Ohio Gov. John Kasich on Friday said that some of the essential health benefits that had been set up under Obamacare were too limiting to customers, proposing that someone have the option to buy a plan that excludes maternity coverage while explaining his decision to mandate autism coverage in his state.

Kasich, a Republican, was appearing in a panel in Washington alongside Colorado Gov. John Hickenlooper, a Democrat with whom he has been working on an Obamacare stabilization plan to lower the costs of premiums and give customers more choices for health insurance plans.

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The Kaiser Family Foundation’s Larry Levitt says, “States actually have a lot flexibility in theory under current waivers, but the guardrails are very hard to meet, which limits the amount of flexibility in practice.” During the repeal-and-replace effort, Republicans wanted to remove some of those “guardrails”—allowing states to chip away more substantively at some of the law’s benefit mandates and coverage guarantees. Sen. Lamar Alexander, though, is trying to keep his proposal more tailored. He’s focusing more on changes to the process of seeking a waiver than on the substance of what can be waived.

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Donald Trump’s gleeful deal with the Democrats—ratcheting up the debt ceiling, as well as the ire of the Republican establishment—puts John Cogan’s mind on 1972. Starting in February of that year, the Democratic presidential candidates engaged in a bidding war over Social Security to gain their party’s nomination. Sen. George McGovern kicked off the political auction with a call for a 20% increase in monthly payments. Sen. Edmund Muskie followed suit, as did Rep. Wilbur Mills, chairman of the Ways and Means Committee. Former Vice President Hubert Humphrey, never one to be outdone, offered a succulent 25%.

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Major bipartisan accomplishments in federal policy feel like a rarity these days. But it was just over 20 years ago that the parties came together to pass significant, positive reforms to our nation’s cash assistance program for families in poverty. The 1996 welfare-reform law, passed by a Republican Congress and signed by President Bill Clinton, significantly strengthened work requirements in a new program, now known as Temporary Assistance for Needy Families (TANF). In the years following the law’s enactment, child-poverty rates dropped significantly and employment among poor mothers increased, while teen pregnancy and abortion rates continued to fall. Policies that encouraged work succeeded in achieving the intended, positive result: fewer Americans in poverty and more Americans providing for themselves.
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A majority of voters back the idea of tying Medicaid eligibility to employment status as the Trump administration weighs whether to give more states the power to impose work requirements on the government health program.

In an Aug. 10-14 Morning Consult/POLITICO poll, 1,997 registered voters were asked whether they generally support requiring individuals to have a job in order to be eligible for the program. Fifty-one percent of voters said they support that proposal, while 37 percent said they oppose it. The survey has a margin of error of plus or minus 2 percentage points.

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“Medicaid for All” has suddenly become the darling of the health reform crowd. Nevada almost became the first state in the nation to adopt Medicaid for All this year — until Gov. Brian Sandoval vetoed the plan in June. Other states, including Massachusetts and Minnesota, are looking into it.

These Medicaid-for-All plans would let anyone “buy into” the program. Middle-class families could pay government-set premiums for Medicaid coverage. They would get guaranteed health benefits at government-subsidized prices. And given that the program pays healthcare providers less than private insurance, Medicaid for All might even rein in health spending — or so the thinking goes.

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For all the attention on various ways to improve Medicaid’s finances and sustainability in recent months, another key area of Medicaid policy that deserves focus is improving the state waiver process. With all the recent calls for bipartisanship, this should be an area where Democrats and Republicans can work together to improve the program.

Medicaid is a state-federal partnership and a critically-important safety net for millions of our nation’s most vulnerable patients. The program dates back to the Great Society era and will cover up to 98 million people and cost taxpayers more than $600 billion this year alone.

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A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.

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The ACA has expanded funding for Medicaid services, but it has also to an even greater degree expanded the pool of people eligible. It used to be that Medicaid did a fair job of providing for the truly disabled and needy. Now it does a lousy job of serving more people. My wife and I have an adult child living at home and will for the rest of our lives. Please join me in supporting the repeal of the ACA and put Medicaid funding back in the pot for the truly needy and disabled in our society. Our daughter will thank you.

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The GOP’s attempt to repeal and replace the Affordable Care Act has generated intense opposition and run into repeated roadblocks on Capitol Hill, despite advancing many worthy reforms. The proposals are right to allow individuals without pre-existing conditions to obtain insurance from a freely-competitive market, right to shift able-bodied individuals from Medicaid to the exchanges, and right to restructure Medicaid so that the largest share of its funds is not captured by the wealthiest states that need it least.

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