States that have expanded Medicaid have seen strong gains in coverage and better access to care without having to sacrifice other social programs, new research has found.

But that may not last long.

An analysis by the Kaiser Family Foundation found the 33 states that expanded their Medicaid program to 133% of the poverty line saw a 7.4% decrease in the uninsured rate from 2013 to 2017 compared to a 2.7% drop to those that didn’t.

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Medicaid has made major headlines over the last year and for good reason. The welfare program originally intended to provide medical assistance to poor children, seniors and individuals with disabilities has expanded to include more and more able-bodied adults.

A program initially intended for the truly needy now covers 28 million able-bodied adults and costs taxpayers more than $500 billion a year.

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Republican Sen. John Kennedy (La.) on Thursday said Medicaid work requirements should be mandatory for states, and the Department of Health and Human Services (HHS) should take the lead to make it happen.

During a hearing on the HHS budget, Kennedy said many Medicaid beneficiaries who aren’t working “would like to know the dignity of work” noting he would like to see HHS work with Congress to put together a program that would institute a mandatory requirement that Medicaid beneficiaries work 20 hours a week.

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The Senate’s two top Republican proponents for individual market exchange stabilization measures are in talks with CMS Administrator Seema Verma about making 1332 state innovation waivers easier to obtain.

Early insurance rate filings from Maryland and Virginia have shown huge premiums spikes, leading Republicans and Democrats on Capitol Hill to question which party is to blame for the hikes months before midterm elections. Sen. Lamar Alexander (R-Tenn.) said he and Verma are discussing speeding up the waiver application process, although he conceded that most of the measures he and Sen. Susan Collins (R-Maine) proposed to keep rates in check for next year would need to be enacted by Congress.

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The CMS on Monday gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

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The Trump administration announced Monday that it is rejecting Kansas’s request to impose lifetime limits on Medicaid benefits, drawing a line against a new level of conservative changes to the program.

The administration has already approved work requirements in Medicaid, a controversial move in itself, but Monday’s decision indicates that time limits on Medicaid coverage go too far for the Trump administration.

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President Trump is sending a plan to Congress that calls for stripping more than $15 billion in previously approved spending, with the hope that it will temper conservative angst over ballooning budget deficits.

Almost half of the proposed cuts would come from two accounts within the Children’s Health Insurance Program (CHIP) that White House officials said expired last year or are not expected to be drawn upon. An additional $800 million in cuts would come from money created by the Affordable Care Act in 2010 to test innovative payment and service delivery models.

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This fall’s midterm election ballot just got a little longer in Utah. In mid-April, progressive activists announced that they’d gathered enough signatures to force a November referendum on Medicaid expansion.

Utah isn’t the only red state flirting with extending free government health insurance to able-bodied, childless adults. Within weeks, activists in Idaho will surpass the number of signatures required for their own ballot referendum. Groups in Nebraska just launched a signature-gathering campaign, too.

If voters choose to expand Medicaid, they’ll surely regret it.

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House lawmakers quickly voted to continue New Hampshire’s expanded Medicaid program Thursday, spending almost no time debating one of the session’s biggest policy issues.

The current program uses Medicaid funds to purchase private health plans for about 50,000 low-income residents, but it will expire this year if lawmakers don’t reauthorize it. The bill approved Thursday would continue the program for five years but change its structure to a more cost-effective managed care model. The plan also would impose new work requirements on enrollees and use 5 percent of liquor revenues to cover the state’s cost as federal funding decreases.

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Supporters of Medicaid expansion sued Maine on Monday to force state officials to implement the voter-approved law that has been held up by Gov. Paul LePage, who has stalled it for months while imploring the Legislature to first fund it on his terms.

In doing so, they put Attorney General Janet Mills on the hot seat, with a lawyer saying the suit will end quickly if the Democratic gubernatorial candidate and frequent foe of the Republican governor agrees with them because she controls the state’s legal representation.

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