Bishop Frank J. Dewane of Venice, Florida, Chairman of the U.S. Bishops’ Committee on Domestic Justice and Human Development, issued a statement in June about a discussion draft of health reform legislation that was then before the Senate, the Better Care Reconciliation Act.  He praised its life protections: “The Bishops value language in the legislation recognizing that abortion is not health care by attempting to prohibit the use of taxpayer funds to pay for abortion or plans that cover it. While questions remain about the provisions and whether they will remain in the final bill, if retained and effective this would correct a flaw in the Affordable Care Act by fully applying the longstanding and widely-supported Hyde amendment protections. Full Hyde protections are essential and must be included in the final bill.”

The leadership in the Senate, the House, and the White House know that any future health reform legislation must contain these strong life protections.

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Medicaid spending and enrollment has skyrocketed in recent years, crowding out resources for all other state priorities. The number of people dependent on Medicaid has more than doubled since 2000, with nearly 75 million individuals currently enrolled in the program. Nowhere is this growth more evident than among able-bodied adults. Nearly 28 million able-bodied adults are now dependent on the program, up from fewer than 7 million in 2000.

This enrollment explosion is fueling a massive spending surge. Total Medicaid spending has nearly tripled since 2000 and spending on able-bodied adults has increased by a jaw-dropping 700 percent.

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The Trump administration will encourage states to pursue work requirements for certain Medicaid beneficiaries, a top official said Tuesday.

The remarks by Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma would signal a significant departure from the Obama administration’s approach to such requests.

Several states have already proposed work requirements, and Verma’s comments indicate a willingness to fast-track those approvals.

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Voters in Maine approved a ballot measure on Tuesday to allow many more low-income residents to qualify for Medicaid coverage under the Affordable Care Act, The Associated Press said. The vote was a rebuke of Gov. Paul LePage, a Republican who has repeatedly vetoed legislation to expand Medicaid.

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At the core of Medicaid’s troubles is its provider reimbursement system, which is based on price controls. In general, it pays rates substantially less than those of private insurance and can even be less than the cost to deliver that care. According to a Kaiser Family Foundation analysis, in 2016, Medicaid reimbursed physicians across the country 72 percent of Medicare rates for all services and 66 percent of Medicare rates for primary care. In general, Medicare rates are already less than those of private insurance. With noncompetitive reimbursement and the administrative hassle of the program, many providers are reluctant to accept Medicaid patients.
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Republicans and Democrats are engaging in warfare over a traditionally bipartisan program to insure children.

The House Energy and Commerce Committee is marking up legislation to extend the Children’s Health Insurance Program by five years. However, Democrats have objected to the legislation because of measures to pay for the program.

“Here we are with a partisan bill that asks us to pay for coverage of children on the backs of seniors and the most vulnerable among us,” said Rep. Diana DeGette, D-Colo.

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Congress should enact waiver legislation that clarifies the availability of federal subsidies for the purposes of evaluating waivers’ deficit neutrality, including all potential federal spending that could be offset by a waiver, and evaluates its impact over a long (8-10 year) time period after an initial pilot period. Federal “guardrails” to prevent unintended consequences on patient outcomes and the deficit should focus on collecting data on costs and impact on vulnerable populations, while expanding consumer choices around affordable, high quality plan options.
Congress should also instruct HHS to create a set of standardized, expedited waivers that could be quickly approved, to enhance confidence in the process. Congress should also allow states to form multi-state compacts to share costs and develop the necessary implementation infrastructure.
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Only in government does modestly slowing spending growth mean severe “cuts.” Opponents of the Graham-Cassidy-Heller-Johnson (GCHJ) proposal to change ObamaCare falsely claim that it will result in massive spending cuts, especially in Medicaid. That simply is not true.

The bill does not spend fewer dollars. In fact, under this bill, taxpayers will spend more over the next 10 years than they are spending right now. The “severe” change being referenced in almost every news story is a reduction in the rate of growth. Some ObamaCare supporters have even claimed that Congress will be unable to afford the GCHJ block grants.
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Conspicuously absent from most commentary arguing that Kansas should expand Medicaid under the Affordable Care Act is any discussion about the program actually improving the health of recipients. Instead, we are left with terribly materialistic arguments about forgone federal money. Why is it that on the biggest policy questions facing Kansas, such as Medicaid or education, we hear lots about money spent and little about health outcomes or student achievement?
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The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. Congress created the Innovation Center in 2010 to test new approaches or “models” to pay for and deliver health care. The complexity of many of the current models might have encouraged consolidation within the health care system, leading to fewer choices for patients. The Trump administration is analyzing all Innovation Center models to determine what is working and should continue, and what isn’t and shouldn’t. Strengthening Medicare and Medicaid will require health care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs.

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