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Category: Medicaid

  • Conservatives on Supreme Court Poised to Block Biden’s Vaccine and Mask Mandates

    Protesters display cardboard cutouts of Justices Brett Kavanaugh and Amy Coney Barrett's faces

    Despite the fact that we are in the midst of an unprecedented and deadly pandemic with no signs of abating, the right-wing majority on the Supreme Court appears unlikely to stop the carnage. The reactionary “justices” seem more inclined to shield corporate profits and red states’ rights than to protect the health and safety of the people.

    Scientists have achieved near unanimity that vaccines and masking are effective in preventing COVID infections. Nevertheless, the high court is being asked to block Biden administration rules that would mandate vaccines and/or masking and testing. On January 7, the court heard arguments in two sets of cases that will have widespread impact on the health of millions of people in the United States.

    The high court is not considering whether to strike down the mandates but rather whether to stop them from going into effect while the lower courts consider their constitutionality, which could take several months. Meanwhile, untold numbers of people are getting sick and dying.

    Stephen Breyer noted that the day before the arguments, there were three-quarters of a million new COVID cases. “Can you ask us to say it’s in the public interest in this situation to stop this vaccination rule? … To me, I would find that unbelievable,” Breyer remarked to Scott Keller, attorney for the business associations challenging Biden’s vaccine-or-mask mandate.

    Six Right-Wingers Poised to Stop Rule Protecting Workers

    The first set of cases the court heard are subsumed under the name National Federation of Independent Business v. OSHA. Twenty-six business associations and attorneys general from 27 (mostly red) states are suing to stop the Occupational Safety and Health Administration (OSHA) from mandating that companies with more than 100 employees require their workers to get vaccinated or wear masks and submit to weekly COVID tests. As Sonia Sotomayor noted, this is not a vaccine mandate, since it presents a choice between vaccines and masking/testing. OSHA estimated that 40 percent of employers would opt for the mask-and-test policy.

    Attorney Keller argued that the vaccine-or-mask mandate was “not a necessary, indispensable use of OSHA’s extraordinary emergency power.” Elena Kagan retorted, “It’s an extraordinary use of emergency power occurring in an extraordinary circumstance, a circumstance that this country has never faced before.”

    Keller predicted that leaving the mandate in effect would cause “a massive economic shift” leading to “billions upon billions of non-recoverable costs” for businesses. He said Congress should have clearly given OSHA the authority to promulgate rules to combat COVID.

    Pursuant to its authority under the Occupational Health and Safety Act, OSHA issued an “emergency temporary standard” to protect workers from viruses that pose “a grave danger.”

    OSHA predicts that the rule would affect 84 million workers and would cause approximately 22 million people to get vaccinated. Estimates project that its implementation would prevent 250,000 people from being hospitalized. There is an exception for workers with religious objections and those who do not come into close contact with other people at their jobs or work substantially outdoors.

    U.S. Solicitor General Elizabeth Prelogar told the court, “Workers are getting sick and dying every day because of their exposure to the virus at work. OSHA amassed substantial evidence of widespread workplace outbreaks across industries.” She said unvaccinated workers have a 1-in-14 chance of being hospitalized and a 1-in-200 chance of dying.

    During argument, all six right-wing members of the court seemed inclined to side with the corporations and the red states. Conservatives suggested that OSHA exceeded its authority under the statute and the vaccine and/or masking requirements are more properly within the purview of Congress or the states (even though it was Congress that enacted the statute giving OSHA such power). They thought the rule was too broad as COVID is not a distinctly “occupational” danger.

    By contrast, Sotomayor, Kagan and Breyer clearly favored protecting workers from the public health crisis caused by COVID. Kagan said, “I would think that workplace risk is about the greatest, least controllable risk with respect to COVID that any person has.” She added, “You have to be there. You have to be there for eight hours a day. You have to be there in the exact environment that the workplace is set up with. And you have to be there with a bunch of people you don’t know and who might be completely irresponsible.”

    Kagan queried, “Why isn’t this necessary to abate a grave risk? This is a pandemic in which nearly a million people have died. It is by far the greatest public health danger that this country has faced in the last century. More and more people are dying every day. More and more people are getting sick every day.” Kagan noted that nearly a million people have died from COVID. “We know that the best way to prevent spread is for people to get vaccinated,” she stated, “and to prevent dangerous illness and death is for people to get vaccinated. That is by far the best. The second best is to wear masks.”

    Indeed, the Centers for Disease Control and Prevention (CDC) found that unvaccinated people have a much higher risk of death than those who are fully vaccinated.

    Sotomayor noted that some states are forbidding employers from requiring vaccines and certain states are stopping employers from requiring their employees to wear masks.

    Breyer made clear he would allow the mandates to continue during the litigation, citing statistics for high rates of infections and deaths from COVID.

    Chief Justice John Roberts said Congress did not specifically give OSHA power to impose a vaccine or test mandate and that OSHA had never before mandated vaccines.

    Neil Gorsuch and Brett Kavanaugh — notorious opponents of deference to agencies that protect people — said the OSHA statute didn’t clearly authorize the agency to impose the mandate, considering the economic ramifications.

    Gorsuch, the only member of the court present during arguments without a mask, said “the flu kills people every year,” and OSHA doesn’t regulate in that area. He erroneously stated that the flu killed hundreds of thousands of people annually. In fact, the flu kills between 12,000 and 52,000 Americans each year, according to the CDC.

    Samuel Alito, who, like all of his colleagues on the court, is fully vaccinated, pointed out that there are “risks [of … adverse consequences” from the vaccines. “Serious side effects that could cause a long-term health problem are extremely unusual following any vaccination, including COVID-19 vaccination,” the CDC says, however. “The benefits of COVID-19 vaccination outweigh the known and potential risks.”

    Alito derisively described OSHA’s interpretation as “squeezing an elephant into a mousehole,” strongly indicating he would refuse to allow the protective rule to go into effect.

    Amy Coney Barrett thought that OSHA should have adopted a more targeted rule, saying this rule was too broad as it covered both dental employees and landscapers.

    Clarence Thomas was not convinced that the mandate was “necessary.”

    Right-Wing Majority May Well Halt Rule Protecting Medicare and Medicaid Patients

    The second bloc of cases the court considered is Biden v. Missouri and Becerra v. Louisiana. They involve the fate of a directive promulgated by the secretary of the Department of Health and Human Services (HHS), which requires vaccinations for more than 17 million health care workers in facilities that accept Medicare and Medicaid. The rule contains an exemption for medical and religious reasons.

    In these cases, a right-wing majority of the court may well strike down the mandate which would affect nearly half the country. But the votes are not as predictable as they are in the OSHA case.

    Lawyers for the states challenging the rule argued that requiring vaccinations would cause health workers to resign from their jobs. “Rural America will face an imminent crisis,” stated Jesus Osete, Missouri’s deputy attorney general.

    But Kagan responded that HHS had considered that eventuality before issuing the mandate. “I don’t know very much about the rural market,” Kagan acknowledged. “But the secretary” of Health and Human Services, “that’s his job.” Kagan added that many workers would feel safer coming to work if their coworkers were vaccinated. She noted that some people aren’t going to the hospital for mammograms and colonoscopies for fear of contracting COVID.

    “The one thing you can’t do is to kill your patients. So you have to get vaccinated so that you’re not transmitting the disease that can kill elderly Medicare patients, that can kill sick Medicaid patients,” Kagan said. She called the elderly on Medicare and the poor who receive Medicaid “the most vulnerable patients there are,” adding, “Poverty has a great deal to do with medical outcome.”

    Sotomayor noted that this rule was promulgated under the Spending Clause, affording the government wide latitude to impose conditions on the monies it disburses. Roberts appeared persuaded by this argument.

    In a likely attempt to appear fair and balanced to protect the legitimacy of the Roberts Court, the chief justice seemed prepared to uphold the Medicare-Medicaid health care mandate. He maintained that it is closely related to COVID’s threat to health so it could be justified in an emergency.

    Gorsuch appeared unmoved in his intention to strike down the mandate aimed at protecting Medicare and Medicaid patients. He echoed the states’ argument that the regulation “effectively controls the employment of individuals at these healthcare facilities in a way that Congress specifically prohibited.” Gorsuch characterized this use of money “as a weapon to control these things,” and suggested that it “should be left to the states to regulate.”

    Kavanaugh also leaned toward blocking the rule, although he wondered aloud why “the people who are regulated are not here complaining about the regulation, — the hospitals and healthcare organizations. A very unusual situation. They, in fact, overwhelmingly appear to support the … regulation.”

    Barrett objected that this was an “omnibus” rule covering ambulatory surgical centers as well as skilled nursing facilities. But she may have been swayed by the argument that Congress explicitly made provisions that the courts found objectionable severable, so those sections could be struck down without dooming the entire mandate. As Sotomayor pointed out, “the vast majority of the regulations across all facilities relate to health and safety.”

    Thomas expressed worry about whether the vaccine “could have significant health consequences” and was troubled that the rule could preempt the issue in some states. Alito was concerned about prior notice to the states about the mandate.

    Although Thomas and Alito seemed unsympathetic to the mandate, they questioned whether the states of Missouri and Louisiana had “standing” to sue on behalf of their citizens.

    The Supreme Court Should Not Play Politics With Our Health

    It is essential that the Biden administration’s mandates become operable to protect millions of people in the United States from illness and death. The response to the pandemic has fallen largely along political lines, so we cannot rely on the states to safeguard their residents.

    Seven of the 10 states that have the highest number of deaths per 100,000 residents as a result of COVID are led by Republican governors.

