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The Week Brings Good & Bad News for Medicaid


Let’s start with the good news. Yesterday, voters in Maine overwhelmingly approved the expansion of Medicaid in their state (59% to 41%), bucking the will of Republican Governor Paul LePage. The Governor had vetoed Medicaid expansion five times, but the people had the final say in yesterday’s referendum.  Now, some 70,000 Mainers should be newly eligible for Medicaid.  That includes thousands of older residents not yet eligible for Medicare who can’t afford private health coverage.  Forbes calls the outcome a “victory for Obamacare.” 

A spokesman for the group that sponsored the ballot initiative starkly defined the stakes.

“Too many Mainers have already waited too long for health care. They shouldn’t have to wait any longer. The governor cannot ignore the law or the Constitution of Maine. Simply put, the governor does not have veto power of citizen’s initiatives and he cannot ignore the law.” – David Farmer, Maine Medicaid expansion advocate

The federal government will cover 90% of the cost of expansion, injecting nearly $500 million into Maine’s economy in the next two fiscal years. A recent study says those federal funds will generate 6,000 new jobs (mostly in the health sector). 

Maine becomes the 33rd state (including D.C.) to expand Medicare.  But as Sarah Kliff writes in Vox, the way Maine did it provides a potential template for expanding the program in other states:

Maine is the first state to expand Medicaid during the Trump administration, and also the first to do so via a ballot initiative than legislation. This offers a possible playbook for health care advocates in other states looking to extend coverage but stymied by political opposition. – Sarah Kliff, Vox 11/7/17

Of the 17 holdout states, Utah, Idaho, and Kansas may see Medicaid expansion on the ballot in 2018.  Increased coverage, better access to care, and a huge economic boon should make this an obvious ‘yes’ vote – though outcomes are not guaranteed, especially without robust advocacy.

Advocates can expect the same kind of pushback from conservatives in these other states.  Governor LaPage peddled the falsehood that the expansion would put an unsustainable financial burden on the Maine government.  The Portland-Press Herald reports that the governor also perpetuated the myth that expanding Medicaid would give “free” healthcare to “able-bodied adults who can work and contribute to their own health insurance costs.”

And that leads us to some bad news, which is that the Trump administration is using that same canard to chip away at Medicaid in red states across the country.  Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), announced a rule change this week that will allow states to impose work requirements on Medicaid beneficiaries.  This supposes, of course, that there are legions of lazy Medicaid enrollees who could work, but just don’t want to – a total myth.

As Talking Points Memo reported, most adults on Medicaid suffer from some of disability and cannot work.  According to a 2017 study by the Kaiser Family Foundation, only 27% of Medicaid beneficiaries are adults without disabilities.  Of those, 60% are, in fact, working.  Most of the recipients not working have one of the following extenuating circumstances: 

  1. Caring for a family member full-time
  2. Lack of jobs in their area
  3. Criminal record prevents employment

The bottom line:  most of the Medicaid recipients who can work do work

These new conditions will especially onerous for some six million older Americans (age 45-64) currently on Medicaid.  This age group experiences more disability and chronic illness than younger recipients do.  If forced to go without care because of new restrictions, they will arrive at the doorstep of Medicare in worse health, which can drive up program costs. 

The Obama administration had it right, by allowing rule changes at the state level which “increase and strengthen overall coverage of low-income individuals” and “improve health outcomes for Medicaid and other low-income populations.” The Trump administration, under Verma’s leadership, is showing its contempt for the elderly and poor – and knee-jerk suspicion of federal programs that actually help society’s most vulnerable. What’s more, CMS’ new rules defy candidate Trump’s promises to “not touch your Medicaid.” But as we’ve seen with his pledges to protect Social Security and Medicare, the President’s promises are not worth the megabits they’re tweeted on. 

 

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National Committee President Warns Senators About GOP Tax & Budget Scheme

Seniors and other vulnerable Americans will be hurt if the just-released GOP tax scheme is enacted.  National Committee president Max Richtman told a hearing room full of Senators - including Sen. Ron Wyden (D-WA), Sen. Elizabeth Warren (D-MA), Sen. Debbie Stabenow (D-MI), Sen. Mazie Hirono (D-HI), Sen. Amy Klobuchar (D-MN), Sen. Bill Nelson (D-FL), and Sen. Chris Van Hollen (D-MD) - that the Republicans' budget and tax legislation must be defeated.

