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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At the 2017 Forbes Healthcare Summit, I interviewed Seema Verma, Administrator of the U.S. Centers for Medicare and Medicaid Services, about her policy agenda. CMS is one of the most important agencies in the federal government, administering programs spending over a trillion dollars a year, including Obamacare.

Our discussion was wide-ranging. Verma spoke about fellow Indianan Alex Azar, President Trump’s nominee for the post of Secretary of the Department of Health and Human Services. She discussed her view of what CMS can do on drug pricing. She talked about the opioid crisis, and how to modernize the Medicare and Medicaid programs and empower patients to take charge of their own health care.

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Maine made history earlier this month by becoming the first state to adopt Obamacare’s Medicaid expansion via ballot initiative. The vote could inspire progressive activists in other states to push for similar referenda.

Expanding Medicaid to cover childless, able-bodied adults would blow a hole in state budgets while yielding few, if any, public health gains. That’s because Medicaid provides such low-quality care that its beneficiaries often experience worse health outcomes than people with no health insurance.

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The Affordable Care Act (ACA) set substantial new federal requirements for health insurance plans and the insurers that provide them. These requirements significantly altered the way insurance is regulated, which was traditionally left to the states. The ACA included in Section 1332 the option for states to apply for a waiver from many of these regulations. However, the myriad stipulations tied to these 1332 State Innovation Waivers limit states’ ability to regain control of their own insurance regulations. Further, states have no guarantee they will be granted a waiver, even if they meet all of the ACA’s requirements for obtaining one.

In response to these issues, two Senate committees have introduced (or at least drafted) legislation that would solve many of the problems that states have had obtaining 1332 waivers. In addition to easing some standards and shortening timeframes for decisions, the bills also provide a standard path for states to gain these waivers in certain circumstances.

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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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