Medicaid

The recent elections in Virginia, Kentucky and Louisiana had two things in common: The first is that all three were huge victories for Democrats (they took control of both the state House and Senate in Virginia, flipped the Governor's seat in Kentucky and held onto it in deep red Louisiana).

The second is that all three elections were won in large part based on...Medicaid expansion.

As Greg Sargent notes in the Washington Post:

Yet Edwards won, in large part, by also stressing his implementation of the Affordable Care Act’s Medicaid expansion in the state during his first term. Indeed, Edwards’s lead pollster, Zac McCrary, told me during an interview that no single issue was more important in driving the governor’s victory.

In 2015, Republican Matt Bevin campaigned for governor on two major healthcare-related platforms:

• Eliminate the state's perfectly-functioning, award-winning, highly-praised and beloved ACA exchange, "kynect" for no particular reason other than spite.

• Eliminate the state's ACA Medicaid expansion program, which as of this writing provides around 480,000 low-income Kentuckians with healthcare coverage.

For some inexplicable reason, voters in Kentucky elected him regardless. Once he got into office, he did indeed make good on the first promise, shutting down the state's perfectly good ACA exchange platform and shifting KY to the federal exchange at HealthCare.Gov.

When it came to eliminating Medicaid expansion, on the other hand, he found it to be a little bit tougher than expected; actually pulling the plug on nearly half a million people's healthcare coverage proved to be a tougher nut to crack than he thought.

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

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

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

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

Some Guy, 2015:

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

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

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

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

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

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

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

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

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

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

— Joan Alker (@JoanAlker1) April 26, 2019

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

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

"Medicaid Work Requirements" have been in the news a lot over the past two years as the Trump Administration has given states the go-ahead to start imposing increasingly draconian, humiliating and ineffective work requirements for low-income people to avoid losing healthcare coverage.

For the most part, though, the work requirement bills have at the very least been restricted to ACA expansion of the Medicaid program to "able-bodied" adults earning up to 138% of the Federal Poverty Line (roughly $17,000/year for a single adult or $23,300 for a couple without minor children).

Today, Joan Alker of the Georgetown University Health Policy Institute Center for Children & Famlies reports that the Florida House of Representatives is planning on taking the cruelty even further:

URGENT: On Thursday, the Florida House will take up the harshest Medicaid work reporting requirement bill that I’ve EVER seen. As many as 100,000, mostly mothers, could lose their health insurance. https://t.co/64uRz23Puk

Combined, the Medicaid and CHIP programs have around 72.5 million Americans enrolled in them as of December 2018. However, the vast majority--over 80% of them--are actually enrolled in privately managed Medicaid programs. Managed Care Organizations (MCOs) are private health insurance companies which states contract with to handle the administration and management. In some cases this works out reasonably well. In others...not so much:

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

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

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

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

March 7th, 2019:

The Tennessee House of Representatives passed a bill on Thursday that would ban abortion after a fetal heartbeat is detected, mimicking laws in other states that have been struck down by the courts and drawing the criticism of both advocates and opponents of abortion rights.

The measure, House Bill 77, would tightly restrict the window of time within which a woman could seek an abortion, because a fetal heartbeat can be detected as early as six weeks into a pregnancy. That is before many women even realize they are pregnant.