“The Republican budget and tax plans allow [Congress] to slash programs critical to older Americans and people with disabilities – all to pay for massive tax cuts for the very wealthy and profitable corporations.” – Max Richtman, 11/1/17

We analyzed the harm that the GOP proposals would wreak on older Americans in a post last week, entitled GOP Budget Resolution a "Lump of Coal" for Seniors, Middle Class.  Among the more heinous measures, Republicans seek to cut nearly $500 billion from Medicare, $1.3 trillion from Medicaid, more than $600 billion from Social Security Disability Insurance (SSDI), and will likely slash billions from other programs that seniors rely on for financial and health security.  

Richtman told the Senators that Medicare beneficiaries “cannot afford to pay more for less coverage” – particularly when half of them have incomes of less than $26,200 a year and spend 25 percent of their Social Security check to pay for Medicare premiums and cost-sharing. “And they cannot afford cuts to Medicare such as those assumed in the House budget – turning Medicare into a voucher program and raising the eligibility age from 65 to 67,” he explained.

What’s more, the tax plan will increase the national debt and compel Republicans to cut seniors’ earned benefits more aggressively in the future – even though Social Security and Medicare Part A are self-financed and do not contribute to federal budget deficits.

 “By increasing the federal budget deficit by at least $1.5 trillion, this measure would leave Social Security, Medicare and Medicaid vulnerable to benefit cuts to make up the difference.” – Max Richtman, 11/1/17

Under the tax bill supported by President Trump and congressional Republicans, the nonpartisan Tax Policy Center estimates the top one percent of Americans would receive 80 percent of the tax cuts. For the top one percent, the average annual tax cut would be over $200,000 by 2027. 

The bottom 80 percent of Americans would receive 13 percent of the tax cuts. In fact, 115 million households earning less than $75,000 a year would receive a tax cut of just $190 on average. But ultimately, most Americans would lose much more in program cuts than they would gain from tax cuts. 

Richtman implored Congress to resist this reckless legislation:

“The National Committee urges all Senators and Representatives to oppose legislation to enact these ‘Robin Hood-in-Reverse’ budget and tax proposals and instead work together to protect the retirement and health security commitments made to generations of Americans." - Max Richtman, 11/1/17


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GOP Budget Resolution a "Lump of Coal" for Seniors, Middle Class

While the media have been largely consumed by the latest outrages from the White House, Republicans in Congress have been quietly working to radically redesign our tax code and cut trillions in spending that benefits ordinary Americans, including and especially seniors. With little fanfare, the Senate voted 51-49 last week to pass a cynical budget resolution that’s really a Trojan Horse for tax cuts for the wealthy and big corporations. Yesterday, the House followed suit by a vote of 216-212.  

Had a few votes gone the other way, these plans would have been stopped dead in their tracks, as we witnessed with Obamacare repeal.  But the public wasn’t paying much attention, and the pressure on Congress to vote in the public interest was nowhere near as intense.

Even if some of the more heinous budget cuts fall away, the resolution is an unsettling declaration of priorities that can only be described as mean-spirited and immoral.  As Dylan Scott keenly observes in Vox:

The budget stands as a vision of what the Republican majority wants to do, and perhaps would do if it had eight or nine more votes in the Senate. It suggests that basically every Republican in each chamber (the only senator opposed was Rand Paul, who wanted deeper cuts) is comfortable aligning himself or herself with an agenda that radically cuts the social safety net for… retirees and the middle class. – Dylan Scott in Vox, 10/26/17

The GOP budget and tax scheme, which leadership would like to pass before the holidays, has been rightly described as a “lump of coal for the middle class.”  Yes, the tax plan is a big, fat Christmas gift to the wealthy, wrapped in a package of distortions.  Despite President Trump’s disingenuous claim that it helps middle income earners, 80% of the tax savings goes to the wealthiest 1% of the American people.  The rest get only a trickle of tax relief.  

Tax policy that benefits the middle class, including deductions for state and local taxes, goes out the window in this plan.  So might existing exemptions for 401K contributions, currently set at $18,000 per year.  GOP leaders have talked about significantly reducing the amount of pre-tax contributions people can make, reportedly to $2,400 per year.  (The exact details are secret, of course, until the plan is unveiled on November 1st.)  The party of personal responsibility is actually proposing to penalize Americans for saving for retirement – as some 50 million of us now do to the tune of $67 billion in tax savings per year.

The GOP would pay for massive tax breaks for the rich by cutting essential safety net programs for seniors and other vulnerable Americans.  These are among the Scrooge-like proposals in the  budget plan:

*Cuts nearly $500 billion from Medicare by privatizing the program and raising the eligibility age.

