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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Stepping toward the political center in a difficult election year, Gov. Scott Walker proposed using $200 million in state and federal money to stabilize the state’s Obamacare market and hold down rising insurance premiums.
While Republicans nationally talk about tax cuts, Wisconsin’s GOP governor has mixed in proposals on health care, the overhaul of a troubled youth prison and funding schools at levels proposed by a leading Democratic challenger.
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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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State lawmakers in Maryland are looking to replace ObamaCare’s individual mandate, which was repealed by Republicans in Congress last month.
A proposal in Maryland would require people to pay a penalty for not having insurance. The money, though, could be used as a down payment for a health insurance plan.
People would also have the option to pay the penalty and get nothing in return.
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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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Whether it was bracing for a possible repeal of Obamacare or pondering an ambitious single-payer program that would overhaul how California provided medical care to its residents, the issue of healthcare kept politicians and policy wonks busy in 2017.
That’s not likely to let up in 2018.
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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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