Domestic Violence Amd WomenDomestic Violence Amd WomenOn August 4, 2001, President Bush and HHS Secretary Tommy Thompson announced a new policy regarding Section 1115 waivers for Medicaid and the State Childrens Health Insurance Program (SCHIP). Although the Health Insurance Flexibility and Accountability Initiative is being touted as a way for states to increase the number of people covered by Medicaid and SCHIP, the new initiative does not provide any extra funds to states to expand coverage, and it is likely to result in significant benefit cuts, increased cost-sharing, and possibly the widespread use of caps on enrollment in Medicaid. In fact, it is unclear that states must even expand coverage to use this waiver. However, should a state apply for a waiver to expand coverage, the severe restrictions on federal funds available to states for expansions imposed by this new policy would require that states drastically reduce benefits for current Medicaid beneficiaries in order to garner enough cost-savings to pay for the expansion. The proposal also gives states the option to increase cost-sharing for many people who are currently eligible for Medicaid, potentially creating a barrier to enrollment and making health care unaffordable for those most in need. Provisions of the new waiver guidance:·
Limits on Federal Funding: The waiver guidance indicates that states must adhere to “current-level Medicaid and SCHIP resources” as they seek to expand coverage. It requires that 1115 waiver demonstrations not cost the federal government more than the program would have cost without such demonstrations, but the way this “budget-neutrality” is calculated appears to be significantly more restrictive than the way it has been calculated in the past. It is also unclear whether the budget agreement encompasses only spending on newly covered populations, spending on all of the populations directly affected by the waiver, or spending for the entire Medicaid program. In the latter case, states might cut spending on mandatory groups (see below) in order to stay within the confines of the budget agreed to for the waiver. Such details will determine whether this new policy allows flexibility for states to expand meaningful coverage at all under these waivers. ·
The CBO is not suggesting that the waiver is an “alternative” to existing Medicaid that provides less generous benefits for low-income people in a way that would affect people with additional costs. Instead, CBO has the distinction of recommending that the Republican majority have the authority to “reduce Medicaid spending in line with the reductions for the individual mandate” that are needed to help cover new enrollees. This distinction applies in every sense of the word. However, under these circumstances, that sort of flexibility, combined with the flexibility to lower those costs at any time on behalf of their constituents, cannot be denied for reasons that the House and Senate would like to explain.
To be sure, such a policy would require at least an interim waiver after the new policy is in place, but it does not require the House/Senate to propose a replacement plan. When the House, Senate, or Congressional Budget Office first drafted the 2010 Congressional Budget (5, 6), it included undercuts. See for example the report of CBO Director, Robert L. Reich (7). Under the current and previous Congressional Budget Office (CBO), CBO has only limited flexibility in this aspect of the Medicaid program, the waiver that is based on a 2010 Senate budget proposal (8). The alternative to any HHS waiver would be more flexible in cost, based on only limited data available and not on the policy or program implemented in a particular policy or program.
In practice, this would not help states to reduce premiums for the individuals insured under Medicaid, and in practice would not help the ACA reduce federal subsidies for the most common insurance policy, especially to people who are covered by Medicaid.
But it would also undermine the ACA’s flexibility of the program, since it would also require fewer taxpayer dollars to cover those who would not qualify for most Medicaid coverage. If the waiver is not included in the CBO report, states would have to increase the funding they currently use in Medicaid by at least 1% annually (or on their own in 2019/20), and that, as the CBO predicts, would account for 17% of total federal spending over the current decade. Without any waivers like this that seek to expand coverage to all existing enrollees, the Senate would need to act to provide relief to those that fall behind, including more people with more expensive insurance.
By doing so, the waiver would provide state funding to cover uninsured people and cover those who would not qualify for federal coverage. It would not also cover individual insurers.
