Virginia Medicaid Expansion Enrollment Exceeds Projections
State officials had estimated 300,000 newly eligible Virginians would sign up for Medicaid coverage in the first 18 months of expansion, which takes effect on Jan. 1, but that estimate has increased based on the current pace of enrollment. As of Thursday morning, 140,643 adults now eligible for coverage under the expansion have enrolled in Medicaid, said Christina Nuckols, a media relations manager with the Virginia Department of Medical Assistance Service. State officials updated their estimate to 375,000 total enrollments by July 2020. That’s still 25,000 short of the 400,000 estimated Virginians who fall within the coverage requirements. Under the Affordable Care Act, states that expand Medicaid allow coverage for people with incomes up to 138 percent of the federal poverty level, which is $16,750 a year for a disabled person or able-bodied adult and $28,700 for a family of three. Virginia residents, find out eligibility requirements and how to enroll in Medicaid here >> A combination of automatic enrollments and streamlined enrollment processes for residents the state already knew were eligible—like those who receive Supplemental Nutrition Assistance Program benefits—are some of the reasons why the pace of signups have exceeded expectations, according to a Washington Post report. As part of the expansion, the federal government is expected to cover 90 percent of the cost of the program, to the tune of $2 billion annually. Virginia will foot its portion of the expansion costs through two new hospital taxes, which are expected to raise $590 million in two years, $248 million of which will be used to boost the reibursment rate for acute care facilities that treat Medicaid patients. The impact on travel healthcare in Virginia Even with less than one month until thousands of new potential low-income patients gain insurance coverage, Virginia hospitals are more worried about handling current needs than worrying about future patient loads, said Imran Chaudry, a senior client advisor for LiquidAgents Healthcare. “In the Richmond area, I can tell you from the feedback I’ve gotten that every hospital is still slammed,” Chaudry said. “I’ve tried talking to all of my…clients about the Medicaid expansion, but nobody is talking about that because they are so wrapped up in their day-to-day.” Job orders for travelers in the state have increased significantly since the start of November, Chaundry said, from around 100 positions to almost 200 open positions as of Dec. 5. Most of the market growth has occurred in the northeast and eastern portions of the state, around the greater Richmond region, Chaundry said. View current Virginia travel healthcare openings on StaffDNA >> Bon Secours Health System, the largest healthcare provider in the Richmond region, merged with Cincinnati-based Mercy Health in September. The merger is expected to boost services for Bon Secours in three markets including the Hampton Roads Health system near the state’s coast, according to a Modern Healthcare report. Both the Richmond region and the Hampton Roads region serve large populations of low-income residents, which could result in a wave of demand for travelers once newly covered Medicaid patients gain coverage in January. Studies have shown that low-income populations prefer using hospital emergency departments instead of primary care doctors for their around-the-clock availability and ease of use.
Montana’s Legislature Could Decide Medicaid Expansion’s Fate
By Eric Whitney, Montana Public Radio A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset. “We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure. The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster. Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish. The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana. Part of the expected $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana. Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act. In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.” Republican State Rep. Nancy Ballance, who opposed I-185, disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.” Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products. “No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.” Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won’t qualify. In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge. North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax hike someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.” This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Midterm Election Boosts Medicaid Expansion, But Challenges Remain
By Phil Galewitz, Kaiser Health News Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election. Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures. Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020. Medicaid proponents also were celebrating the Democrats’ takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people. “Tuesday was huge for the Medicaid program,” said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. “The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect.” But health experts caution that GOP opposition won’t fade away. David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. “I see this as a turning point in ACA politics,” he said. Still, he added‚ “it’s not inevitable.” Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities. The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest. GOP opposition has left about 4.2 million low-income Americans without coverage in various states. “It’s not over until it’s over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. “But the trend overall has been to increasing implementation and increasing coverage.” Montana Fails To Endorse Funding Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program. In addition, Democrats secured the governor’s offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it. Current and incoming Republican governors in Utah and Idaho said they wouldn’t block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase. It wasn’t a clean sweep, however, for Medicaid on Tuesday. In preliminary results, a ballot issue to fund Montana’s Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products. The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so. Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected. Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements. “There are some people in the state who may not have disabilities but need some help to access coverage,” she said. “I think we can pass something without people having a gap in coverage. … That will be a priority.” “It was never our intent to simply sunset the expansion and have it go away,” she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes. Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along. But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the state’s sales tax, just over a penny for a $10 purchase. Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the state’s ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage. “I think it showed there was a clear need for it,” he said. The legislature likely won’t block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps. Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom
Nebraska Voters Approve Medicaid Expansion Ballot Initiative
Nebraska joined the likes of several other states who approved Medicaid expansion Tuesday, with more than 53 percent of the vote in favor with 90 percent of precincts reporting. As many as 90,000 newly eligible residents will gain coverage and the uninsured rate could fall from to 9.6% from 12.4% next year, according to an independent study by the Urban Institute. Along with the new Medicaid patients, the state will also see a cash flow of federal dollars—as much as $68 million annually—to help cover the program’s costs. The approval is a big win for advocates who have watched attempts to expand Medicaid fail six times in the state’s legislature. Advocates successfully petitioned and got the initiative added to the ballot in July. Voters also said yes despite heavy opposition from the Republican-controlled state representatives and Gov. Pete Ricketts, who saw it as a “government entitlement program.” Depending on when Nebraska’s Medicaid expansion program is officially implemented, the state could see a new wave of job opportunities in the travel healthcare market in 2019. Studies have shown that Medicaid expansion states have increased patient demands and healthier hospital budgets, which can lead to a higher volume of traveler needs. We will update this story with the final election totals when they are made available.
