to people in the individual and small-group markets (i.e., everyone not covered by a large company health plan). (Jon Healey, 5/25)

Tribune News Service: Obamacare Replacement Would Give Women Better Options, Lower Costs
Women make the majority of decisions about care and insurance for our families, and we generally consume more healthcare than men. As a result, women have a lot at stake when it comes to the laws that govern American healthcare and insurance. In 2010, the Affordable Care Act — Obamacare — made it illegal for insurers to charge women more than men and mandated that insurance plans cover women’s preventive care, including birth control, with no copay. Therefore, some now suggest repealing the Affordable Care Act would be detrimental for women’s health. But the opposite is true: Repeal will afford women greater choice and lower costs when it comes to insurance plans, doctors and care. (Hadley Heath Manning, 5/25)

Detroit Free Press: Who Will Play Fred Upton In Senate Sequel To House Health Care Farce?
Fred Upton is a 16-term congressman who may or may not be interested in becoming Michigan’s next U.S. senator. But there are almost certainly some Republican U.S. senators interested in becoming the next Fred Upton. A grandson of Whirlpool Corp. co-founder Frederick Upton, Rep. Upton is among the wealthiest members of Congress. Until 2016, he served as chair of the House Committee on Energy and Commerce. (Brian Dickerson, 5/25)

Sacramento Bee: California Democrats Did Far More Than Flip Off Trump 
California Democrats now number more than 8 million for the first time, hold every constitutional office, and command a supermajority in the Legislature because we reflect the values of the citizens of our state.But we are not resting on our laurels, far from it. While President Donald Trump and Republicans in Congress are talking about slashing health care for 23 million Americans, California Democrats re-emphasized their belief that health care is a right, not a privilege, as we pursue Medicare for all with Senate Bill 562. (Eric Bauman, 5/25)

Des Moines Register: Privatized Medicaid Was Supposed To Save Money?
Iowa is now 14 months into its experiment with privatized Medicaid management. … Privatization is a slow-motion train wreck, with providers across the state closing up shop or taking out loans to make payroll because the checks from Medicaid are slow to arrive and patient services are being paid at a lower rate. At the same time, the managed care organizations that Iowa hired to administer Medicaid say they are losing millions, and need an enormous increase in funding in order to make ends meet. This was not only predictable, it was predicted. (5/25)

St. Louis Post-Dispatch: Western Missouri Becomes A Canary In Obamacare Coal Mine
In what could be a disturbing portent, Blue Cross Blue Shield of Kansas City on Wednesday announced it was pulling out of the Obamacare health exchanges in 2018. The decision will leave 67,000 people in 25 Missouri counties and two Kansas counties with no option for private insurance, subsidized or not, under the Affordable Care Act. Blue Cross Blue Shield announced it had lost nearly $100 million on Obamacare policies since 2014; only last year did it take in more premium money than it paid out, and overhead costs pushed the Blues into the red. (5/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Early Hospital Discharges; Missed Vaccinations; Growth In Spending

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? … In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 5/17)

Annals of Internal Medicine: Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations
40 810 adult travelers were included [in an observational study in U.S. pretravel clinics]; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]). (Hyle et al., 5/16)

Urban Institute/Robert Wood Johnson Foundation: The Evidence On Recent Health Care Spending Growth And The Impact Of The Affordable Care Act
Conventional wisdom holds that health care cost growth is high and the Affordable Care Act (ACA) has done little to address the problem. However, overall increases in national health expenditures (NHE) since the law passed have been lower than anticipated, premiums and premium growth in the ACA’s health insurance marketplaces are high in some states but quite low in others, and growth in Medicare and Medicaid spending per enrollee has been very modest. NHE are still high, now at 18.3 percent of gross domestic product …. In this brief, we attempt to address several misconceptions about recent spending increases; these misconceptions are centered in three areas: the recent and projected growth in NHE the levels and recent growth of ACA marketplace premiums the recent and projected spending growth in the Medicaid program. (Holahan et al., 5/25)

Urban Institute: Medicaid/CHIP Participation Rates Rose Among Both Children And Parents In 2015
Using the 2013-2015 American Community Survey, this brief finds improvements for both parents and children in uninsurance, Medicaid/CHIP participation, and the number who are eligible for Medicaid/CHIP but not enrolled. Uninsurance fell nationally and in nearly every state, and the number of eligible but uninsured children fell to 2.1 million – declining by over half since 2008. Children’s participation reached 93.1 percent in 2015 (exceeding 90 percent in 36 states), while participation among parents rose to 80.2 percent, with larger gains between 2013 and 2015 in expansion states than nonexpansion states. Participation grew among every subgroup of children and parents examined. (Kenney et al., 5/17)

The Kaiser Family Foundation: Financing Family Planning Services For Low-Income Women: The Role Of Public Programs
Medicaid, the Title X Family Planning Program, and Section 330 of the Public Health Service Act (PHSA) are the leading sources of federal funding for the over 10,000 safety-net clinics across the country that provide reproductive health services to low-income women, men, and teens. The Trump administration and the Republican leadership of the 115th Congress have proposed to block federal Medicaid funds from going to Planned Parenthood …. Changes to these programs and funding to the clinics that provide family planning services could limit the availability of contraceptive services, STI screenings and treatment, and preventive cancer screenings, along with other primary care services to low-income women. … One in three low-income women reported that they obtained birth control from a family planning clinic such as Planned Parenthood or another health center or public health clinic. (Ranji et al., 5/11)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Wis. Committee Approves Gov. Walker’s Plan To Test Some Medicaid Enrollees For Drugs

The plan, if it wins full legislative approval and is endorsed by federal officials, would be the first of its kind in the country.

The Associated Press: Walker’s Medicaid Drug-Testing Wins Approval
Gov. Scott Walker’s proposal making Wisconsin the first state to require drug tests to receive Medicaid health benefits has won approval from the Legislature’s budget-writing committee. The Joint Finance Committee on Thursday voted to give itself oversight and final approval on Walker’s plans to drug-test able-bodied, childless adult Medicaid applicants. There would also be a drug test requirement for food stamp recipients. Democratic opponents argue the drug testing would be unconstitutional. (5/25)

The proposal in Wisconsin is one of a number of conservative proposals to modify Medicaid being considered in states.

The Washington Post: At Trump’s Urging, States Try To Tilt Medicaid In Conservative Directions
Wisconsin is preparing to recast its Medicaid program in ways that no state has ever done, requiring low-income adults to undergo drug screening to qualify for health coverage and setting time limits on assistance unless they work or train for a job. The approach places BadgerCare, as the Wisconsin version of Medicaid is known, at the forefront of a movement by Republican governors and legislatures that is injecting a brand of moralism and individual responsibility into the nation’s largest source of public health insurance. (Goldstein and Eilperin, 5/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

‘You’ve Got Mail’: Emails And Robocalls Hit Home In Promoting Medicaid Enrollment

Postcards, robocalls and other low-tech outreach tools can be as effective as personalized enrollment assistance at encouraging eligible people to sign up for Medicaid, a new study found.

Researchers conducted two randomized, controlled trials in Oregon that evaluated the extent to which people who were potentially eligible for Medicaid signed up for coverage following different types of outreach in 2013.

Medicaid is the federal-state health insurance program for low-income people, and Oregon is one of 31 states and the District of Columbia that expanded Medicaid under the Affordable Care Act to cover adults with incomes up to 138 percent of the federal poverty level (about $16,000).

For one study group, researchers targeted people who were likely eligible for Medicaid coverage under the ACA because they were already enrolled in assistance programs with similar income standards, including the Supplemental Nutrition Assistance Program (often referred to as food stamps) or those whose kids were signed up with the state Medicaid program.

