Tag Archives: Medicaid

Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

Note: One more state is attempting to include work requirements for Medicaid recipients, as previously posted in Arkansas Medicaid Work Requirement Failing Out of the Gate.

 

Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.

Source: Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

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Arkansas Medicaid Work Requirement Failing Out of the Gate

Health Affairs blog published an article recently about the early experience of Medicaid recipients in Arkansas after that state implemented a work requirement in June.

Last month, I wrote an article that reported that work requirements for Medicaid worsen health.

The author of the Health Affairs article, Dr. Jessica Greene, is a Professor and the Luciano Chair of Health Care Policy at Baruch College, City University of New York. She conducted in-depth interviews with 18 adult Medicaid recipients in northeast Arkansas in mid-August.

Dr. Greene admits that the interviews are too small a group to provide generalizable results, the interviews do illustrate how the state’s policy is interacting with the day-to-day lives of Medicaid recipients to produce serious potential consequences that have little to do with policy’s stated objectives.

She outlined the results of her interviews as follows:

Lack Of Awareness

Two thirds of the Medicaid recipients (12/18) I interviewed had not heard anything about the new work requirement. “First time I’ve ever heard anything [about it],” a 31-year old man, who had started a vocational training program the day we spoke, said. “You’d think it’d be on the news or something. I ain’t seen it on the news, and I watch Channel 8 news every night.”

At Risk Of Losing Coverage

Of the nine people who, based on their age, should have received a DHS letter letting them know they were subject to the work requirement, four said they had received a letter. Two said the letters indicated they were exempt because they already met the SNAP work requirement.

The other two were at risk for losing Medicaid coverage. One, a 47-year old woman, said she had received her letter about three months earlier; she believed, incorrectly, that she had three months to report her hours. When I asked her if reporting her hours was an obstacle, she said she was struggling with very stressful life issues, including a mentally ill sister, and as a result the work requirement had not received much of her attention. The other person, a 40-year-old woman, described being overwhelmed by receiving the letter: “Basically… I’m like, okay, I’ve got this letter. I file it and I don’t know what to do with it…”

The other five who should have received a work requirement letter were either not sure if the letter arrived or thought it had not. When asked about receiving a DHS letter, a 42-year-old woman said, “I don’t know, I’m going to have to check and make sure [I didn’t receive the letter], because I need my Medicaid card for my sugar pill and my blood pressure pills.” A 46-year-old man, who had recently completed an inpatient drug treatment program, kicking a multi-decade drug addiction, wasn’t sure either. “I may have [received the letter]…I’m horrible about opening mail….I probably throw’d it away.” While the three others did not believe they received the letter, they were all exempt by either working and/or having children in the home, but likely needed to report their hours and exemptions in the portal to maintain Medicaid coverage.

Policy Not Sparking Work-Related Changes

Of the nine participants who were likely subject to the policy, only two were not meeting the 80 hour work-related activity requirement and did not seem to qualify for an exemption. Both told me that they were actively seeking work, and that the work requirement had not at all impacted their job seeking. In addition, those I interviewed between the ages of 19-29, who will be subject to the policy in 2019, either worked, went to school, and/or had children under 18 years old in the home. No one I spoke with reported that the policy had or would spark them to change their work-related activities.

Online Portal Challenging For Many

Participants described a very wide range of computer and online skills and access. Approximately a third said that reporting hours on the online portal would not be possible for them: “I can’t do that. I don’t have a phone. I don’t have a computer.”

Several, who were confident of their own skills, mentioned family members who would struggle. “Half my family probably doesn’t have a smart phone….A lot of people here don’t have internet still,” a 19-year old woman explained.

Mixed Attitudes About Linking Medicaid And Work-Related Activities

Almost all the participants believed that people who could work should be working. “I believe if you are able to work and you want the extra help that Medicaid gives, then you should work,” said a 28-year old woman who was currently working and has young children. But several expressed concern about those who had mental or physical conditions that would prevent them from meeting the requirement. One man raised questions about people who were “borderline” who were not officially considered disabled but still had serious health conditions. A 42-year-old woman, who works with people with disabilities said, “I think it’ll do more harm than good…. What they supposed to do, just get cut off Medicaid because they can’t meet those requirements?”

Others raised concerns about transportation needed to get to work and volunteering. “Some people don’t have vehicles, and sometimes it’s not necessarily their fault. Sometimes something happens and they lose their money… It’s not fair,” said a 21-year old recipient who is a college student. When I asked a woman who was looking for work whether she had tried to get help from the Department of Workforce Services, she said that she couldn’t get there because it was 30 miles away and there is no public transportation.

