Though Republicans in Congress are pushing a new bill to repeal Obamacare and block-grant Medicaid, it has a slim-to-zero chance of passage this year. The real wars over Medicaid and the Affordable Care Act are still raging on the state level.
Trump’s CMS Administrator Seema Verma made three big announcements on Monday: She approved New Hampshire’s bid to become the fourth state to impose Medicaid work requirements, rejected Kansas’ proposal to kick people off of Medicaid after three years, and punted the decision down to individual states on whether Native Americans have to follow the new Medicaid work rules.
The Kansas waiver denial is significant, sending the message to other states applying for some kind of lifetime limit on Medicaid — including Arizona, Maine, Wisconsin, and Utah — to slow their roll. Even as CMS approves work requirements, premiums, and other hurdles for enrollees in state Medicaid programs, lifetime limits are apparently a bridge too far.
As CMS considers waivers from nearly a dozen more states, Michigan’s Medicaid work requirement proposal has come under fire for privileging the state’s more rural, whiter population over its inner-city residents of color. Michigan’s waiver would exempt people who live in counties where the unemployment rate is higher than 8.5 percent. Even though the unemployment rate is much higher than that in Detroit and Flint, the cities’ more affluent suburbs make the county rate lower overall, meaning people in those cities would not qualify and would have to comply with the work requirement.
Verma said in a Monday speech that Medicaid as it functions today is “on an unsustainable trajectory” and that policies like work requirements can ease the burden. But a new study out of Alaska finds that the requirements might cost even more to implement than they will save — even if, as is predicted, they lead to tens of thousands of people per state losing their health coverage.
Meanwhile, Maine Gov. Paul LePage (R) is still refusing to expand Medicaid six months after residents of his state voted overwhelmingly to do so, and his own Attorney General is refusing to defend him in the ensuing lawsuit. LePage is term-limited out of office this fall, but he may inspire other anti-Medicaid governors to slow-walk their own expansions.
As of this week, Utahans have enough signatures to put a Medicaid expansion on their ballot this November; advocates in Montana are still gathering signatures.
And finally, the prophesied 2019 Obamacare rate hikes have begun to arrive.
On Friday, Virginia’s two biggest insurers announced huge increases for their individual market customers, with some jumping as much as 64 percent. Maryland insurers on Monday asked for rate hikes ranging from 18.5 to 91.4 percent. While most people receive a subsidy and will be protected from the increase, those with middle class incomes will feel the pain. Insurance companies and industry groups have said openly for months that Trump administration policies are largely to blame — including the repeal of the individual mandate, the proliferation of skimpy, deregulated plans, and the sabotage of open enrollment.
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