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For the other study group, researchers identified people who had expressed interest in and won a lottery to enroll in Medicaid coverage under the state’s existing program for low-income nondisabled adults. After winning the lottery, they had 45 days to sign up for coverage.

Members of the lottery trial were randomly assigned to one of three groups. The control group received the state’s basic outreach materials, which included a notification letter and an application packet. In addition to the basic state outreach materials, the second group got other “low-intensity” nudges, including additional postcards and other mail, emails and automated phone calls to encourage them to sign up. The third, “high-intensity” group received all the other materials plus in-person enrollment help from trained assistants as well as personalized phone calls.

Twenty-seven percent of the people in the lottery control group signed up in the roughly six weeks after being notified. Enrollment was significantly higher — 41 percent — among those who received extra outreach efforts. There was no difference in enrollment between the people who received one-on-one help and those who were sent mass-outreach materials.

The low-intensity interventions cost an average $1.75 per person, while the high-intensity interventions cost $28 per person, on average, the study found.

“The extra personalization and individual-level contact that we layered on didn’t add much,” said Katherine Baicker, a professor of health economics in the Department of Health Policy and Management at Harvard University’s school of public health, who co-authored the study published in the May issue of Health Affairs. That’s good news for states, Baicker said, who can get more enrollment bang for the buck.

Since the high-intensity interventions had proven relatively ineffective, researchers tested only the low-intensity interventions against the control group in the second trial of people who were likely eligible under the ACA’s Medicaid expansion and looked at the effect on enrollment in the program over time.

The differences in enrollment were less pronounced in that trial. Thirty-eight percent of the control group were still enrolled a year after the intervention, compared with 41 percent of those who had received additional low-intensity encouragement to sign up.

The less dramatic difference in results for this study group makes sense, said Baicker.

In contrast to the lottery group, who had already expressed an interest in being included in the state’s Medicaid lottery, “this group didn’t proactively express any interest in being insured,” she said. However, once the outreach tools got through to them, people stayed insured. “Those people that we reached, there was a durable response,” Baicker said.

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Perspectives On The Trump Budget: Questionable Math; Who Feels The Most Pain?

Editorial pages across the country include analysis and review of President Donald Trump’s fiscal blueprint, including some tough talk about its political and policy implications.

The New York Times: Trump’s Budget: The Math Is Phony But The Cruelty Isn’t
Phony math is a time-honored tradition in the Washington world of budget making, but the first full fiscal plan from the Trump administration breaks new ground. The bottom line: A budget that the White House says will be in balance by 2027 would, in reality, remain deeply in red ink throughout the coming decade and ultimately add trillions of dollars to the national debt. … This budget’s blatant disregard for intellectual integrity is matched by the extraordinary extent to which it seeks to slash social welfare programs, including another $616 billion out of Medicaid on top of $800 billion that would be sliced as part of the Republicans’ health care plan. That’s a 28 percent reduction to the existing Medicaid budget plan. (Steven Rattner, 5/24)

Chicago Tribune: Trump’s Budget: A Slow Boat To Disaster
The plan has been assailed by Democrats and various activist groups for coddling the rich, punishing the poor and shortchanging important functions. Trump proposes to cut outlays for Medicaid, food stamps, Head Start and Social Security disability. Ditto for Environmental Protection Agency enforcement and State Department security. He would close the National Endowment for the Arts, the National Endowment for the Humanities and the Corporation for Public Broadcasting. (Steve Chapman, 5/24)

Forbes: Trump’s Budget For Seniors: Bad, But It Could Have Been Worse
The best that can be said about President Trump’s 2018 budget and older adults: It could have been worse. In a fiscal plan focused on historic domestic spending cuts, programs for older adults were hit by substantial reductions, though not slashed as deeply as other domestic programs. Medicare was largely untouched. So was Social Security for seniors, although Trump would tighten eligibility and reduce some benefits in the Social Security disability program. (Howard Gleckman, 5/23)

The Des Moines Register: Donald Trump 2018 Budget Could Turn Off His Voters And Sink His Approval Rating
The best way to think about the fiscal 2018 budget released by the White House is as a Trump political campaign rally on paper. The budget was clearly developed to make a statement to President Trump’s base of voters in the hope that they will see it as him keeping his campaign promises. According to Office of Management and Budget Director Mick Mulvaney, the budget will be in surplus in 10 years, construction will start on the wall between the U.S. and Mexico, there will be more money for enforcing immigration laws, and there will be much more for the Pentagon. Meanwhile, wasteful government spending will be cut and taxes will be reduced. (Stan Collender, 5/24)

Louisville Courier-Journal: Tell Congress The Budget Must Provide For The Poor
“A preferential option for the poor” is a fundamental concept in Catholic social teaching. Though the phrase itself is only 50 years old, it derives from Jesus’ Gospel message to pay special attention to poverty. … The concept is shared by many religions and has become part of the ethos of the United States. Whether through Social Security, Medicaid, food stamps or foreign aid, our nation has recognized that our worth is judged by how we treat the most vulnerable among us. … The U.S. Congress is now considering a budget proposal by the current administration. So many helped in this country and abroad would be devastated by this budget. (Archbishop Joseph E. Kurtz, 5/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Visions: Are Republicans Trying ‘To Starve’ Obamacare To Death; Analyzing The State Of ACA Insurance Markets And Premiums

Opinion writers offer a variety of thoughts on health policy issues, including whether the health law is “collapsing under its own weight,” some ominous predictions about the individual insurance markets, the importance of the public option and a range of other ideas.

The New York Times: How The G.O.P. Sabotaged Obamacare
Obamacare is not “collapsing under its own weight,” as Republicans are so fond of saying. It was sabotaged from the day it was enacted. And now the Republican Party should be held accountable not only for any potential replacement of the law, but also for having tried to starve it to death. The Congressional Budget Office on Wednesday released its accounting of the House Republicans’ replacement bill for the Affordable Care Act, and the numbers are not pretty: It is projected to leave 23 million more Americans uninsured over 10 years, through deep cuts to insurance subsidies and Medicaid. The report underscores how the bill would cut taxes for the rich to take health care away from the less well-off. (Abbe R. Gluck, 5/25)

The Wall Street Journal: How To Read An ObamaCare Prediction
The political world waited with rapt attention Wednesday for the oracles at the Congressional Budget Office to release their cost-and-coverage predictions for the revised House health reform bill, which arrived late in the afternoon. But while Washington stood by, two reports emerged from the real world that are far more consequential. (5/24)

Los Angeles Times: Trump’s Team Issues A Stunningly Dishonest Study Of Obamacare Rate Increases
The Department of Health and Human Services seemed mightily pleased with a statistic it issued Tuesday. The agency’s figures showed that premiums on the Affordable Care Act exchanges “doubled” from 2013 through this year. This might not sound like good news for the people buying their coverage on those exchanges, but to HHS it was vindication. “This report is a sobering reminder of why reforming our healthcare system remains a top priority of the Trump administration,” agency spokesperson Alleigh Marré said. (Michael Hiltzik, 5/24)

Kansas City Star: Should A Limited Public Option Be Part Of Health Care Reform? 
Weren’t we focused on health care reform just a few weeks ago? Yes we were. And as it turns out, while we’re all looking at other things, lawmakers in Washington are still working on a rewrite of the Affordable Care Act. There were two important developments over the last two weeks we should think about. (Dave Helling, 5/24)

Stat: Native Americans’ Health Threatened By Denial Of Medicaid Expansion
America has broken several centuries worth of promises to its indigenous people. And we’re poised to do it again. … The Affordable Care Act provided a way to improve the health of thousands of Native Americans through Medicaid expansion. It provided a much-needed injection of funding to the long-neglected Indian Health Service and tribal health facilities by raising the income level needed for eligibility. With the poverty rate at 28 percent among Native Americans, this group disproportionately benefited from Medicaid expansion. (Kevin Duan and Aaron Price, 5/25)