The Election’s Impact On Healthcare: Some Bellwether Races To Watch
By Julie Rovner, Kaiser Health News Voters this year have told pollsters in no uncertain terms that health care is important to them. In particular, maintaining insurance protections for preexisting conditions is the top issue to many. But the results of the midterm elections are likely to have a major impact on a broad array of other health issues that touch every single American. And how those issues are addressed will depend in large part on which party controls the U.S. House and Senate, governors’ mansions and state legislatures around the country. All politics is local, and no single race is likely to determine national or even state action. But some key contests can provide something of a barometer of what’s likely to happen — or not happen — over the next two years. For example, keep an eye on Kansas. The razor-tight race for governor could determine whether the state expands Medicaid to all people with low incomes, as allowed under the Affordable Care Act. The legislature in that deep red state passed a bill to accept expansion in 2017, but it could not override the veto of then-Gov. Sam Brownback. Of the candidates running for governor in 2018, Democrat Laura Kelly supports expansion, while Republican Kris Kobach does not. Here are three big health issues that could be dramatically affected by Tuesday’s vote. 1. The Affordable Care Act Protections for preexisting conditions are only a small part of the ACA. The law also made big changes to Medicare and Medicaid, employer-provided health plans and the generic drug approval process, among other things. Republicans ran hard on promises to get rid of the law in every election since it passed in 2010. But when the GOP finally got control of the House, the Senate and the White House in 2017, Republicans found they could not reach agreement on how to “repeal and replace” the law. This year has Democrats on the attack over the votes Republicans took on various proposals to remake the health law. Probably the most endangered Democrat in the Senate, Heidi Heitkamp of North Dakota, has hammered her Republican opponent, U.S. Rep. Kevin Cramer, over his votes in the House for the unsuccessful repeal-and-replace bills. Cramer said that despite his votes he supports protections for preexisting conditions, but he has not said what he would do or get behind that could have that effect. Polls suggest Cramer has a healthy lead in that race, but if Heitkamp pulled off a surprise win, health care might well get some of the credit. And in New Jersey, Rep. Tom MacArthur, the moderate Republican who wrote the language that got the GOP health bill passed in the House in 2017, is in a heated race with Democrat Andy Kim, who has never held elective office. The overriding issue in that race, too, is health care. It is not just congressional action that has Republicans playing defense on the ACA. In February, 18 GOP attorneys general and two GOP governors filed a lawsuit seeking a judgment that the law is now unconstitutional because Congress in the 2017 tax bill repealed the penalty for not having insurance. Two of those attorneys general — Missouri’s Josh Hawley and West Virginia’s Patrick Morrisey — are running for the Senate. Both states overwhelmingly supported President Donald Trump in 2016. The attorneys general are running against Democratic incumbents — Claire McCaskill of Missouri and Joe Manchin of West Virginia. And both Republicans are being hotly criticized by their opponents for their participation in the lawsuit. Although Manchin appears to have taken a lead, the Hawley-McCaskill race is rated a toss-up by political analysts. But in the end, the fate of the ACA depends less on an individual race than on which party winds up in control of Congress. “If Democrats take the House … then any attempt at repeal-and-replace will be kaput,” said John McDonough, a former Democratic Senate aide who helped write the ACA and now teaches at the Harvard School of Public Health. Conservative healthcare strategist Chris Jacobs, who worked for Republicans on Capitol Hill, said a new repeal-and-replace effort might not happen even if Republicans are successful Tuesday. “Republicans, if they maintain the majority in the House, will have a margin of a half dozen seats — if they are lucky,” he said. That likely would not allow the party to push through another controversial effort to change the law. Currently, there are 42 more Republicans than Democrats in the House. Even so, the GOP barely got its health bill passed out of the House in 2017. And political strategists say that, when the dust clears after voting, the numbers in the Senate may not be much different so a change could be hard there too. Republicans, even with a small majority last year, could not pass a repeal bill there. 2. Medicaid expansion The Supreme Court in 2012 made optional the ACA’s expansion of Medicaid to cover all low-income Americans up to 138 percent of the poverty line ($16,753 for an individual in 2018). Most states have now expanded, particularly since the federal government is paying the vast majority of the cost: 94 percent in 2018, gradually dropping to 90 percent in 2020. Still, 17 states, all with GOP governors or state legislatures (or both), have yet to expand Medicaid. McDonough is confident that’s about to change. “I’m wondering if we’re on the cusp of a Medicaid wave,” he said. Four states — Nebraska, Idaho, Utah and Montana — have Medicaid expansion questions on their ballots. All but Montana have yet to expand the program. Montana’s question would eliminate the 2019 sunset date included in its expansion in 2016. But it will be interesting to watch results because the measure has run into big-pocketed opposition: the tobacco industry. The initiative would increase taxes on cigarettes and other tobacco products to fund the state’s increased Medicaid costs. In Idaho, the ballot measure is being embraced by a number of Republican leaders. GOP Gov.
