(NOT MY) pres drumpf / trump, (NOT MY) vice-pres pence, and the republican party are determined to cut the entitlement programs serving mainly seniors (Social Security, Medicare and Medicaid) as well as social safety net programs like SNAP (food stamps) to pay for the tax cut that has benefited the rich and corporate America. This highlights the hypocrisy of their attitude toward the poor and need, the least among us in this self proclaimed Christian nation, an attitude that will be experienced by many of base of drumpf / trump-pence and the gop / greed over people (republican) party, hopefully they will remember this when we vote in November 2020. From the New York Times and Vox, be sure to watch the videos with (NOT MY) vice-pres pence, his ignorance about the Medicaid cuts and lack of concern about cutting healthcare for millions is disturbing and disgusting.
States will be able to cap a portion of spending for the safety-net program, a change likely to diminish the number of people receiving health benefits through it.
WASHINGTON — The Trump administration said on Thursday that it would allow states to cap Medicaid spending for many poor adults, a major shift long sought by conservatives that gives states the option of reducing health benefits for millions who gained coverage through the program under the Affordable Care Act.
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society.
The announcement by Ms. Verma, who often speaks of wanting to “transform” Medicaid, comes as her efforts to let states require adults on Medicaid to work or train for a job — which led to 17,000 people in Arkansas losing coverage in 2018 — are mired in court battles.
“Government has a solemn responsibility to provide for the most vulnerable among us,” Ms. Verma said in a morning call with reporters. “Part and parcel of that responsibility is making sure the Medicaid program is sustainable.”
Democrats, health care providers and consumer groups warned that capping federal funding for adults on Medicaid and giving states more freedom to decide who and what the program covers would jeopardize medical access and care for some of the poorest Americans. A legal challenge is inevitable.
“After failing to cut Medicaid in 2017 through congressional action, the Trump administration has consistently tried to achieve the same results through administrative attacks,” said Emily Stewart, the executive director of Community Catalyst, a consumer group. “With fewer dollars to provide care to millions of people, let alone address current and future public health issues, C.M.S. is opening the floodgates to allow states to cut benefits and limit services.”
The new funding option could possibly have the effect of increasing the number of Medicaid beneficiaries in some states — namely, the 14 that have not yet expanded Medicaid, who might see it as a more conservative way to move forward in covering poor adults. States that have already expanded Medicaid could also pursue the option, which could lead to pared-down coverage for that population, though some experts predicted most would not.
“There’s no question this plan provides unprecedented flexibility to states to restrict health care under Medicaid,” said Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation. “What is less clear is how many states will want to do that and be willing to roll the dice with a cap on federal contributions.”
States can use the new approach only with adult beneficiaries younger than 65 who aren’t eligible for Medicaid because of pregnancy, a disability or their need for long-term care — in essence, those whom the Affordable Care Act gave states the option of covering.
Medicaid has always provided unlimited federal matching payments to states based on whatever they spend providing care to the poor. Some of what the program covers is mandatory — emergency and hospital care, for example — but states can also choose to provide additional benefits, such as dental care or prescription drugs. No matter how much a state’s enrollment or spending rises, the federal share of funding rises with it.
But under the waiver program Ms. Verma is proposing, a state would use a formula to determine ahead of time how much it will spend on its adult Medicaid population in a given year, then get a fixed federal share in either a lump sum or a per-person amount. Critics said this could be devastating if more people became eligible for Medicaid because of a recession, or if costs went up because a lot of enrollees needed an expensive new medicine; Ms. Verma said the program would “allow adjustments” under such circumstances.
The plan — called “the Healthy Adult Opportunity” — would allow states to cover fewer drugs for enrollees in the block-grant program. And while it would require a minimum level of coverage based on the Affordable Care Act’s 10 categories of “essential health benefits,” states could decide who exactly to cover and omit traditional Medicaid benefits like long-term care, transportation to medical appointments and retroactive coverage for people who got care in the months before they got Medicaid.
“Another big difference could be in the scope of the service,” said Cindy Mann, who ran Medicaid during the Obama administration and is now a partner at Manatt Health, a consulting firm. “It could skinny down the benefits significantly.”
States would also be allowed to impose premiums and out-of-pocket costs on the waiver population, but nobody would be required to pay more than five percent of their household income.
