Medicaid Expansion

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:

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.

As I noted at the time, MI GOP claims that the work requirements will "fill job openings" is a load of hot, steaming garbage:

Montana didn't expand Medicaid under the Affordable Care Act until January 2016, and when they did so, the legislation was written with an automatic sunset date of June 30, 2019 unless it's expanded beyond that. Unfortunately, the ballot proposal to make Medicaid expansion permanent failed last November, which put the issue back in the hands of state lawmakers.

The good news is that the Montana state legislature did indeed finally vote to extend the program, which covers around 96,000 people, this week. The bad news is...well:

The bill to continue Medicaid expansion in Montana passed out of the state Senate Tuesday after teetering on the edge of a deadline for end of session negations.

A week or so ago there was an important ruling by a federal judge which shot down Medicaid expansion work requirements in two states (Arkansas and Kentucky) while also having a ripple effect in two more (Idaho and Iowa):

The [Idaho] Senate Health and Welfare Committee voted 7-2 to hold in committee a House bill that would create a work requirement for Medicaid expansion beneficiaries — after lawmakers found out during the hearing that a federal judge had just struck down Medicaid work requirements in Kentucky and Arkansas.

Meanwhile, a Senate bill that would create a voluntary job training requirement for Medicaid expansion beneficiaries is still in that chamber’s amending order and could come up soon. The Medicaid budget for 2019-2020 is still being held in the full House. And Gov. Brad Little has said he won’t let lawmakers adjourn for the year until Medicaid expansion and funding is resolved.

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