Milwaukee Journal Sentinel: Health Care Reform The Wisconsin Way
Wisconsin has been a leader in covering its residents with high-quality health care and providing community supports so people with disabilities and frail elders can stay in their homes and communities and out of costly facilities. The American Health Care Act poses a particularly dangerous threat to our state’s residents, in part because we have done so much right. (Barbara Beckert, 5/24)

Lexington Herald Leader: Calling Dr. Paul: Seriously, You Don’t Think The U.S. Can Afford Health Care?
The United States spends more per person on health care than any other country, but our health outcomes are far from the best. Simply put, the challenge facing Congress is how to get more value for all that money. Yes, the details are complex, but we’re a big, complex country with a big, complex economy. Our elected leaders should engage that complexity and produce practical reforms and solutions that inspire confidence in the future. That is a reasonable expectation. (5/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Citing CBO Report, Critics Decry GOP Bill’s Potential Fallout In California

Though the budget analysis released Wednesday on the GOP health care bill didn’t address California specifically, both the state’s Medicaid program and its individual market could be seriously harmed if the legislation passes, according to legislators, consumer advocates and other critics.

“I feel like I am in a bad dream,” said Sen. Ed Hernandez, the West Covina Democrat who chairs the state Senate Health Committee.

The Congressional Budget Office confirmed what Hernandez expected — that large numbers of people would lose coverage and poorer, older Californians would pay significantly more for coverage under the American Health Care Act.

The Republican bill passed the House of Representatives earlier this month with no Democratic support and is now in the hands of the Senate, which is working on its own version.

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Hernandez said he’s especially concerned about the changes to the Medicaid program, known as Medi-Cal in California. “The state budget is not going to be able to absorb this,” he said. “We are going to have a real problem.”

All 14 members of California’s Republican delegation in the House voted for the GOP bill. Like their counterparts nationally, several have said that President Obama’s signature health law was failing and that the new legislation would offer consumers more choice and better care at better prices.

But critics said the law would roll back much of what California had achieved when it heartily embraced the Affordable Care Act, which brought the state’s uninsured rate to record lows.

Nationally, the $119 billion in savings projected by the CBO over a 10-year period doesn’t seem worth the anticipated cost of adding 23 million to the rolls of the uninsured, said John Baackes, CEO of LA Care Health Plan.

In California, Baackes said, the cuts to Medi-Cal “will create a huge gap that the state would have to fill.” And he said it could end the Medicaid expansion ushered in by the Affordable Care Act. Since the law took effect, about 5 million more people enrolled in Medi-Cal, including 3.7 million who became newly eligible under the expansion.

An earlier analysis of the House bill by the California Department of Health Care Services, which oversees the state’s Medicaid program, estimated that the state would lose more than $24 billion annually by 2027 compared to what it would have received under the ACA.

Covered California officials declined to comment on the budget analysis Wednesday but have said in the past that the GOP legislation would make coverage unaffordable for many Californians, especially those who have lower incomes and live in pricier areas.

Even assuming California keeps the 10 essential benefits spelled out under the ACA and continues to prohibit higher premiums for those with preexisting conditions, the individual market in the state would be destabilized, said Laurel Lucia, a health care researcher at the University of California-Berkeley Labor Center.

For many people, the Republican proposal also would reduce premium subsidies for Covered California plans, which Lucia said would make coverage less affordable. And proposed caps on federal Medicaid spending would tightly squeeze the California program, she said.

“Overall there would be substantial loss of coverage for low- and middle-income Californians, especially older Californians,” Lucia said.

Jen Flory, a policy advocate at the Western Center on Law & Poverty in California, said the CBO report shows that “drastic cuts to Medicaid are largely offsetting tax cuts for wealthy Americans.”

Flory said she also feared that that optional Medi-Cal benefits under the law — such as prescription drugs and nursing home care — would be at risk. “The state would be faced with some really tough choices,” Flory said.

Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates, said the CBO score is “devastating.”

“It will impact millions in the state of California,” she said.

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Categories: Medicaid, Repeal And Replace Watch, The Health Law

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CBO Score Of Revised GOP Health Bill: Over Next Decade, 23M Would Be Left Uninsured, Deficit Reduced By $119B

May 24 2017

The nonpartisan Congressional Budget Office issues its latest report on the American Health Care Act.

The New York Times: C.B.O. Projects Dismantling Obamacare Increases Uninsured By 23 Million In A Decade
A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated. It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers. (Pear, 5/24)

NPR: CBO: Republicans’ AHCA Would Leave 23 Million More Uninsured
The deficit reduction in the latest version of the bill represents a decline from previous versions. When the CBO first scored the AHCA, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings to $150 billion. By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes. (Kurtzleben, 5/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO’s Score On The GOP Health Plan

A selection of opinions on health care from around the country.

Bloomberg: Rule Of Law Actually Applies To Democrats, Too
Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

The New York Times: How To Read The C.B.O. Score Of The Health Bill Like An Expert
Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

RealClear Health: Why Nutrition Standards And Policies Should Continue
The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

WBUR: America’s Food Access Problem Starts On The Farm 
Given that we’re tangled in knots over how to pay for health care, it’s remarkable that food and farm policy isn’t more in the public’s mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, “food is medicine, food is health,” with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

San Jose Mercury News: Single-Payer Detracting From Big Medi-Cal Fight
Sen. Ricardo Lara’s single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. … It’s merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump’s inhumane effort to slash the nation’s Medicaid budget by more than $880 billion through 2026? (5/23)

Stat: Risk Scores For Preventing Heart Disease, Stroke Must Take The Long View
Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual’s risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual’s lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

On the Ground: Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On Doing The Math: Trying To Add Up ‘Trumponomics;’ The Trump Budget’s ‘Best New Idea’

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration’s proposed budget plan.

Los Angeles Times: Surprise, Surprise: Trump’s Budget Punishes The Sick And The Poor While Rewarding The Wealthy
One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration’s proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce — in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today’s employers — the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children’s health. (5/23)

The Washington Post: Trumponomics: The Philosophy That It Doesn’t Suck Enough To Be Poor
For months, pundits and political advisers have tried to figure out what “Trumponomics” really stands for. Even President Trump himself struggled to characterize it, saying, “It really has to do with self-respect as a nation.” Now that we have the president’s budget in hand, we have a more definitive answer: Trumponomics — like Ryanonomics — is based on the principle that living in poverty doesn’t suck quite enough. That is, more people would be motivated to become rich if only being poor weren’t so much fun. (Catherine Rampell, 5/23)

The New York Times: Trump’s Budget Doesn’t Make Sense
Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans — including, notably, Paul Ryan, the speaker of the House — have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The New York Times: Why Work Requirement Became A Theme Of The Trump Budget
The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren’t. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

USA Today: Trump Budget’s Best New Idea
Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don’t take advantage of that option for the simple reason that they can’t afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

USA Today: Trump’s Parental Plan Will Hurt
President Trump’s budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

Bloomberg: Trump’s DOA Budget Has Two Silver Linings
It also breaks Trump’s campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don’t count because they’re not retirement payments. (Albert R. Hunt, 5/23)

The Kansas City Star: Trump Budget Replicates Disastrous Kansas Approach. This Won’t End Well.
But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state’s social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Some States, Facing Tight Budgets, Working To Recertify Medicaid Enrollees’ Eligibility

Missouri, Wyoming and Mississippi have enacted laws to scrutinize whether Medicaid or food stamp recipients are eligible, and several other states are considering such measures. News outlets also report on Medicaid news from Oregon, Iowa, Indiana and Kansas.