*Cuts $1.3 trillion from Medicaid over ten years, jeopardizing long term care services and supports for the elderly.

*Cuts $653 in Supplemental Security Income (SSI) for some 8 million low-income seniors and people with disabilities.

*Will likely require cuts in in Older Americans Act programs (e.g., Meals on Wheels), home heating assistance for seniors, and research into diseases affecting the elderly, including Alzheimer’s and cancer.

Meanwhile, the supposedly budget-conscious GOP has voted to allow itself to deficit-fund $1.5 trillion of the tax cut package. As the hole in the deficit grows, Republicans will then be able to come after Americans’ earned benefits – Social Security and Medicare – to try to close the gap, even though Social Security and Medicare Part A are self-funded and don’t affect general revenues.  

Of course, the long-planned assault on Medicare has already begun – with new viability now that Republicans control all branches of government. The budget resolution contains oft-told prevarications about the program:

"Medicare spending is on an unsustainable course… Given this untenable situation, the budget resolution supports work by the authorizing committees to recommend legislative solutions extending Medicare's solvency in the near term, while pursuing policies that place the program on a sustainable long-term path." – GOP 2018 Budget Resolution

The way to strengthen Medicare now and for the future is to keep the Affordable Care Act in place (which is already saving Medicare hundreds of billions) and allow the government to negotiate prescription drug prices with drug companies, for starters. 

Because Congressional leadership is forcing reckless tax cuts through the reconciliation process (where measures can pass the Senate with a simple majority), Democrats will be unable to impede this cruel juggernaut.  As we saw in the Obamacare repeal battle, it will once again fall to a handful of Republicans of conscience to put the brakes on unfair tax and budget cuts.  But they will do so only if they hear loudly and clearly from all of us.


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GOP Tax Cuts Could Cost Seniors in the Long Run

The GOP had scarcely emerged from the defeat of their latest Obamacare repeal legislation when they pivoted lightning-quick from healthcare to taxes.  The tax reform plan the party unveiled last week may ultimately endanger the well-being of older Americans more than the vanquished healthcare bill.  Here’s why:  The nonprofit Tax Policy Center estimates that the GOP tax plan will reduce federal revenues by a net $2.4 trillion in the next 10 years.  As the deficit grows, Congress will look to cut spending.  Republicans have already called for deep cuts to Social Security and Medicare, and would no doubt come after those programs looking for massive savings. Seniors’ earned benefits could be used as piggy banks to pay for reckless tax cuts that largely benefit the wealthy.

Americans for Tax Fairness put it his way:

"[The tax plan’s] eye-popping cost will lead to deep cuts in Social Security, Medicaid, Medicare, and public education that will leave working families in the cold."- Americans for Tax Fairness

… while House Democratic leader Nancy Pelosi predicted:

“Make no mistake: after Republicans’ tax plan blows a multi-trillion dollar hole in the deficit, they will sharpen their knives for Social Security, Medicare, Medicaid.” – House Minority Leader Nancy Pelosi 

Budget hawks (including President Trump’s budget director Mick Mulvaney and House Speaker Paul Ryan) have long dreamed of cutting Social Security and Medicare.  Once their tax plan balloons the deficit, they will have the perfect excuse for gutting those programs – even though Social Security and Medicare Part A are completely self-funded by workers’ payroll contributions; they contribute not a penny to the deficit.

In fact, the budget cutters’ knives are already sharpened. The 2018 House Budget resolution calls for nearly $500 billion in cuts to Medicaid over the next decade.  That would be devastating for the 1.4 million seniors who rely on Medicaid for long-term care, and millions of others who are dually eligible for Medicaid and Medicare.  The House budget resolution also includes nearly $500 billion in cuts to Medicare over the next ten years.  Under the House budget plan, Medicare would be privatized and the eligibility age raised from 65 to 67 (an effective benefit cut). If these changes are enacted, seniors will be left to fend for themselves in the private insurance market with vouchers that may not keep up with rising costs. 

Despite President Trump’s protestations that the GOP tax plan won’t benefit the rich, that’s precisely who would reap the biggest gains.  (Trump himself could save an estimated $1 billion in taxes!)  According to the Tax Policy Center’s analysis:

"Taxpayers in the top 1 percent would receive about 50 percent of the total tax benefit from the tax overhaul, with their after-tax income forecast to increase an average of 8.5 percent." – Tax Policy Center 

On the other hand, some in the middle class would see their taxes go up.  One in seven households earning between $48,000 and $86,000 per year would pay more in taxes next year; the proportion would double during the next decade.  For households earning $150,000-217,000 a year, one third would immediately pay more in taxes. 