    Unvaccinated people tend to focus on their personal choice and not on the good of the whole. “But the point is that it’s not the risk to the individual that’s at question; it’s that risk plus the risk to others,” Sotomayor noted. “When you remain unmasked or unvaccinated, you put yourself at risk, but you put others” at risk as well.

    This post was originally published on Latest – Truthout.

  • Census Undercounts Mean Less Medicaid Funding For Most Southern States

    The 2020 census faced an inordinate number of challenges, including delays caused by the coronavirus pandemic and multiple failed attempts by the Trump administration to add a citizenship question to the decennial survey. Demographers and policy analysts worried that the United States population would be significantly undercounted as a result.

    But nationwide, the undercount has been estimated at only 0.5%, according to an Urban Institute report released this month — far less than many feared.

    However, seven states had undercounts estimated at more than 1% of their population: Alaska, Georgia, Louisiana, Mississippi, New Mexico, New York, and Texas. Among the Southern states, the estimated undercounts were greatest in Mississippi, at 1.3%, and Texas, at 1.28%, according to the report, titled “2020 Census: Miscounts and the Fairness of Outcomes.”

    As a result, Texas is expected to lose out on $247 million in Medicaid funding over the next decade, while Mississippi is expected to lose out on $20 million for its Medicaid program. Other Southern states that will lose out on federal health care funding for the poor due to population undercounts are Alabama ($5 million), Arkansas ($10 million), Florida ($88 million), Georgia ($47 million), Louisiana ($46 million), North Carolina ($24 million), and South Carolina ($16 million), the report found. In considering how undercounts affect federal funding, the Urban Institute focused on Medicaid because it’s among the federal programs that use census data most directly to distribute funds.

    The reasons for the undercounts in Southern states are complex, according to Diana Elliott, the principal research associate at the Urban Institute’s Center on Labor, Human Services, and Population and one of the report’s authors.

    “It’s more that those states have populations that are historically hard to count, and maybe have not invested in get-out-the-count efforts as much as other states,” Elliott said. “There’s a lot of complexity involved in terms of what makes a population hard to count.”

    She noted that homeless people are hard to count accurately in the census, along with renters, undocumented people, young children, and people of color in both rural and urban areas. Increasing distrust of the government also contributes to undercounts.

    “What you see in the South is that a lot of those factors that make groups and geographies harder to count kind of come together at a confluence in a lot of communities,” she said.

    Elliott and co-authors Steven Martin, Jessica Shakesprere, and Jessica Kelly used a microsimulation model to estimate a hypothetical full census count of the U.S. population, meaning no one was left out or counted twice. The microsimulation measured fairness, net accuracy, and quality. The Urban Institute model found that the 2020 census most likely had 4.1% omissions (undercounts) and 3.6% erroneous inclusion (overcounts), leading to the overall net undercount of 0.5%.

    The Black population nationwide was undercounted by an estimated 2.45% and the Latino or Hispanic population by 2.17%, the study found. Children under 5 were undercounted by an estimated 4.86%, undocumented people by 3.36%, and renters by 2.13%.

    Undercounts in these historically hard-to-count groups were expected, as was an overcount of the white population, Elliott said.

    But even though they were aware of the risk of an undercount, Texas officials waited until August 2020 — four months after the census count began — to spend $15 million on an ad campaign to encourage participation, the Texas Tribune reported. And Mississippi spent less than $500,000 in 2020 to increase census participation, Mississippi Today reported.

    “If states are concerned — and they should be concerned — about having an accurate count, building up networks and thinking about how to message the importance of the census and various Census Bureau efforts, it’s really important to do that earlier rather than later,” Elliott said.

    To improve the 2030 census, the report called for more promotion at state and local levels, along with operational changes and better funding.

    “If you want to have a community that gets the right investments of health care or vaccines or testing, those estimates are ultimately derived from census data collection efforts,” Elliott said. “It’s really important for states and communities to understand that these products and the Census Bureau’s work is incredibly important for their communities and their residents.”

    This post was originally published on Latest – Truthout.

  • Belabored: Our Neglected Human Infrastructure, with Sadé Dozan

    Sadé Dozan of Caring Across Generations discusses the Build Back Better bill, which would put some $150 billion into Medicaid-supported homecare services.

    This post was originally published on Dissent MagazineDissent Magazine.

  • Corporate Democrats’ Toothless Drug Pricing Alternative Is A Coup For Big Pharma

    It wasn’t enough for Democratic Representatives Kurt Schrader of Oregon, Scott Peters of California, Kathleen Rice of New York and Stephanie Murphy of Florida to vote against a robust bill that would allow Medicare to negotiate drug prices, the Lower Drug Costs Now Act (H.R. 3). These politicians — compelled by their unhappy corporate donors — tried to derail efforts to lower the cost of prescription drugs by introducing a toothless alternative in a pathetic public stunt to appease the industry.

    The post Corporate Democrats’ Toothless Drug Pricing Alternative Is A Coup For Big Pharma appeared first on PopularResistance.Org.

    This post was originally published on PopularResistance.Org.

  • Despite Pandemic, Poverty Declined Thanks To Stimulus Checks

    By: Arthur Delaney.

    The coronavirus pandemic threw millions of Americans into unemployment last year, leading to the first drop in household income from work since 2011, according to a new report from the U.S. Census Bureau.

    But even though the official poverty rate also increased, a supplementary measure that accounts for stimulus payments found that poverty actually fell while incomes rose.

    In other words, the public health calamity turned out not to be an economic calamity, or at least less of one, thanks to government programs that provided people with assistance. Government programs that provided people with health insurance probably helped people too, although the evidence on that is a little murkier.

    “Despite delays and other issues with how relief was provided, poverty would have been far worse without the unprecedented relief,” said Sharon Parrott, president of the Center on Budget and Policy Priorities.

    Not long after the first coronavirus cases had been confirmed in the U.S., Congress enacted the Coronavirus Aid, Relief and Economic Security Act, creating a massive payroll subsidy for small businesses, the largest-ever expansion of unemployment insurance, and an unprecedented $1,200 relief payment for the vast majority of American adults.

    The stimulus payments, in particular, had a big effect, boosting incomes by 4% and lifting more than 11 million households above the poverty line, for a 2.6 percentage point decrease in the poverty rate to 9.1%, according to the Census Bureau’s supplemental poverty measure.

    The official poverty rate measure, which omits the payments because they were technically tax credits, increased by 1 percentage point to 11.4%, while the median income for households, not counting the payments, ​​declined 2.9% to $67,521.

    It wasn’t the first time Congress sent out stimulus payments, but it was the first time lawmakers sent payments even to households that had no incomes at all, meaning the money was especially effective at pushing households above the poverty line.

    Congress followed the CARES Act payments with a round of $600 checks in December and then a $1,400 payment earlier this year. The payments proved popular, and Democrats set up recurring monthly checks of as much as $300 per child for most households this year.

    Now Democrats are hoping to continue the child payments through 2025, but are facing some opposition from members of their own party. And Sen. Joe Manchin (D-W.Va.), a key vote in the Senate, said Sunday that he doesn’t think households with no work income should be eligible for the payments.

    “Don’t you think, if we’re going to help the children, that the people should make some effort?” Manchin said.

    Children had higher poverty rates than adults or seniors in 2020, according to both the supplemental and official poverty measures. Experts have said the monthly child payments wold likely reduce child poverty substantially.

    No Change In The Uninsured, Probably Because Of Obamacare

    For health insurance, the new census report focuses on comparisons between 2020 and 2018, not 2019, in order to provide a more accurate picture of how coverage changed from before the pandemic.

    Overall, the proportion of the population without coverage basically stayed the same. It went from 8.5% in 2018 to 8.6% in 2020, a tiny change that’s well within the margin of error.

    The result is consistent with other recent studies, including one from the Urban Institute and one from the U.S. Centers for Disease Control and Prevention, that found no significant change in the number of uninsured Americans despite so many people losing insurance because they lost their jobs.

    The likeliest explanation for that, scholars have agreed, is the existence of government insurance programs ― in particular, the Affordable Care Act, or “Obamacare,” which has made Medicaid and subsidized private insurance available to many more Americans. Official Medicaid data, from the U.S. Department of Health and Human Services, shows that enrollment increased substantially between early 2020 and early 2021.

    But there’s a wrinkle in the census report: It picked up no Medicaid enrollment increase, even though it found a decline in employer-sponsored insurance. One possible explanation is that low-income Americans were less likely to respond, or at least to respond accurately, to questions about health insurance.

    Although this is always a problem with survey data, it may have been particularly severe during the pandemic, as the Census Bureau made clear in an accompanying blog post. Among other things, COVID-19 relief measures blocked states from requiring people to reestablish their eligibility for Medicaid, as they frequently do, during the public health emergency. As a result, many people on Medicaid might not realize they still have coverage.

    “We know based on actual data from states that Medicaid enrollment is up substantially, so the census survey is very likely an undercount of how many people are covered by Medicaid,” Larry Levitt, executive vice president of the Henry J. Kaiser Family Foundation, told HuffPost. “The census report is based on people self-reporting their health insurance coverage, which is subject to error, and probably particularly so during a turbulent period like this. States have been prohibited from ending Medicaid eligibility for anyone on the program during the pandemic, which may leave some people especially confused.”

    A separate finding in the census report offers more reason to think government programs made a difference. As always, the bureau broke down insurance coverage by state, which makes it possible to compare what happened in states that expanded Medicaid eligibility to cover their entire low-income populations, taking advantage of funds the Affordable Care Act made available, and those that have not.

