2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Medicaid Expansion

Your Health Idaho doesn't post presse release very often, but when they do it's usually helpful info:

Open Enrollment for Idaho is coming to a close, don’t miss out on enrolling in an affordable health insurance plan! You can set up an account, shop for plans, and apply for coverage online. Visit Apply and Enroll for more information. No computer? No problem. To apply over the phone or to request a paper application, call Your Health Idaho at 1-855-944-3246.

We’re Here to Help!

Your Health Idaho will have extended hours throughout December*:

  • December 1 – 6: 7am – 7pm
  • December 9 – 13: 7am – 8pm
  • December 14 (Saturday): 10am – 4pm
  • December 16 – 20: 7am – 8pm
  • December 21 (Saturday): 10am – 4pm

This is the perfect opportunity for those Idahoans who were unable to reach us during the busy work week.
*All times are in Mountain Time Zone.

What is an Open Enrollment Period?

Just days after a lawsuit was filed challenging Michigan's impending Medicaid expansion work requirements, Michigan Governor Gretchen Whitmer sent a letter to legislative Republicans urging them to stop throwing good money after bad on a policy which is pretty much doomed to failure anyway:

Gov. Gretchen Whitmer said delaying implementation of work requirements for enrollees in Michigan's Medicaid expansion program would prevent the state from potentially wasting at least $1 million.

The Democrat issued a special message to legislative leaders Tuesday, a day after saying the Republican-controlled Legislature should pause the rules taking effect in January.

Whitmer said the state has spent $28 million to implement the workforce engagement requirements and is on track to spend an additional $40 million this fiscal year — an unnecessary expense if a federal judge blocks the rules.

Coming on top of not one, not two, but three other states either scrapping or "delaying" implementation of Medicaid expansion work requirements (Arizona, Indiana and Montana), this one isn't particularly surprising given that Democrats hold the governor's seat and just flipped both the state House and Senate. Still welcome, though!

Gov. Ralph Northam has directed Virginia's Medicaid program to "pause" negotiations with the federal government on approval of a work requirement that was central to a political deal that allowed the state to expand eligibility for the program's health care benefits to hundreds of thousands of uninsured Virginians.

Northam cited the Democratic takeover of both chambers of the General Assembly in legislative elections last month. He also referred to litigation that has faced other states that have tried to link Medicaid health benefits to requirements that program participants seek work, training, education or other forms of civic engagement.

From The Hitchhiker's Guide to the Galaxy:

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

From a June story about Arkansas' "Designed to Fail" Medicaid work requirement disaster:

Under the Arkansas law, targeted enrollees were notified by the state via mail and informational flyers that they were required to work 80 hours a month, participate in another qualifying activity such as job training or community service, or meet criteria for an exemption such as pregnancy, a disability or parenting a child.

As my friend, U of M Law Professor and former Deputy Assistant Attorney General Sam Bagenstos just noted, this was pretty much inevitable:

BREAKING -- Poverty rights group files suit in federal court against work requirements MI has enacted for those on expanded Medicaid program Healthy Michigan.

— Gongwer News Service (@GongwerMichigan) November 22, 2019

A lawsuit has been filed challenging Michigan's new Medicaid work requirements that take effect Jan. 1. Plaintiffs are 4 people enrolled in the Medicaid expansion program known as Healthy Michigan #MiLeg

— David Eggert (@DavidEggert00) November 22, 2019

Fellow U of M law professor Nicholas Bagley already has the legal complaint itself:

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.

via the Idaho Statesman:

About 35,000 Idaho residents have signed up for Medicaid under expanded coverage in the first few days it has been offered, state officials said Monday.

The Department of Health and Welfare said that's more than a third of the estimated 91,000 people who are eligible. The agency started taking applications Friday, and it is tracking numbers on its website.

That's the good news. Of course, Republican legislators couldn't leave well enough alone:

Voters authorized Medicaid expansion last year with an initiative that passed with 61% of the vote after years of inaction by state lawmakers. But lawmakers earlier this year added restrictions requiring five waivers from the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.

...Most recently, Idaho last month submitted a waiver requiring patients to get referrals from primary physicians before they can get family planning services such as birth control, abortions or pregnancy care.

Back in June, I noted that the Michigan legislature was trying to slap a band-aid on the terrible GOP-passed & signed Medicaid work requirement bill (aka "God's Safety Net" bill) which passed about a year ago.

As you may recall, the original bill added fairly draconian work requirements to Michigan's implementation of the ACA's Medicaid expansion program, known here as "Healthy Michigan". Around 670,000 Michiganders are covered by the program (the number fluctuates between around 650K - 700K from week to week) today.

At the time, several reports had come out putting the number of people likely to lose healthcare coverage under the new requirements (which go into effect on January 1st, 2020) as high as 183,000 statewide, or as much as 28% of the total covered population...thousands of whom would lose coverage even if they do comply with the rules but aren't able to comply with the reporting requirements.

via Crystal Thomas of the Kansas City Star:

Groups hoping to make Missouri the 37th state to expand Medicaid officially launched a campaign Wednesday to put the question on 2020 ballot.

In Missouri, the state-run Medicaid program, MO HealthNet, provides health insurance only to children, pregnant women, those with disabilities and some seniors.

Expansion could mean coverage for an additional 200,000 Missourians under the proposal, according to Healthcare for Missouri, the campaign committee leading expansion efforts.

The committee was formed in March and spent the summer exploring whether expansion was possible in Missouri through initiative petition. On Wednesday, it announced it would commit to putting the question in front of voters in 2020.

...the campaign includes supporters like the Missouri Hospital Association, the Missouri Primary Care Association and a similarly named permanent advocacy group, Missouri Health Care for All.

A new analysis from the National Bureau of Economic Research has quantified something which healthcare advocates have been arguing for years:

The United States could have averted about 15,600 deaths if all 50 states expanded Medicaid under the Affordable Care Act, new research suggests.

...As of 2019, 36 states and the District of Columbia have adopted the Medicaid expansion, and 14 have not.

Four researchers — University of Michigan economist Sarah Miller, University of California, Los Angeles public health scholar Laura Wherry, National Institutes of Health’s Sean Altekruse and Norman Johnson with the US Census Bureau — used that difference to study what happened to people’s health outcomes in states that expanded the program compared to those that did not. A new working paper published by the National Bureau of Economic Research details their results.

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.

As I noted back in February, this one was pretty unexpected:

Bill expanding ‘Insure Oklahoma’ program passes Senate committee

A Senate bill seeking to expand the Insure Oklahoma program has advanced out of committee Monday morning.

Senate Bill 605, authored by Sen. Greg McCortney, R-Ada, directs the Oklahoma Healthcare Authority to implement "the Oklahoma Plan" within Insure Oklahoma. An agency spokesperson said the program provides premium assistance to low-income working adults employed by small businesses.

The latest numbers from Insure Oklahoma show less than 19,000 are enrolled.

According to McCortney, the intent of his bill is to provide insurance for Oklahomans who would qualify for Medicaid in states which opted to expand but are currently not insured.

Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:

New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.

Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.

That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.

Politically, it's generally better to underpromise and overdeliver. Unfortunately, when it comes to the actual legislative process it's usually the other way around.

Case in point: Connecticut.

It was just twelve days ago that Connecticut Governor Ned Lamont rolled out his proposed ACA improvement policy package, which included a bunch of key elements including the ballyhooed "Connecticut Option"...a Public Option which would have opened up the existing state employee healthcare plan to anyone on the individual or small group markets.

The full suite was supposed to include nine major provisions:

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