Republicans claim that the tax cuts will pay for themselves through intense economic growth.  They have tried this before (Most recently, with the Bush tax cuts in the early 2000s), and it didn’t work out.  Instead, deficits swelled, reinforcing budget hawks’ instincts to cut programs for the most vulnerable members of our society, including and especially seniors.  One of the (repentant) architects of the failed trickle-down economics of the 1980s, Bruce Bartlett, put it best in a recent column for USA Today: 

"Tax cuts and tax rate reductions will not pay for themselves; they never have. Republicans don’t even believe they will, they are just excuses to slash spending for the poor when revenues collapse and deficits rise." – Bruce Bartlett, former Congressional economist

 

 

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Two Paths Forward on Obamacare: One Reasonable, the Other Perilous

Newly back from summer recess, Senators are taking two divergent paths on healthcare after the Republicans’ spectacular failure to repeal and replace the Affordable Care Act (ACA).  For Americans who rely on the ACA for health insurance, one path is encouraging; the other, fraught with peril. 

On the encouraging side, the Republican and Democratic leaders of the House Education, Labor, and Pensions (HELP) committee are working on a bi-partisan plan to stabilize the ACA insurance markets, recognizing that the healthcare of millions of Americans hangs in the balance.  In fact, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) are up against a hard deadline.  Insurers need to know the level of federal support for the ACA marketplaces before they set premiums for 2018 at the end of September.

The legislation they devise will likely beef up cost-sharing payments to insurers who waive certain out-of-pocket costs for lower income patients, as well as re-insurance payments to help insurers cover high-risk populations.  While President Trump and hardline conservatives in Congress have indicated they would be content to let the Affordable Care Act languish, Senator Alexander wisely recognizes that the public will hold Republicans accountable if Americans lose healthcare.  In other words, the GOP will own the ACA, whether they like it or not. 

Unlike the Senate and House leadership during the repeal and replace debacle, the HELP committee has been holding hearings (imagine that!) to get input from outside of Congress on possible fixes to the ACA.  Last week, a group of Republican and Democratic governors of widely different ideologies sang from the same hymnal:  the ACA marketplaces must be stabilized.

Senators Alexander and Murray must finish their hearings, mark-up the bill, pass it out of committee, and hope that it reaches the Senate floor.  If Senate leadership feels the bill has bipartisan support, it may come to a vote.  Whether all of that can happen by the end of September is anyone’s guess.

On the discouraging side, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) just won’t let go of the repeal and replace agenda.  Undaunted by the GOP’s failure to get rid of the Affordable Care Act, Senators Cassidy and Graham are working on legislation to try, try again.  The Cassidy-Graham amendment is just as bad as - if not worse than - the failed Senate repeal bill last summer, and retains many of the most objectionable parts of the House-passed legislation.  Among other things, Cassidy-Graham:

*Ends the ACA’s Medicaid expansion  

*Cuts hundreds of billions of dollars in Medicaid spending

*Imposes per capita caps on Medicaid payments to the states

*Ends ACA subsidies and replaces them with inadequate block grants

*Leaves older and poorer Americans with no guarantee of affordable or adequate coverage

Were Senators Cassidy and Graham not paying attention when Americans at town halls across the nation expressed outrage at the GOP repeal and replace plans, including drastic cuts to Medicaid and more than 20 million people losing health coverage?  Did they not take seriously the Congressional Budget Office reporting on the negative impacts of repeal and replace on everyday Americans?  Apparently not. 

Fortunately for seniors – and all Americans who need healthcare – Senators Cassidy and Graham are running out of time.  Under Senate rules, their amendment cannot pass with a simple majority vote after the fiscal year ends on September 30th.  If they wanted to keep pushing for passage after that, they’d need 60 votes under regular order – a threshold they are not likely to meet.

Of course, it is premature for supporters of the ACA to declare victory.  We have seen seemingly dead repeal and replace bills suddenly spring back to life.  The legislative rollercoaster of last Spring and Summer are fresh in our memories.  Advocates and everyday Americans must keep the pressure on their elected representatives to work in a bipartisan fashion (like Sens. Alexander and Murray) to strengthen the Affordable Care Act– and reject repeal and replace once and for all.

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