Stateline: What Happens When States Go Hunting For Welfare Fraud
Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several … states are taking … steps to ensure that people receiving welfare benefits are eligible for them. Under their proposals, which are modeled on legislation drafted by a national conservative group, recipients would face tougher and more frequent eligibility checks. And the checks could be conducted by private contractors who are motivated to justify their hiring by knocking as many people as possible off the rolls. (Fifield, 5/23)

The Oregonian: Health Authority Estimates 32,000 Medicaid Recipients Could Be Ineligible 
Oregon Health Authority officials told a legislative committee Tuesday that the agency might have provided Medicaid benefits to some 32,000 people who no longer qualified for them. If historical trends hold true, as the state processes a backlog of 115,000 Medicaid renewals, 28 percent of them could be deemed ineligible because they make too much money. But Lynne Saxton, director of the health authority, flatly rejected the idea that the lingering questions about the state’s Medicaid rolls poses a financial risk for the state. The questions come just as state lawmakers consider a new tax on health care providers. At the federal level, the Trump administration continues to push for the repeal of the Affordable Care Act and the sweeping Medicaid changes that came with it. (Manning, 5/23)

Des Moines Register: Privatized Medicaid Appears To Be Saving Iowa Money. But Is It Real?
Iowa will spend $600 less on each Medicaid recipient this year compared with before private companies were hired to manage the program, according to a projection from the nonpartisan Legislative Services Agency. … The data does not account for millions of dollars in losses the private companies hired to manage the program have accrued in the current fiscal year, losses Iowa has agreed to at least partially repay in 2018. Those losses won’t show up in the current year’s budget. (Clayworth, 5/23)

Modern Healthcare: Indiana Medicaid Director Moser Steps Down
Joe Moser, a key architect of Indiana’s alternative Medicaid expansion program has stepped down from his role as the state’s Medicaid director. Moser was appointed by then-Gov. Mike Pence in 2013 and oversaw the care of more than 1.5 million Medicaid and Children’s Health Insurance Program enrollees. Moser told Modern Healthcare he has no plans to work with the Trump administration, but would be open to that possibility. He decided to leave Indiana’s Medicaid agency in order to pursue new opportunities. (Dickson, 5/23)

Kansas City Star: Federal Officials Accept Plan To Fix Kansas Medicaid Program 
Federal officials have accepted a corrective action plan for Kansas’ privatized Medicaid program, an important hurdle in ensuring the program can continue to operate next year. The federal Centers for Medicare & Medicaid Services had rejected the state’s request to extend its KanCare program through 2018 in January after finding that the program was “substantively out of compliance” with federal regulations. (Lowry, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

New Hampshire Governor Supports Moving State To High-Risk Pool Model

Meanwhile, the state’s conservatives speak out against reported rate increases for next year. “The latest premium increases under Obamacare will break many families’ budgets,” says New Hampshire Republican State Committee Chairman Jeanie Forrester.

New Hampshire Union Leader: Sununu Proposes Return Of High-Risk Pool
Gov. Chris Sununu and the state’s top insurance official on Monday backed a revision in state law that would allow officials to waive some of the provisions of Obamacare — including provisions addressing pre-existing conditions. In a joint statement, Sununu and New Hampshire Insurance Commissioner Roger Sevigny endorsed an amendment to House Bill 469, which they said would authorize Sevigny to seek federal waivers if they would keep insurance affordable and available in the state. On Sunday, the New Hampshire Sunday News reported about a document that details a potential premium increase of 44 percent next year on the Obamacare Exchange. (Hayward, 5/23)

New Hampshire Union Leader: NH Conservative Groups Critical Of Possible Obamacare Rate Increases 
Granite State conservative groups weighed in Monday on a report in the New Hampshire Sunday News that health insurance policies through the Affordable Care Act could see high rate increases in the coming year. “The latest premium increases under Obamacare will break many families’ budgets. The law is obviously failing working people and is doing far more harm than good. Republicans in Congress are actively working to reform our nation’s healthcare system with a plan that lowers premiums while ensuring folks have access to quality coverage,” said New Hampshire Republican State Committee Chairman Jeanie Forrester. (5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

New York State Wants Its Prescription Drug Money Back — Or Else

New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs — such as eyeing their relative effectiveness and their profit margins — to coax additional discounts from drugmakers.

The rules, signed into law in mid-April as part of the state’s budget, don’t go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the “skyrocketing costs of prescription drugs,” but they retain elements guaranteed to get under a pharmaceutical executive’s skin.

For example, those who don’t agree to voluntarily rebate or pass money back to the state when Medicaid drug spending rises fast could face multiple layers of reviews regarding profit margins and how well their drugs work.

The rules are the latest response to growing dissatisfaction about drug costs from the public, lawmakers and those who run programs like Medicaid, the state-federal health insurance program for low-income people.

“It clearly is going to put more pressure on manufacturers to address prices if they want to stay in business in New York,” said Jack Hoadley, a health policy analyst at Georgetown University who studies Medicaid.

The new law also is part of a growing inclination among states to take on prescription drug costs themselves rather than waiting for a response from Congress or the federal government.

New York’s rules are novel, though, because they are the first to set an annual cap on Medicaid prescription drug spending. The target aims to limit total payments to the sum of medical inflation plus 5 percent, a goal that would have been exceeded in recent years, state officials say.

The law also stands out because — if that target is likely to be exceeded — it explicitly allows regulators to pursue a type of review drugmakers dislike. Such reviews, which are more common in the private sector, use scientific studies and other information to evaluate whether specific medications are overpriced proportionate to their medical benefit.

Drugmakers generally object to such reviews and often dispute their results.

To avoid having their drugs sent for such a review under the law in New York, targeted manufacturers could agree to add additional discounts.

The law “creates an incentive to want to collaborate with us and give us rebates,” said New York State Medicaid Director Jason Helgerson.

Drugmakers had strong objections to the governor’s proposal since its earliest iterations, and Priscilla VanderVeer, a spokeswoman for the industry’s trade lobby, said the group still has “significant concerns” about the price cap and “the chilling effect it could have on New York’s economy,” which she said benefits from 240,000 industry-related jobs.

It’s Not Just New York

States, which pay health costs for millions of employees, prisoners and Medicaid beneficiaries, are particularly sensitive to recent increases in brand and generic drug prices, as well as the introduction of very expensive products, such as treatments for hepatitis C.

New York’s Medicaid program, for example, has seen its drug spending rise on average 8 percent each year over the past three years, after taking into account existing rebates. The program, which uses federal and state funds, serves more than 6 million people. Drugs represent about 5 percent of the cost of the program — with the state paying out $3 billion last year for prescriptions, Medicaid officials said.

Though its law is unique, New York’s efforts are “in keeping with the mood in a number of other states,” said Rachel Sachs, an associate professor at Washington University-St. Louis School of Law who studies intellectual property, health law and food and drug regulation.

For instance:

  • Vermont lawmakers last year adopted legislation that requires drugmakers to provide justification for price increases it determines are driving up spending in state programs, such as Medicaid.
  • Maryland lawmakers in March passed legislation, still awaiting the governor’s signature, that directs Medicaid to notify the attorney general when off-patent or generic drugs experience an “excessive price increase” — and sets financial penalties if the drugmaker can’t justify the hike.
  • In Louisiana, officials have asked whether a rarely used federal law could be tapped to sidestep patents and allow government programs to get lower-cost generic versions of pricey hepatitis C treatments.

A Trigger For Action

Under the New York law, everything plays off an annual spending growth cap.

The new rules are triggered if the combination of price increases and use of drugs is forecast to push spending to exceed that target. First, regulators will ask drugmakers seen as driving that spending to voluntarily offer rebates.

No specific drugs have yet been named, and it isn’t clear how they will be chosen.

