Medicaid Expansion

Apparently it still has to be kicked back to the state Assembly for a final vote, but it appears to be a done deal at last:

The Virginia Senate just passed Medicaid expansion, which three Republicans joining all 19 Democrats voting in favor. The House, which already passed expansion, has to vote again. We'll have more later, but here's the backstory. https://t.co/ldFEb5vYyt

— Jeffrey Young (@JeffYoung) May 30, 2018

There's one downer, of course:

Elections have consequences: To get enough GOP votes, this Medicaid expansion includes a work requirement and premiums above the poverty line, which will cut into coverage gains. Virginia must continue the fight.

— Topher Spiro (@TopherSpiro) May 30, 2018

I know this is like the third "It's on the ballot!" post I've written regarding Medicaid expansion in Idaho, but this time it appears to be for real...almost:

BOISE — A Medicaid expansion proposal has passed the signature threshold, officials confirmed on Thursday, but said further review is needed before it gets on the November ballot.

Ada County Chief Deputy Clerk Phil McGrane says county clerks across the state have verified roughly 58,000 signatures that organizers submitted earlier this month.

The effort needed at least 56,192 signatures to qualify. However, those signatures must also come from 6 percent of the registered voters in at least 18 of Idaho’s 35 legislative districts.

McGrane says it’ll be up to the state to determine if the signatures meet the legislative district requirements.

Reclaim Idaho, the group that organized the Medicaid expansion effort, did not immediately return a request for comment.

Sadly, this is pretty much exactly what I've been expecting:

Sen. Mike SHIRKEY (R-ClarkLake) said today he's hammered out an agreement with the administration and the House on creating work requirements for Medicaid recipients.

Speaking during a taping of "Off The Record," Shirkey said, "We have a deal." All sides have signed off on the exemptions to the work requirement, but he didn't get into all fo them pending a formal announcement coming as soon as later this week.

From the wording of this, it sounds an awful lot like "all sides" appears to refer to Republican Senator Shirkey, the rest of the Republican State Senate, the Republican State House and the Republican Governor.

Shirkey confirmed that the 29-hour job requirement in the Senate bill has been pared back to 20 to which he says, "I was hoping Michigan could take a leadership position and set a new standard for that." But rather than jeopardize the entire package, he compromised.

Two big developments (or in one case, a lack of development) out of Virginia this evening.

First: Just yesterday I was noting that it looked as though after 8 years, Virginia's state legislature might finally be going ahead and expanding Medicaid under the ACA as soon as today:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

Unfortunately...that didn't happen:

Governor Northam Statement on Virginia Senate Budget Process

Several stories like this throughout Monday afternoon/evening (via Michael Martz of the Richmond Times-Dispatch:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

(The article goes into all the other non-Medicaid related stuff in the budget as well, of course, although some of it is obviously healthcare-related.)

*(To be honest, all of these types of bills--work requirements for Medicaid, drug testing for welfare benefits, photo ID for voting--have at least a tinge of racism to them no matter what, but at least this one isn't blatantly racist anymore).

This just in off the AP newswire...

LANSING, Mich. (AP) — The sponsor of proposed Medicaid work requirements said Monday that lawmakers are removing a provision to exempt recipients who live in Michigan counties with high unemployment, saying it would have been too difficult to administer and denying allegations of racism.

Republican Sen. Mike Shirkey of Clarklake also told The Associated Press that the proposed 29-hour-a week workforce engagement requirement for able-bodied adults is being lowered to “very close” to 20 weeks. That is in line with the three states that have enacted Medicaid work laws and with Michigan’s work requirement for food assistance beneficiaries.

A week or so ago, I noted that Republicans in my home state of Michigan have come up with a clever way of having their (chocolate) cake and eating the (vanilla) cake too. As first noted by Nancy Kaffer of the Detroit Free Press:

Although HB 897 threatens to end Medicaid benefits for hundreds of thousands living elsewhere in the state, it includes exemptions for people who live in counties with an unemployment rate of more than 8.5%, like the ones Schmidt represents.

Live in Detroit? You're out of luck.

The city's unemployment rate is higher than 8.5%, but the unemployment rate in surrounding Wayne County is just 5.5% — meaning Detroiters living in poverty, with a dysfunctional transit system that makes it harder to reach good-paying jobs, won't qualify for that exemption. The same is true in Flint and the state's other struggling cities.

...which brings me to today's Detroit News, via Jonathan Oosting:

Senate uses salary threat to push Medicaid work plan

Lansing — Michigan’s Republican-led Senate is pressuring Gov. Rick Snyder to back sweeping changes to the state’s Medicaid health insurance system, including proposed work requirements and a tougher 48-month benefit limit for the Healthy Michigan plan.