    Among nonelderly adults living at or below the poverty line, the uninsured rate basically didn’t change in expansion states. But it went up by 2.6 points in states that didn’t expand.

    There are a dozen such states, including Florida, Georgia and Texas, mostly scattered across the South and all under the control of Republican officials.

    The dramatic differences in insurance coverage between states that expanded Medicaid and those that did not is nothing new. But the finding has particular relevance today, because a key part of the spending bill President Joe Biden and the Democrats are trying to pass would finance insurance coverage for low-income people living in those states and currently ineligible for Medicaid.

    The post Despite Pandemic, Poverty Declined Thanks To Stimulus Checks appeared first on Basic Income Today.

    This post was originally published on Basic Income Today.

  • Medicaid Enrollees Are Getting Vaccinated at Lower Rates Than General Population

    A health care worker fills out a COVID-19 vaccination card at a community event in Los Angeles, California, on August 11, 2021.

    Medicaid enrollees are getting vaccinated against covid-19 at far lower rates than the general population as states search for the best strategies to improve access to the shots and persuade those who remain hesitant.

    Efforts by state Medicaid agencies and the private health plans that most states pay to cover their low-income residents has been scattershot and hampered by a lack of access to state data about which members are immunized. The problems reflect the decentralized nature of the health program, funded largely by the federal government but managed by the states.

    It also points to the difficulty in getting the message to Medicaid populations about the importance of the covid vaccines and challenges they face getting care.

    “These are some of the hardest-to-reach populations and those often last in line for medical care,” said Craig Kennedy, CEO of Medicaid Health Plans of America, a trade group. Medicaid enrollees often face hurdles accessing vaccines, including worries about taking time off work or finding transportation, he said.

    In California, 49% of enrollees age 12 and older in Medi-Cal (the name of Medicaid in California) are at least partly vaccinated, compared with 74% for Californians overall.

    Unlike some other large states, such as Texas and Pennsylvania, California provides its Medicaid plans with information from vaccine registries, which can help them target unvaccinated enrollees. But still, the rate of immunizations lags far behind that of the general population.

    According to detailed reports showing vaccination rates by county and by health plan, rates around the state vary dramatically. In Silicon Valley’s Santa Clara County, 63% of Medi-Cal members have been vaccinated, versus 38% in neighboring Stanislaus County. California health plans are working with community groups to knock on doors in neighborhoods with low vaccination rates and providing shots on the spot.

    This fall, California — which has the nation’s largest Medicaid program, with nearly 14 million people — will offer its Medi-Cal health plans $250 million in incentives to vaccinate members. The state is also putting up $100 million for gift cards limited to $50 for each enrollee.

    In other states — such as Kentucky and Ohio — health plans are giving $100 gift cards to members when they get vaccinated.

    While more than 202 million Americans are at least partly vaccinated against covid, nearly 30% of people 12 and older remain unvaccinated. Surveys show poor people are less likely to get a shot.

    More than two-thirds of Medicaid beneficiaries across the country are covered by a private health plan. States pay a monthly fee to the plan for each member to handle medical needs and preventive care.

    Nationally, about 70% of Medicaid enrollees are at least 12 years old and eligible for the vaccines, according to a KFF analysis.

    State Medicaid programs that can track their progress show modest results:

    • In Florida, 34% of Medicaid recipients are at least partly vaccinated, compared with 67% for all residents 12 and older.
    • In Utah, 43% of Medicaid recipients are at least partly vaccinated, compared with 68% statewide.
    • In Louisiana, 26% of Medicaid enrollees are at least partly vaccinated, compared with 59% for the state population.
    • In Washington, D.C., 41% of Medicaid enrollees are at least partly vaccinated, compared with 76% of all residents.

    “We know how we are doing, and it’s not great,” said Dr. Pamela Riley, medical director of the D.C. Department of Health Care Finance, which oversees Medicaid.

    Hemi Tewarson, executive director of the National Academy for State Health Policy, said she “had hoped there would not be this much of a disparity, but clearly there is.”

    Medicaid agencies in several states, including Pennsylvania, Missouri, New Jersey and Texas, said they lack complete data on vaccination rates and don’t have access to state registries showing who has been immunized. Health experts say that, without that data, the Medicaid vaccine campaigns are virtually flying aimlessly.

    “Having data is step one in knowing who to reach out to and who to call and who to have doctors and pediatricians help out with,” said Julia Raifman, assistant professor of health law, policy and management at Boston University.

    For years, Medicaid programs have worked with providers to improve vaccination rates among children and adults. But now, Medicaid officials need more direction from the federal government to set up “a more clear and focused and effective approach” to control covid, Raifman said.

    Chiquita Brooks-LaSure, the administrator of the Centers for Medicare & Medicaid Services, said the federal government is giving extra funding to state Medicaid programs to encourage covid vaccinations. “We’re also encouraging states to remind people enrolled in their state Medicaid plans that vaccines are free, safe, and effective,” she said in a statement to KHN. Kennedy, of Medicaid Health Plans of America, said the job of getting shots to Medicaid enrollees is harder when states don’t share immunization data.

    “We need access to the state immunization registries so we can make informed decisions to get those unvaccinated people vaccinated and identify those doing a great job, but it all starts with data sharing,” he said.

    Medicaid agencies’ claims data doesn’t account for the many enrollees who get vaccinated at federal immunization sites and other places that don’t require insurance information.

    California Medicaid officials said they can track enrollee vaccination by linking to the state Department of Public Health’s immunization registry, which captures residents’ inoculations regardless of where they occur in the state.

    Data as of Aug. 8 shows rural Lassen County in northeastern California with the lowest vaccination rate among Medi-Cal enrollees, at 21%, and San Francisco with the highest, at 67%.

    Medicaid enrollees’ vaccination rates fall short even compared with those of other people in the same county. In San Diego County, for example, 91% of residents are at least partially vaccinated, compared with 51% of Medicaid recipients.

    Jana Eubank, executive director of the Texas Association of Community Health Centers, said her clinics would be grateful to know which Medicaid recipients are vaccinated to better target immunization campaigns. Having the data would also help providers make sure people get an additional dose, often called a booster, being recommended this fall.

    “We have a pretty good sense, but it would be great to have more detail, as that would allow us to be more focused with our finite resources,” Eubank said.

    Pennsylvania’s Department of Human Services, which oversees Medicaid, said it requested vaccine registry data from the state health department in the spring but hasn’t received it. A health department spokesperson said her agency was working through legal issues to safeguard the registry’s personal health data.

    “Getting accurate, comprehensive vaccination data for our Medicaid recipients is a priority, but we cannot do so based off claims and ad hoc data alone,” said Ali Fogarty, a Pennsylvania Medicaid spokesperson.

    Dr. David Kelley, chief medical officer of the state’s Medicaid program, said the lack of immunization data hasn’t slowed the agency’s vaccination work: “We are continuing full steam ahead to get folks immunized.”

    AmeriHealth Caritas, which operates Medicaid health plans in Pennsylvania, Florida and six other states and the District of Columbia, has about 25% of its Medicaid enrollees vaccinated, said Dr. Andrea Gelzer, senior vice president of medical affairs.

    AmeriHealth is working with its doctors and community organizations to support vaccine clinics. It has offered free transportation and made vaccines available to homebound enrollees.

    In Louisiana, the Medicaid program has offered bonuses to five health plans to spur vaccines. But so far only one, Aetna, has qualified.

    Louisiana Medicaid is paying Aetna $286,000 for improving its vaccination rates by 20 percentage points from May to August, state and health plan officials said. Aetna had at least partly vaccinated 36% of its enrollees as of Aug. 16.

    John Baackes, CEO of L.A. Care Health Plan, said he remains skeptical about paying people to get their shots and said it could upset enrollees who already have been vaccinated and won’t qualify for cash or a gift card. “We don’t think gift cards are going to move the needle very much,” he said.

    As part of its strategy to increase vaccinations, the health plan has called members at high risk of covid complications to get them into walk-up or drive-thru immunization sites and helped homebound members get shots where they live. About half the plan’s eligible enrollees have received at least one dose.

    Richard Sanchez, CEO of CalOptima, the Medicaid health plan in Orange County, California, said offering $25 Subway gift cards helped increase vaccinations among members living at homeless shelters.

    As of mid-August, about 56% of its eligible enrollees were at least partly vaccinated. “We are not where we should be, and the nation is not where it should be,” Sanchez said.

    Subscribe to KHN’s free Morning Briefing.

    This post was originally published on Latest – Truthout.

  • We Must Fight Privatization of Medicare and Medicaid to Win Single-Payer

    It’s time the U.S. had a health care system that operates as a public good, free from the demands of profit-making.

    Right now, there are essentially two approaches to improving our health care system. Either we expand the Affordable Care Act, or we expand Medicare. So far, President Joe Biden has pushed for the former with his administration’s expansion of insurance subsidies in the American Rescue Plan. Neither approach, however, will get us to what we need if the privatization of Medicare and Medicaid continues unchecked.

    The threat is real. Private health insurance companies, hospitals and pharmaceuticals care about one thing: making more money. Since the creation of Medicare and Medicaid in 1965, these companies have worked diligently to privatize what are ostensibly public goods.

    Medicare and Medicaid were created to provide health care to the elderly and poor in our country. It was designed as a public good financed and administered by the government, and as such, was a landmark expansion of our understanding of what our government could do for us.

    But over the years, private interests have encroached on that early promise, turning what was once a public good into another profit-making opportunity for the health care industry. Their first big breakthrough was when former President George W. Bush passed the Medicare Advantage program (also known as Medicare Part C) in 2003. Suddenly, millions of elderly Americans — and the billions of dollars that the government was spending on their care — were now available to private companies.

