Tag Archives: medicaid

Medicaid Is the Most Widely Used Benefit Program in Existence

by AlyciaLinder Posted on June 3, 2017

Mother Jones

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Aaron Carroll points me to this surprising result from a new Kaiser survey:

Is it really true that 71 percent of Republicans think it’s important to keep ACA’s Medicaid expansion? Yes it is, though with less intensity than Democrats and Independents. Is it because they’re confused and think this is about Medicare? Nope. The question explicitly starts out, “Now thinking specifically about Medicaid, the program for certain low-income adults and children…”

The answer probably lies here:

Even among Republicans, nearly half say Medicaid is personally important to their family. If that’s the case, it’s not really surprising that 71 percent support Medicaid expansion. That includes all the Republicans who think it’s personally important plus another sizeable chunk who have one or more friends who depend on it. (Plus, presumably, some who are unaffected by Medicaid but support it out of ordinary human decency anyway.)

These numbers may seem surprisingly high, but they’re really not. In the Kaiser poll, among all party IDs, 58 percent say that Medicaid is personally important to them and their families. In the US there are, roughly speaking:

68 million Medicaid enrollees
85 million families

If, say, there are 35 million families with one Medicaid enrollee; 10 million with two; and 4 million with three or more; that’s a total of 68 million Medicaid enrollees spread out among 49 million families. And that’s 58 percent of all families.

It’s a big number because Medicaid is the most widely used major benefit program in existence.1 Most people don’t know this.

1I think. It’s more widely used than Social Security (61 million), Medicare (55 million), food stamps (44 million), unemployment insurance (6 million at the height of the recession), the home mortgage deduction (about 60 million), 401(k) plans (about 52 million), IRAs (about 60 million), EITC (26 million), and TANF (about 4 million). Am I missing any major programs?

There is one fly in this ointment: employer health insurance. About 155 million people receive medical coverage through their employers, and they all benefit from the tax advantages of employer health plans. If you count this, then Medicaid is only the second most widely-used benefit program.

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Medicaid Is the Most Widely Used Benefit Program in Existence

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Trump WH: Birth Control Mandate Is Unnecessary Because of Planned Parenthood, Which We’ll Also Defund

by DelmarPenny Posted on June 1, 2017

Mother Jones

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The Trump administration’s argument for letting lots of employers opt out of covering birth control is…not exactly bulletproof.

Yesterday, Vox reported that the Trump administration is considering a broad exemption to Obamacare’s mandate on contraceptive coverage, according to a leaked draft of the proposed rule. If passed, the rule would allow virtually any employer, not just a religious one, to remove birth control coverage from its insurance plan if contraception violates the organization’s religious beliefs or “moral convictions”—a broad and murky standard.

But, in a curious twist, part of the Trump administration’s justification for the move hinges on the existence of hundreds of Planned Parenthood clinics, many of which the White House is actively trying to close by “defunding” Planned Parenthood.

As the draft text explains, the administration believes the past rationale for Obamacare’s contraception mandate is insufficient. The document lists several reasons why this is the case. Here’s one of them:

“There are multiple Federal, state, and local programs that provide free or subsidized contraceptives for low-income women, including Medicaid (with a 90% Federal match for family planning services), Title X, health center grants, and Temporary Assistance for Needy Families. According to the Guttmacher Institute, government-subsidized family planning services are provided at 8,409 health centers overall. Various state programs supplement Federal programs, and 28 states have their own mandates of contraceptive coverage as a matter of state law. For example, the Title X program, administered by the HHS Office of Population Affairs (OPA), provides voluntary family planning information and services for clients based on their ability to pay.

…

“The availability of such programs to serve the most at-risk women identified by IOM Institute of Medicine, now known as the National Academy of Medicine diminishes the Government’s interest in applying the Mandate to objecting employers.”

The implication here is that since there are already programs like Medicaid and Title X to help low-income women afford contraception, the requirement that most employers provide no-cost birth control is less pressing.

But there are a couple of glaring contradictions here: First of all, of the 8,409 health centers that provide Medicaid and Title X family planning services, as cited in the rule, 817 of them are run by Planned Parenthood—the very group that Congress and the administration are trying to exclude from using Title X and Medicaid funds to provide health care.

Trump has already signed a bill into law allowing states to exclude Planned Parenthood and other providers who offer abortions from receiving Title X family planning funding—never mind that Title X funding is used exclusively for nonabortion services. Beyond that, there are several more proposals moving through government—including in the House’s American Health Care Act and in the Trump budget proposal—to withhold Medicaid and other federal dollars, including Title X, specifically from Planned Parenthood.

