N/U Medicaid Cuts Now

Selena Simmons-Duffin 23 [Simmons-Duffin reports on health policy for NPR, 5/24/23, “In some states, hundreds of thousands dropped from Medicaid,” ] //mh

States have begun to remove people from Medicaid, something they could not do for three years during the COVID-19 pandemic.

State Medicaid programs are reviewing the eligibility of roughly 90 million beneficiaries in the U.S., now that a rule suspending that process has expired. Those who remain eligible should be able to keep their coverage, and those who don't will lose it.

But new data from states that have begun this process show that hundreds of thousands of people are losing coverage – not because of their income, but because of administrative problems, like missing a renewal notification in the mail.

And a poll this week from KFF found that 65% of Medicaid enrollees across the country didn't know states can now remove people from the program if they are not eligible or don't complete the renewal process.

"I've been worried about this for a year and a half," says Joan Alker, a public policy researcher and the executive director of the Georgetown Center for Children and Families. "If anything, I'm concerned that it's going worse than I expected in some places."

Starting Saturday, millions of Americans could get kicked off Medicaid

For instance in Florida, nearly 250,000 people lost coverage in April, and for 82% of them, it was for procedural reasons, Alker found after reviewing data provided by the state to federal health officials. Many of those who lost coverage are children, because Florida didn't expand Medicaid to more low-income adults.

Liz Adams of Plant City, Fla., has two kids and they were among those in Florida who lost coverage in April. She found out while trying to figure out the time of her son's biopsy appointment. Her son survived leukemia and has a variety of ongoing health problems.

"I called the surgery center [asking] what time is this appointment? 'Oh, we canceled that. He doesn't have insurance," she says. "So I jump on the portal and sure enough, they don't have insurance."

She was incredibly frustrated that she then had to try and re-enroll her children in health insurance, while figuring out how to get her son's care back on track.

"I waited a year to get in with a rheumatologist, and we finally got the biopsy and we finally got blood work ordered, and I can't go do any of it because they canceled my insurance," she says.

"I am very worried about Florida," Alker says. "We've heard the call center's overwhelmed, the notices are very confusing in Florida – they're very hard to understand."

Some other states have also dropped many people from Medicaid. But Alker says that unwinding is not going badly in every state.

"We're really seeing divergence here," she says. "We've seen very, very concerning numbers from Florida, from Arkansas, from Indiana, but we've seen much more reassuring numbers from Arizona and Pennsylvania."

In Pennsylvania, for instance, only 10% of people whose Medicaid eligibility was reviewed in April lost coverage, and in Arizona, that figure was 17%, according to a state report.

The federal government can require states to pause disenrolling people from Medicaid when there are problems, Alker says, but it remains to be seen if federal health officials will use that enforcement power.

Republican efforts to get rid of Medicaid are inevitable---either they terminally fail OR will succeed regardless of the plan

Dylan Scott 23 [Scott is a reporter based in healthcare, 4/19/23, “Medicaid is popular. So why are Republicans still trying to cut it?,” ] //mh

The House Republican majority has released its demands for major government spending cuts in exchange for increasing the federal debt limit. And they include a familiar target for conservatives: Medicaid.

It’s a gambit that may be more than a decade out of a date and could pose a political risk to the party. For years, Republicans have believed that Medicaid, which primarily serves low-income Americans, is less politically potent than Medicare or Social Security, two of the other core features of the US social safety net, and therefore a safer target for proposed cuts.

There may be some truth to that notion — but Medicaid is plenty popular on its own terms. Over the past two decades, the health insurance program has become an increasingly crucial part of the safety net. Enrollment has roughly doubled from about 46 million people in 2007 before the Great Recession to more than 92 million today. More than 75 percent of the US public says they have very or somewhat favorable views of the program. Two-thirds say they have some kind of connection to Medicaid, either because they themselves or a loved one was enrolled.

In state after state, when the question of expanding Medicaid to working-age, childless adults has been put to voters in red states, they’ve voted in favor of giving more people access to health insurance. Even the Republican legislature in North Carolina recently made peace with expanding the program.

The House’s work requirement proposal — dubbed a “community engagement” requirement in the bill’s text — would roll back those coverage gains by requiring many recipients to be working, looking for work, or participating in another kind of community service. Children under 18, adults over 56, people with mental or physical disabilities, and parents of dependent children would be exempted.

The Congressional Budget Office has previously estimated requiring non-disabled, non-elderly childless adults to work in order to receive Medicaid benefits would slash the program’s spending by $135 billion over 10 years — largely because more than 2 million people would lose coverage for failing to meet the work requirement.

Diapers, food, rent-- around the world, prices are rising. So, what can we do about it?

The last time Republicans tried (and failed) to pass significant cuts to the Medicaid program, in the first year of the Trump presidency as part of their Affordable Care Act repeal plans, they paid the price during the 2018 midterm elections. So if Medicaid has proven popular quite recently, why have Republicans seemingly convinced themselves that they can try to cut it again without penalty?

The answer is partly about the method they’ve chosen to cut the program: work requirements, which leaders think will go over well in competitive congressional districts. But it’s also about how Republicans have (in some cases reluctantly) embraced other facets of the social safety net, leaving themselves with few other options.