    By offering coverage that traditional Medicare did not, such as for nursing home and long-term care, plus hearing, vision and dental care, companies were able to increase profits by signing up elderly Americans and getting both government money to pay for the care, plus the extra premiums that Medicare Advantage charged. What had once been administered as a purely public, not-for-profit program by the government has now become an increasingly corporate-controlled system. In 2020, 42 percent of Medicare beneficiaries were enrolled in a Medicare Advantage program.

    The same pattern has played out with Medicaid. In the place of Medicare Advantage programs, we now have Medicaid Managed Care Organizations (MCOs). Here, states give blocks of money to private, for-profit organizations to provide coverage to Medicaid beneficiaries. With the passage of the Affordable Care Act in 2010, Medicaid was expanded to all adults with incomes up to 133 percent of the federal poverty level in states that didn’t opt out. By 2018, 69 percent of Medicaid beneficiaries were enrolled in MCOs.

    With the privatization of Medicare and Medicaid, the government has ceded decisions over who gets care and for what to private companies whose driving interest is increasing their bottom line. This inevitably leads to narrowed networks, refusal of care and curtailed benefits. Meanwhile, the government is paying for both the health care of its elderly and poor — and covering whatever profits health insurance companies can skim off the top.

    Meanwhile, health insurance companies know that Medicare for All is an increasingly popular policy. In theory, this could wipe out their very existence. Instead, they are trying to dismantle Medicare and Medicaid piece by piece, and turn a public good into another cash cow for the industry.

    The immediate solutions are not complicated. First, we can eliminate Medicare Advantage programs and MCOs. Furthermore, we can stop underfunding Medicaid; fill in the gaps in Medicare, so that the elderly can get hearing, vision and dental care; close Medicaid coverage gaps; and allow Medicare to bargain down drug prices. Finally, we can lower the Medicare eligibility age and create a public option. Ultimately, though, all Americans should be able to get the health care they need, free of narrow networks, cost barriers and a system that incentivizes denial of care.

    When Americans push for Medicare for All, they must also push back against the insurance industry’s relentless infiltration of Medicare and Medicaid, or we will be back where we started — health care meted out by private corporations, always looking at their bottom line.

    This post was originally published on Latest – Truthout.

  • Missouri’s GOP Governor Forced to Expand Medicaid Access Following Court Ruling

    A Missouri judge has ruled that state lawmakers, including Missouri’s Republican Gov. Mike Parson, can no longer deny adults who are newly eligible for Medicaid from accessing the program.

    Cole County Judge Jon Beetem, who had initially ruled in favor of allowing Parson and other Republicans the ability to restrict eligible participants earlier this year, changed his ruling after the state Supreme Court had found the legal arguments he had favored were improperly accepted. In his opinion published on Tuesday, Beetem said he was changing his initial finding “in accordance with the Mandate of the Supreme Court of Missouri.”

    The state Supreme Court’s ruling had been a unanimous one.

    Beetem’s new ruling also requires the state to treat newly eligible Medicaid participants similarly to those who are already in the program, and forbids the state from offering different tiers of benefits to Medicaid recipients.

    The ruling on Tuesday affirms a referendum outcome from August 2020, which saw more than 53 percent of Missourians vote in favor of expanding the state’s Medicaid program in accordance with the Affordable Care Act (ACA). While the outcome of that vote was hailed at the time by health advocates as a promising step forward, Republicans in the state have since tried to block the expansion, through court challenges and legislative actions.

    But those challenges would no longer remain obstacles to individuals getting Medicaid coverage.

    “People who make up to 138 percent of [the] federal poverty level [in Missouri] can start applying now,” wrote St. Louis Public Radio correspondent Jason Rosenbaum. “It will take some time to get enrolled, but they can’t be denied coverage. Medicaid expansion in Missouri has arrived.”

    Parson, reacting to the order on Tuesday, said he would “follow the law.” But he also expressed doubts over his and other lawmakers’ ability to find funding for the program, stating that one of the ways he could do so might be to lessen the benefits that Medicaid recipients in his state receive.

    “We don’t have the funding to support it right now. So we’ve got to figure out how we’re going to do that, you know, whether we’re going to dilute the pool of money that we have now for the people that’s on the program, and just how we’re going to move forward,” Parson said.

    Those comments from Parson suggest that the slashing of Medicaid benefits may become the next major political battle on health care in the state.

    With Missouri now officially legally bound to expand access to Medicaid, 38 states plus Washington, D.C. have now adopted Medicaid expansions. Twelve states, however, have opted out of doing so since the ACA became law more than 10 years ago. (States were given the opportunity to opt out of the expansion because of a federal Supreme Court ruling on the law in 2012.)

    According to the Kaiser Family Foundation, hundreds of studies have shown positive outcomes from states’ Medicaid expansion, including greater access and utilization of care, healthcare affordability, and even improvements to states’ economies. One study from the National Bureau of Economic Research in 2019 suggested that thousands of lives — around 19,000 in total — have been saved due to states deciding to opt into expanding their Medicaid programs through the ACA. Conversely, around 15,000 lives have been lost because states have refused to accept funding to expand their programs, that same study found.

    This post was originally published on Latest – Truthout.

  • Democrats Propose Medicare for a Few More Instead of Demanding Medicare for All

    President Joe Biden speaks briefly to reporters after having lunch with Senate Democrats at the U.S. Capitol on July 14, 2021, in Washington, D.C. Biden came to the Hill to discuss with Senate Democrats the $3.5 trillion reconciliation package that would boost Medicare spending.

    Health care activists were uniformly disappointed, albeit not surprised, when President Joe Biden, in initially proposing the American Families Plan, failed to include in the legislation his major campaign promise to prioritize expanding Medicare.

    The response from Democrats was as swift as it was tepid. Instead of fighting for real health care reform, the House and Senate wrote letters respectfully requesting the administration to tweak the plan around the edges: lower the eligibility age for Medicare from 65 to 60; decrease prescription drug costs; place an out-of-pocket cap on health care costs; and expand coverage to include dental, vision and hearing.

    The letter failed to acknowledge the administration’s own desire to make increases to the Affordable Care Act’s health insurance exchange subsidies permanent, not to mention expanding Medicare to cover everyone, and include all medically necessary services, prescription drug coverage and long-term care. This should be what Congress is fighting for as COVID-19’s Delta variant brings the pandemic raging back with a fourth wave. Shamefully, they are not.

    Why are progressive Democrats proposing such incrementalist reforms? What does this signify for Medicare for All supporters, and what are the prospects for such a program in the future? Rather than inspire, Democrats scold and deflate the energy necessary to win. Rather than organize, they ask for crumbs, get even less, and then blame activists for not supporting their “leaders’” plans.

    Even the $3.5 trillion package Democrats are assembling, which addresses some health care concerns, still falls far short of what is needed to save a health care system besieged by a pandemic.

    Weak Proposals Leave Much on the Table

    Lowering the eligibility age to 60 sounds good. After all, it would add 23 million Americans to Medicare. However, of those, 75 percent already have private health insurance, 12 percent have Medicaid and 7.8 percent are uninsured. In other words, only 1.8 million individuals in this age group would gain health coverage that do not already have it. The proposal is even weaker than Hillary Clinton’s in 2016, when she offered to lower the age to 50 or 55 even without the presence of a global pandemic.

    It is unclear what the bulk of the new beneficiaries, over 17 million individuals who have private health insurance through their employers, would choose to do. Do they buy supplemental coverage, or will they become cherry-picked by Medicare Advantage plans?

    The Office of the Inspector General reported that private Medicare Advantage plans continue to inflate risk-adjustment payments, cheating tax payers out of billions of dollars every year. Medicare Advantage companies, ready to enroll a healthier, younger group, are watering at the mouth with yet another proposal to increase profits and continue to drain the Medicare Trust Fund. (We are told funding will not come from the Trust Fund, although it is unclear how that would work.)

    Are Democrats using tax dollars to expand Medicare simply to increase profits of corporations? Is this the message they want to send to the public as we gear up for midterm elections?

    Equally unknown is what would happen to the 3 million people on Medicaid who would be newly eligible for Medicare. True, these low-income beneficiaries will have access to broader networks under traditional Medicare, but will certainly be exposed to more out-of-pocket costs, including premiums, deductibles, co-pays, prescription drug costs, and for some, a lack of dental, hearing or vision coverage.

    Only a criminal health care system would deny dental, vision and hearing coverage at the time in one’s life when these are needed the most. No doubt Medicare needs to be improved, but this incrementalist approach makes it harder to mobilize a public that supports improved and expanded Medicare for All.

    A program that only produces a small (and questionable) net gain of coverage for some, leaves the majority of the population without any incentive to join the fight. The July 24 rallies in over 50 cities, largely shunned by Democrats and corporate media, show people are ready to move for Medicare for All, not Medicare for a Few More.

    The Fight That Will Mobilize the Nation

    Democrats’ request, which the president agrees with, states that Medicare should have the power to negotiate with pharmaceutical companies and maintain the savings that would be achieved by such price negotiations — up to $450 billion over a decade — to pay for the improvements and expansions to Medicare. Sen. Bernie Sanders and 16 other Democratic senators write that their demands present “an historic opportunity to make the most significant expansion of Medicare since it was signed into law.”

    Really? Democrats can make this a truly historic opportunity by doing everything they can to instead pass the Medicare for All Act of 2021, which would establish a national health insurance program for all U.S. residents from birth or residency; cover all medically necessary services including inpatient, outpatient, prescription drugs, mental health and substance use services, reproductive health care, gender-affirming care, dental, vision, hearing, physical therapy and long-term care; eliminate all premiums, deductibles, co-pays and co-insurance; abolish obscene profit-making from our health care system; reduce classism and racism by eliminating a means-tested program for the poor; save over 68,000 lives every year; eradicate medical bankruptcy; and save $458 billion every year.