“This policy will not affect the vast majority of drugs,” said Helgerson, adding that it will target “the manufacturers that attempt to use periods of patent protection to drive outrageous prices.”

Attorney John Shakow, who represents drug manufacturers, said his clients’ reaction is “mystification and concern,” in part because it is unclear how regulators will select which drugs or manufacturers to pursue for additional rebates.

“It seems prone to abuse, if they want to go after a manufacturer for political reasons or otherwise,” said Shakow, a partner at King & Spalding who specializes in drug price cases. “Laws that are this amorphous and nonspecific and vest so much discretion in regulatory authorities strike us as being ripe for challenge.”

Other laws already require drugmakers nationwide to give Medicaid programs their “best price” — equal to or less than what it is paid by private insurers. Most states, including New York, already seek supplemental rebates, often in exchange for priority placement on lists of which drugs can be dispensed.

But the new law goes further in seeking additional rebates on top of those.

If the targeted drugmakers balk at offering discounts, regulators are granted a range of options that ramp up pressure by requiring those uncomfortable reviews.

Regulators, for example, can refer specific drugs to an evaluation by the state’s Drug Utilization Review Board.

The board would recommend a target rebate. If the state could not get the drugmaker to agree to at least 75 percent of that rebate amount, other sanctions could apply. Prior authorization — meaning a doctor would have to get special permission to prescribe — could be placed on the drug. Advocates fear that could make access to needed medications more of a hurdle for patients.

The state could also require drugmakers to disclose how much was spent on research and marketing, what it charges for the drug in other countries and its average profit margin over a five-year period. Such “transparency” rules are strongly opposed by the drug industry, which says they don’t capture all the costs that go into drug development — and won’t help consumers. With a few exceptions, the industry has successfully fought efforts in various states to pass such legislation.

And, finally, the strongest enforcement mechanism would allow the state to bar some medications entirely, so long as they were not the only drug for a particular condition or treatment. It isn’t clear how that would square with other federal requirements.

If it all works according to plan, the state expects to save $55 million this fiscal year and $85 million the next under the law, Helgerson said.

Categories: Health Industry, Medicaid, Pharmaceuticals, States

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Republicans Race The Clock On Health Care — But The Calendar Is Not Helping

Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month.

In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda.

One of the immediate casualties is the renewal of the Children’s Health Insurance Program. CHIP covers just under 9 million children in low- and moderate-income families, at a cost of about $15 billion a year.

Funding for CHIP does not technically end until Sept. 30, but it is already too late for states to plan their budgets effectively. They needed to know about future funding while their legislatures were still in session, but, according to the National Conference of State Legislatures, the local lawmakers have already adjourned for the year in more than half of the states.

“If [Congress] had wanted to do what states needed with respect to CHIP, it would be done already,” said Joan Alker of the Georgetown Center for Children and Families.

“Certainty and predictability [are] important,” agreed Matt Salo, executive director of the National Association of Medicaid Directors. “If we don’t know that the money is going to be there, we have to start planning to dismantle things early, and that has a real human toll.”

In a March letter urging prompt action, the Medicaid directors noted that while the end of September might seem far off, “as the program nears the end of its congressional funding, states will be required to notify current CHIP beneficiaries of the termination of their coverage. This process may be required to begin as early as July in some states.”

CHIP has long been a bipartisan program — one of its original sponsors is Sen. Orrin Hatch (R-Utah), who chairs the Finance Committee that oversees it. It was created in 1997, and last reauthorized in 2015, for two years. But a Finance hearing that was intended to launch the effort to renew the program was abruptly canceled this month, amid suggestions that Republicans might want to hold the program’s renewal hostage to force Democrats and moderate Republicans to make concessions on the bill to replace the Affordable Care Act.

“It’s a very difficult time with respect to children’s coverage,” said Alker. Not only is the future of CHIP in doubt, but also the House-passed health bill would make major cuts to the Medicaid program, and many states have chosen to roll CHIP into the Medicaid program.”

“We’ve just achieved a historic level in coverage of kids,” she said, referring to a new report finding that more than 93 percent of eligible U.S. children now have health insurance under CHIP. “Now all three legs of that coverage stool — CHIP, Medicaid and ACA — are up for grabs.”

But it’s not just CHIP at risk due to the congested congressional calendar. Congress also can’t do the tax bill Republicans badly want until lawmakers wrap up the health bill.

That is because Republicans want to use the same budget procedure, called reconciliation, for both bills. That procedure forbids a filibuster in the Senate and allows passage with a simple majority.

There’s a catch, though. The health bill’s reconciliation instructions were part of the fiscal 2017 budget resolution, which Congress passed in January. Lawmakers would need to adopt a fiscal 2018 budget resolution in order to use the same fast-track procedures for their tax changes.

And they cannot do both at the same time. “Once Congress adopts a new budget resolution for fiscal year 2018,” said Ed Lorenzen, a budget-process expert at the Committee for a Responsible Federal Budget, that new resolution “supplants the fiscal year 2017 resolution and the reconciliation instructions in the fiscal year 2017 budget are moot.”

That means if Congress wanted to continue with the health bill, it would need 60 votes in the Senate, not a simple majority.

There is, however, a loophole of sorts. Congress “can start the next budget resolution before they finish health care,” said Lorenzen. “They just can’t finish the new budget resolution until they finish health care.”

So the House and Senate could each pass its own separate budget blueprint, and even meet to come to a consensus on its final product. But they cannot take the last step of the process — with each approving a conference report or identical resolutions — until the health bill is done or given up for dead. They could also start work on a tax plan, although, again, they could not take the bill to the floor of the Senate until they finish health care and the new budget resolution.

At least that’s what most budget experts and lawmakers assume. “There’s no precedent to go on,” said Lorenzen, because no budget reconciliation bill has taken Congress this far into a fiscal year. “So nobody really knows.”

Categories: Medicaid, Repeal And Replace Watch, The Health Law

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Viewpoints: Opening For Medicare Long-Term Care?; Texas Seeks Planned Parenthood Money

A selection of opinions on health care from around the country.

Forbes: Congress May Open The Door To Some Medicare Long-Term Care
Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. … the biggest changes would apply to the care provided by managed care programs. One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small. The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. (Howard Gleckman, 5/17)

Los Angeles Times: Texas Wants To Use Federal Money To Attack Planned Parenthood — And Might Get It
Five years ago, Texas voluntarily gave up $30 million a year in federal funding for women’s health programs, just so it could exclude Planned Parenthood from the roster of approved providers. Instead, the state established its own so-called Healthy Texas Women program in which it could set its own rules. Now, staggering under the cost of the program and hopeful that the Trump administration will see things its way, Texas is applying for a restoration of the federal subsidy under the same terms. Signals from the White House and the Department of Health and Human Services suggest the state might succeed. If so, some other states may follow, and the cause of women’s reproductive health will suffer a major blow. (Michael Hiltzik, 5/18)

Des Moines Register: Health Has No Religion; Health Care Shouldn’t Have One Either
A policy with wide-ranging consequences for patients of Mercy Medical Center was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S. How are these institutions fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars? (Rekha Basu, 5/18)

Next Avenue: Aging at Home Will Be Harder With Medicaid Cuts
Proposed cuts to Medicaid under the American Health Care Act passed by the House recently could change life for (Ti) Randall and many others. Medicaid is not only an insurance program for low-income people. It’s a lifeline for older adults like Randall who need supportive services to stay at home. At-home services are a lifeline for Medicaid as well, which would otherwise be paying for more expensive care in an institutional setting. (Beth Baker, 5/17)

