Several States Considering Their Own Version Of The ACA’s Individual Mandate.
The Wall Street Journal (2/4, Armour, Subscription Publication) reported that several states are mulling their own versions of the ACA’s individual mandate, which could exacerbate differences between Democratic states that aim to stabilize the ACA, and Republican ones which want to repeal the healthcare law. The article said Maryland legislators are pushing a proposal to replace the ACA’s mandate, while California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont and Washington, as well as the District of Columbia, are also mulling the idea.
Legislation and Policy
Repeal Of ACA’s Individual Mandate Could Cause Nebraska Premiums To Increase.
The AP (2/4, Schulte) reports that Nebraska consumers could see health insurance premiums increase in the future because the federal government has “gutted the legal requirement to purchase coverage” under the ACA. The AP explains that Republicans ended the tax penalty that was key to the individual mandate, rendering the mandate “toothless.” The piece says that while the Congressional Budget Office estimates that 13 million people will become uninsured because of the new provision, it is unclear how the change will affect Nebraskans, adding that even if premiums increase, federal subsidies also would rise to blunt the effect on individual consumers.
Public Health and Private Healthcare Systems
WPost: Medicaid Work Requirements May Create An Opening For Compromise On Virginia Medicaid Expansion.
In an editorial, the Washington Post (2/4) says that Virginia Republicans should stop blocking legislative efforts to expand Medicaid because the state is “close to the bottom” in “per capital Medicaid spending on the poor, the disabled and others, including children, who are unable to afford health insurance” – ranking 47th in the nation in 2017. The Post observes that House of Delegates Speaker M. Kirkland Cox (R) insists that Medicaid expansion include a work requirement which may only affect “a very small cohort of current recipients,” and that “there may be room for a compromise between Republicans and Democratic Gov. Ralph Northam, a doctor who won a near-landslide victory last fall partly by promising to expand Medicaid.”
CMS Administrator Seema Verma Praises States Seeking To Add Medicaid Work Requirements In Op-Ed.
Seema Verma, administrator of the Centers for Medicare & Medicaid Services, writes in the Washington Post (2/4) that the ACA “fundamentally changed Medicaid by shifting predominantly low-income adults – often without children, healthy and working-age – into a program that wasn’t designed for them.” Verma says that the federal government “must allow the program to be more flexible” and allow states to “design innovative programs that meets their diverse needs.” She applauds the applications from 11 states that seek to add work and community-engagement requirements for their “non-disabled, working-age populations.”
Opinion: Medicaid Work Requirements Add Another Burden For Trans Workers.
Cyrée Jarelle Johnson writes in the New York Times (2/5, Subscription Publication) that healthcare and employment discrimination are “pivotal” and “overlapping issues” for transgender communities, and became “more so last month when the Trump administration decided to allow states to institute work requirements for Medicaid.” Johnson explains, “The unemployment rate for trans people is three times higher than the national average, according to a 2015 survey produced by the National Center for Transgender Equality – a rate that results, in many cases, from anti-trans job discrimination.” She concludes that Medicaid work requirements not only roll back ACA protections, “they are far more likely to dehumanize trans people and prevent Americans from accessing necessary medical care.”
HHS Approves Indiana’s Waiver For Medicaid Work Requirements.
The Washington Post (2/2, Goldstein) reported on Friday, HHS approved Indiana’s request to impose work requirements, study or public service on certain Medicaid recipients. Indiana was the second state to receive such approval. The article added that HHS Secretary Alex Azar traveled to Indiana to join Gov. Eric Holcomb (R) in making the announcement. Azar said this “announcement is just one step in a long legacy of innovation” in Indiana’s healthcare system, and that it is an indication “Medicaid can be a pathway out of poverty.”
Politico (2/2, Cancryn) reported that Indiana’s “waiver builds on the conservative Medicaid expansion model pioneered in 2015 by then-Gov. Mike Pence, and developed by CMS Administrator Seema Verma, who was then a consultant.” The change requires that “able-bodied individuals under 60 years old…work at least 20 hours a week on average, be enrolled in school, or participate in the state’s job training and search program.” Recipients who fail to meet these “standards will be suspended from the program until they can comply with the requirements for a full month.” Those who are pregnant, who are primary caregivers, or who are medically frail would be exempt from the requirements.
Kentucky’s Medicaid Premiums Could Hinder Efforts To Roll Back Expansion.
Modern Healthcare (2/3, Meyer, Subscription Publication) reported that HHS’ approval of Kentucky’s Medicaid waiver “has garnered national attention for its controversial work requirement, but the state’s decision to charge all beneficiaries premiums has raised serious legal questions that could doom the policy.” The article said under this proposal, “Kentucky will have the highest Medicaid premiums and copayments in the nation, with premiums ranging up to 4% of income.” However, “a proposed class-action lawsuit challenges whether the CMS has the authority to let states impose any charges on low-income Medicaid enrollees.”
North Carolina Lawmakers Slow To Expand Medicaid, Even With Work Requirement Approval.
The Winston-Salem (NC) Journal (2/5, Craver) reports that even though the federal government has approved a work requirement for Medicaid recipients, the Republican-controlled North Carolina “General Assembly remains in no hurry to move forward with Medicaid expansion.” The “Carolina Cares” legislation includes a work requirement, but the bill “has not appeared on either chamber’s agenda for the special session after not advancing out of committee during the regular 2017 session.” The Journal says that “most” Republican legislative leaders have called Medicaid expansion a “non-starter” and many insist that the federal government “may not be able to keep its pledge of covering 90 percent of the administrative costs of expansion.”