Trump Push for Medicaid Work Requirements Suffers Election Setback

Trump Push for Medicaid Work Requirements Suffers Election Setback

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Wednesday, November 6, 2019

Trump Admin Push for Medicaid Work Requirements Suffers Election Setback

The Trump administration's effort to impose work requirements on Medicaid beneficiaries experienced a setback Tuesday with the apparent defeat of Kentucky Gov. Matt Bevin.

Bevin, a Republican, hasn’t conceded defeat in his reelection race, but he trails his Democratic opponent, Kentucky Attorney General Andy Beshear, who has declared victory. Beshear made the elimination of Medicaid work requirements a central part of his campaign and said Wednesday that he would rescind them as soon as he takes office.

The background: Medicaid expansion provides health coverage for about 400,000 Kentucky residents. In 2018, the Trump administration gave the state the first federal waiver to allow work requirements for Medicaid beneficiaries, though legal challenges have prevented the new rules from taking effect. At the time, Bevin said the work requirements were long overdue, even though they would result in an estimated 95,000 state residents losing their health insurance. Like many supporters of work requirements, Bevin said they were designed to cut costs and to help Medicaid enrollees personally. “There is dignity associated with earning the value of something you receive,” he said.

The political lesson: Bevin nationalized his campaign, tying himself to President Trump, so it’s hard to tease out just how much his loss might be about national politics or state issues like Medicaid expansion. Still, political observers suggest Bevin’s unpopularity — compared to Trump, who remains popular in Kentucky — is rooted in the position he staked out on Medicaid along with his push for pension reforms that cut retirement benefits for new teachers and funding for public schools, sparking teacher protests.

Joan Alker, director of the Center for Children and Families at Georgetown University, said Wednesday that Medicaid expansion in Kentucky has been popular, in part because it covers 40% to 50% of adults in rural areas in the state. “This continues a trend we have seen in recent elections where Medicaid has a lot of support at the ballot box across political parties,” Alker told The Hill. “It’s really remarkable how important Medicaid expansion has become as an issue in red states. And the voters want it.”

Bevin’s effort to cut Medicaid was likely a problem for him with some portion of Kentucky’s rural voters, which may have been the difference in an extremely tight race. “As it turns out, when the governor slashes social programs in one of the poorest states in America, voters don't want to re-elect him,” Alex Wagner, a contributing editor at The Atlantic, said Wednesday.

Mixed messages elsewhere: Medicaid expansion was part of the electoral mix in two others states Tuesday. In Virginia, where Medicaid expansion passed last year, voters gave control of the legislature to Democrats, which could result in Democratic Gov. Ralph Northam withdrawing or freezing a pending request to impose work requirements on beneficiaries. In Mississippi, voters appeared to reject Medicaid expansion, electing Republican Tate Reeves, who ran against it on “philosophical grounds.”

Pete Buttigieg's Path to Lower Hospital Prices

Medicare for All and Elizabeth Warren’s plan to finance such a system have dominated the health-care debate in recent days, but it’s not the only proposal out there to expand coverage and bring down high medical costs in the U.S.

At The New York Times’s Upshot, reporter Margot Sanger-Katz looks at Pete Buttigieg’s plan for reining in hospital prices, a key part of any plan since hospitals are the largest component of health-care spending.

“The real problem in the last years is not that Medicare is not able to control prices, but that the private sector is not able to control prices,” Gerard Anderson, a professor at Johns Hopkins, tells Sander-Katz.

Where Warren’s plan would have the government sharply reduce payments to doctors and hospitals, Buttigieg’s plan takes aim at those costs in a less direct way. Buttigieg, the mayor of South Bend, Indiana, who has risen in Democratic primary polls lately, has put forth a “Medicare for All Who Want It” plan that proposes to create a public insurance option to compete with private insurers.

