Why Medicaid is More Important Than Ever

  

Too often overlooked in recent debates is the role that Medicaid plays in children’s healthcare coverage. Of the 74 million Americans covered by Medicaid, nearly 36 million are children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) – which was enacted in 1997 to ensure affordable and accessible healthcare coverage for low-income children. Roughly 38 percent of American children receive healthcare services through these two programs, and they have been critical in increasing the percentage of American children with health insurance coverage to a historic high of 95.5 percent in 2016.

Medicaid and CHIP are particularly important to some of the nation’s most vulnerable children – 76 percent of children living in poverty, 48 percent of children with special health needs, and 48.8 percent of children ages three and under are covered under Medicaid and CHIP. Furthermore, 49 percent of births are covered by Medicaid. Without these two programs, millions of children would go without crucial healthcare services, positioning them for a lower quality of life further down the road.

And yet, despite the indubitably positive impacts that these programs have for America’s youngest and most vulnerable, Congressional Republicans and the Trump Administration have repeatedly attempted to scale them back and reduce the number of Americans who receive coverage. Congress voted on several bills in 2017 – all of which failed to pass both chambers – which would have reduced Medicaid eligibility, slashed funding, and imposed caps on state Medicaid programs. Congress also chose to play political football with CHIP, which expired on September 30, 2017, and did not re-authorize the program until January 2018, a full four months after its funding had expired. The Trump Administration has also opened the door for states to impose work requirements on Medicaid recipients. These proposals have all been aimed at low-income Americans, who are burdened enough already as they work to make ends meets.

Reducing coverage to reduce poverty and encourage work is counterintuitive given that Medicaid actually encourages Americans to remain employed, and implementing such proposals would have drastically negative impacts on the nation’s low-income and vulnerable populations. Seventeen percent of American parents receive health insurance coverage through Medicaid; reducing Medicaid eligibility and funding for adults would also reduce coverage for those children whose parents receive coverage through Medicaid. Medicaid also helps to keep millions of Americans out of poverty and out of debt. The burden of this reduction in coverage, meanwhile, would fall equally, and unfairly, on parents and their children.

While CHIP has been fully re-authorized for 10 years and there are currently no legislative proposals to roll back Medicaid coverage that appear close to passage this Congress, it is important to recognize not only during this Medicaid Awareness Month, but all year, the impact the Medicaid has on such a large segment of Americans. ANA continues to support universal access to affordable and accessible healthcare coverage and continues to stress the importance of preventive services. Medicaid and CHIP are some of the most important programs toward achieving those principles, and we urge Congress and the Trump Administration not to jeopardize Medicaid coverage for any Americans.

Omnibus Spending Bill Is Two Steps Forward, One Step Back for Public Health Issues

  

President Trump today signed into law a major $1.3 trillion omnibus spending bill which funds the federal government through the end of the fiscal year on September 30, 2018. This bill significantly increases both defense and domestic discretionary spending, and includes several important healthcare provisions critical to nurses.

ANA is pleased to note that this spending measure fully funds Title VIII Nurse Workforce Development Programs and includes a $20 million funding increase for such programs. We applaud Congress for recognizing the importance of a nursing workforce that is ready to meet the challenges of our current healthcare environment. ANA also applauds Congress for providing an additional $3 billion to fight the opioid crisis. As providers on the frontlines of this epidemic, nurses witness firsthand the devastation of addiction and overdose. We hope that this combination of workforce and opioid funding will enable the health care system – and nurses in particular – to put an end to this devastating scourge.

Congress also started to show signs of progress on gun violence prevention, as thousands of engaged Americans across the country prepare for this weekend’s March for Our Lives. Congress clarified that the Centers for Disease Control and Prevention (CDC) is permitted to engage in some gun violence prevention research, and laid the groundwork for an improved background check system. That said, much work remains to keep our children and nation safe from these senseless tragedies.  Acknowledging the CDC’s authority to study the problem without actually allocating resources carries the same chilling effect on conducting research as an outright ban.