Allowing states to exclude certain drugs from Medicaid coverage appears to be a policy reversal, said Rachel Sachs, an associate law professor at Washington University in St. Louis. Today, states must cover all medically necessary drugs, but the proposal appears to allow states that participate in the block-grant program to exclude certain drugs, in an effort to secure deeper discounts by pitting competing manufacturers against each other.
In 2017, Massachusetts asked for permission to exclude “drugs with limited or inadequate evidence of clinical efficacy,” but the Trump administration denied the application.
Stacie Dusetzina, an associate professor of health policy at Vanderbilt University School of Medicine, said a balance would need to be struck between excluding drugs as a way of saving money, and not limiting access to drugs that patients need.
Republicans have proposed block grants in various forms for decades, going back to the Reagan administration. Most recently, Republicans’ bills to repeal and replace the Affordable Care Act in 2017 proposed giving states a choice between a fixed annual sum per Medicaid recipient or a block grant — both of which would have led to major cuts in coverage over time, analysts projected. Concerns from moderate House Republicans about the potential of deep cuts to Medicaid — which now serves more than 71 million people, or more than 1 in 5 Americans — helped doom the repeal effort.
Conservatives say Medicaid spending, which consumes a major and growing portion of the federal and states’ budgets — it cost about $620 billion in 2018, and accounted for 9.5 percent of the federal budget — needs to be reined in. They contend that the current system of unlimited federal matching funds has encouraged states to milk as much as they can, sometimes wastefully. Capping funding, their argument goes, would make Medicaid more efficient and ensure it can continue to help the sickest and most vulnerable Americans.
Although the federal government generally pays between 50 and 77 percent of a state’s total Medicaid costs, depending on the state’s wealth, it covers much more — 90 percent of the costs — for the adults who became eligible for Medicaid under the Affordable Care Act. While most adults who qualified for Medicaid in the past were disabled, pregnant or extremely poor parents of small children, the newly eligible group — nearly 15 million people, Ms. Verma said — includes adults who may be healthy and childless and have somewhat higher incomes.
Ms. Verma has often suggested that adding healthy working-age adults to the program has threatened its viability for more fragile populations, like children, the elderly and the disabled. She did so again on Thursday, saying in a call with reporters that Medicaid “was not originally designed for this group” and that many states had been “far too lax” in verifying whether people are even eligible.
The popularity of Medicaid raises the question of why Mr. Trump would sign off on a contentious block grant program heading into his re-election campaign. The threat posed to the program by Republican efforts to repeal the Affordable Care Act helped Democrats retake the House in the 2018 midterm elections. But if the new option is taken up by states that have not yet expanded Medicaid at all, Mr. Trump could point to it as a new expansion of health coverage.
“Trying to get to the bottom of the politics of this is hard,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “I assume that they are trying to look like they are helping poor people, without in any way extending the entitlement.”
Gov. Kevin Stitt of Oklahoma, a Republican, was on hand for the announcement and said his state would be among the first to seek federal approval for the new spending arrangement. Advocacy groups in Oklahoma collected enough signatures to get a question on this November’s ballot asking voters whether to expand Medicaid; similar efforts have succeeded in Maine, Idaho, Utah and Nebraska. But Mr. Stitt opposes expanding Medicaid in this way, and may see the new opportunity as a way to get out in front of the ballot question.
How much federal funding a participating state would receive would be based on a complex formula. If states spent more than their predetermined budget, they wouldn’t get more federal money. But if they spent less, they could keep part of the unspent federal funds.
Katie Thomas contributed reporting from Chicago.
The viral video of Mike Pence being grilled by an ER doctor about Medicaid cuts, explained
Pence struggled to justify a new policy in an exchange that captured something profound about the health care debate.
Dr. Rob Davidson was grabbing a bite at the Drake Diner in Des Moines, Iowa, on Thursday when Vice President Mike Pence just happened to stroll in. The polite but determined exchange that ensued became a viral video — and captured something profound about the state of the health care policy debate in President Trump’s America.
Davidson works as an emergency room doctor in western Michigan and is the executive director of the Committee to Protect Medicare. He told Vox he was in Iowa for a press conference related to his work for the committee. So as Pence glad-handed around the diner, Davidson took the opportunity to press him on a new plan the Trump administration rolled out earlier that same day that would allow states to use waivers and block grants to cut federal Medicaid funding.