Not Going To Lift People Out Of Poverty

Participants were very skeptical about the Governor’s claim that the work requirement policy would help them out of poverty, as many were already working and still struggling financially.

One participant argued that the policy was not about getting people to work at all, but about reducing the number of Medicaid recipients: “It seems like a ploy for the state to save money. That’s all it is. It’s nothing about trying to get people back to work…”

Summing Up

Of the people I interviewed who were at risk of losing Medicaid coverage as a result of the work requirement, most were at risk because they lacked awareness of the policy or were overwhelmed by it, rather than because they were not meeting the 80 hours a month of work-related activities or the terms of an exemption. If this is true more broadly, the state will be ending people’s health coverage for the wrong reasons, adding credence to those who argue this policy is about reducing the rolls, rather than supporting people to get employment.

A 38-year-old woman who recently had to quit her job to get her niece, who she mothers, a birth certificate and other paperwork to start school argued that the policy does not take into account the complex lives of low-income people. “You are saying this should be possible, but you don’t know my circumstances. You haven’t been here,” she explained.

Given this limited, but anecdotal survey of the experience of 18 Medicaid recipients, it is clear that this idea is not rooted in any realistic and scientific study of how work requirements will affect Medicaid recipients, but rather is another way of getting people off the roles and moving towards eliminating Medicaid altogether, which is precisely what the Republican Party has been trying to do for decades. The war on the poor continues.

 

Free Medical School Tuition Could Solve Physician Shortage

Earlier this week, Elizabeth Rosenthal , former correspondent of the New York Times, and now the editor in chief of Kaiser Health News, wrote an opinion piece in response to the announcement by New York University’s School of Medicine’s decision to eliminate tuition for all current and future medical students.

Rosenthal, an emergency room doctor who became a journalist, stated that the goal of the free tuition was to eliminate a financial barrier for medical school applicants, and to address a crucial imbalance in the country’s physician work force.

She indicated that research had proven that the burden of medical school debt discourages doctors from going into practices that are poorly paid, such as primary care, or working in places where many patients are on Medicaid.

Rosenthal notes that there is a shortage of doctors working in these areas. Readers will recall that I have posted several articles on the predicted physician shortage. Those articles suggested medical travel could be an alternative solution in workers’ comp cases.

Even though the US has about the same number of doctors for our population as does Canada, Britain, and Japan, Rosenthal noted — American doctors are more likely to be paid more in subspecialties such as orthopedic surgery, rather than primary care.

Rosenthal cites N.Y.U.’s Law School when she points out that the medical school got it wrong as having a better solution.

Instead of making medical school free for everyone, Rosenthal states, N.Y.U., and all medical schools, should waive tuition for those students who commit to work where they are needed most.

The law school is a model and has a program that attracts the best and brightest to the low-wage corners of the legal profession. Students who commit to a career in public service, pay no tuition; those who go to corporate law pay the full amount.

Rosenthal recommends that medical schools should commit to so that students entering medical school, and who are not sure of their path, is to forgive or paying back the loans of doctors who go into lower-paying fields or set up a practice in underserved areas.

The government, she writes, could demand a system from academic medical centers as a precondition for receiving subsidies and payments.

Also, if a doctor chooses to deliver babies in rural Oklahoma or practice pediatrics in the South Side of Chicago, they should keep their salary.

The government, military, and some states already subsidize tuition, or pay back loans in exchange for limited-time service commitments, as my younger brother did when he graduated medical school.

The real goal, Rosenthal says, is to enable and support young doctors who feel that medicine is a calling, not as we know it today — as a means to get to the top 1 percent.

As the idea for free tuition for public colleges and universities is debated, doing so for medical school will alleviate the predicted physician shortage, allow more lower income minority students to attend without debt hanging over them when they graduate, and will improve the health of those in underserved and poorer neighborhoods.

That will likely impact the overall cost of health care as more people can see a doctor in their neighborhood, and not in an emergency room.

P.S. I am a graduate of N.Y.U.’s Graduate School of Arts and Sciences, and took out loans that were paid back more than ten years later. Perhaps one day, that will also be a thing of the past.

Nearly 20% of US hospitals weak or at risk of closing, analysis finds | Healthcare Dive

Key risk factors including low capital expenditures, more capacity in a 10-mile radius and for-profit versus nonprofit status, the Morgan Stanley report said.

Source: Nearly 20% of US hospitals weak or at risk of closing, analysis finds | Healthcare Dive

Medicaid Work Requirements Worsen Health

Back in May, I posted a link to a Health Affairs blog article, Social Determinants Of Health: A Public Health Concept In Conflict in which it was reported that the current regime was seeking to impose work requirements for people on Medicaid.