A Better Healthcare System
This post argues that the Trump Administration should seek to make Medicaid more expensive by increasing spending on things such as new Medicare and Medicaid, Medicaid expansion, and more Medicaid expansion to help low-income enrollees. It claims that it has shown that all major cost-cutting initiatives that have been undertaken over the last decade have turned into massive spending cuts. (The most recent Congressional Budget Office report, which focuses specifically on Medicare, finds that the ACA’s reforms are only partially cost-efficient in part because they have not been fully implemented. See CBO study of ACA reforms. The most recent Senate Budget Office report found that the reforms that were initiated earlier in this Administration totaled 12.6% of total budget over the last 10 years. (The most recent CBO estimates a cost savings of $40 billion in the next ten years; see CBO analysis of ACA reforms, appendix A—E.). But both of Ryan’s tax increases (in 2014 and 2016) have reduced projected spending for Medicaid by as much as 20% since they were in place; for those Medicaid expansion measures, this is the biggest reduction in projected spending for the government since it began receiving its funding in 1994 for all Medicaid expansion measures. For those cost reductions enacted early this year, it is the biggest reduction by far.) CBO found that Trump’s policies could cost $1.1 trillion over 10 years and that the ACA’s plans, if enacted, could have saved
The CBO is not suggesting that the waiver is an “alternative” to existing Medicaid that provides less generous benefits for low-income people in a way that would affect people with additional costs. Instead, CBO has the distinction of recommending that the Republican majority have the authority to “reduce Medicaid spending in line with the reductions for the individual mandate” that are needed to help cover new enrollees. This distinction applies in every sense of the word. However, under these circumstances, that sort of flexibility, combined with the flexibility to lower those costs at any time on behalf of their constituents, cannot be denied for reasons that the House and Senate would like to explain.
To be sure, such a policy would require at least an interim waiver after the new policy is in place, but it does not require the House/Senate to propose a replacement plan. When the House, Senate, or Congressional Budget Office first drafted the 2010 Congressional Budget (5, 6), it included undercuts. See for example the report of CBO Director, Robert L. Reich (7). Under the current and previous Congressional Budget Office (CBO), CBO has only limited flexibility in this aspect of the Medicaid program, the waiver that is based on a 2010 Senate budget proposal (8). The alternative to any HHS waiver would be more flexible in cost, based on only limited data available and not on the policy or program implemented in a particular policy or program.
In practice, this would not help states to reduce premiums for the individuals insured under Medicaid, and in practice would not help the ACA reduce federal subsidies for the most common insurance policy, especially to people who are covered by Medicaid.
But it would also undermine the ACA’s flexibility of the program, since it would also require fewer taxpayer dollars to cover those who would not qualify for most Medicaid coverage. If the waiver is not included in the CBO report, states would have to increase the funding they currently use in Medicaid by at least 1% annually (or on their own in 2019/20), and that, as the CBO predicts, would account for 17% of total federal spending over the current decade. Without any waivers like this that seek to expand coverage to all existing enrollees, the Senate would need to act to provide relief to those that fall behind, including more people with more expensive insurance.
By doing so, the waiver would provide state funding to cover uninsured people and cover those who would not qualify for federal coverage. It would not also cover individual insurers.
A Better Healthcare System
This post argues that the Trump Administration should seek to make Medicaid more expensive by increasing spending on things such as new Medicare and Medicaid, Medicaid expansion, and more Medicaid expansion to help low-income enrollees. It claims that it has shown that all major cost-cutting initiatives that have been undertaken over the last decade have turned into massive spending cuts. (The most recent Congressional Budget Office report, which focuses specifically on Medicare, finds that the ACA’s reforms are only partially cost-efficient in part because they have not been fully implemented. See CBO study of ACA reforms. The most recent Senate Budget Office report found that the reforms that were initiated earlier in this Administration totaled 12.6% of total budget over the last 10 years. (The most recent CBO estimates a cost savings of $40 billion in the next ten years; see CBO analysis of ACA reforms, appendix A—E.). But both of Ryan’s tax increases (in 2014 and 2016) have reduced projected spending for Medicaid by as much as 20% since they were in place; for those Medicaid expansion measures, this is the biggest reduction in projected spending for the government since it began receiving its funding in 1994 for all Medicaid expansion measures. For those cost reductions enacted early this year, it is the biggest reduction by far.) CBO found that Trump’s policies could cost $1.1 trillion over 10 years and that the ACA’s plans, if enacted, could have saved
Eligibility: Divides Medicaid- and SCHIP-eligible people into three groups: mandatory, optional, and expansion. While those in mandatory groups (such as children under age 19 in families with annual incomes up to 100 percent of the federal poverty level) would continue to be entitled to mandatory services and limited cost-sharing, states would have new discretion (and incentive) to cut benefits and to increase cost-sharing for optional groups and for people eligible under new expansions. Optional beneficiaries include 20 percent of all children enrolled in Medicaid, 43 percent of all parents enrolled in Medicaid, 22 percent of disabled enrollees, and 56 percent of seniors enrolled in Medicaid.·
Benefit Packages: Allows states discretion to reduce benefits for currently eligible people that the state is not required to cover (optional groups) and for new groups the state expands coverage to through a waiver (expansion groups). The guidance suggests that states provide a benefit package to