Medicaid

The Kaiser Family Foundation has updated their estimated breakout of the entire uninsured population of the United States as of 2019, and what sort of healthcare coverage they're eligible for thanks to the Affordable Care Act and the American Rescue Plan's expanded/enhanced subsidies.

Obviously a lot has changed since then, primarily due to the COVID-19 pandemic, but I presume this is the most recent comprehensive, reliable data they've been able to compile:

March 2, 2021:

The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...

Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).

Last week I reported that the GOP-controlled Missouri legislature decided to wipe their asses with their own state constitution by refusing to fund Medicaid expansion in the state despite the voters demanding they do so via a statewide ballot proposal last August:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.

The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.

August 5, 2020:

We did it!

Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare! pic.twitter.com/azHN0GJjEW

— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020

Last summer, when activists in both Missouri and Oklahoma were preparing for this historic vote, I wrote the following:

 

During the early days of the Affordable Care Act (and again during the insane "Repeal/Replace" saga of 2017), one of the dumbest and most disingenuous talking points of Republicans was to attack the ACA for being "too long."

I'm quite serious...many Very Serious Conservatives stroked their beards and wrung their hands over the sheer length of the ACA's legislative text (officially around 2,700 pages, though if you includ the mountain of regulations which are included with any major bill impacting hundreds of millions of people it could theoretically be tracked at 20,000 pages or so).

This silliness was most clearly expressed by Donald "Who?" Trump's first press secretary, Sean Spicer, who infamously put a copy of the House Republican's "replacement plan" (the AHCA) next to a copy of the ACA itself and cited the difference in pages between the two as some sort of "proof" that the AHCA was "better" for reasons unknown.

Anyway, the AHCA, Sean Spicer and Donald Trump are now gone, good riddance.

 

Nearly six years ago:

In other words, only about 10% (at most) of those still in the Medicaid Gap could 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.

  • “Get Covered America Day” — Dec. 10 — is a call to wear a mask to prevent the spread of COVID-19 and a public statement that you want your family and friends to get health insurance.
  • With COVID-19 cases surging nationally, the day is a call to action to encourage people to post a picture of themselves wearing a mask on social media, include a personal message about the importance of being COVID-safe and how friends, family and neighbors can get financial help for insurance now, sharing the website GetCovered2021.org and using the hashtag #GetCovered2021.
  • With an estimated 16 million uninsured Americans eligible for financial help — through their Affordable Care Act marketplace, or free coverage through Medicaid — Get Covered 2021 encourages people to check their health care options and get insured.

    NATIONAL COALITION LAUNCHES “GET COVERED 2021” URGING AMERICA TO MASK UP AND GET INSURED – FOCUS ON COVID AND COVERAGE FOR 16 MILLION AMERICANS ELIGIBLE FOR FINANCIAL HELP NOW

    • “Get Covered” is a call to wear a mask to prevent the spread of COVID as well as a public statement that you want your family and friends to get health insurance.
    • COVID underscores why insurance matters - but not just because of the pandemic - coverage can help people stay healthy and provide a pathway to care for diseases like cancer, diabetes, and many others that impact people’s lives.
    • Get Covered 2021 will focus on getting the estimated 16 million uninsured people across America eligible for financial help – through their Affordable Care Act marketplace, or free coverage through Medicaid – insurance coverage now.
    • The Get Covered 2021 coalition announced that December 10th will be Get Covered America Day -- a day of action where everyone will be encouraged to keep wearing their mask and post a picture of themselves on social media, including a personal message about how friends, family and neighbors can get financial help for insurance now, sharing the website GetCovered2021.org and using the hashtag #GetCovered2021.

    Five states held their primary elections for non-Presidential races yesterday, including Missouri...and Missouri also had another important measure on the statewide ballot:

    On Tuesday, August 4, all Missourians will have the chance to vote Yes On 2 to bring more than a billion of our tax dollars home from Washington every year – money that’s now going to places like California and New York instead.

    By bringing our tax dollars home, we can protect thousands of frontline healthcare jobs, help keep rural hospitals open, and deliver healthcare to Missourians who earn less than $18,000 a year. That includes thousands of veterans and their families, those nearing retirement, working women who don’t have access to preventive care, and other hardworking Missourians whose jobs don’t provide health insurance.

    Back in 2018, I was all over the trend of deep red states putting ACA Medicaid expansion on the ballot after getting fed up with years of their elected leaders refusing to do so. Idaho, Utah and Nebraska voters all did exactly that, passing it by solid margins. Unfortunately, state Republicans got in the way (or at least tried to) in all three states, adding hurdles, barriers and caveats which have either delayed or partly weakened them.

    Nonetheless, Utah and Idaho have both implemented Medicaid expansion to low-income residents (and thank God, given the current ongoing COVID-19 pandemic), while as far as I can tell, Nebraska is scheduled to launch their expansion program (called "Heritage Health") starting this October.