    Passing H.R.1976, the Medicare for All Act of 2021, is the kind of history-making this country needs from Democrats right now. The pandemic is still here, and we cannot delay any longer.

    This post was originally published on Latest – Truthout.

  • The child tax credit is blowing up on TikTok. That should tell lawmakers something.

    The videos of parents getting their checks aren’t just a fun meme — they suggest a path for making the one-year policy permanent.

    By: Dylan Matthews

    Enter the child tax credit, which was greatly expanded temporarily in President Joe Biden’s American Rescue Plan, with monthly payments hitting households starting on July 15. The sudden deposits — of up to $250 per child ages 6-17, and $300 per child under 6 — were such a delight to many parents that the hashtags #childtaxcredit and #childtaxcredit2021 blew up on TikTok, with tens of millions of views under each as of this writing.

    Paul Williams, an economist and writer, has been compiling some of the best posts (many incorporating Usim E. Mang’s popular “Alors on Danse” dance) in a Twitter thread.

    I’m partial to @yellowha’s mother-son version:

    https://twitter.com/i/status/1415785452498563074
    https://twitter.com/i/status/1415788867647643650

    And the account @wifeandmomlife’s, set to the soul classic “Bound” by the Ponderosa Twins Plus One:

    https://twitter.com/i/status/1415784531009937413
    https://twitter.com/i/status/1415784605425221634

    This is a continuation of a trend we also saw with the stimulus checks of April 2020, December 2020, and March 2021 — when the government sends out cash like this, outside of the normal tax return process and to a larger population than those affected by programs like SNAP/food stamps or Section 8 housing vouchers, that policy penetrates the public consciousness. The checks get memed. People post dance videos about them.

    As someone who supported those stimulus payments, and strongly supports making the new child tax credit payments permanent and easy to access, this is tremendously encouraging stuff. It implies that check-based programs can avoid some of the worst pathologies of American government, and unlock one of the most powerful, and positive forces in politics: policy feedback.

    Checks are moving us past the submerged state

    Usually, when the US government decides to help people, it does so in a veiled, even inscrutable way.

    Take housing. There is no government agency whose website you can go to, fill out a form, and receive, say, a $10,000 check to help you with a down payment for a house.

    Instead, there are obscure measures and opaque institutions that aim to help. There’s the Federal Housing Administration, which insures some mortgages in the hope of making it easier and cheaper for homebuyers to get a loan. That agency runs two quasi-governmental corporations, Fannie Mae and Freddie Mac, that bundle mortgages and sell them to investors, in the hope of indirectly making your mortgage cheaper. It also offers a tax deduction for your mortgage interest, once you buy a house — but only if you itemize your deductions.

    That system of indirect government interventions that are obscure or invisible to the average citizen are part of what Cornell political scientist Suzanne Mettler calls “the submerged state.”

    The obscurity of the submerged state, Mettler argues, has major costs for our democracy. It erodes public belief in the effectiveness of government by hiding from view the government benefits voters receive.

    Another example: Middle-class Americans who got subsidized student loans to pay for college, and deduct mortgage interest from their taxes, are getting government benefits, too — but those benefits aren’t perceived the same way as, say, Social Security.

    In addition to keeping government’s role in improving lives hidden, the submerged state has another major cost. Georgetown political scientists Don Moynihan and Pamela Herd have argued compellingly that submerged state-like schemes impose major “administrative burdens” on low-income people, from work requirements in programs like food stamps to the burden of navigating the earned income tax credit’s complex parameters.

    Johns Hopkins’s Steven Teles has called this problem “kludgeocracy” — a government held together through “inelegant patch[es] put in place to solve an unexpected problem” rather than designed to work cleanly from the start. Teles argues this piecemeal approach also leads to exorbitantly high compliance costs, makes government administration more difficult, and makes it easier for businesses to extract rents from the government.

    This problem has, for years, been a major concern for people who study American government.

    What’s striking about the child tax credit expansion, and the stimulus checks before it, is how completely it rejects the submerged state model. The payments are not hidden or obscure to their beneficiaries: They take the form of a big fat check in the mail, or a big, sudden deposit in your bank account. The IRS also mailed recipients letters explaining they were going to get the money.

    What’s more, the payments all happen at once, making them a natural thing to post about on social media, where your friends will be going through the same thing and find it relatable.

    This is not, of course, to say that the rollout of the child tax credit was perfect. The system for signing up people who don’t file taxes was far too difficult to use. But the process has been much more accessible than most government programs. If something’s a meme on TikTok, it pretty much definitionally is not part of the submerged state.

    How policies can create new constituencies

    Precisely because the child tax credit expansion is not very submerged, it could unlock political dynamics that allow it to survive past 2021. This gets at a powerful and intuitive idea from political science: policy feedback.

    Berkeley political scientist Paul Pierson, in his classic 1994 book Dismantling the Welfare State? and 1996 paper “The New Politics of the Welfare State,” has demonstrated that once a welfare policy is enacted, and enough people who benefit from it are aware of it and able to defend it, that policy can be quite difficult to roll back.

    “People who are receiving benefits, they’re going to react pretty strongly to that being taken away from them,” Pierson told me in 2017, when precisely these dynamics were stopping Republicans from repealing the Affordable Care Act. “A taxpayer is paying for a lot of stuff and cares a little bit about each thing, but the person who’s receiving the benefits is going to care enormously about that.”

    There’s reason to think this dynamic has cooled a bit in recent years, as parties have become more ideologically intense and polarized. While the Affordable Care Act was not repealed, in large part because seven Senate Republicans were unwilling to repeal the ACA’s expansion of Medicaid coverage, it still came close, which never happened to earlier programs like Social Security or Medicare.

    Now, the child tax credit expansion is set to expire within a year. Given its tremendous impact on child poverty, making it permanent should be a priority for Democrats. Considering how polarized Congress is, and its status quo bias, one shouldn’t be too confident about the prospects of a permanent expansion.

    That said, a policy with a strong, vocal base of beneficiaries who can advocate for it is a strong policy. And, in total seriousness, the TikTok memes about the child tax credit give me hope that the policy is building that kind of base of support. Look at how delighted all these parents are — and just think how furious they’d be to have this support taken away.

    The post The child tax credit is blowing up on TikTok. That should tell lawmakers something. appeared first on Basic Income Today.

    This post was originally published on Basic Income Today.

  • Democrats Seek Workarounds to Republican Resistance on Medicaid Expansion

    Sen. Raphael Warnock speaks at a rally outside the Supreme Court in Washington, D.C., on June 9, 2021.

    Over the course of the COVID-19 pandemic, Southern states have been among those that have done the least to protect their residents from contracting the deadly virus.

    They were some of the last to impose mask mandates and among the first to reopen after temporary shutdowns. And many sectors in the region, like poultry processing, never shut down at all. That makes it particularly striking that essential workers in Southern states disproportionately fall in the Medicaid coverage gap. Not provided health insurance through their jobs and unable to afford it in the private market, these workers risk their lives to keep the economy running — and disproportionately die in the process. Eight of the 12 states that have refused to accept federal funds to expand Medicaid under the Affordable Care Act are located in the South: Alabama, Florida, Georgia, North Carolina, Mississippi, Tennessee, Texas, and South Carolina. All have Republican-controlled legislatures.

    A recent report by the Center on Budget and Policy Priorities (CBPP) looked at data from 2019, the year before the pandemic hit, and calculated that over 550,000 people working in essential or frontline industries fall in the Medicaid coverage gap. The states with the greatest number of essential workers in the coverage gap are Texas (209,000) and Florida (98,000) — GOP-led states that have had notoriously ineffective public health responses to the COVID-19 pandemic. In total, over 2 million people living in Southern states fall into the gap.

    “A large body of research demonstrates that Medicaid expansion increases health insurance coverage, improves access to care, provides financial security, and improves health outcomes,” the report states.

    CBPP also documented glaring racial disparities, finding that people of color make up 60% of those in the Medicaid coverage gap even though they account for only 41% of the non-elderly adult population in non-expansion states. In Texas, 74% of those in the coverage gap are people of color, while Black people account for a majority of people in the coverage gap in Mississippi and 40% in Georgia and South Carolina. At the same time, people of color face a higher risk of COVID-19 infection, hospitalization, and death.

    The report notes that about three in 10 adults in the coverage gap have children at home. And a third are women of childbearing age, meaning that if they get pregnant they can apply for existing Medicaid coverage. However, the coverage would not begin until they are determined to be eligible, meaning they could miss out on critical prenatal care during the first months of pregnancy. CBPP points to an Oregon study that found Medicaid expansion was associated with an increase in early and adequate prenatal care.

    In addition, CBPP calculates that about 15% of people in the Medicaid coverage gap have disabilities. That includes 7% with serious cognitive difficulties, and more than 6% who have difficulty with basic physical activities such as walking, climbing stairs, carrying, or reaching.

    In the years leading up to the pandemic, states that expanded Medicaid cut their uninsured rates by half. That made them better prepared for both the ensuing public health crisis and consequent economic downturn, which resulted in an estimated 2 million to 3 million people nationwide losing employer-based coverage between March and September.

    Efforts are now underway in the Democratic-controlled Congress to find a way to bring Medicaid to more essential workers — and Americans in general — despite Republican resistance at the state level.