The problem with the White House’s logic boils down to this: As the nation’s largest provider of federal Title X-funded care, in 2015 Planned Parenthood centers served more than 40 percent of women nationwide using Title X-funded family planning care—a whopping 1.58 million patients. But if Planned Parenthood can no longer receive a single federal dollar to provide contraception and other family planning care—an oft-repeated goal of the Trump administration—then these nearly 1.6 million low-income patients will suddenly lose their family planning care. And now their employers may not cover that care either.

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Trump WH: Birth Control Mandate Is Unnecessary Because of Planned Parenthood, Which We’ll Also Defund

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Democrats Don’t Brag Enough About the Stuff They Do

by BufordDelvalle Posted on May 29, 2017

Mother Jones

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A couple of days ago Paul Krugman wrote about the Trump double-cross:

Let’s talk about West Virginia, which went Trump by more than 40 percentage points, topped only by Wyoming. What did West Virginians think they were voting for?

They are, after all, residents of a poor state that benefits immensely from federal programs: 29 percent of the population is on Medicaid, almost 19 percent on food stamps. The expansion of Medicaid under Obamacare is the main reason the percentage of West Virginians without health insurance has halved since 2013.

….Trumpcare, the budget office tells us, would cause 23 million people to lose health insurance, largely through cuts to Medicaid….Then we need to add in the Trump budget, which calls for further drastic cuts in Medicaid, plus large cuts in food stamps and in disability payments. What would happen to West Virginia if all these Trump policies went into effect? Basically, it would be apocalyptic.

….So many of the people who voted for Donald Trump were the victims of an epic scam by a man who has built his life around scamming. In the case of West Virginians, this scam could end up pretty much destroying their state. Will they ever realize this, and admit it to themselves? More important, will they be prepared to punish him the only way they can — by voting for Democrats?

Since I happened to be chatting about this yesterday, I want to offer an alternative explanation for what’s going on here. More accurately, I guess, it’s a supplementary explanation, since there’s not much question that Donald Trump has indeed pulled a very long con on voters like the ones in West Virginia.

Basically it’s this: what do you expect if Democrats don’t support their own policies? For the past five years, Republicans have battered Obamacare as the most horrific policy ever enacted. Democrats have—what? Hidden under rocks, mostly. Moderates looked at the polls and decided to avoid even talking about Obamacare. Progressives mostly scorned it as a piece of crap and spent their energy explaining why we should all support single-payer instead. So what’s the result? Lots of people think Obamacare is horrific. After all, that’s what one side says, and the other side hardly even fights back.

West Virginians on Medicaid probably have no idea they’re getting it via Obamacare. West Virginians who buy insurance from Healthcare.gov probably have no idea they’re insured via Obamacare. West Virginians who got a payroll tax break early in the Obama years probably have no idea they even got it, let alone that it came from Democrats. West Virginians who got new roads or schools from the stimulus program probably have no idea it came from Democrats. West Virginians who got an increase in the minimum wage in 2007-09 probably have no idea it was passed by Democrats.

On the other hand, they certainly do know that Obamacare is destroying the nation; that Democrats want to take away their guns; that Mexicans took away all their jobs; that Obama wanted to let a flood of ISIS terrorists into the country; and that fanatical leftists want to allow men into their daughters’ bathrooms.

Republicans are going to say what they’re going to say. There’s not much you can do to stop them from lying. What you can do is to loudly and proudly demand credit for the stuff you’ve done. If no one really knows that you subsidized their insurance or provided them with Medicaid or raised their wages or built them new schools, you can hardly expect them to vote for you.

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Democrats Don’t Brag Enough About the Stuff They Do

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Donald Trump Just Released a Plan to Destroy Medicaid

by FannyOleary8 Posted on May 23, 2017

Mother Jones

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When President Donald Trump released his first full budget Tuesday, he directly contradicted one of his most explicit promises from the presidential campaign. “I’m not going to cut Medicare or Medicaid,” Trump unequivocally promised back in 2015.

Trump’s 2018 budget, if approved by Congress, would do just that. It calls for more than $1.4 trillion in cuts to Medicaid—the federal program that provides health insurance to low-income Americans—spread out over the next decade. Rather than simply adopting the Medicaid cuts that House Republicans passed earlier this month as part of their bill repealing of Obamacare, the president’s budget actually goes even further.