I've trashed CMS Administrator Seema Verma many times for her callous and backward-logic driven push to impose pointless, counterproductive work requirements on ACA Medicaid expansion enrollees. However, it appears that even she has her limits when it comes to treating people terribly:

The Trump administration has drawn a red line on Medicaid cuts. There are some proposals that the Centers for Medicare and Medicaid Services won’t approve.

In a letter on Monday, CMS Administrator Seema Verma told Kansas officials that her agency would not approve the state’s request to impose lifetime limits, which would have capped a person’s eligibility at three years, after which they could no longer be covered by the program.

Verma noted that the administration had approved proposals by other states to cut off benefits for Medicaid enrollees only if they fail to meet certain work requirements.

I've written quite a bit about the attempt by the GOP-controlled state legislature to push through work requirements for ACA Medicaid expansion here in Michigan. The bill (SB897) was quickly passed on partisan lines in the state Senate last week, and has now been taken up by the appropriations committee in the state House.

I actually shlepped my butt all the way out to Lansing yesterday morning to attend the committee hearing. Unfortunately, there were so many others who wanted to speak during the Public Comment period, I didn't get a chance to chime in.

Anyway, during the hearing, there was a reference to one provision of the proposed Senate version of the bill which caught my attention:

NOTE: Just to clarify, here's where the headline comes from:

...Sponsoring Sen. Mike Shirkey, R-Clarklake, created exemptions in the Michigan legislation that would waive the work requirement for parents with young children, pregnant women or caretakers for disabled family members. But asked about people like Maitre who could still lose health care, he told reporters the social safety net “by definition, has a lot of holes in it.”

“The best safety net ever invented by God is family,” Shirkey said, “but I’m not sure that government is supposed to supplement that process.”

Well, here we go:

#BREAKING tomorrow morning the House Appropriations Committee is taking up SB 897. Another Republican attempt to take away healthcare from Michigan families https://t.co/WsUhyntINj

— MI House Democrats (@MIHouseDems) May 2, 2018

What the heck, I'll make this Medicaid Expansion News Day:

Virginia’s Republican-led legislature is on the verge of doing something that would’ve been almost unthinkable just a year ago: approving legislation that would use money from the Affordable Care Act to expand Medicaid to as many as 400,000 people.

That coverage expansion would come at a price for Democratic legislators, progressive activists and low-income Virginians, however. Any Medicaid expansion bill that makes it out of the General Assembly will carry with it new work requirements for Medicaid enrollees, a priority for the GOP at large and for President Donald Trump’s administration.

Democrats in the Virginia legislature have tried in vain for six years to persuade their GOP counterparts that accepting federal dollars to extend Medicaid coverage to poor adults is the right thing to do. Accepting a work-requirements policy that would create bureaucratic obstacles to eligible Virginians appears to be the compromise needed to win the bigger fight.

As long as I'm focusing on Medicaid expansion news (and since I write about Montana pretty rarely), here's a mildly interesting tidbit:

Last June I noted that ACA Medicaid expansion in Montana had increased dramatically in a year and a half, from 47,000 in early 2016 to over 77,000 enrollees as of May 2017.

According to this article, they're now up to 91,000:

HELENA — There are 91,563 Montanans participating in the Medicaid expansion HELP act as of Jan. 15, generating nearly $40 million in savings in Medicaid benefits, a state panel was told Thursday.

Members of the Legislature’s Children, Families, Health and Human Services Interim Committee reviewed a report on Medicaid expansion. The committee took no immediate action after hearing the report.

As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.

However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!

Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.

Back in January, I noted that Wisconsin GOP Governor Scott Walker, who has followed the party line on the ACA since it was first signed into law, has suddenly found religion:

It looks to me like after his short-lived 2016 Presidential campaign (seriously,it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decidedto go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he'sscrambling to move back to the center policy-wisejust in time to run for a third term this November:

Scott Walker proposes plan to prop up Obamacare marketplace

After years of fighting Obamacare, Gov. Scott Walker is now seeking to stabilize the state marketplace under the law.

Wisconsin plans to permission to cover expensive medical claims for health insurers on the marketplace, which should lower premium increases and could bring back companies that dropped out, the governor said in an interview with reporters on Friday ahead of his election-year State of the State address Wednesday.

The state will also ask to permanently continue SeniorCare, a prescription drug program Walker has previously sought to pare down, he said.

Walker also said he’ll ask the state Senate to pass a bill authored by Democratic lawmakers and passed by the Assembly that would enshrine into state law access to private insurance for people with pre-existing conditions.

In the most significant of his health care proposals, Walker will ask the Legislature to join a few other states in adopting a reinsurance programto prop up the individual market, which is used by some 216,000 residents, in a state innovation waiver allowed under the Affordable Care Act, or Obamacare.

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