ANA is also very disappointed by Congress’s failure to ensure affordable and accessible healthcare coverage for all Americans. The omnibus spending measure notably did not include a measure or any funding intended to stabilize the individual health insurance markets. Without such market stabilization efforts, individual premiums will continue to skyrocket and many Americans will choose to forgo health insurance coverage altogether, exposing them to physical and financial risks. ANA continues to urge Congress to act toward implementing market stabilization measures.

ANA again applauds Congress for ending (for now) the familiar cycle of lurching from budget crisis to budget crisis with no long-term, bipartisan solutions to outstanding policy issues. While the provisions noted above – nursing workforce, opioids, gun violence prevention – are a start to solving some of these issues, they do not go far enough. We urge Congress to continue to work toward solving these critical policy issues, and to realize that continuing to play politics with the stability of the individual health insurance market hurts vulnerable Americans who rely on affordable and accessible health coverage.

Trump Administration’s Moves Continue to Fracture the U.S. Healthcare System

  

The Trump Administration continues to create uncertainty in the U.S. healthcare system – uncertainty that has led states to take measures which could ultimately result in drastically disparate health outcomes, both across states and populations. In addition to repealing the individual mandate in December 2017’s tax legislation, the administration in the last several months has proposed several rules which could further exacerbate these divides (ANA will submit comment letters on all three of these proposed rules).

  • The first of these rules was issued by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and would act to expand the ability of employers to offer health insurance coverage through Association Health Plans; ANA submitted a comment letter on this proposed rule on Friday March 2nd. This rule would facilitate the proliferation of insurance coverage that does not cover Essential Health Benefits, and would make it more difficult for older individuals and those with pre-existing conditions to purchase individual health insurance coverage while driving up prices in the federal and state health insurance exchanges.
  • The second proposed rule comes from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights and focuses on enforcing statutory conscience rights of healthcare workers – including nurses. ANA strongly supports the fundamental right of nurses and all healthcare workers to listen to their moral and ethical consciences; however, we also believe that this proposed rule as written opens the door for discrimination against marginalized groups, including LGBT individuals, which already experience lower quality health outcomes and would lead to further population health disparities.
  • The third proposed rule comes from the U.S Department of Treasury’s Internal Revenue Service, EBSA, and HHS and focuses on expanding the use of short-term, limited-duration insurance. This rule would have an impact similar to that of the Associated Health Plan proposed rule described above.

These rules – in addition to the repeal of the individual mandate – threaten to fracture the national healthcare system framework established under the Affordable Care Act (ACA). This is not the first time this has happened since President Obama signed the ACA into law in 2010 – the King v. Burwell  Supreme Court decision in 2012 ensured that not all states would provide the same level of Medicaid coverage, and as a result 17 states still have yet to expand Medicaid. The Trump Administration, however, has accelerated this fracturing, and states are increasingly taking measures to react to these federal policy decisions.

Some states – including California, New York, and Maryland – have seen proposals to pass their own state-level individual mandate, while others such as Oregon have created reinsurance programs to insulate insurance companies from the extremely high costs of covering patients with chronic and complex health conditions – thus helping to keep premium costs down for the overall population.

Other states – bolstered by the Trump Administration’s moves – have pushed the limits of what is allowable under the ACA. While the ACA allows states to experiment with their health systems under Section 1332 waivers, some states are arguably moving beyond what is allowed even under such waivers. Idaho, for instance, recently attempted to allow insurers to sell individual health insurance policies which do not comply with some of the ACA’s requirements, including the elimination of lifetime caps and the coverage of Essential Health Benefits. The Trump Administration, however, informed Idaho that this plan is non-compliant with federal statute and that the sale of such plans would not be allowed.

ANA strongly supports innovation and creative approaches to ensuring comprehensive, affordable healthcare coverage for all Americans. These proposals, however, would likely have the opposite effect by driving up premium prices, pushing individuals in at-risk populations out of the insurance market, and widening population health disparities. ANA reiterates its previously stated support for legislative proposals which shore up the individual health insurance marketplace and reinstate critical cost-sharing reduction payments to help low-income families pay for much-needed primary care and other healthcare services.

Photo: Evan Vucci/Associated Press