It’s hard to overstate how dramatic these Medicaid cuts would be. The House bill not only rolls back Obamacare’s expansion of Medicaid, it also imposes a cap on how much money the federal government sends to state governments. The Congressional Budget Office expects that Medicaid spending would drop by $880 billion over the next 10 years under the GOP’s plan, compared with current law. The cuts compound over time. By 2026, yearly Medicaid spending would have dropped by 25 percent, with 14 million fewer people enrolled in the government insurance program.

But Trump’s budget doesn’t end there. It calls for an additional $610 billion drop in Medicaid funding over the next decade. How, exactly, it achieves that isn’t entirely spelled out, but the budget outline emphasizes spending caps and block grants that would lower the amount of Medicaid dollars that the federal government gives to states. If both the House’s Obamacare repeal and Trump’s budget were put into effect, in 2027 federal Medicaid spending would be nearly 50 percent lower than it would be under current law.

Trump’s embrace of Medicaid reductions could put a group of Republican senators in a tricky position. Before their colleagues in the House had even unveiled their plan to dismantle the Affordable Care Act, four senators wrote a letter to their House counterparts warning them against dramatic cuts to Medicaid funding. Those four senators—Rob Portman (R-Ohio), Shelley Moore Capito (R-W.Va), Cory Gardner (R-Colo.), and Lisa Murkowski (R-Alaska)—have good reason to be wary. All four represent states that adopted Obamacare’s Medicaid expansion, which offers insurance for people earning up to 138 percent of the federal poverty level. So far 19 states have resisted taking federal funds for the program, but it’s popular with the public, and politicians might face a backlash if they suddenly take those benefits away from their constituents.

“I am seriously interested in reforms to Medicaid and better ways to make the money go further, but I’ve seen a lot of benefits to the Medicaid expansion in our state, particularly in the mental health and opioid and drug abuse areas,” Capito said earlier this month after the House bill passed.

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Donald Trump Just Released a Plan to Destroy Medicaid

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Iowa Just Showed Us What Defunding Planned Parenthood Under Trumpcare Would Look Like

by kathrynhudgens7 Posted on May 18, 2017

Mother Jones

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In a harbinger of what’s to come if the Obamacare repeal bill becomes law, Planned Parenthood has announced that it will close four health clinics in Iowa next month that serve nearly 15,000 patients.

The move is a direct result of a defunding measure signed into law by Iowa Gov. Terry Branstad last week that will go into effect on July 1. The new law rejects federal Medicaid dollars and replaces them with a state-run family planning program that will prohibit low-income patients from using their publicly funded insurance for care at providers, like Planned Parenthood, that also offer abortions.

“What is happening in Iowa is what we could see across the country if Congress passes this dangerous law to defund Planned Parenthood,” said Dr. Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America, in a statement. “This is hardest on people who already face barriers to accessing health care—especially people of color, young people, people with low to moderate incomes, and people who live in rural areas.”

The defunding measure enacted by Iowa is similar to the one attached to the Obamacare repeal bill, the American Health Care Act (AHCA), that passed the House earlier this month and must now head to the Senate. That proposal would undo a federal statute that allows Medicaid patients to use their coverage broadly, prohibiting states from excluding abortion providers in doling out Medicaid reimbursements for nonabortion care. (The Hyde Amendment prohibits the use of federal Medicaid funds for most abortions.) Iowa’s new law rejects federal Medicaid funding and replaces it with state money so as not to run afoul of this federal requirement.

A number of other states have attempted to exclude abortion providers from their Medicaid programs, but only Texas has ever done so successfully, doing in 2011 exactly what Iowa did last week. Texas’ state-funded program promised to maintain the same level of care for patients without Planned Parenthood, through community health clinics, federally qualified health centers, and more. In reality, there was a significant drop in care for low-income patients: A number of clinics closed. Other health centers attempted to step in, but nearly 26,000 fewer women received reproductive health care. Medicaid contraception claims declined by 35 percent, suggesting that fewer low-income women were obtaining contraceptive care. There was also an increase in childbirths among women receiving Medicaid who’d previously received contraception from Planned Parenthood clinics. The areas that saw the largest drops in women served were those where Planned Parenthood clinics had to close.

The Iowa counties that will be losing Planned Parenthood clinics are poised for a similar decline in access to care: In three out of the four counties with health centers closing—Burlington, Keokuk, and Sioux City—Planned Parenthood served at least 80 percent of the family planning patients using publicly funded insurance, according to 2015 data.