As reported then, and on Monday in a follow-up article, CMS approved the first waiver to implement a work requirement for Medicaid beneficiaries in Kentucky on January 12th.

The article stated that a couple of weeks ago, a district court found the approval of these work requirements to be “arbitrary and capricious”, and in direct violation of the Administrative Procedures Act of 1996.

According to the article, CMS failed to consider whether the waiver’s estimated removal of 95,000 Kentuckians was in line with the program’s goals of furnishing medical assistance, and the judge ordered the waiver to be returned to CMS.

It was the government’s argument, the article states, that new research into the social determinants of health demonstrate that income and employment are associated with improved health, and so a work requirement thereby fits within the goals of the program.

The case in Kentucky hinged on the fact that work requirements worsened financial assistance, which the judge pointed out is a main tenet of the program.

The author then writes that if CMS wants to use research within the social determinants of health, then he will analyze Medicaid work requirements through this lens. A recent post in Health Affairs focused on the perversion of social determinants of health as a concept, and the current post builds off that one, to demonstrate that this regime’s justification for Medicaid work requirements is misguided at best.

To illustrate this, he follows a theoretical low-income worker, a 50-year-old from Louisville, who could no longer work in his job as a longshoreman due to cardiovascular disease and suffered chest pain whenever he exerted himself. He is uninsured, has a wife and three adult children. And is also trying to find a job.

The author continues by examining the following issues: Unemployment and Health, Medicaid Improves Health, Medicaid Work Requirements Harm Those With Jobs, and concludes by stating that Medicaid Work Requirements Worsen Health.

The theoretical case of the 50-year-old longshoreman is not so theoretical, as each of the 16 Kentucky plaintiffs in the case demonstrated. One is a graduating student with endometriosis, another is a mother of four with congenital hip dysplasia, and another is a partly blind mortician (no jokes, please) with chronic lung disease. All would have risked losing their coverage as a result of work requirements.

And to make the case more clearly, your humble blogger, while not currently on Medicaid, but eventually will be, has end-stage renal disease, and does peritoneal dialysis every night at home, and goes to the clinic twice a month for blood work and to see the nephrologist. In addition, every two weeks on a Monday, as will happen this coming Monday, I have to be home to receive my supplies, and this Friday must call in another order. Working a full-time job, if one were available that matched my experience, would prevent me from doing so.

This is another reason why our health care system is broken and needs to be replaced by a single payer system that does not separate out older beneficiaries, as Medicare does, poorer ones as Medicaid does, and children and military personnel, as the other programs do.

One system for all Americans.

Social Determinants Of Health: A Public Health Concept In Conflict

Source: Social Determinants Of Health: A Public Health Concept In Conflict

ACA Gains Reversing

The Commonwealth Fund reported today that the marked gains in health insurance coverage made since the passage of the Affordable Care Act (ACA) in 2010 are beginning to reverse.

This is according to new findings from the latest Commonwealth Fund ACA Tracking Survey.

According to the survey, the coverage declines are likely the result of two major factors:

1) lack of federal legislative actions to improve specific weaknesses in the ACA and

2) actions by the current administration that have exacerbated those weaknesses. These include the administration’s deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law.

Here are the key findings:

*  About 4 million working-age people have lost insurance coverage since 2016
*  The uninsured rates among lower-income adults rose from 20.9 percent in 2016 to 25.7 percent in March 2018
*  The uninsured rate among working-age adults increased to 15.5 percent
*  The uninsured rate among adults in states that did not expand Medicaid rose to 21.9 percent
*  The uninsured rate increased among adults age 35 and older
*  The uninsured rate among adults who identify as Republicans is higher compared to 2016
*  The uninsured rate remains highest in southern states
*  Five percent of insured adults plan to drop insurance because of the individual mandate repeal
What are the policy implications of this reversal?
The absence of bipartisan support for federal action has seen legislative activity shifted to the states.
Broadly, the leaving of policy innovation to states will lead to a patchwork quilt of coverage and access to health care across the country. It will fuel inequity in overall health, productivity, and well-being.
Folks, as I wrote about in What’s Really Wrong With Health Care? and Obamacare: The Last Stage of Neoliberal Health Reform, until we see a change in the consciousness of both the American people, their representatives in Congress, and in Corporate America, especially within the financial industry to radically alter the direction health care is heading, the situation will only get worse.
We need to get the money and the greed and the corporations out of health care altogether. We need a single payer system that does not proletarianize physicians, does not turn health care into a commodity, does not financialize it, commercialize it, and compromise it for the benefit of a few, and to the detriment to the many.
As this is May Day, the international workers’ day, wouldn’t it be nice if we could start moving in that direction, as so many other nations have already done?