Stat: Doctors Must Be Honest About Their Own Biases When Treating People In Pain
Many doctors enter medicine to prevent and treat suffering. Yet it seems that as we advance in our training, the more bothersome and frustrating evaluations of pain become. We want to make people feel better, but we don’t always know why or how much someone is hurting. And there are consequences of both prescribing too much or too little pain relief. So we turn to this language to minimize the pain we don’t understand or can’t fix. Unfortunately, this tends to occur more often with patients of color. (Katherine Brooks, 5/17)

Stat: Why Taking Drugs To Treat Addiction Doesn’t Mean You’re ‘Still Addicted’
My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths. (Sarah E. Wakeman and Maia Szalavitz, 5/18)

JAMA: Primary Care Of Patients With Chronic Pain
Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose. (Jill Schneiderhan, Daniel Clauw and Thomas L. Schwenk, 5/18)

Des Moines Register: Iowa Should Allow Needle Exchange Programs
The Iowa Department of Public Health in February released its first report on hepatitis C infections in this state. The number of Iowans diagnosed with the liver-damaging virus that can lead to death has increased nearly three-fold, from 754 cases in 2000 to 2,235 cases in 2015. The number of infected Iowans aged 18 to 30 has quadrupled in recent years. … preventing the spread of the virus is so important, and Iowa is not doing all it can. Unlike several other states, we do not have a needle exchange program, which is an important part of infection prevention. (5/18)

The (Eugene, Ore.) Register-Guard: Oregon’s Medicaid Mess
“Troubling” doesn’t begin to describe the current situation at the Oregon Health Authority, which, state auditors have discovered, has been doling out hundreds of millions of dollars to tens of thousands of Medicaid recipients who may or may not be eligible for the benefits. … About three years ago, Oregon got permission from federal regulators to temporarily quit verifying that each OHP patient still qualified for Medicaid. At the time, the state was in the throes of extricating itself from Cover Oregon, which failed spectacularly in setting up an online program to enroll people in health care. Somehow, the state never got around to resuming these routine eligibility checks. (5/19)

Morning Consult: Turning Up The Volume On Over-The-Counter Hearing Aids
Hearing aids currently cost around $5,000 per pair. Fitting and tuning are not covered by Medicare or most private insurance plans. Unable to afford these out-of-pocket costs, nearly 80 percent of Americans with hearing loss choose to suffer on their own. … It shouldn’t be this way. The technology exists to deliver relief to these patients and the families that love them. But government has to act to ensure that those who stand to gain the most from that innovation are able to access it. The Over-the-Counter Hearing Aid Act of 2017 would be a needed update to federal policy. (Rep. Joe Kennedy III (R-Mass.) and Rep. Marsha Blackburn (R-Tenn.), 5/18)

The Kansas City Star: Vital Diabetes Device Denied By Medicare
I’m angry because people like me are being denied an essential medical treatment by Medicare, the federal program that’s supposed to be supporting seniors, not forcing them to abandon an essential medical device. The device I use is called Omnipod. It’s a wireless insulin delivery pump. … A few months before turning 65, I was told that unlike almost all private insurers in this country, Medicare wouldn’t pay for Omnipod. And I was even more confused to learn that this was the only FDA-approved insulin pump not covered by Medicare. (Susan Vietti, 5/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On Health Debate: GOP Disregard Of ACA Maintenance; Miss USA’s Health Stand

Even as other issues are overtaking the air waves, some opinion writers keep an eye on the health debate.

The New York Times: Trumpcare Is Already Hurting Trump Country
The mere threat that Obamacare will be dismantled or radically changed — either by Congress or by President Trump himself — has persuaded several big insurance companies to stop selling policies or significantly raise premiums. The practical effect is that some lower-income and middle-class families may have no good options for insurance and will have to spend more on health care. (5/19)

Los Angeles Times: Miss USA Spoke For Many Americans When She Said Healthcare Isn’t A Right
[W]e probably shouldn’t be surprised that the person who has most clearly articulated America’s core philosophical belief when it comes to healthcare is our newly crowned Miss USA, Kara McCullough. She was asked at this week’s celebration of swimsuits, evening gowns and womanhood whether she thought “affordable healthcare for all U.S. citizens is a right or a privilege.” “I’m definitely going to say it’s a privilege,” the 25-year-old answered without hesitation. … Miss USA initially was voicing a position common to many Americans, mostly conservatives — a stance that has prevented the United States from joining all other developed countries in providing its citizens with universal coverage. (David Lazarus, 5/19)

Morning Consult: Despite What You’ve Read, Many Small Businesses Support Obamacare
Now, the latest round of stories on the Republican attempt to repeal and replace the Affordable Care Act give the impression that America’s small businesses will be glad to see the ACA go if and when Congress manages to repeal it. While most small business owners agree there are portions of the ACA that can and should be improved, polling shows that a majority of small businesses actually prefer the current law over the GOP replacement plan, and that key provisions of the ACA are helping entrepreneurs succeed. (John Arensmeyer, 5/19)

Medscape: Is Medicaid Only For Those Who ‘Deserve’ It?
I am irritated today. Why? Because we keep getting proposals from Washington that suggest that people ought to work if they want to be eligible for Medicaid. What bothers me about this is that it is a reversion to 19th-century thinking, that the people who deserve healthcare are only those who earn it. This was the attitude when Charles Dickens wrote Oliver Twist, which was a bit biographical in that his own dad was hauled off to debtor’s prison when the author was a child. He bemoaned the idea that only the “deserving” poor should get our aid. (Art Caplan, 5/18)

The New York Times: The Best Replacement For Obamacare Is Medicaid
In defending their efforts to repeal the Affordable Care Act, Republican leaders in Congress argue that the insurance marketplaces created by the law are failing. They aren’t completely wrong. Trouble began with faulty websites during the rollout in 2013. Since then, enrollment continues to be below expectations. Obamacare plans often have higher premiums and out-of-pocket expenses than expected. Some markets, mainly in rural areas, may not attract a single insurer in 2018. And insurers that stay are likely to impose double-digit premium increases. (Michael S. Sparer, 5/18)

Louisville (Ky.) Courier-Journal: A Country Of The Well, A Country Of The Sick
I am alarmed at many of the ideas underlying the House Republican health care plan and the administration’s proposed budget. Each seems to be driven by an idea that there is an “us” (rich, healthy, young) and a “them” (poor, sick, old). The winners and the losers, each residing in their unchanging, indisputable categories. This cold-blooded social Darwinism is poised to deprive millions of health care, while millions more will find insurance prices prohibitive and go without basic health care, or the astronomical cost of insurance and health care will bankrupt them. According to the logic of this health care plan, it is their own fault for having pre-existing conditions, or being old, or poor. (Sara T. Baker, 5/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Medicaid Wellness Programs; Preexisting Conditions; Changes In Subsidies

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants
As part of Iowa’s Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program’s implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program’s existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. … The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed. (Askelson et al., 5/2)

JAMA: Trends And Patterns Of Geographic Variation In Cardiovascular Mortality Among US Counties, 1980-2014
In this study of small area estimation models applied to death records from the National Center for Health Statistics, the difference between county-level mortality rates declined substantially over the past 35 years for both ischemic heart disease and stroke; however, large differences remained in 2014. The largest concentration of counties with high cardiovascular disease mortality extended from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky, and several cardiovascular disease conditions were clustered substantially outside the South, including atrial fibrillation (Northwest), aortic aneurysm (Midwest), and endocarditis (Mountain West and Alaska). (Roth et al., 5/16)

The New England Journal of Medicine: Aerobic Or Resistance Exercise, Or Both, In Dieting Obese Older Adults
In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). … Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Villareal et al., 5/18)

