This has been a very busy week for Medicaid news. Let’s start with the big news. Work requirements for Medicaid have been struck down in Arkansas and Kentucky.
The judge who had both cases in his court room hammered home a simple point: The core purpose of Medicaid is the provision and payment of medical services for qualified individuals. Everything else is not core.
These rulings are limited to only these two states. The impact of these rulings are not limited to these states.
Within an hour of work requirements being legally struck in Kentucky and Arkansas, Idaho puts a hold on adding work requirements to their expansion. https://t.co/99g3O3wSLi
— Emma Sandoe (@emma_sandoe) March 27, 2019
Iowa has also canned their work requirement legislation. The district court judge has set a very high standard for a work requirement waiver to clear and new work requirement legislation merely guarantees work for a lot of lawyers.
Harold Pollack raises a good point about these rulings as potentially not good news for future expansions:
I do worry that striking down work requirements may hurt many people. Although these are bad policies, they provide a politically dignified path for red state Republicans to expand coverage.
— Harold Pollack (@haroldpollack) March 28, 2019
I think that there is another pathway forward and that is partial Medicaid expansions to only 100% Federal Poverty Level instead of 138%. Georgia is joining Utah on this waiver request:
Georgia Becomes Latest State To Push For Partial Medicaid Expansion https://t.co/9IE8DnmIch
— InsideHealthPolicy (@InHealthPolicy) March 27, 2019
Finally there are strong rumors that something interesting could be happening in North Carolina for Medicaid Expansion:
All signs indicate North Carolina is on its way to some type of Medicaid expansion. Expect significant compromises to bring along majority conservative legislature. https://t.co/ejka4LzB53
— Alex Gertner (@setmoreoff) March 26, 2019
So there is a lot of Medicaid action this week and the next few months promise an avalanche.
rikyrah
Not buying Mr. Pollack. These evil demons ? don’t want to expand Medicaid- period.
eclare
@rikyrah: Agreed
Matt McIrvin
Are there any signs that the possibility of the Supreme Court overturning the entire ACA is slowing these efforts down? I assume that part of the point of these trollish suits is to create uncertainty and suppress any commitments that depend on the law applying in the future.
Soprano2
There are petitions in MO to put the issue on the ballot. The Republican supermajority here would never expand Medicaid voluntarily, even with rural hospitals closing down. There’s too much chance more of “those people” would get benefits. We’ll probably be one of the last states still not expanding Medicaid.
p.a.
Looking at this politically, because that’s what we are reduced to instead of concerns on health and morality issues, whatever can even temporarily ^ enrollment is good, just on the chance the KillACA lawsuit is successful at the next step(s). Need as big a pro-ACA constituency as soon as possible.
Patricia Kayden
Overall, this is all good news. Good on the Judge for reigning in Republican pettiness and good on Georgia and North Carolina for moving forward with expanding Medicaid.
Barbara
I can’t remember whether we are up to 33 or 34 jurisdictions, most of which expanded with no work requirement. And those that have expanded with work requirements are more likely to drop the requirement than the expansion. I went to a presentation by the group that has been a significant presence and resource in this litigation, and if you would like to follow this issue or contribute, here is the link: https://healthlaw.org/
We have to get past the “maybe we should be nicer so they will throw us some crumbs” mentality reflected in the tweet by Pollack. They didn’t expand Medicaid to be nice. They did it because hospitals are closing and people are starting to look around and realize that their suffering isn’t necessary.
rikyrah
@p.a.:
ICAM.
This should be a Democratic Party priority in 2020- getting Medicaid expansion on the ballot in every state that doesn’t have it. It’s good politics, and it might bring some new folks to the polls.
OzarkHillbilly
@Soprano2: I think Republicans are of two minds on this issue: On one hand they hate HATE HATE the idea of some undeserving layabout getting into a hospital without being financially destroyed and sentenced to a lifetime of servitude, but on the other hand the idea of corporations upping their bottom lines with the CEOs getting filthy rich off of the rigging of govt programs is right in the wheel house.
Redshift
@rikyrah: I don’t entirely disagree with him. In Virginia, I think work requirements were the fig leaf a few GOP members needed to support Medicaid expansion after they got decimated in the blue wave but still had a majority. We’ll probably get a minority this year (and will eliminate the work requirement of we do) but having Medicaid expansion two years earlieris still good, as is having a big victory to run on.
But I think the ball is really rolling now, and it will get harder and harder for red states not to do expansion.
RepubAnon
On a side note, Arizona police recently conducted a raid on parents who refused to take their sick, unvaccinated child (105 degree fever) to the hospital. One factor: the $3,000 cost of any ER visit.
https://www.wtnh.com/news/arizona-parents-reported-to-police-after-refusing-to-take-unvaccinated-child-with-fever-to-hospital_20190328025128/1882069259
With Medicare / Medicaid coverage, this might not have happened.
But Republicans, of course feel life is only sacred from the moment of conception to the moment of birth. After that, they don’t much care.
OzarkHillbilly
@RepubAnon: Children are the property of the parents. Just ask Rand Paul.
Barbara
@RepubAnon: Arizona expanded Medicaid almost out of the starting gate. Jan Brewer took one look at the financial proposition and bullied her way through the legislature. A vaccinated child might not have gotten sick.
Wayne Marks
I’m so glad I don’t live in a State dominated by MAGA hat mouth breathers. We have a lot of them here in NJ, but they’re a minority.
OzarkHillbilly
@Wayne Marks: Most of them are pretty quiet. The real problem is they vote and that sucks.
Steve in the ATL
Way to bury the lede, David!
OzarkHillbilly
@Steve in the ATL: Don’t book the cruise just yet.
Barbara
@Steve in the ATL: It does not guarantee work for lawyers because by and large people on Medicaid can’t afford lawyers even if they desperately need one. It’s simply a way of reducing the number of people who have a claim for benefits and it is absolutely chaotic for health care providers trying to get reimbursed for providing services to Medicaid beneficiaries.
Ohio Mom
@rikyrah: Harold Pollack is good people. And knowledgeable — he teaches health care policy at the University of Chicago
He is just naturally more optimistic than most of the rest of us.
Ella in New Mexico
FYI: If you put Medicaid eligibility back down to 100% of poverty all the working poor get tossed off their insurance. 138% is only 16753 annually. Seriously dumb idea.
Thats someone working for $8.00 bucks an hour, 40 hours a week. My son’s girlfriend fell off her parent’s policy. She plans to go to Vet school someday but needs to work a while first. Currently makes what’s considered a “competitive” $10/hr as a veterinary tech around 32 hrs a week, and she got Medicaid health insurance because her annual income fell just under New Mexico’s income limits. Personally, I think she deserves it.
Never forget that numbers have faces my friends.
FlipYrWhig
@rikyrah:
IMHO a lot of people would vote for a Medicaid expansion and then also vote for a Republican rep. They want Democratic policies without the pesky Democrats.
Soprano2
@OzarkHillbilly: I think you’re right, but so far they’re on the side of making sure the “layabouts” have to go bankrupt if they need medical care. I cannot understand how a state that votes down right-to-work by 60+%, votes to raise the minimum wage, and passed Amendment 1 by 60+% can also have the state government and legislature we have.
Brachiator
But this is part of the problem. The “politically dignified path” is not rational, or good actuarial or social policy.
Barbara
@Brachiator: What about the indignity of being forced to go to an ER and hope that they don’t send you home after giving you the perfunctory once over and then sending you a bill that sends you into bankruptcy? This exquisite sensitivity to the dignity of assholes is going to kill us.