No, it won't go anywhere with the House held by Democrats, but even so:
President Trump is releasing a $4.7 trillion budget plan Monday that stands as a sharp challenge to Congress and the Democrats trying to unseat him, the first act in a multi-front struggle that could consume Washington for the next 18 months.
The budget proposal dramatically raises the possibility of another government shutdown in October, and Trump used to the budget to notify Congress he is seeking an additional $8.6 billion to build sections of a wall along the U. S.-Mexico border.
Here we go again...
Trump’s “Budget for a Better America” also includes dozens of spending cuts and policy overhauls that frame the early stages of the debate for the 2020 election. For example, Trump for the first time calls for cutting $845 billion from Medicare, the popular health care program for the elderly that in the past he had largely said he would protect.
Amidst all the depressing news about various GOP states moving backwards on healthcare policy by gunking up Medicaid programs to add draconian work requirements, lowering the eligibility thresholds, stripping benefits and so forth, there were two positive developments in deep red territory last week, both relating to Medicaid work requirements:
A bill that sought to place work or other requirements on Medicaid recipients in West Virginia has died in the House of Delegates.
A House committee put the bill on its inactive calendar Wednesday, Feb. 27, the final day that legislation could be passed in their chamber of origin. The full House earlier Wednesday debated the bill but stopped short of voting on it, and did not take up the bill during a late evening session before adjourning.
The bill would have required able-bodied adults to work, participate in workforce training or community service, or attend a drug treatment or recovery program for at least 20 hours per week.
Last week, the state of Arkansas released its latest round of data on implementation of its Medicaid work reporting requirement – the first in the country to be implemented. As readers of SayAhhh! know, over 18,000 lost coverage in 2018 as a result of not complying with the new reporting rules. And the policy is clearly failing to achieve its purported goal – incentivizing work – with less than 1% of those subject to the new policy newly reporting work or community engagement activities.
The contrast in how a completely Republican-held state government like Utah and a completely Democratic-held state government like New Mexico deal with Medicaid is pretty astonishing.
In Utah, just four months ago the public voted, clearly and unequivocally, to enact a full expansion of Medicaid to all adults earning up to 138% of the Federal Poverty Line...but the GOP state House, Senate and Governor decided to ignore the voters and override their will by cutting the expansion down to a 100% FPL cap, including work requirements, which will cover tens of thousands fewer people while costing the state $50 million more.
In New Mexico, meanwhile, a newly-enabled Democratic trifecta (I believe both houses of the state legislature were already held by Dems, but the Governorship flipped from Republican Susana Martinez to Democrat Michelle Lujan Grisham) has been on a tear in their first month and a half:
Light posting for the next two weeks as I'm dealing with my kid's upcoming bar mitzvah and some other personal stuff, but this one literally hits home.
You may recall that last spring, Republicans in the Michigan legislature attempted to push through a bill to change the state's current ACA Medicaid expansion program (which is close to "vanilla" Medicaid with a few minor tweaks) by tacking on pointless, ineffective and (in an earlier draft) blatantly racist work requirement provisions:
White, Rural GOP Counties Get Exempted from Medicaid Legislation
Republicans in the legislature are working to change Medicaid in Michigan, but only for certain people, as they have tailored the language of pending legislation to exempt some of their constituents from being affected.
Things have been happening so quickly of late that I'm getting farther and farther behind on some important healthcare policy developments, particularly at the state level. There are two extremely important Public Option announcements which could be game changers if they make it through the legislative process.
Since I don't have time to do full write-ups on either one right now, I'll just present these summaries:
BLOCK GRANTS FOR MEDICAID — A Trump plan is in the works. Scoop today, behind the firewall right now. https://t.co/2PdVQKPoLH
The Trump administration is plotting a path for Medicaid block grants for states, a longstanding GOP goal to rein in spending on the entitlement program. News from me and @ddiamondhttps://t.co/EPkeqlPiSV
Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year
RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.
“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”
...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.
...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.
...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.
A few years back I posted an entry which breaks out the income eligibility thresholds for Medicaid and CHIP in every state. I've reposted an updated version below, which also takes into account Basic Health Plan (BHP) eligibility in Minnesota and New York. This comes directly from the Centers for Medicare & Medicaid. Note the footnotes at the bottom. The pink cells on the right indicate that the state has not yet expanded Medicaid under the ACA (Maine and Virginia have passed but note implemented doing so, while Medicaid expansion is on the ballot in Idaho, Nebraska and Utah this November).
As a reminder, here's the 2018 Federal Poverty Level income chart for every state except Alaska and Hawaii (Alaska is 25% higher, Hawaii is 15% higher):
I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system. The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.
Louisiana officials will have to notify around 60,000 people who are elderly or disabled in early May that they are slated to lose their Medicaid benefits in July as a result of the Legislature's stalemate over the state budget and taxes.
Gov. John Bel Edwards has proposed eliminating some Medicaid programs that provide long-term care in order to cope with a $994 million budget deficit. The governor said he doesn't want to put forward such cuts, but he doesn't have much of a choice given the state's financial restrictions starting July 1, when the new budget year begins.
The Louisiana Department of Health is legally obligated to warn people about what might cuts be coming in July two months ahead of time, even if the programs are ultimately spared.
Alabama, which has refused to expand Medicaid for low-income adults under the Affordable Care Act (ACA), is now proposing to make work a condition of Medicaid eligibility for very low-income parents, stating that it wants to encourage work. Its proposal, however, actually would penalize work: because Alabama hasn’t expanded its program, those who comply with the new requirements by working more hours or finding a job will raise their income above the state’s stringent Medicaid income limits, thereby losing their Medicaid coverage and likely becoming uninsured.