    U.S. Rep. Lloyd Doggett, a Texas Democrat, recently proposed the “Cover Outstanding Vulnerable Expansion-Eligible Residents (COVER) Now Act.” The bill, which already has over 40 cosponsors, would authorize the federal Centers for Medicare and Medicaid Services (CMS) to work directly with counties, cities, and other local governments to expand Medicaid coverage in states that have refused to do so. It’s based on previous successful demonstration projects in several counties in California, Illinois, and Ohio, and it’s won the endorsement of groups including the American Diabetes Association, National Alliance on Mental Illness, and the Texas Academy of Family Physicians.

    “The COVER Now Act empowers local leaders to assure that the obstructionists at the top can no longer harm the most at-risk living at the bottom,” Doggett said in a statement.

    And over in the Senate, Raphael Warnock of Georgia this week announced that he is drafting a proposal that would bypass his state’s Republican leadership while calling on the White House to include a “federal fix” in the next jobs package. Warnock told reporters that he’s hoping to introduce legislation soon. The Georgia Recorder has reported that Gov. Brian Kemp (R) is pushing a plan to expand Medicaid to about 50,000 additional Georgians, but the Biden administration has put the brakes on it over concerns that it requires participants to rack up 80 hours of work, school, or other qualifying activity every month to gain and keep their coverage.

    In a letter sent last month to Senate Majority Leader Chuck Schumer of New York and Minority Leader Mitch McConnell of Kentucky, Warnock and U.S. Sen. Jon Ossoff of Georgia suggested that one possible solution could be a federal Medicaid look-alike program run through the CMS.

    “We have a duty to our constituents and a duty to those suffering from a lack of access to health care to provide for them when they are in need,” Warnock and Ossoff said in the letter. “We can no longer wait for states to find a sense of morality and must step in to close the coverage gap and finally ensure that all low- and middle-income Americans have access to quality, affordable health care.”

    This post was originally published on Latest – Truthout.

  • Why Cash Is Better Than Expanded Health Insurance for the Poor

    Cash transfers go directly to people in need, while health insurance expansions pay mainly for care that the uninsured already receive, an economist says.

    By: Amy Finkelstein

    The Biden administration is moving in a new direction. It is trying to help low-income Americans by pushing for direct cash assistance in addition to expanding health insurance.

    Each is a laudable goal. But doing both at once may not be feasible, as lawmakers raise concerns about the total price tag of Biden’s plans.

    If the administration has to make hard choices, it can do more to help the poor by prioritizing cash transfers over expanded health insurance. That’s because cash helps recipients directly, while health insurance would pay mainly for care that many uninsured people were already receiving at low or no cost.

    For over a decade, health insurance expansions have dominated the budget and politics of legislation directed toward the poor. In 2019, the government spent more than $600 billion on Medicaid — the major health insurance program for low-income Americans. This was more than 10 times the amount spent on the largest cash transfer program, the earned-income tax credit.

    By contrast, the $1.9 trillion rescue legislation enacted in March brought a welcome shift in focus toward cash benefits. Among its temporary provisions were about $100 billion in increased payments to low-income families with children and $15 billion in stepped-up wage subsidies for low-income workers, overshadowing the approximately $35 billion in new spending for health insurance.

    The evidence indicates that for the low-income recipients of these programs, cash transfers will provide a greater bang for the government’s buck. Two separate studies that my collaborators and I conducted found that, on average, low-income adults would benefit more from a dollar in cash than a dollar of government spending on health insurance.

    These kinds of comparisons are inherently difficult. One approach we took to measuring the value of health insurance to recipients was to see how much they were willing to pay for it. Another was to estimate the effects of such insurance on their lives, like improved health and increased economic security. Neither approach is airtight.

    But they gave very similar answers: The benefit of Medicaid coverage received by a newly insured adult is less than half what that coverage costs taxpayers, which is about $5,500 a year.

    The reason is simple: The uninsured already receive a substantial amount of health care, but pay for only a very small portion of it, especially when their medical bills are high.

    We have estimated that 60 percent of government spending to expand Medicaid to new recipients ends up paying for care that the nominally uninsured already receive, courtesy of taxpayer dollars and hospital resources. In other words, from the recipient’s perspective the alternatives are $5,500 in cash or only about 40 percent of that — $2,200 — in health insurance benefits, on top of the care they were already receiving.

    The United States has a longstanding tradition of providing free medical services to the indigent. Hospitals emerged in the 18th century largely to care for those with no other sources of help. In modern times, federal and state governments have enacted a grab bag of policies to help defray some of the costs incurred by hospitals and clinics in providing humanitarian care.

    The result is today’s health care safety net for the uninsured. It is grossly inadequate and inefficient. It needs a radical overhaul.

    But in the meantime, the direct benefits from expanding insurance to the low-income uninsured are, paradoxically, limited by the imperfect patches currently in place. Hospitals are major beneficiaries of health insurance expansions, which reduce their financial burdens and increase their profit margins.

    Health insurance has always been an important financial tool for hospitals. During the Great Depression, they pioneered the first widespread health insurance in the United States to help ensure payment for provided care.

    More recently, in 2006, when Senator Mitt Romney was the Republican governor of Massachusetts, he embraced the state’s health insurance expansion — which became the blueprint for Obamacare — as a way to reduce the costs that uninsured patients imposed on hospitals and taxpayers. Hospitals later used similar logic in lobbying for Medicaid expansions under Obamacare and against their repeal.

    Of course, the newly insured have also benefited greatly from health insurance expansions. On this point, the evidence from Obamacare is in, and the research results are clear: Medicaid coverage is better than the safety-net care available to the uninsured.

    Studies have shown that the health insurance expansions under Obamacare saved lives. They also increased access to medical care and reduced medical debt, which can impose substantial financial and emotional pain on patients and their families, even though most of it is never repaid. Covering some of the remaining 30 million Americans who are still uninsured would most likely produce similar benefits.

    But people in need also benefit greatly from cash. And there is evidence that cash transfers can also save lives.

    In addition, a large body of work shows that wage subsidies to low-income workers with children help lift their families out of poverty, increase economic self-sufficiency, and improve their health and well-being.

    A recent experiment found that wage subsidies very similar to the ones that were temporarily expanded in March also increase employment and earnings for low-income adults without dependent children. Likewise, direct cash transfers provide important benefits to families and their children, whose academic achievement and physical and mental health can improve as a result.

    In an ideal world, everyone would have health insurance and sufficient income. But in the real world, budgetary and political constraints often force wrenching trade-offs.

    There are powerful moral imperatives for making sure that everyone has adequate medical care, as well as sufficient income for their nonmedical needs. It’s hard for economists to weigh competing moral imperatives.

    But we can, at least, stack dollars on scales. And the good done by cash transfers tips the scale in their favor.

    The Biden administration is now trying to make permanent its temporary expansions of both cash subsidies and health insurance. If forced to prioritize how best to help those who are struggling economically — either because of the coronavirus pandemic or from longer-term, structural obstacles — it’s time to recognize that cash is more effective than insurance.

    __________________________________________

    Article originally appeared in New York Times: https://www.nytimes.com/2021/05/13/business/health-insurance-cash-Biden.html

    The post Why Cash Is Better Than Expanded Health Insurance for the Poor appeared first on Basic Income Today.

    This post was originally published on Basic Income Today.

  • Missouri GOP Lawmakers Block Expansion of Medicaid, Despite Voter Referendum

    The Missouri state flag is seen flying outside the Missouri State Capitol Building on January 17, 2021, in Jefferson City, Missouri.

    Republican lawmakers in Missouri are refusing to fund an expansion of the state Medicaid program that constituents approved in a vote last year, a move that will likely spur legal challenges in the months ahead.

    In August, voters in Missouri were asked whether they supported expanding Medicaid eligibility as laid out in the Affordable Care Act (ACA). Though the vote was somewhat close, more than 53 percent of voters said they supported the expansion, with less than 47 percent saying they opposed it.

    The expansion would cover an additional 230,000 residents of the state, Politico reported at the time.

    Thirty-nine states and D.C. have adopted measures to expand Medicaid since the ACA became law in 2010, with 12 states refusing to do so. Of those 39, however, two states — Oklahoma and Missouri — adopted expansion through a referendum vote but have not implemented it yet.

    In spite of the outcome of the ballot initiative, Republican lawmakers last week stripped provisions from the state budget that would fund the expansion, essentially defying the will of voters.

    During debate on the provision last week, some Republicans said that it was up to Missourians themselves to get insured through their places of work, implying that increasing Medicaid expansion would encourage laziness in the workforce.

    “I’m sorry, if you’re a healthy adult, you need to get a job,” State Senator Andrew Koenig, who leads the Ways and Means Committee in Missouri, said.

    Democratic lawmakers blasted Koenig’s assertions as out of touch with reality, noting that many who would qualify under the expansion of coverage are employed.

    “We have a working class that cannot afford for-profit health insurance, and I’m one of those people, that could be one illness or one injury away from bankruptcy,” Democratic State Senator Brian Williams retorted. “And those are people who go to work every single day.”

    Koenig also ignored the fact that not everyone with a job gets insurance, as only 52 percent of the workforce in Missouri currently receives employer-based health insurance. Meanwhile, more than 1-in-10 residents (10.1 percent) are uninsured, higher than the national rate (9.2 percent), a gap that could be closed by increasing eligibility requirements for Medicaid.

    Others in the GOP have attempted to frame the issue as a fiscal problem. In an interview that was published over the weekend, Senate President Pro Tempore Dave Schatz, a Republican, complained that the expansion of Medicaid was too expensive to push forward on.

