Amanda Michelle Gomez Archive

Millions to lose benefits under Trump’s proposal to change how poverty is defined, new study shows

Amanda Michelle Gomez Health Reporter, Think Progress

A new study released Tuesday shows just how insidious the Trump administration’s proposal to change the way the federal government measures poverty actually is. In short: millions could lose health and food benefits.

By way of background, in May, Trump’s budget agency sought public comment on updating the inflation rate used by the Census Bureau to determine the poverty line and estimate who’s poor. This technical change matters a lot because the federal poverty line is used to determine who’s eligible for government benefits like Medicaid, food stamps, and other assistance programs.

The administration floated a lot of options to replace what’s known as the Consumer Price Index (CPI), which is what the government currently uses to estimate the federal poverty line. But given the administration’s desire to slash benefits, as made clear over the years in proposed budgets and bills, it is likely to use a measurement that would redefine poverty in a way that cuts federal assistance to millions of low-income Americans.

The Center for Budget and Policy Priorities (CBPP) analyzed the effects of one optionthe administration is likely leaning towards: “chained CPI” (or C-CPI), which was also used in the GOP tax bill passed in 2017. Chained CPI usually grows slower than traditional CPI, which means a lot of low-income people would be at risk of losing aid if the administration moves forward with this option.

The CBPP estimated that by the 10th year of calculating the poverty line using chained CPI, millions of people — including pregnant women and children — would become ineligible for or receive less help from various government programs.

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American Medical Association is warming up to single payer after decades-long opposition

Amanda Michelle Gomez Health Reporter, Think Progress

The American Medical Association (AMA) — one of the nation’s most powerful health groups — is warming up to policy ideas that expand the role of government-run health care, thanks to activists trying to change minds from the inside.  

Every year, the country’s largest physician group hosts a meeting to discuss its priorities. The top-line from this year’s annual conference is that the organization will continue its support for the Affordable Care Act (ACA) while still opposing single-payer health care. “The ACA should be strengthened, not abandoned,” said the AMA, summarizing the conference on its website.

But on Tuesday, the AMA nevertheless came close to eliminating its decades-long position against single payer, or a system where everyone gets health care through one insurer run by the federal government. A day before, the AMA agreed to study public option approaches, where the federal government would expand access to existing public plans while leaving private plans alone. The growing support within AMA to at least neutralize its long-held position on the matter presents something of an internal tension, as the group is part of a coalition of organizations which are actively lobbying against these kinds of policies.

The AMA did not respond for comment.

The House of Delegates, the policy-making body within the more than 200,000 member organization, rejected a resolution introduced by the AMA’s own student caucus to put an end to its current stance on single payer. Many dismissed the vote as just another rebuke to Medicare for All, but it was the closest single-payer activists ever came to changing AMA’s position; the vote was 292 to 254, or 53% to 47%. Activists intend to try again.

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183 Republicans vote against bill to protect people with pre-existing conditions

Amanda Michelle Gomez Health Reporter, Think Progress

The House of Representatives on Thursday passed a bill that would block the Trump administration from granting states the leeway to skirt Obamacare rules —- a measure designed to ensure that patients with pre-existing conditions continue to receive affordable robust coverage — in a 236 to 183 vote. The bill is not expected to pass the GOP-controlled Senate, but even if it does, the president has threatened to veto the measure.

Every House Democrat and four Republicans voted in favor of the bill, H.R. 986, known as the Protecting Americans with Preexisting Conditions Act of 2019. Meanwhile, 183 Republicans voted against it — including members who vowed in 2018 that they would protect people with pre-existing conditions.

The Department of Health and Human Services issued new guidance around the Affordable Care Act (ACA) last November that encourages states to make changes to their marketplaces even if that means skirting federal rules and putting people with pre-existing medical conditions in jeopardy of increased health care costs. The Kaiser Family Foundation called the change “significant,” as it “eliminates the requirement to demonstrate comparable protections for people with high health risks.”