    The big story with COVID-19 the past few weeks has been, of course, the out-of-control increase in new cases (if not actual deaths...yet) from the virus in red states like Texas, Florida and especially Arizona which were relatively unscathed throughout the spring while the pandemic was raging across Northeastern blue states like New York, New Jersey and Rhode Island, as well as Michigan and California.

    While most of the states being hit with the summer wave are historically Republican strongholds (the states being hit hardest in June/July also include Georgia, Arkansas, South Carolina, etc.), there's one important exception to this: California, which was hit early but which clamped down fairly quickly, has re-emerged as a major hot spot. So what gives?

    On April 14th, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.

    On April 28th, they announced that the number was up to 84,000 new ACA exchange enrollees, averaging around 2.5x as many as enrolled via standard Special Enrollment Periods during the same period a year ago.

    On May 20th, they announced the total was up to 123,000 new ACA exchange enrollees via the COVID SEP, "nearly" 2.5x the rate of a year before.

    On April 14th, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.

    On April 28th, they announced that the number was up to 84,000 new ACA exchange enrollees, averaging around 2.5x as many as enrolled via standard Special Enrollment Periods during the same period a year ago.

    On May 20th, they announced the total was up to 123,000 new ACA exchange enrollees via the COVID SEP, "nearly" 2.5x the rate of a year before.

    On April 14th, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.

    On April 28th, they announced that the number was up to 84,000 new ACA exchange enrollees, averaging around 2.5x as many as enrolled via standard Special Enrollment Periods during the same period a year ago.

    Today they issued another update:

    Covered California Sees More Than 123,000 Consumers Sign Up for Coverage During the COVID-19 Pandemic

    via Covered California:

    Covered California for Small Business Works to Help Struggling Businesses Keep Employees Covered During the COVID-19 Pandemic

    • Covered California for Small Business will allow small businesses an additional 30-day grace period to make their premium payments for the months of April and May.
    • Employers interested in the program will be able to defer up to 75 percent of their premium payments for April and May in an effort to keep thousands of small business employees insured during the current health care crisis.
    • A survey found that more than three out of every four Covered California for Small Business employers are either operating in a limited capacity or are temporarily closed.

    Two weeks ago, Covered California reported that 58,000 residents had enrolled in ACA exchange coverage during their COVID-19 Special Enrollment Period, of which roughly 20,000 did so via standard SEPs (losing coverage, moving, getting married/divorced, etc), while an additional 38,000 took advantage of the COVID-specific SEP.

    Today they issued a press release with updated numbers and more:

    Covered California Continues to See Strong Consumer Interest in Quality Health Care Coverage During the COVID-19 Pandemic

    This just in via Covered California:

    Covered California Enrolls Tens of Thousands as Impacts of COVID-19 Pandemic Hits California Households

    • More than 58,000 people have signed up for coverage through Covered California since March 20, when a special-enrollment period was announced in response to the COVID-19 pandemic.
    • Covered California has seen a tremendous surge in consumers visiting CoveredCA.com and the website’s Medi-Cal page.
    • The special-enrollment period allows anyone uninsured and eligible to enroll in health care coverage through Covered California to sign up through June 30.
    • Consumers can enroll in as little as 30 minutes, either through CoveredCA.com or over the phone with the help of one of Covered California’s thousands of Certified Insurance Agents or enrollers.
    • In addition, Medi-Cal enrollment is open year-round for consumers who qualify.

    SACRAMENTO, Calif. — Covered California announced on Monday that 58,400 people had enrolled in health care coverage since the exchange announced a special- enrollment period in response to the COVID-19 pandemic. The pace of sign-ups has been nearly three times the level that Covered California saw during the same period in 2019.

    One by one, the dozen or so states which had either already implemented work requirement programs for Medicaid expansion enrollees or which were planning on doing so have either "delayed" or dropped those requirements entirely, either by force due to a federal judge ruling against them, or "voluntarily" due to them seeing the writing on the wall and realizing that a federal judge was going to rule against them in the near future.

    Every state except one, that is: Utah.

    Utah passed ACA Medicaid expansion solidly back in 2018...and they passed a "clean" version, which was supposed to mean anyone earning up to 138% of the Federal Poverty Line would be eligible, and the program wouldn't have any barriers or hurdles like work requirements and so forth.

    California Responds to COVID-19 Emergency by Providing Path to Coverage for Millions of Californians

    • Covered California Expands Special Enrollment and Medi-Cal Seeks Waivers to Encourage Coverage
    • Effective immediately, anyone uninsured and eligible to enroll in health care coverage through Covered California can sign up through the end of June.
    • The Department of Health Care Services announces new steps to help those eligible for Medi-Cal sign up easily and get immediate coverage.
    • The moves come amid widespread disruption in the lives and livelihoods of Californians as public health officials seek to reduce the spread of COVID-19.
    • All medically necessary screening and testing for COVID-19 are free of charge, and all health plans available through Medi-Cal and Covered California offer telehealth options.
    • These actions build on increased state subsidies and the implementation of a state penalty, both of which took effect in January 2020

    Last week I noted that House Democrats introduced the Families First Coronavirus Response Act, which includes a whole mess of important measures to deal with the economic and public health crisis fallout of the global pandemic. This act is by no means all that's needed, but it's an important start. The bill included, among other things, additional/emergency funding for:

    This just broke moments ago so I don't have much in the way of details yet:

    DC district court just entered summary judgment holding Michigan’s Medicaid work requirements are unlawful.

