Nov 09

About That Big Medicaid Victory in Maine

Maybe no so much. You may have missed it but Seema Verma, head of the Health and Human Services Department’s Centers for Medicare and Medicaid Services wants to institute work requirements for benefits.

States will be allowed to impose Medicaid work requirements, top federal official says
By Paige Winfield Cunningham, Washington Post
November 7, 2017

The government will give states broader leeway in running their Medicaid programs and allow them to impose work requirements on enrollees, a top federal health official said Tuesday in outlining how the Trump administration plans to put its mark on the insurance program for low-income Americans.

Seema Verma, who heads the Health and Human Services Department’s Centers for Medicare and Medicaid Services, did not spare criticisms of the Obama administration and called its opposition to work requirements “soft bigotry.”

“Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma said in a sweeping address to the National Association of Medicaid Directors. “Those days are over.”

The speech was Verma’s most detailed public explanation of how she plans to approach Medicaid in a highly politicized era in which Republicans still hope to roll back its expansion under the Affordable Care Act as well as enact future spending cuts through their various health-care bills.

The program’s chief problems, according to Verma, include the expansion to add able-bodied adults and overall costs, which now comprise 29 percent of total state spending. She also faulted the federal government for requiring too much reporting from states and for delaying approval of states’ waiver requests to run their programs in alternative ways.

I guess it depends on your definition of “able bodied”. All the Medicaid recipients I know (except for the children kicked on the street by the Republican failure to renew SCHIP) are shambling wrecks at least 30% disabled (that’s slightly worse than just missing an arm or a leg) and all of them are dirt poor. The reason they don’t have jobs is that no one will hire them either because they’re too unwell to work or their chronic medical conditions will raise the employer’s group insurance premiums. To pretend that they’re simply lazy is to toss them on an ice flow so they can die out of sight because they’re sick or old or both.

Is this what you want to happen to your mother?

If you had/have a bad relationship it’s certainly understandable but unless you’re Kellyanne Conway (I know nothing about her relationships with her parents) and embrace “alternative facts” you must admit that the largest share of Medicaid money goes to long term care of the elderly.

Most people who embrace cuts to the program are unaware that it means Mom and Dad will move in to die in their house and are unprepared to deal with that fact. It is really horrible and messy, you have to burn the bed.

Republicans, all of them, want to take that money and give it to the Super Rich. As Paul Waldman, also in the Post, puts it-

Americans love Medicaid. Republicans hate it. Here’s where the fight is going next.
By Paul Waldman, Washington Post
November 8, 2017

As you might have seen, voters in Maine approved a ballot initiative Tuesday to accept the Affordable Care Act’s expansion of Medicaid by a margin of 59 percent to 41 percent. The expansion has been resisted by Paul LePage (R), to whom I fondly refer as America’s Worst Governor™.

Now LePage is actually proclaiming that he’ll refuse to implement the new law unless the legislature funds it. Even though the federal government will pick up 90 percent of the cost of the expansion, Republicans control the state senate by a one-vote margin and may follow LePage’s lead and refuse to fund the expansion, denying health coverage to tens of thousands of their constituents.

If you’re looking for a microcosm of the national picture on what has become one of the most important functions the government serves, you couldn’t do much better. The public wants Medicaid, but Republicans hate it and will do everything they can to undermine it.

The real point of this is to make recipients jump through more hoops and reduce the number of people on the program. In fact, the Trump administration is explicitly rejecting the idea that the purpose of Medicaid is to make sure people have health insurance. In Verma’s speech, she said she wants to get people off Medicaid. “The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working age, able-bodied adults does not make sense,” she said. Allowing states more flexibility to kick people off the program will enhance “the dignity and respect of high expectations.”

That’s the GOP position, and Republicans do have reason to be worried about it. They’ve been alarmed by Medicaid’s growth in recent years, since the program (along with the Children’s Health Insurance Program, which is essentially a Medicaid subsidiary) now provides insurance to more than 74 million Americans. Since many Republicans would literally rather see someone have no insurance than get health coverage from the government, they find that to be an abomination.

Yet the public does not share these views. Polls show that Medicaid is spectacularly popular, even with Republican voters. In Kaiser Family Foundation polls, 74 percent of Americans have a favorable view of the program (including 61 percent of Republicans) and 87 percent want its funding increased or kept the same (including 76 percent of Republicans). In states that refused the expansion of Medicaid, 73 percent have a favorable view of the program. It was the fact that their repeal bills would have slashed Medicaid as much as any other factor that led to their demise.

That brings us to the implications of the Maine vote for the future. Even though Republican officials in 19 states refused the expansion — in which the federal government would pay for almost all the cost of insuring their poor citizens — voters in those states don’t seem to agree with the choice their representatives made. Which means that if activists can put measures on the ballots in those states to accept the expansion, they may succeed not only in changing the policy but also in shaping the debate and getting more Democratic-friendly voters to the polls.

Since the Maine State Senate is still controlled by a Republican Majority (one vote) there is a possibility LePage will get his way (though they’ve overridden his vetos before). In any event the move is of dubious legality and would certainly be attacked in court.

However, just a small reminder of what the Republican agenda is.

It’s not all about Trump.

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