A state, for example, could ask to subsidize plans that don’t cover addiction treatment, a plan that is useless for someone struggling with substance misuse. Healthier people, however, would likely gravitate toward such a cheaper plan. If enough people in perfect health flock to these less comprehensive plans, parallel markets would inevitably form based on risk posed to insurance companies. This means people with pre-existing conditions are left with plans that get increasingly expensive, especially if they don’t qualify for tax credits or cost-sharing subsidies.

So far, no state has asked the federal government to skirt ACA rules. But Reps. Ann Kuster (D-NH), Don Beyer (D-VA) and Joe Courtney (D-CT) wanted to ensure no state gets the chance by introducing the measure that advanced on Thursday. 

Republicans in Congress have demonstrated time and time again that they prioritize cheaper health plans over comprehensive ones. Yet, many have tried to distance themselves from their own voting records, especially ahead of the midterm elections. In fact, several Republican Senators introduced a bill last August called the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” that didn’t protect sicker patients as much as current health law does.

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What a Democratic House will mean for Medicare for All

Amanda Michelle Gomez Health Reporter, Think Progress

Thousands of people dialed into a call Tuesday evening to strategize how Democrats can make unprecedented progress on Medicare for All. A week after the midterm elections handed House Democrats the majority, organizers with National Nurses United hosted a conference call with lawmakers, activists, and just about any #M4A enthusiast, outlining how single-payer legislation passes at least one chamber of Congress. By the end of the one-hour call, most unmuted to say “I believe that we will win” — which started off sounding like static noise given the volume of calls but ended on laughs.

“When we have that majority, we need to make sure that we put it to use,” said Rep. Pramila Jayapal (D-WA). 

Jayapal is calling for a committee hearing and vote on H.R. 676, or the Expanded & Improved Medicare For All Act, when Democrats take back the House. She’s asking every one of the 123 co-sponsors — really, every member of the Democratic caucus — to push for debate, as it’s not enough to say they just support legislation anymore. The Seattle representative and co-founder of the Medicare for All caucus is the new legislative lead on the House bill after former Rep. Keith Ellison (D-MN) left to become the Minnesota attorney general and Rep. John Conyers (D-MI) resigned after multiple sexual misconduct accusations.

“This is going to be an inside, outside strategy,” said Sen. Bernie Sanders (I-VT). “We are going to do our best on Capitol Hill but we need grassroots support.” 

Sanders emphasized the need for loud public support to counter the health sector’s influence, who’s bankrolling anti-M4A efforts. Already, a coalition of insurers, hospitals, and pharmaceutical companies have created the Partnership for America’s Health Care Future to lobby against Medicare for All legislation. Physicians for a National Health Program’s Adam Gaffney, who also joined the call, also warned of competing proposals on the Hill.

“It’s time to talk about where we are going and how we are going to get there,” said Bonnie Castillo, executive director of National Nurses United, an active get-out-the-vote group. “We cannot simply rely on the electoral process.”

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Patient advocate groups sue Trump administration over skimpy health plans

Amanda Michelle Gomez Health Reporter, Think Progress

Seven patient advocate and health care groups are suing the Trump administration for expanding short-term limited duration plans, cheap health insurance with a history of discrimination.

These groups — representing patients, providers, and insurers — accuse the Trump administration of jeopardizing health care for the most vulnerable, as these short-term plans can skirt consumer protections outlined in the Affordable Care Act (ACA) and deny people with pre-existing conditions or charge them more. Indeed, roughly half of these plans do not cover services for mental health or addiction treatment and none cover maternity care. And many people with HIV are generally denied coverage entirely.

The Obama administration only permitted people to purchase these plans for up to three months, as they were only intended to cover people who, for example, are in between jobs. But, in August, the Trump administration issued a final rule, allowing people to purchase these plans beginning October 2nd for up to one year and renewable for three. This rule was largely unpopular; in fact, 335 of 340 formal comments criticized it, according to the Los Angeles Times.

“At a time when suicide and overdose deaths have hit epidemic levels and continue to rise, the last thing we need is a rule that confuses consumers and offers worse mental health and substance use benefits,” said Paul Gionfriddo, president and CEO of Mental Health America, in a statement. “The [short-term] rule not only violates the intent of Congress in the ACA, it also rips away needed treatment and threatens the lives of countless Americans.”