JAMA Internal Medicine: Perceived Discrimination Experienced By Physician Mothers And Desired Workplace Changes
In a large cross-sectional survey of physician mothers, we found that perceived discrimination is common, affecting 4 of 5 respondents, including about two-thirds of the respondents who reported discrimination based on gender and more than a third who reported maternal discrimination. The overlap of groups reporting gender and maternal discrimination was less than half, suggesting that they are somewhat different phenomena. (Adesoye et al., 5/8)

International Journal of Health Services: Availability Of Outpatient Mental Health Care By Pediatricians And Child Psychiatrists In Five U.S. Cities
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. (Cama et al., 5/9)

The Kaiser Family Foundation: Gaps in Coverage Among People With Pre-Existing Conditions
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy. … Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver. (Levitt et al., 5/17)

Urban Institute: Premium Tax Credits Tied To Age Versus Income And Available Premiums: Differences By Age, Income, And Geography
This paper compares tax credits offered through the Affordable Care Act (ACA) with those in the American Health Care Act (AHCA). They examined the premium levels in 10 cities, five of which have relatively low premiums and five of which have relatively high premiums. The authors find that younger people typically receive larger insurance premium tax credits under the AHCA, while older adults typically receive larger premium tax credits under the ACA. The analysis also shows that lower-income older adults currently receive higher tax credits under the ACA than they would under the AHCA regardless of where they live. (Holahan, Blumberg and Wengle, 5/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Fearing Deportation, Parents Worry About Undocumented Kids In Medicaid Program

Luz felt relieved and grateful when she learned that her 16-year-old son qualified for full coverage under Medicaid. Now, she worries that the information she provided to the government health program could put her family at risk of deportation.

Luz’s son is one of nearly 190,000 children who have enrolled in Medi-Cal — California’s version of the federal Medicaid program for people with low incomes — since California opened it to undocumented children last year. Luz, her husband and her son came to Merced, Calif., from Mexico without papers about 10 years ago. Luz asked that the family’s last name not be used, for fear of being identified by federal immigration authorities.

In the current political climate, immigration and health advocates worry that children, like Luz’s son, will drop out of Medi-Cal and that new kids won’t enroll out of concern that personal information may be used to deport families.

Luz would need to renew her son’s coverage in October, but she remains undecided even though the program paid for his hospital visit when he injured a foot. “I’m still thinking about it,” she said.

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Last May, the state Department of Health Care Services (DHCS) implemented the new “Medi-Cal for All Children” law allowing California children under 19 to receive full Medi-Cal benefits, including dental care and mental health, regardless of their immigration status. Previously, undocumented children could receive only emergency care through Medi-Cal.

California followed Illinois, Massachusetts, New York, Washington and the District of Columbia in offering state-supported health coverage to children in the country illegally.

The federal government pays for a significant portion of California’s Medi-Cal program, as it does for all states. But expanded coverage for undocumented kids is funded by the state.

From last May through April 6, 189,434 undocumented children signed up for the program, according to the most recent state data. The health care services department estimates that another 61,000 children are eligible but not enrolled. Advocates say now is the time for a push to sign up these “harder-to-reach” children and to encourage those already in the program to stay.

Immigrant families have become more reluctant to share personal information with government programs because of the Trump administration’s planned changes in health care and immigration policies, according to a recent survey of 62 individuals working for pediatric practices, community clinics, local public health departments and hospitals serving immigrant communities throughout the state.

Immigrants are also increasingly skipping doctor’s appointments because of similar concerns, according to the survey, conducted in March by the advocacy group Children Now.

Kelly Hardy, Children Now’s managing director of health policy, said some families even have sought to withdraw their children from the Medi-Cal program because they fear that their immigration status might be shared with immigration officials.

“Holding on to the kids who have recently enrolled is going to become critically important,” Hardy said. She said she hopes families will see that the coverage is a boon to their health and will not be scared away.

In an email last week, the DHCS reiterated to California Healthline that an applicant’s immigration status is “only used for the purposes of determining Medi-Cal eligibility.”

But that doesn’t eliminate the worry for some parents.

“This fear is horrible. We don’t know who to trust,” Luz said.

Before the coverage-for-all law took effect last year, undocumented children could get coverage through the Healthy Kids insurance program in some California counties. However, many of those children have been transferred to Medi-Cal, and the Healthy Kids programs are closing down.

Carlos Jimenez, a health policy advocate at the Mixteco Community Organizing Project in Oxnard, Calif., said the nonprofit doubled its enrollment assistance efforts after the law was implemented.

Community health educators known as promotoras, spread word about the new law in farm fields, in front of supermarkets and outside churches. Last year, enrollment counselors saw up to 400 people a month who had questions about Medi-Cal, the majority looking to enroll their children, Jimenez said.

But after the November presidential election, enrollment counselors at Mixteco saw the number of people seeking help drop by nearly half, Jimenez said. Staffers had expected more inquiries about renewals by now, he said.

Most people ask whether enrolling an undocumented child would bring any problems with the U.S. Immigration and Customs Enforcement agency, Jimenez said. “We tell them their information is safe. But even then, they’re afraid.”

The Children Now survey showed that participants had questions about the future of Medi-Cal for undocumented children — in particular, whether it would continue if the Affordable Care Act were replaced.

In an interview with California Healthline in February, Sen. Ricardo Lara (D-Bell Gardens), who authored the Medi-Cal for All Children law, said there was no reason for people to be concerned about the program’s durability.

Democratic Gov. Jerry Brown continues to make this program a priority, Lara said, noting that California is spending $279.5 million to continue benefits for undocumented kids this year. That’s up from the $188 million it provided for the program last year.

Health advocates in California are hoping to extend the program to young adults. Earlier this month, the California Immigrant Policy Center and Health Access California, launched an online petition requesting that full Medi-Cal benefits be made available to people ages 19 to 26.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: Medicaid

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Different Takes: Benefits Of Broad Health Reform Consensus; Senate’s Path To Crafting Its Repeal-And-Replace Bill

Editorial writers examine different aspects of the current debate surround the GOP repeal-and-replace measure in Congress and the status of Obamacare’s marketplaces.

JAMA: Building A Broader Consensus For Health Reform
Republican leaders in Congress are trying to pass legislation rolling back and replacing key features of the Affordable Care Act (ACA) without securing any Democratic support in the effort. … In political terms, it might be best for Republicans if their effort stalls. The ACA was passed in 2010 with only Democratic votes, and that is a major reason the law remains politically and, to a degree, programmatically unstable. … It would be better for the United States if a broad consensus could be reached on health care. A bill that passed with support from some Republicans and some Democrats has a better chance of political survival than a bill passed by just one party. It should be possible to reach a broader consensus on health policy because both sides of the debate are forced to work within the significant constraints of existing arrangements. (James C. Capretta, 5/15)

Huffington Post: Hope You Don’t Expect The Senate GOP To Be Transparent About Obamacare Repeal
Senate Republicans have spent the last 10 days or so promising not to tackle health care in the same hurried, irresponsible way that their House counterparts did. “We are not under any deadlines,” Sen. John Cornyn (R-Texas) said last week, “so we are going to take our time.” … All of that is probably true ― and less meaningful than it sounds at first blush. It’s possible to write a bill in a slower, more deliberative manner than the House did without allowing the kind [of] lengthy, open public debate that legislation of such magnitude would seem to require. It’s also possible to pass less disruptive, less extreme legislation that would nevertheless take away insurance from many millions of people, causing widespread hardship. (Jonathan Cohn, 5/13)

Los Angeles Times: The Costs Of Trump’s Sabotage Of Obamacare Already Are Showing Up In Rate Hikes
The easiest prediction to make about the healthcare business was that the efforts by Congress and the Trump administration to sabotage the Affordable Care Act would produce a flood of rate hikes by insurers for 2018. We are now standing on the edge of the water. Early rate requests have come in from insurers in five states, according to ace ACA-tracker Charles Gaba, who calculates the weighted average rate request increase in those states at about 30% (that is, weighted for the enrollment of each insurer). (Michael Hiltzik, 5/16)