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Iowa Just Showed Us What Defunding Planned Parenthood Under Trumpcare Would Look Like

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Senate Republicans Are Arguing About How Badly to Screw the Poor

by MargartHaddock5 Posted on May 14, 2017

Mother Jones

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Medicaid doesn’t get a lot of attention in the debate over Trumpcare, but it’s likely that more people would be affected by Medicaid cuts than by any other single part of the bill. However, the Wall Street Journal reports that Senate conservatives still aren’t satisfied:

Some conservative Senate Republicans, such as Mike Lee, want to immediately start phasing back federal money for expansion enrollees, a process that would take 10 years….Conservatives also hope to use a different formula to calculate federal Medicaid funding that would mean less money for states. The House bill would slash an estimated $839 billion from Medicaid over the next 10 years, according to the CBO. Senate conservatives want to change federal funding of Medicaid in part by pegging it to a different inflation measure, which long term would mean less generous payments to the states than under the House GOP bill.

….Centrist GOP senators are on board with some Medicaid cuts but disagree over how best to implement them. Some say the House plan to halt federal funding for new expansion enrollees in 2020 is too harsh and want a longer sunset of the program.

Nearly a quarter of all Americans depend on Medicaid as their primary (or only) source of health coverage. That’s the American health care system for you. Nonetheless, of course Republican centrists are on board with “some” Medicaid cuts. They only want to quibble over whether 10 million poor people should be tossed out of the program by 2026 or if it would be more humane to toss out 9 million poor people by 2028. Decisions, decisions.

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Senate Republicans Are Arguing About How Badly to Screw the Poor

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Chart of the Day: Obamacare’s Triumph—Except in the South

by LemuelFindlay Posted on April 27, 2017

Mother Jones

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The CDC has a new report out on the chronically uninsured. Here’s the good news:

Starting in 2014, when Obamacare went into effect, the number of chronically uninsured plummeted by more than half, from 15.7 percent to 7.6 percent. That’s a huge public policy victory.

Now here’s the bad news—at least for some people:

States that resisted Obamacare in general, and refused the Medicaid expansion in particular, were largely in the South. In 2013 those states already accounted for 46.1 percent of the uninsured even though they have only 35 percent of the US population. By 2016, as other states were making progress, their share of the chronically uninsured skyrocketed to 54.7 percent.

Put another way: by 2016, the per capita rate of chronically uninsured in the South was more than twice what it was in the rest of the country even though southern states could have reduced their uninsured rate practically for free. This is the triumph of Republican bitterness over human decency.

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Chart of the Day: Obamacare’s Triumph—Except in the South

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Kansas Republicans Just Defied Donald Trump and Voted to Expand Medicaid

by SallyLandon Posted on March 24, 2017

Mother Jones

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On the same day the House was supposed to pass a bill dismantling Medicaid, Kansas Republicans took a big step toward expanding the program in their state.

In a voice vote Thursday morning, a committee in the Kansas Senate approved legislation that would enable the state to take advantage of an Obamacare provision offering Medicaid health insurance coverage to a wider group of poor people. The federal government would provide the vast majority of the funding.

Many deep-red states like Kansas have rejected Medicaid expansion based largely on their ideological objections to Obamacare. But as I reported earlier this week, a new bloc of moderate Republicans in the state—back by the health care industry and business community—have teamed up with Democrats to push Medicaid expansion. They point out that the state has given up, to date, nearly $2 billion in federal funds that could have helped both improve the health of the state’s low-income communities while also boosting its economy.

The Kansas House overwhelming passed Medicaid expansion earlier this year. The full state Senate is expected to vote on the issue Monday, according to KCUR. But they would likely need to cobble together a veto-proof majority, since Gov. Sam Brownback (R) has vocally opposed to adopting the program. In fact, Brownback released a letter Thursday, signed with seven other Republican governors, asking Congress to pass the repeal of Obamacare, which would eventually end funding for new sign-ups in the Medicaid expansion and would prevent states such as Kansas signing up in the meantime.

It’s unclear if Congress will heed Brownback’s request. The GOP’s bill to repeal and replace Obamacare was supposed to get a vote in the full House sometime Thursday, but with both conservatives and moderate Republicans balking, the vote was delayed. The Trump administration set a deadline for a Friday vote, saying the White House would otherwise abandon the effort. Congress is currently debating the measure, but vote counts from various news outlets suggest Republicans currently lack enough votes to pass the bill.

Read more about the fight for Medicaid expansion in Kansas here.