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Arkansas Medicaid beneficiaries sue the Trump administration over work requirements

Amanda Michelle Gomez Health Reporter, Think Progress

Three Arkansas residents with Medicaid health insurance are suing the Trump administration for approving an 80-hours-a-month work requirement, as the policy jeopardizes their coverage and livelihood.

This is the second lawsuit filed in federal court against the Trump administration’s work requirements. The first was against Kentucky’s, and plaintiffs scored a victory there when a federal judge temporarily blocked the 20-hours-a-week work requirement in June.

Arkansas’ work requirements took effect earlier that month — the first state to do so in the country. State officials will drop residents from Medicaid rolls if they don’t comply for three consecutive months, meaning people could lose coverage as early as September.

Tuesday’s lawsuit offers residents a chance to maintain health coverage. Already, more than 7,000 Arkansas residents have failed to report work or other volunteer opportunities online in June to meet the requirement, putting them at risk of losing their coverage.

The lawsuit was filed on Tuesday by the National Health Law Program (NHeLP), Legal Aid of Arkansas, and Southern Poverty Law Center in the U.S. District Court for the District of Columbia. Plaintiffs are suing the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and senior officials who approved and implemented the Arkansas waiver. The state of Arkansas is not being sued.

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Republicans renew attempts to repeal Obamacare

Amanda Michelle Gomez Health Reporter, Think Progress

A group of Republicans and Washington D.C. think tanks released a proposal Tuesday that aims to resurrect Obamacare repeal. The consistent chatter around the proposal has drawn ire from the White House and GOP leadership, as the midterms are just months away, and repeal efforts haven’t proved to be winning strategies.

The seven-page whitepaper titled “The Health Care Choices Proposal: Policy Recommendations to Congress” asks lawmakers to scrap the Affordable Care Act (ACA) and replace it with block grants. In other words, the bill would eliminate Obamacare subsidies and Medicaid expansion, and give states a fixed dollar amount so they can set up their own health system.

“But Obamacare is broken, can’t be fixed, and continues to do great harm. What’s needed is a fresh approach — one that gives Americans more choices of private, affordable coverage while making sure the most vulnerable are protected,” the proposal reads.

The “fresh approach” resembles the Graham-Cassidy bill, one of six failed GOP health bills from last summer that effectively deregulated the insurance market. “States decide how much insurers can charge people who are sick, required benefits, and cost-sharing,” Kaiser Family Foundation’s Larry Levitt said last September of the bill. Had it been enacted, millions of additional people would be uninsured, according to the Congressional Budget Office.

Last year’s Graham-Cassidy bill didn’t even make it to a floor vote, as there were too many Senate hard “no’s” against Obamacare repeal. It’s hard to see how this proposal is any different.

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Virginia Legislature sends Medicaid expansion to governor, who’s expected to sign

Amanda Michelle Gomez Health Reporter, Think Progress

Advocates have been trying to get the Virginia Legislature to expand Medicaid for at least five years, and on Wednesday, lawmakers handed them a big win.

Four Senate Republicans joined all 19 Democrats, by a vote of 23-17, to pass a two-year $115 billion budget that includes Medicaid expansion. When state senators initially voted to add Medicaid expansion, only three Republicans joined. The Senate passed its $115 billion two-year budget on Wednesday, and later in the evening the House followed suit, by a vote of 67-31.

The bill now heads to Gov. Ralph Northam’s (D) desk, and he is expected to sign it into law.

Virginia will likely join 32 states, as well as the District of Columbia, that have expanded Medicaid eligibility under the Affordable Care Act (ACA), providing health coverage to about 300,000 to 400,000 low-income residents.

The House passed a budget with Medicaid expansion in April — a reality many advocates likely couldn’t have predicted years ago. Republicans in Virginia’s General Assembly have resisted Medicaid expansion for years, despite the fact that 61 percent of residents supported it as early as September 2014.

Medicaid expansion was only possible after a record number of voters, largely mobilized by heath care, elected more Democrats to the House last November. Going into the election, Republicans held a 66-34 majority, but now barely maintain control at 51-49. The turn of events was notable as poor heath is associated with lower levels of voter turnout — but Medicaid has proven to be a galvanizing political force. (States that expanded Medicaid see higher voter turnout.)