Sanger-Katz explains:

“It would allow insurers and medical providers to agree on whatever prices they wish in a contract. But it would limit how much insurers have to pay when providers are ‘out of network.’ The limit, double what Medicare pays them, would help patients who end up at a place that is not covered by their insurance. But it will also tend to influence the negotiations between hospitals and insurance companies, putting downward pressure on in-network prices. ...
“Currently, most hospitals charge insurers around double the Medicare price, but some charge more. ‘You’re lopping off the top tail,’ said Matthew Fiedler, a fellow at the Brookings Institution, who has been studying similar pricing rules in other contexts. He said the strategy would be particularly useful for services related to medical emergencies.”

Sanger-Katz notes that the idea of explicit price regulation, once out of the political mainstream, has grown more popular as prices continue to rise. But there’s sure to be plenty of pushback: “Medical providers are sure to dislike a plan with price controls, of course, and are likely to fight this feature of Mr. Buttigieg’s plan with much of the vigor they’re expected to bring to opposing single-payer.”

Read the full story at The New York Times.

Quote of the Day

“Everyone's fretting about costs. Everyone's wringing their hands. We have very strong scientific evidence that close to $1 trillion a year is absolute waste. You'd think that in any industry that had a brain, we'd be going after that money hard.”

– Donald Berwick, a doctor who served as administrator of the Centers for Medicare and Medicaid Services in the Obama administration and advised Elizabeth Warren on her Medicare-for-All financing plan, in an Axios interview on why he backs a single-payer system and improvements that can be made to U.S. health care.

Senate Committee Approves Budget Reforms

The Senate Budget Committee on Wednesday approved a bipartisan bill that aims to reform the federal government’s budget process. The Bipartisan Congressional Budget Reform Act “would provide a more orderly and deliberative budget process focused on long-term fiscal planning,” according to committee chair Sen. Mike Enzi (R-WY), who sponsored the bill along with Sen. Sheldon Whitehouse (D-RI).

Here’s Whitehouse's summary of what the bill would do:

  • Move the budget resolution to a two-year cycle, while maintaining annual appropriations.
  • Require more involvement from Senate spending and taxing committees, including by requiring detailed spending and revenue plans to better inform budget development.
  • Focus on fiscal sustainability by requiring the budget resolution to establish a debt-to-GDP target backed by a deficit-reducing special reconciliation process to promote adherence to the budget plan.
  • Create a mechanism within the regular budget process to end the brinksmanship surrounding the statutory debt limit by conforming the limit to levels called for in the budget resolution. 
  • Establish an optional new bipartisan budget pathway through which the budget would set a glideslope of deficit reduction that includes health care, revenue levels, and appropriations, and tax expenditures. Such bipartisan budgets would require the support of at least 60 Senators, including at least 15 members of the minority party, and would be considered in the Senate under expedited procedures jointly agreed to by the Majority and Minority Leaders.
  • Provide a more orderly, deliberative process for Senate consideration of budget resolutions that preserves the ability of Senators on both sides of the aisle to offer amendments.
  • Enhance fiscal transparency by requiring that up-to-date tabulations of congressional budget action be publicly posted and that information on the interest effects of authorizing and revenue legislation be included in cost estimates prepared by the Congressional Budget Office (CBO).  The legislation also supports transparency efforts underway at CBO.
  • Require CBO and the Government Accountability Office to regularly review and report to Congress on portfolios of federal spending to help lawmakers make more informed budgetary decisions.

For more on the reform effort, see this letter of support from the Committee for a Responsible Federal Budget, and this critical op-ed in The Hill that says the legislation could be harmful.

Number of the Day: 27%

Salaries for federal employees are nearly 27% lower, on average, than those for their private-sector counterparts, according to figures reported Tuesday by the Federal Salary Council, an advisory body responsible for making recommendations regarding such pay disparities.

The gap between federal and private-sector pay shrank by 4.25 percentage points since April 2018, the council said, but there was “no readily apparent reason” for the change, according to The Washington Post.

The pay gap figures are based on Labor Department data on salaries across a range of occupations, levels and locations, the Post’s Eric Yoder writes. “Other studies, using different methods, produce different conclusions,” he adds. “Some conservative and libertarian organizations have found a difference in favor of federal employees, while the Congressional Budget Office in 2017 found salaries overall to be about comparable, although with variations by educational level.”


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