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Kansas Republicans Just Defied Donald Trump and Voted to Expand Medicaid

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Republicans Unveil Their Health Care Plan. It’s a Bloodbath.

by ElizabethDeboer Posted on March 7, 2017

Mother Jones

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Republicans have finally released their shiny new health care plan. It’s pretty much the same as the discussion draft that leaked a couple of weeks ago, and includes the following basic features:

Subsidies (in the form of advanceable tax credits) are age-based, starting at $2,000 for young people and going up to $4,000 for older folks.
The subsidies begin to phase out above incomes of $75,000 ($150,000 for households). This will affect about 10 percent of the population and probably reduces the cost of the bill by about 5 percent.
Obamacare’s Medicaid expansion is frozen in 2020 and then gradually phased out.
The bill allocates about $10 billion per year for high-risk pools run by states. This is far too little to work effectively.
The tax meant to pay for everything was removed.
Insurers are required to cover everyone who applies, even if they have pre-existing conditions. However, if you have a coverage gap longer than two months, insurers can impose a premium surcharge of 30 percent for one year. This “continuous coverage” provision is designed to motivate people to buy insurance, since the bill repeals the individual mandate.
The funding formula for Medicaid is changed to a “per-capita allotment,” which is a fancy way of saying it gets cut.
All the Obamacare taxes on the rich are repealed.

Oh, and the bill includes a one-year ban on funding for Planned Parenthood. Conservatives love this, but it’s also likely to generate some sure no votes in the Senate. Remember that Republicans can only afford two defections in the Senate. Any more than that and their bill fails.

Needless to say, there’s not yet an analysis from the Congressional Budget Office about how much the GOP plan will cost or how many people it will cover. It’s safe to say that on the cost side, it will be a lot cheaper than Obamacare. In fact, since the tax credits are so stingy, it’s likely that very few people in the bottom third of the income spectrum will use them. They leave insurance too expensive for most poor people to afford.

Because of this, my horseback guess is that the Republican plan will be used by about 3 million people, compared to 10 million for Obamacare. The Medicaid expansion will be unchanged for a while, continuing to cover about 10 million people. Total cost for subsidies + high-risk pools + Medicaid expansion will run about $25 billion per year, compared to $100 billion for Obamacare.

Three million is far too small a pool for any kind of successful program, and the pre-existing conditions clause ensures that the pool will be not just small, but very, very heavily weighted toward the very sick. It’s a disaster for insurance companies, who will almost surely refuse to participate.

That’s my guess, anyway. It’s a bloodbath. More detailed analysis from think tankers will be available soon, and the CBO will weigh in eventually too. It’s not going to be pretty.

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Republicans Unveil Their Health Care Plan. It’s a Bloodbath.

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Trump Offers to Let Planned Parenthood Keep Its Funding—If It Stops Performing Abortions

by Natalia0857 Posted on March 6, 2017

Mother Jones

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The Trump administration has reportedly tried to cut a deal with Planned Parenthood: You can keep your federal funding—maybe even increase it—if you stop providing abortions.

The informal proposal was revealed Monday by the New York Times.

Not surprisingly, the White House offer was a non-starter. Planned Parenthood executive vice president Dawn Laguens told the Times that the women’s health care organization rejected the idea out of hand. “Offering money to Planned Parenthood to abandon our patients and our values is not a deal that we will ever accept,” she said.

Currently, several proposals to defund Planned Parenthood are moving through Congress. One was approved by the House, another was introduced in the Senate, and a third cropped up in a draft of the proposed bill to repeal Obamacare. The measures would make Planned Parenthood and any other clinic that offers abortions “prohibited entities” for the use of Medicaid. This means that low-income patients with Medicaid coverage would be barred from using their federally funded benefits at Planned Parenthood—even to obtain non-abortion health care, such as pap smears, cervical cancer screenings, STI testing, and contraception. It is already illegal for Medicaid to cover most abortions, and it has been for more than 40 years.

In the last Congress, a broader bill to deny federal funds to Planned Parenthood passed both chambers, but it was vetoed by then-President Barack Obama. Donald Trump, however, said repeatedly on the campaign trail that defunding Planned Parenthood would be a priority for his administration.

Since Inauguration Day, it’s become increasingly apparent that even some Republicans are worried about the political repercussions of defunding Planned Parenthood, particularly through the Obamacare repeal. “We are just walking into a gigantic political trap if we go down this path of sticking Planned Parenthood in the health insurance bill,” said Rep. John Faso (R-N.Y.) in leaked audio of a closed-door meeting obtained by the Washington Post in January.

It would seem that the deal-maker-in-chief is trying to avoid any possible backlash over a crackdown on Planned Parenthood funding. The Times reported that White House officials have even offered a possible increase in federal money for Planned Parenthood if it stops providing abortions.

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Trump Offers to Let Planned Parenthood Keep Its Funding—If It Stops Performing Abortions

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