    “The social services, senior services, that portion of the budget is about 46 percent of our state’s budget,” Schatz said. “That’s a very, very large program, and continues to grow.”

    Increasing the number eligible to the program would only cost a small fraction of the state’s budget — about $1.9 billion in total (Medicaid spending in Missouri is about $10.1 billion). Of that amount, more than 9-in-10 dollars would be provided by federal funds, with the state only paying for $130 million in additional costs.

    The expansion of eligibility for all residents with household incomes at or below 138 percent of the federal poverty level would be a drastic change for the state. Currently, Missouri doesn’t allow any childless adults to qualify for its Medicaid program, and families with children can only qualify if they make less than 21 percent of the federal poverty level. For a family with two parents and a single child, for example, eligibility is cut off after the household income exceeds $5,400 per year.

    Gov. Mike Parson, a Republican, has the final say on whether the eligibility requirements will be expanded starting on July 1. In a tweet discussing the issue, Parson indicated his office was still undecided.

    “We will assess our options and legal requirements on how to move forward with Medicaid expansion, once the budget is finalized,” Parson wrote.

    If Parson doesn’t expand eligibility requirements, it will likely lead to lawsuits from those who expected to be eligible as a result of the referendum last year, said Jim Layton, a former official within the state’s attorney general’s office.

    “The [state] constitution says people up to this level of income qualify in Missouri for Medicaid and that’s just what we have to live with,” Layton said in an interview with Fox 4 in Kansas City this past week. “The question will be when someone gets online or goes in an office on July 1 and says, ‘I wasn’t eligible on June 30 but today I’m eligible.’”

    This post was originally published on Latest – Truthout.

  • Biden Urged to Withdraw All Trump Era Medicaid Work Requirements

    Seema Verma, administrator of the Centers for Medicare and Medicaid Services, speaks as President Trump listens on November 20, 2020, in the Brady Briefing Room of the White House in Washington, D.C.

    While the White House in recent weeks has taken steps to overturn a Trump-era initiative enabling states to restrict Medicaid eligibility by imposing punitive work requirements, healthcare advocates on Monday urged President Joe Biden to rescind all Medicaid work requirement policies approved by his predecessor.

    In 2018, Seema Verma, then-director of the Centers for Medicare and Medicaid Services under former President Donald Trump, issued guidance allowing states to apply for a waiver to significantly alter eligibility requirements for Medicaid, a Great Society-era program on which more than 72 million low-income adults, people with disabilities, and children rely for health insurance.

    Several Republican-led states quickly jumped at the offer to strip healthcare away from poor and vulnerable Americans, and the Trump administration ultimately approved policies to “take Medicaid coverage away from people who don’t comply with stringent work requirements” in 13 states, as Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities (CBPP), noted Monday in a blog post.

    While litigation and the coronavirus pandemic have put the implementation of work requirement policies “on hold,” Wagner stressed that “taking coverage away from enrollees or otherwise conditioning coverage on meeting a work requirement doesn’t further Medicaid’s purposes,” which exists to provide healthcare to the impoverished. “Accordingly,” she added, “the Biden administration should now withdraw all of the previous approvals.”

    The White House in February invalidated the previous administration’s guidance allowing states to apply for Medicaid eligibility restriction waivers and notified states that had already been given permission to impose work requirements that the policies would soon be reversed due to the detrimental impact of coverage loss on Medicaid recipients, particularly during the pandemic, as Common Dreams reported at the time.

    Last month, the Biden administration told Medicaid officials in New Hampshire and Arkansas — which was the first and only state to fully implement Medicaid work requirements, taking healthcare away from at least 18,000 people over a period of several months in 2018 — that approval for their work requirement policies had been rescinded.

    While “Georgia, Indiana, Nebraska, Ohio, South Carolina, and Utah have objected” to Biden’s efforts to dismantle Medicaid work requirements, Wagner reiterated that “the administration should nevertheless continue with its plan.”

    Wagner continued: “The Trump administration claimed that requiring work or other activities as a condition of coverage would ‘improve beneficiaries’ health,’ ignoring evidence from other programs suggesting these restrictions would significantly harm Medicaid enrollees. After states began implementing these policies, their experiences confirmed the harmful effects of work requirements.”

    Citing a new analysis from the Department of Health and Human Services, Wagner wrote that “these policies are deeply harmful to Medicaid enrollees and confirms that they don’t promote Medicaid’s objectives.”

    Referring to the 18,000 Arkansas residents who lost Medicaid coverage in 2018, Wagner said that “uninsurance rates among people subject to the work requirement rose, but their employment rates didn’t.”

    Arkansans “who lost coverage were more likely to have chronic conditions, and many had difficulty paying their medical bills and accessing healthcare and medications,” she continued. “Data from New Hampshire and Michigan also show a significant loss of coverage would have occurred if the states’ work requirement policies had been implemented, largely due to enrollees’ limited awareness of the policies and challenges in reporting compliance.”

    “The evidence of the detrimental impact of work requirements from Arkansas, New Hampshire, and Michigan demonstrates that other state policies would face the same challenges and harmful consequences,” she added. “All policies that take away coverage from people not meeting work requirements are marred by complex rules about who is exempt and what activities count, challenges communicating with enrollees, and burdensome paperwork and reporting requirements. These policies inevitably lead to eligible enrollees losing coverage — work requirements can’t be fixed.”

    According to Wagner, “There’s nothing left to demonstrate by letting more states take risks with Medicaid enrollees’ health. The Centers for Medicare and Medicaid Services should withdraw all waiver authority for policies that take coverage away from people not meeting work requirements or otherwise condition coverage or benefits on meeting them and make clear that these policies won’t be allowed in Medicaid.”

    This post was originally published on Latest – Truthout.

  • Across the Country, Republican Legislatures Are Keeping Trump’s Agenda Alive

    Donald Trump

    GOP state lawmakers across the country are pushing a tidal wave of anti-progressive bills addressing cracking down on voting, protesting, pandemic management, Medicaid expansion, and transgender protections.

    In Arkansas, Gov. Asa Hutchinson signed a new law on Thursday banning transgender women and girls from competing in school sports teams that correspond with their gender identities. A trio of Iowa GOP lawmakers introduced a bill in the same spirit, but quickly withdrew it from consideration last week. The Iowa bill would have required students to present signed statements from licensed doctors confirming their biological sex before being admitted to any sports team. On Monday, North Carolina hopped on the anti-trans bandwagon, with lawmakers introducing a bill that would apply similar restrictions on transgender students in middle and high school. Mississippi and North Dakota passed similar laws last month.

    Activists say that the Republican state-level pushback indicates a “coordinated attack” against the transgender community. Opponents of equality failed to claw back marriage equality and failed in their push for bathroom bills,” the Human Rights Campaign said in a statement. “These bills are not addressing any real problem, and they’re not being requested by constituents. Rather, this effort is being driven by national far-right organizations attempting to sow fear and hate.”

    State Republicans have also taken aim at public demonstrations in the wake of the George Floyd protests, which triggered a cascade of vague handwringing from GOP lawmakers about so-called “left-wing violence.”

    On Thursday, the Florida House opened debate on H.B. 1, a bill that would strengthen penalties against rioters by designating misdemeanors as felonies. “We’ve proposed the strongest anti rioting, pro-law enforcement reforms in the nation,” Florida Gov. Ron DeSantis said to lawmakers earlier this month. “We will not allow our cities to burn and violence to rule the streets, and we will not leave any doubt in the minds of those who wear the uniform that the state of Florida stands with you.”

    Opponents of the bill have railed against its overbroad definition of “riot,” stressing that it would heighten the potential for police violence by expanding the circumstances in which the use of force is warranted. The Florida bill was preceded by a flurry of similar anti-protests bills introduced in state legislatures immediately after the Capitol riot, according to The Intercept. At the time of the report’s publication, at least nine states were considering 14 anti-protest bills.

    In Georgia, a bill currently under review increases penalties for anyone that commits a crime during a protest. A Kentucky bill would criminalize insulting a police officer.

    Republican state officials have also systematically blocked any expansions to Medicaid.

    In Missouri, the House Budget Committee voted along party lines to impede a bill that allowed the state to spend respectively $130 million and $1.6 billion in state and federal funds in order to bolster Medicaid, a move that would allow 230,000 uninsured low-income Missouri residents to get coverage. Although Missouri voters approved the measure on a ballot question last August with a 53% majority, Republicans have argued that the cost of expansion would be too high, even though the Affordable Care Act already covers 90 percent of the cost. Mississippi is pulling a similar stunt, as Salon reported last week. The Magnolia State’s governor, Tate Reeves, signaled on Mar. 14 that he would not expand the state’s Medicaid program, even though the move would make the state eligible for a 15% federal match in funding. As already noted, since the Affordable Care Act already covers 90% of the cost, the governor is effectively turning down a 105% match, or 5% credit.

    Many states are also facing a severe curtailment of voting rights.

    On Wednesday, Michigan Republicans filed 39 election reform bills with proposals that would, among other measures, require voters to request absentee ballots, prohibit online absentee voting, and bar clerks from providing prepaid return postage on absentee ballots. State Democrats have demurred the bills as both undemocratic and racist, as they would disproportionately affect low-income people of color.

    Earlier this month, the Georgia state legislature passed a similar bill that, as Salon reported, would “limit Sunday voting to a single day, restrict mail ballot drop boxes to early voting locations, require voter ID for mail ballots, set the deadline for voters to request mail ballots to 11 days before the election, and cut the amount of time between general elections and runoffs from nine weeks to four.” Former gubernatorial candidate Stacey Abrams, D, said the bill likens “post-Reconstruction Jim Crow-era laws.” Texas also joined the fold last week by introducing a new wave of voting restrictions that would prohibit drive-thru voting, restrict voting machines at polling centers, slash early voting hours, and more.