When Pence walked up to his table, Davidson introduced himself and said, “I’m an emergency doctor. I’m worried about the plans [Trump] talked about last week to maybe cut Medicare, and then the rollout today of cutting Medicaid. I work in one of the poorest counties in Michigan and my patients depend on expanded Medicaid, so how is that going to affect my patients?”
Pence, however, didn’t seem to be familiar with the plan his administration had announced.
“Uh ... I hadn’t heard about cuts,” he said, prompting Davidson to explain the block grant proposal to him.
“Cutting Medicaid — yeah,” Davidson said. “The head of CMS [the Centers for Medicare and Medicaid Services] announced the plan to let states file for waivers so they could get block grants, so that would essentially cut the amount of money going to states. So that would cut federal Medicaid funding. Is that a good idea?”
As Vox’s Dylan Scott explained, enacting block grants, a long-held goal of ideological conservatives, “would fundamentally change how the program is financed” and ultimately result in funding cuts and less coverage:
Instead of addressing the question, Pence deflected by bringing up the Medicaid expansion that happened in Indiana while he was governor. But Davidson pressed him to actually address his question.
“Right — but now they’re talking about scaling back the Medicaid expansion that we got with the Affordable Care Act. 680,000 Michiganders, 600,000 in Iowa — a lot of people got health care,” Davidson said. “I’m just talking about the president and your administration right now.”
But Pence still seemed to be confused.
“I think you’re oversimplifying things,” he said.
“Well, I think it comes down to that for the people I take care of all the time,” responded Davidson. “People I see in the emergency department that can’t get primary care doctors, [but] once they got Medicaid they could get primary care doctors. They stay out of the ER, they actually work more, they actually contributed to our community more.”
“Now, if you tell those people, ‘Sorry, you don’t get your health care’ — that’s going to be a real negative in their lives,” Davidson continued.
1/2 I just ran into @VP Mike Pence at the Drake Diner in Des Moines. I confronted him about his damaging health care cuts because for me it's not about politics, it's about saving lives.#DrakeUniversity #IowaCaucus #TrumpRallyIA #MedTwitter
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The conversation extended into a second video. Pence continued to deflect by touting his health care record in Indiana, and Davidson kept pressing him to address what the Trump administration is doing right now.
“I think if the Trump administration wanted to expand Medicaid, that’d be great. But the problem is they’re contracting Medicaid,” Davidson said, alluding to the contradiction involved in Pence bragging about expanding Medicaid while he was governor of Indiana while being part of a presidential administration that’s actively working to cut it.
The interaction ended with Pence telling Davidson, “I respectfully disagree” — even though Davidson’s observations about the Trump administration’s new plan were not a matter of opinion.
2/2 When I told him he is putting my patients' lives at risk, @VP deflected and denied knowledge of the policy. He either doesn't understand, or doesn't care about the impact of this administrations' policies on patients everywhere.
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Davidson told Vox that block-granting Medicaid has been part of mainstream Republican thinking about health care for decades, so he doesn’t buy that Pence was as ignorant about his administration’s new plan as he seemed to be. (The White House didn’t immediately respond to a request for comment.)
“I think he was not expecting to be pressed on that, and didn’t have his talking points prepared, so he retreated back to his safe space,” Davidson said. “I believe he understands exactly what his administration is doing.”
The interaction encapsulated a dynamic at the core of the current debate about health care policy: Republican plans involve unpopular spending and coverage cuts, so they dress them up with nice-sounding jargon like “consumer-directed.”
“‘Innovation,’ ‘flexibility’ — that’s all code for cutting spending and putting more in the laps of people who can’t afford it,” Davidson said. “This would further reduce that funding.”
Asked what he hopes people take away from the video — which has been shared more than 20,000 times on Twitter and has nearly 1.5 million views as this is published — Davidson said he hopes it raises awareness about his work with the Committee to Protect Medicare and encourages doctors to feel comfortable in the policy space.
“We all have the ability to stand up to any level of folks who are coming along and proposing policies that hurt our patients,” Davidson said. “I think it’s time now for doctors to step out of the exam room and get out into the public space and advocate in a bigger way, and I hope that health care providers who see this want to join with us or in some way on their own become advocates for health care.”
“Patients have a hard enough time scrounging to get coverage,” Davidson added. “If we won’t stand up for them, I’m not sure who will.”
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