    — Jane Perkins (@perkins_nhelp) March 4, 2020

    Work requirements are a policy disaster -- and their suspension by court order here in Michigan is an extraordinarily positive development.

    — Nicholas Bagley (@nicholas_bagley) March 4, 2020

    There is, however, also this:

    This just broke moments ago, so I don't have a lot of details, but the bottom line is this:

    US Appeals Court in DC rules today that Trump admin. unlawful in approving Arkansas Medicaid work requirement

    — Stephanie Armour (@StephArmour1) February 14, 2020

    Here's the opinion itself.

    As always, University of Michigan Law Professor Nicholas Bagley has the skinny:

    It's a clean win for the plaintiffs, and it comes in a short, decisive opinion written by Judge Sentelle -- a very conservative Reagan appointee. 

    Before: PILLARD, Circuit Judge, and EDWARDS and SENTELLE, Senior Circuit Judges. Opinion for the Court filed by Senior Circuit Judge SENTELLE.

    Four days ago, from Trump Administration Centers for Medicare & Medicaid Administrator, Seema Verma:

    No, the Trump administration is not cutting Medicaid. https://t.co/bk5uMMKof4

    — Administrator Seema Verma (@SeemaCMS) February 6, 2020

    (sigh) Honestly not sure why I'm bothering posting this. Anyone who doesn't understand that the only promises Trump keeps are the racist, xenophobic, homophobic, misogynistic, antisemitic and corrupt ones by this point is either a complete idiot or willfully ignorant:

    The Trump administration wants to slash billions of dollars in federal support from Medicaid, food stamps and other safety net programs for the poor, while largely sparing the Medicare program that benefits seniors.

    I'm a bit late on this one. It was reported a week or so ago but was officially introduced today:

    Trump administration finalizing Medicaid block grant plan targeting Obamacare

    • The plan is guaranteed to enrage critics and invite attacks from Democrats in an election year.

    The Trump administration is finalizing a plan to let states convert a chunk of Medicaid funding to block grants, even as officials remain divided over how to sell the controversial change to the safety net health program.

    CMS Administrator Seema Verma plans to issue a letter soon explaining how states could seek waivers to receive defined payments for adults covered by Obamacare's Medicaid expansion, according to seven people with knowledge of the closely guarded effort. An announcement is tentatively slated for the end of next week, more than one year after Verma and her team began developing the plan.

    Even as I'm typing this, Democratic (!) Kansas Governor Laura Kelly and Republican legislative leaders are holding a press conference to announce an agreement to finally expand Medicaid under the ACA:

    TOPEKA, Kan. (KWCH) Gov. Laura Kelly and Republican leadership announce an agreement on Medicaid expansion in Kansas.

    During a press conference on Thursday, the governor said the program would be funded by the hospital administrative fee. At this time, it's unknown if that fee would be passed on to patients.

    Kelly said the hospitals have endorsed the program.

    Kansas Senate GOP Majority Leader Jim Denning said the bill would be pre-filed on Thursday with 22 co-sponsors.

    If passed in the Kansas Senate and House, the full expansion would go into effect no later than Jan. 1.

    (Obviously that's January 1st of 2021 at this point, of course)

    Here's some live tweeting of the event by a Kansas-based political reporter:

    Elections matter.

    True to his word, newly-inaugurated Democratic Kentucky Governor Andy Beshear has indeed eliminated the state's controversial and much-litigated Medicaid work requirement provision for the 400,000 state residents who are on the low-income healthcare program thanks to the Affordable Care Act:

    Former Republican Gov. Matt Bevin’s controversial plan to impose work requirements and monthly premiums for many Kentucky Medicaid recipients is no more, Democratic Gov. Andy Beshear announced Monday.

    (Monday = Last Monday; this is from a week ago)

    In one of his first major moves as the 63rd governor of Kentucky, Beshear signed an executive order Monday rescinding Bevin’s Kentucky HEALTH plan, which sought to impose strict work requirements for able-bodied, working-age adults. It would have ended health coverage for an estimated 95,000 Kentuckians.

    I haven't written about Utah's batcrap Medicaid expansion program in quite awhile...since last March, in fact. As a reminder, here's where things stood at the time:

    Yes, that's right: Not only did they lop 50,000 people out of the loop entirely, the other 90 - 100K enrollees will also be subject to...wait for it...work requirements. Well...sort of; keep reading.

    First, it looks like they'll have to apply to at least 48 employers as well. So...what, if they get hired by the first one they still have to apply with 47 more?

    Note that it says "and" before the fourth item, not "or"...which means all of them will have to register online, complete a training assessment, apply to at least 48 companies and complete an online training course.

    ...Oh by the way, one more thing: The minimum wage in Utah is $7.25/hour.

    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.

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