    Other states around the country are continuing to undermine federal public health guidance as the pandemic wanes. Ohio’s state legislature, for example, voted on Wednesday to limit the ability of Gov. Mike DeWine, R, to issue public health orders. DeWine has argued that the move “jeopardizes the safety of every Ohioan” and “restrict local health departments’ ability to move quickly to protect the public from the most serious emergencies Ohio could face.”

    This post was originally published on Latest – Truthout.

  • 20 Rural Hospitals Closed in 2020. 13 Were in the South.

    The closures will leave many rural communities without their primary employer and main economic infrastructure.

    For the Southwest Georgia Regional Medical Center, the last straw was the COVID-19 pandemic, which strained the critical access hospital’s already-precarious finances past the breaking point. In Florida, two hospitals closed inpatient non-emergency services after being bought out by the HCA hospital chain. In Tennessee and West Virginia, financial problems combined with the strain of the pandemic led two more rural hospitals to shut their doors.

    Of the 20 rural hospitals that closed in 2020, 13 were in the South, according to data from the Sheps Center at the University of North Carolina at Chapel Hill, which defines a closed hospital as one that no longer offers inpatient services. Tennessee was the Southern state most affected, losing four rural hospitals last year alone.

    “One person mentioned that right now, the nearest hospital is 25 miles away. And the community is deflated and angry, because it feels like nobody cares if they die,” said Kinika Young, the senior director of health policy and advocacy at the Tennessee Justice Center, which last fall conducted a phone survey of rural communities that had lost or were at risk of losing a hospital.

    Rural health care providers in the South, and across the nation, warned from the onset of the COVID-19 pandemic that they were financially vulnerable, as Facing South reported a year ago. “It is becoming absolutely dire,” Maggie Elehwany, then the government affairs and policy vice president for the National Association of Rural Hospitals, said at the time.

    The factors that lead rural hospitals to close are complex, and they can vary from community to community. Rural communities themselves are diverse in population, needs, and infrastructure. “There’s just all kinds of ways, from the demographics to the economics to the existing infrastructure to the geography, that will make needs differ,” said George Pink, a professor at UNC-Chapel Hill’s Department of Health Policy and Management and a senior research fellow at the Sheps Center. Because of this, he said, there’s no silver bullet policy solution that will fix rural health care’s precarity problem. Instead, he said, it will take a combination of federal and state policy initiatives, and more research on what works and what doesn’t.

    The South’s rural hospitals have long been among the most vulnerable to closure, in part because the region’s rural populations have particularly high rates of poverty and uninsurance. There are racial disparities, too: A 2015 Sheps Center report found that hospitals were more likely to close entirely, with no outpatient care provided, in markets with higher proportions of Black patients. Just five Southern states have expanded Medicaid, the joint federal-state health care program for people living in poverty, which many advocates believe is one of the most effective steps a state can take to avoid losing rural health access.

    “In states that have expanded Medicaid, the rate of rural hospital closures is six times less than in states that haven’t expanded,” said Young, citing findings from a 2018 study. “Positioning Medicaid expansion as a potential solution to the struggles that rural hospitals are facing has been a big rallying cry” for groups like the Tennessee Justice Center, she said.

    The American Rescue Plan, the COVID-19 stimulus package signed into law earlier this month, incentivizes states that have not yet expanded Medicaid to do so by increasing their reimbursement from the federal government for two years. An National Law Review analysis of the legislation found the slight increase probably won’t be enough incentive for non-expansion states to expand Medicaid. “However, ballot initiatives, a change in the governor’s mansion, or change in control of the state legislature could lead additional states to Medicaid expansion,” it said.

    In Tennessee, the legislature tried to overhaul the state’s Medicaid program by getting approval from the Trump administration back in January to receive Medicaid dollars through a block grant, giving the state a fixed annual payment rather than open-ended funding in exchange for greater flexibility over the program. It’s an approach favored by conservatives who believe that states freed from strict federal oversight can find ways to provide care more efficiently. But that approval could be rescinded under Biden. And many advocates would rather see the certainty of expansion anyway. The money provided under the block grant approach “just doesn’t add up” to funding available under an expanded Medicaid program, Young said.

    There are three basic sets of factors that tend to make rural hospitals vulnerable to closure, Pink said. First, there are market factors, when a hospital serves a shrinking or highly uninsured population. Then there are hospital factors, when hospitals struggle to recruit or retain employees, contend with old buildings and/or equipment, or struggle with fraud or safety concerns.

    “The most important, though, is the financial bucket,” Pink said. “These hospitals, what they have in common is they tend to have high rates of charity care, of bad debt, they may have substantially high levels of debt, they generally have low profitability over a long period of time, and they just literally run out of cash.”

    The pandemic exacerbated these long-term financial factors. Many states required hospitals to cancel or postpone elective surgeries and other outpatient and primary care visits, which typically make up a major part of hospital revenue streams. Expenses increased because hospitals had to purchase personal protective equipment and ventilators, and in some cases hire temporary staff when others were in quarantine. And hospitals ran out of cash.

    Four of the 13 rural Southern hospitals that closed in 2020 cited financial difficulties worsened by COVID-19 as a reason for shutting their doors.

    These closures will have long-term effects. In many rural communities, hospitals are a primary employer. They support businesses, families, and sometimes the entire economic infrastructure of a rural community.

    “When a hospital closes in a rural community, that’s it. The people in the community don’t have a lot of other options, typically, that they can replace that care with. They’re then traveling 15, 20, 30 miles,” said Pink.

    Young with the Tennessee Justice Center said that the closures tend to have a domino effect. Some of the people her group spoke to during the fall phone survey said that businesses were considering leaving their county, and that even preventative care services were less accessible now that the hospital was gone, she said.

    “People in rural communities don’t want to be forgotten. They have been hit hard by the pandemic because of the geographic isolation and the fact that they were already dealing with lower incomes and less access to care,” she said. “When you add a pandemic on top of that, they’re basically at their breaking point, and they’re looking to their leaders for help, for attention.”

    This post was originally published on Latest – Truthout.

  • The Rise of Healthcare in Steel City

    An interview with Gabriel Winant on deindustrialization, the care economy, and the living legacies of the industrial workers’ movement.

    This post was originally published on Dissent MagazineDissent Magazine.

  • Federalism Is Killing Us

    Deference to state governments has severely undermined public health efforts during the pandemic and deepened geographic inequality in the United States.

    This post was originally published on Dissent MagazineDissent Magazine.

  • How This Country Fails Its Most Vulnerable

    A field guide to our threadbare social safety net. Continue reading

    The post How This Country Fails Its Most Vulnerable appeared first on BillMoyers.com.

    This post was originally published on BillMoyers.com.

  • Biden Plans to Rescind Trump-Era Medicaid Work Requirements

    Administrator of the Centers for Medicare and Medicaid Services Seema Verma listens as President Trump speaks in the Brady Briefing Room at the White House on April 7, 2020, in Washington, D.C.

    The Biden administration on Friday is expected to begin the process of rescinding a Trump policy allowing states to impose punitive work requirements on Medicaid recipients, a move celebrated as a crucial step toward reversing one of the former president’s most vicious attacks on the poor and vulnerable.

    According to the Washington Post, which obtained a draft of the Biden administration’s plan, federal health officials on Friday “will withdraw their predecessors’ invitation to states to apply for approval to impose such work requirements and will notify 10 states granted permission that it is about to be retracted.”

    The brainchild of Seema Verma, head of the Centers for Medicare and Medicaid Services under Trump, the work requirements initiative began in 2018 with guidance allowing states to apply for a waiver to significantly alter Medicaid eligibility requirements. Several Republican-led states quickly jumped at the offer; Arkansas, the first and only state to fully implement Medicaid work requirements, threw at least 18,000 people off the healthcare program over a period of several months in 2018.

    While the destructive efforts of Arkansas and other states were largely stymied by federal court interventions, the Biden administration’s plan to roll back the Trump work requirements guidance was applauded as key progress toward definitively ending one of the former president’s most prominent efforts to strip healthcare from low-income people.

    “We worked so very hard for this,” Matthew Cortland, an attorney and disability rights activist, said of the effort to defeat the work requirements. “We celebrate this win — this win that we made happen — even while mourning the loss of every person who relied on Medicaid and didn’t survive the calamity of Trump’s disastrous administration.”

    Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, argued in a series of tweets late Thursday that “the Trump administration’s Medicaid work requirement policy was never really about work,” noting that “93% of Medicaid beneficiaries who are not on Medicare or SSI are already working, taking care of a family member, going to school, or not working due to illness.”

    “Medicaid work requirements have roots in the ideology that healthcare under Medicaid should be considered welfare for the deserving poor rather than a right,” Levitt added.

    In a last-ditch effort to preserve the work requirements policy during the final weeks of the Trump administration, Verma “asked states to sign contracts that would establish a lengthy process for unwinding work requirements and other conservative changes to their Medicaid programs,” Politico reported Thursday.

    “Medicaid experts have questioned whether those contracts are legally enforceable,” the outlet noted.

    The Biden administration’s plan — which points to the ongoing coronavirus pandemic as a major reason to end the Trump era guidance — will come over a month before the U.S. Supreme Court is set to hear a case on the legality of the Medicaid work requirements. According to the the Wall Street Journal, Biden health officials are “expected to move quickly to end work requirements in Medicaid… because doing so could moot” the Supreme Court case.

    This post was originally published on Latest – Truthout.