Cleveland Plain Dealer: GOP Health Care Reform Plan Could Cripple Ability To Treat Opioid Addiction Victims
At the same moment I was caring for more patients struggling with addiction and its devastating health effects, House Republicans passed the American Health Care Act (AHCA). Sadly, the AHCA would replace President Barack Obama’s Affordable Care Act with a law that would end Medicaid expansion and simultaneously make health care more expensive for my most vulnerable patients and reduce important protections for them. (Robert Bonacci, 5/17)

Bloomberg: Cost Of Health Insurance Isn’t All About Fairness
Should women have to pay more for health insurance than men? That has been a critical question for opponents of Republican health-care reform, and it requires grappling with the fundamental nature of insurance, market prices and fairness. Related are questions about how much older people should pay relative to the young, or to what extent individuals with pre-existing conditions should be vulnerable to higher premiums. (Tyler Cowen, 5/16)

WBUR: Hey, Millennials: Want To Help The Underserved? Sign Up For Insurance
I often wonder why President Obama, when he was promoting the Affordable Care Act to millennials, didn’t bring out a young person like me to help my peers understand why it matters… As politically aware, or “woke” as my peers seem to me, I worry that making the effort to understand and sign up for health insurance is low on people’s priority list. (Aditi Juneja, 5/17)

WBUR: Single-Payer Health Care Is The Key To Democratic Victory In 2018 
The Democratic base wants a single-payer system, a slight majority of Independents are warming to the idea and even some conservative voters appear to be growing amenable to cutting insurance companies out of the picture. Thanks to the GOP health care bill’s creation and advancement, the Republican Party’s dream of turning American health care over to the private sector is becoming our new, shared reality. (Miles Howard, 5/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Administration Reportedly ‘Encouraged” Texas To Pursue Millions In Withheld Medicaid Funds

State officials will ask the Trump administration to hand over millions of dollars that the Obama administration withheld because the state cut Planned Parenthood centers from a family planning program.

Houston Chronicle: Texas Officials Say They’ve Been ‘Encouraged’ To Seek Millions In Withheld Medicaid Funds
Texas officials say they’ve been “encouraged” to ask President Donald Trump’s administration to hand over millions of dollars the previous administration withheld from the state for cutting Planned Parenthood centers from a key family planning program. States aren’t supposed to cut out willing eligible providers from federal Medicaid programs, according to federal law. (Zelinski, 5/16)

Dallas Morning News: After Shunning Planned Parenthood, Texas Asks Feds To Reinstate Funding For Women’s Health
Texas has long looked to limit the operation and scope of Planned Parenthood, focusing its efforts both on the arm of the organization that performs elective abortions and the one that offers general health care and family planning services. “The state is now testing the current administration to see if they’re going to be able to get away with it,” said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes. “It really opens up a huge can of worms that could be very destructive.” (Mekelburg, 5/15)

Modern Healthcare: Texas’ Medicaid Waiver Is A ‘Canary In The Coal Mine’ For Abortion Carve-Outs
The Trump administration will soon review Texas’ proposed plan to regain federal funding for its family planning program that does not include Planned Parenthood or providers that support or perform abortions. If the CMS approves the waiver, other states could seek similar permissions and risk millions losing access to care. Texas lost federal funding for its family planning program known as Healthy Texas Women in 2013 after it stopped reimbursing for services performed at Planned Parenthood. Since then, the program has been totally state-funded. Now facing a $2 billion budget shortfall, Texas is looking for ways to reduce spending. (Dickson, 5/16)

Politico Pro: Texas Request For Family Planning Funds Could Set Trend 
The state’s pending request for Medicaid to fund a women’s health program that excludes abortion providers will be the first major test of the Trump administration’s willingness to let states cut off dollars to Planned Parenthood. Texas’ health agency will ask the feds to restore funding for a family planning Medicaid waiver the state dropped six years years ago when the Obama administration insisted states couldn’t block abortion providers from their programs. (Rayasam, 5/16)

Meanwhile, in Wyoming –

Casper (Wyo.) Star-Tribune: Wyoming To Lose Only Planned Parenthood Clinic; Casper Location Closes In July
Wyoming’s only Planned Parenthood clinic will close this summer because of financial reasons, the organization confirmed Tuesday. “This is a challenging decision,” said Planned Parenthood of the Rocky Mountains official Adrienne Mansanares. Planned Parenthood’s lone health center in Wyoming is in Casper. It opened in 1975 and serves around 500 patients per year, Mansanares said. It will close July 21. (Rosenfeld, 5/16)

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Some States See Opening For Key Medicaid Changes With Trump Administration

At least six states have submitted waiver requests to make significant revisions to their Medicaid programs. Meanwhile, Pennsylvania announced it will expand Medicaid coverage for hepatitis C, and Oregon says it is checking to see if some enrollees got benefits without meeting income requirements for the program.

Governing: 6 States Hoping To Revamp Medicaid In The Trump Era
With Donald Trump in the White House and Tom Price leading the Health and Human Services (HHS) Department, conservative states will likely see their long-denied wishes [to revamp Medicaid] come true. Both officials support giving states more flexibility than the Obama administration, and a final bill to replace the ACA would likely increase states’ power as well. So in the early days of the Trump administration, some governors enthusiastically submitted waivers. …. If some of these proposals get the greenlight as expected, they could drastically change the structure of Medicaid in their states and have national implications. These are the six states with planned or submitted waivers worth watching. (Quinn, 5/15)

The Philadelphia Inquirer: In Major Shift, Pa. To Expand Hepatitis C Treatment For Medicaid Patients
Under pressure from advocacy organizations that had threatened a lawsuit, the Wolf administration said Tuesday that it would expand Medicaid coverage for treatment of hepatitis C, a major change that many states have put off over fear of spiraling costs. … Until now, state policy had been to wait until patients showed signs of liver damage before approving treatment. Allowing earlier treatment was recommended one year ago Wednesday by the department’s Pharmacy and Therapeutics Committee. (Sapatkin, 5/16)

The Oregonian: State Of Oregon Says It May Have Dispensed Millions To Ineligible Medicaid Recipients
The state of Oregon said Tuesday it had dispensed millions of dollars in Medicaid assistance to thousands of Oregonians with no idea whether they were eligible. The Oregon Health Authority says it is working to clarify whether as many as 115,000 Medicaid recipients have incomes low enough to qualify for the benefits they have been receiving. As the Affordable Care Act vastly expanded the Medicaid population in Oregon, the state got approval to skip the normal once-a-year eligibility check on its Medicaid clients. Recipients did qualify initially, agency officials said, but the state failed to check to ensure they still qualified. (Manning, 5/16)

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It’s Time To Take The Pulse Of Our Readers

Even the most exalted among us realize health care policy is complicated.
Here’s a pop quiz to see what you have learned as a regular reader of Kaiser Health News.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Pharmaceuticals

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Texas May Become Litmus Test For Banning Medicaid Funds For Planned Parenthood

After refusing federal Medicaid money so that it could ban Planned Parenthood from its family planning program, Texas is asking for the money back. If it’s granted, it could be a green light for other states to do the same.

The New York Times: Texas Seeks Medicaid Money It Gave Up Over Planned Parenthood Ban
Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back. The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.” (Goodnough, 5/15)

The Associated Press: Texas Tests Trump Administration Over Abortion Providers
The stakes potentially extend far beyond Texas. Abortion-rights groups worry that if Texas succeeds, other conservative states will also cut off Planned Parenthood and put clinics in jeopardy. “There is a new administration, and we’re looking at what opportunities may exist for us,” said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission. (Weber, 5/15)

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