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Trump’s big idea for health insurance excludes maternity care and barely covers addiction treatment

Amanda Michelle Gomez Health Reporter, Think Progress

The Trump administration’s “affordable alternative” to the Affordable Care Act (ACA) is short-term health plans, but a new Kaiser Family Foundation (KFF) study published on Monday shows just how bare-bones this coverage actually is.

A KFF review of short-term health health plans offered on two large private insurance websites, eHealth and Agile Health Insurance, in 45 states and Washington, D.C. shows these plans rarely if at all pay for essential coverage: no plans cover maternity care; 43 percent do not cover mental health services; 62 percent do not cover substance use disorder treatment (both alcohol and other drugs); and 71 percent do not cover outpatient prescription drugs.

KFF found that seven states — Alaska, California, Hawaii, Maryland, Montana, New Mexico, and Utah — did not cover any of the four aforementioned benefits. In five states, short-term plans aren’t offered on these websites, primary because of state laws that regulate these plans.

The country is current facing multiple public health crises, including the worst rate of maternal deaths in the developed world and the deadliest drug epidemic in U.S. history. And short-term health plans, a favorite GOP policy, could exacerbate this. As HuffPost’s Jeffrey Young writes, “The Republican Party’s brightest idea for how to fix [the health care system]? Make health insurance worse — is to free up access to insurance that does not cover maternity care and hardly covers addiction or mental health services.”

Short-term plans have been around for a long time and predate the ACA. These plans aren’t meant to be a long-term insurance option, but simply cover gaps between coverage — like for a person in between jobs, waiting for health benefits to kick in.

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400,000 Virginia residents edge closer to Medicaid expansion after key Republican splits with party

Amanda Michelle Gomez Health Reporter, Think Progress

Virginia is inching closer to providing health care to 400,000 low-income residents after a key state Republican signaled this week that he was willing to split with his party and support Obamacare’s Medicaid expansion.

Virginia is among 18 states that has not expanded Medicaid under the Affordable Care Act (ACA), leaving roughly 400,000 in a “coverage gap” — meaning, they’re uninsured because they make too much to qualify for Medicaid but too little for subsidized private insurance. But this year, the state legislature could change that, thus fulfilling a goal Democrats have been trying to accomplish for years.

Democrats need two Republicans in the state Senate to pass Medicaid expansion as part of the main budget — Republicans control 21 seats and Democrats 19 — and on Friday, state Sen. Frank Wagner (R) joined state Sen. Emmett W. Hanger Jr. (R) in saying that he was willing to support expansion on certain conditions.

Wagner wants, for example, to condition Medicaid eligibility on work and provide a more generous tax credit for those who buy insurance on Hanger, on the other hand, wants to eliminate a hospital “bed tax,” which would be used to pay for the expansion.

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Paul Ryan’s cruel vision for American health care will haunt Congress after his retirement

Amanda Michelle Gomez Health Reporter, Think Progress

House Speaker Paul Ryan (R-WI) is on his way out the door.

But while he’s largely failed to implement his vision before retirement — that is, to repeal Obamacare and privatize every safety-net program there is — Republicans aren’t going to stop trying to do so anytime soon. In fact, they’ll likely take cues from his record.

Throughout his time in Washington, Ryan built a career on portraying himself as a deficit hawk, somehow convincing people he’s some great wonk. In 2012, The New York Times’s James Stewart praised Ryan, calling his approach to tax reform “eminently sensible.”  Former Clinton administration budget chief, Alice Rivlin, called Ryan “smart and knowledgeable” and decided to partner with him on his quest to privatize Medicare, which failed.

But in reality, there’s nothing genius about a career spent trying to cut “entitlement reforms” — code for popular health programs like Medicare and Medicaid — to validate the notion that you’re a deficit hawk. Ryan has worked to scrap nearly every safety net program in existence, while ignoring the deficit.

His most ambitious proposal — to privatize Social Security — demonstrated he was too radical for even the Bush administration.

But that didn’t stop him. While you can’t call Ryan a moderate, you can call him ambitious, even tenacious.

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