Oregon aggressively expanded its Medicaid rolls under the Affordable Care Act, adding enough people to leave only 5 percent of its population uninsured — one of America’s lowest rates.

Now, with the reduction of a federal match that covered those enrollees, the state is calling on voters to decide how to pay for its ballooning Medicaid costs.

A special election on Tuesday asks Oregonians whether they approve of a tax on hospitals, health insurers and managed care companies that would leave Medicaid, as it is now, untouched. More than 1 in 4 residents here rely on it.

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“The Trump administration’s action today is cruel,” said Democratic Congressman Frank Pallone Jr. of New Jersey. The new policy is “the latest salvo of the Trump administration’s war on health care,” according to a health-care advocacy group. “The pain is the point” of the policy, wrote columnist and economist Paul Krugman.

They were attacking the Trump administration’s decision last week to allow states to impose work requirements on Medicaid beneficiaries. But far from being a “cruel” action designed to inflict “pain” on the vulnerable, the administration’s decision is completely reasonable.

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A battle is brewing in the courts over the Trump administration’s move to let states impose work requirements for recipients of Medicaid, the health insurance program for the poor. Advocacy groups are gearing up to sue the administration, arguing that it doesn’t have the power to allow work requirements and other rules for Medicaid without action from Congress.

But the administration is defending the legality of the shift. When unveiling guidance Thursday on the work requirements, top Medicaid official Seema Verma said the administration has “broad authority” under current law to allow states to make changes through waivers.

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A day after the Trump administration announced that it would allow states to compel poor people on Medicaid to work or get ready for jobs, federal health officials on Friday granted Kentucky permission to impose those requirements.

Becoming the first-in-the-nation state to move forward with the profound change to the safety-net health insurance program is a victory for Kentucky’s Republican governor, Matt Bevin, who during his 2015 campaign for office vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.

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In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it is offering a path for states that want to seek work requirements on Medicaid recipients.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people’s lives and in their health.

The administration’s latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on “able-bodied” adults. Technically, those waivers would be “demonstration projects.” In practical terms, they would represent new requirements for beneficiaries in those states.

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Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). On March 14, 2017, the CMS sent a letter to state governors that signaled a willingness to use Section 1115 authority to support work requirements and the alignment of Medicaid programs with private insurance policies.

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Mississippi has received the first-ever 10-year extension of a Medicaid Section 1115 demonstration waiver, allowing the state to continue providing family planning services for people with income of up to 194% of the federal poverty level.

The CMS said the 10-year extension is part of the agency’s effort to give states greater flexibility in running their Medicaid programs, without having to ask the government for frequent approvals. Up to now, the agency typically granted Section 1115 waivers, which are supposed to be budget-neutral for the federal government, for five-year periods.

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California’s “Medi-Cal” program is one of the worst offenders when it comes to controlling costs.  It’s getting worse not better.  In fact, Medi-Cal is such a big spender it begs the question what is driving out of control spending in the Golden State – waste, fraud, abuse, incompetence, or all of the above?  Every taxpayer in America should be asking these questions, as we are all footing the majority of the bill.

Over the past ten years, Medicaid spending in California has almost tripled, growing from $37 billion per year to a whopping $103 billion per year—including both state and federal funding. And things have only accelerated since the state expanded Medicaid to a new group of able-bodied adults.

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Democrats won a wave election in Virginia a month ago, not only winning the gubernatorial race but at least coming close to taking control of the legislature. Recounts are continuing in three races that could put Republicans in the minority, an astounding defeat for a party that assumed that they could maintain their position by doubling down on Donald Trump. Ralph Northam arguably has a broad mandate to pursue the Democratic agenda in the Old Dominion, but he tells the Washington Post that he wants to de-escalate the bitter partisanship first.

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How many individuals would knowingly want to enroll in a form of health coverage with “persistently inferior” outcomes? A new study published in the Journal of the American Medical Association Oncology suggests that Medicaid provides those persistently inferior outcomes in the nation’s largest state of California, raising more questions about the program that represents the bulk of the coverage expansion under Obamacare. Overall, the study found “substantial and persistent disparities in survival for patients with either no or other public insurance compared with private insurance for all five cancer sites examined.”

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