The GOP has tried to cut other social welfare programs and failed

Once upon a time, conservatives wanted to remake Social Security and Medicare just as eagerly as they still wish to overhaul Medicaid.

President George W. Bush invested much of his political capital in his second term in pursuing his doomed attempt to privatize Social Security. Paul Ryan, who became the party’s intellectual leader in the early 2010s as the Tea Party backlash to President Barack Obama was rising, made further privatizing Medicare a central plank of the Republican platform.

But those proposals proved politically disastrous. Democrats campaigned against Bush’s Social Security proposal when they gained seats in the 2006 midterms. The 2012 Obama campaign hung Ryan’s Medicare overhaul on Mitt Romney, who had picked Ryan to be his vice presidential candidate.

Then in 2016, the window for so-called entitlement reform slammed shut. Donald Trump bulldozed through the Republican primary, where he promised not to cut Medicare and Social Security as so many GOP candidates before him had pledged to do. When Republicans retook the House in 2022 and began plotting for the pending debt-limit debate, they preemptively took Medicare and Social Security cuts off the table.

But there’s a reason Republicans had targeted those programs in the past: they are two of the biggest outlays in the federal budget. Social Security alone accounts for 20 percent of federal spending. Medicare covers another 12 percent or so. If you assume Republicans are unwilling to cut defense spending and veterans benefits, that means almost half of the federal budget is off limits from the start.

So what is the GOP willing to cut, or at least to propose cutting to start its negotiations with the Biden White House and Senate Democrats? Enter Medicaid. In a Monday speech given at the New York Stock Exchange, House Speaker Kevin McCarthy laid out his party’s priorities in the debt-ceiling talks and sought to justify their proposed cuts to social programs. He said he wanted the government to give Americans “a hand up, not a handout.”

There is a certain logic to Republicans’ commitment to pursuing Medicaid cuts: Social Security and Medicare are universal programs. Everyone pays in while they work, and then enjoys the benefits when they retire. Medicaid, on the other hand, is targeted to people who have low incomes. Republicans argue that this program, like food stamps and cash welfare, discourages people from seeking work, since they only qualify for benefits if their income is below a certain threshold.

“Assistance programs are supposed to be temporary, not permanent,” McCarthy said. “A hand up, not a handout. A bridge to independence, not a barrier.”

Republicans will inevitably push Medicaid costs onto the states---they already tried it during the debt negotiations

Ron Wyden 23 [Ronald Lee Wyden is an American politician and retired educator serving as the senior United States senator from Oregon, 5/15/23, “Wyden Statement on Senate Floor on Republican Proposed Cuts to Medicaid,” .] //mh

Here’s why House Republicans want to slash Medicaid by billions. They say it’s about work. But really, it’s all about securing an ideological trophy on the evidence-free proposition that Americans near the poverty line are actively choosing to stay there instead of working. So what this work reporting requirement is really about is ripping away health care coverage from Americans who Republicans have judged to be unworthy.

Don’t take it from me: an analysis from the Kaiser Family Foundation paints a clear picture of who will be at risk of losing their coverage. As of 2021, there are 25 million adults aged 19-64 enrolled in Medicaid. 43 percent are working full time, and 18 percent are working part time. I will stop right there and note that is equal to the national labor force participation rate at 61 percent.

Now who are the remainder with Medicaid coverage who aren’t actively working: 13 percent are caregiving for a child or relative. 11 percent are unable to work due to an illness or disability. 6 percent are attending school. The remaining 9 percent, about 2 million Americans, aren’t working because they are retired or unable to find work.

Here’s the catch: under the House Republican scheme, the majority of these Americans will be forced to report to their states whether they are working and how much each and every month, under the threat of losing their health insurance. My Republican colleagues are fond of sharing their “small government bona fides” but to me that sounds like an awful lot of bureaucratic government paperwork. What’s worse, the Congressional Budget Office found in an analysis just last year that work requirements do not increase employment.

I am now going to explain how this ill-conceived proposal is going to hurt more Americans than those who are subject to work reporting requirements. The House Republican bill cuts Medicaid by over $100 billion. That cut comes from one source: Americans getting kicked off their Medicaid coverage. The only way for Americans to retain Medicaid coverage will be for states to pick up the whole tab. And that’s simply shifting the federal share of Medicaid onto the states that don’t want to saddle their health programs with bureaucratic red tape that has never been shown to increase employment.

Shifting Medicaid costs to states has real consequences; it is not an abstract exercise. When the federal government pares back how much it contributes to a states’ Medicaid program, the state is left holding the bag to make up the difference. That means states face tough choices about which Americans will have health coverage and whether hospitals and nursing homes will face funding cuts that threaten their ability to stay open.

Doctors could see their pay cut. State options like a full year of postpartum care, which Congress created on a bipartisan basis just last year, would be subject to cancellation. These cuts will jeopardize your parents’ or your spouses’ access to Medicaid’s nursing home benefit, or cut resources for home care, which allows people with disabilities and the elderly to receive care in their homes instead of moving into an institution.

Unfortunately, there are some real world examples to illustrate what happens when a state implements work reporting requirements. During the Trump Administration, federal health agencies allowed Arkansas to conduct this work reporting experiment. Within the first year, 18,000 lost their Medicaid coverage, about quarter of those subject to work reporting. A year later, nearly 90 percent of those who lost coverage had not re-enrolled.