Tobacco Tax Battle Could Torch Montana Medicaid Expansion
By Eric Whitney, Montana Public Radio Montana legislators expanded Medicaid by a very close vote in 2015. They passed the measure with an expiration date: It would sunset in 2019, and all who went onto the rolls would lose coverage unless lawmakers voted to reapprove it. Fearing legislators might not renew funding for Medicaid’s expanded rolls, Montana’s hospitals and health advocacy groups came up with a ballot measure to keep it going — and to pay for it with a tobacco tax hike. If ballot initiative I-185 passes Tuesday, it will mean an additional $2-per-pack tax on cigarettes and levy a tax on e-cigarettes, which are currently not taxed in Montana. The tobacco tax initiative has become the most expensive ballot measure race in Montana history — drawing more than $17 million in opposition funding from tobacco companies alone — in a state with fewer than 200,000 smokers. Amanda Cahill works for the American Heart Association and is a spokeswoman for Healthy Montana, the coalition backing the measure. She said coalition members knew big tobacco would fight back. “We poked the bear, that’s for sure,” Cahill said. “And it’s not because we were all around the table saying, ‘Hey, we want to have a huge fight and go through trauma the next several months.’ It’s because it’s the right thing to do.” Most of the $17 million has come from cigarette maker Altria. According to records from the National Institute on Money in Politics, that’s more money than Altria has spent on any state proposition nationwide since the center started keeping track in 2004. Meanwhile, backers of I-185 have spent close to $8 million on the initiative, with most of the money coming from the Montana Hospital Association. “What we want to do is — No. 1 — stop Big Tobacco’s hold on Montana,” Cahill said. Also, she continued, it’s imperative that the nearly 100,000 people in Montana who have gotten Medicaid under the expansion will be able to keep their health care. Cahill said I-185 will allocate plenty of money to cover the expansion, though some lawmakers say the state can’t afford the expansion even with higher taxes. Nancy Ballance, a Republican representative in the Montana state Legislature, opposes the measure. “In general I am not in favor of what we like to refer to as ‘sin taxes,’ ” Ballance said. “Those are taxes that someone determines should be [levied] so that you change people’s behavior.” Ballance also isn’t in favor of ballot initiatives that, she said, try to go around what she sees as core functions of the Legislature: deciding how much revenue the state needs, for example, or where it should come from, or how it should be spent. “An initiative like this for a very large policy with a very large price tag — the Legislature is responsible for studying that,” Ballance said. “And they do so over a long period of time, to understand what all the consequences are — intended and otherwise.” Most citizens, she said, don’t have the time or expertise to develop that sort of in-depth understanding of a complicated issue. Montana’s initiative to keep Medicaid’s expansion going would be a “double whammy” for tobacco companies, said Ben Miller, the chief strategy officer for the nonprofit Well Being Trust. “People who are covered are more likely to not smoke than people who are uninsured,” said Miller, who has studied tobacco tax policies for years. He notes research showing that people with lower incomes are more likely than those with higher incomes to smoke; and if they’re uninsured, they’re less likely to quit. Federal law requires Medicaid to offer beneficiaries access to medical help to quit smoking. Plus, Miller added, every time cigarette taxes go up — thereby increasing the price per pack — that typically leads to a decrease in the number of people smoking. And that, he said, works against a tobacco company’s business model, “which is, ‘you need to smoke so we can make money.’ ” Ballance agrees that tobacco companies likely see ballot initiatives like I-185 as threats to their core business. But, she said, “for anybody who wants to continue smoking, or is significantly addicted, the cost is not going to prohibit them from smoking.” The U.S. Centers for Disease Control and Prevention says tobacco use is the leading cause of preventable disease and death in the U.S. Montana’s health department says that each year more than 1,600 people in the state die from tobacco-related illnesses. This story is part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News. This story originally appeared on Kaiser Health News. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
An Update On Medicaid Expansion Efforts and How They Affect Travelers
As we move closer and closer to November midterm elections in the U.S., healthcare access and quality issues have become a heated political battleground for legislators and citizens across the political spectrum. Medicaid expansion, a tentpole policy part of the Affordable Care Act passed in 2010, is one of the key divisive topics in this realm. It’s also something healthcare providers—and by extension travel healthcare professionals—are keeping an eye on, as expansion can have an impact on provider funding and patient care. What Is Medicaid Expansion? Under the Affordable Care Act, states can expand Medicaid eligibility to nonelderly adults with incomes at or below 138 percent of the federal poverty level, which equals about $16,700 a year for a single person and $34,600 for a family of four. Expansion states are funneled billions of dollars from the federal government to support expansion efforts and coverage for newly insured populations. In states that haven’t expanded, those adults fall into a “coverage gap” for having incomes above traditional Medicaid eligibility but below the limit to get approved for ACA marketplace premium tax credits. So far 34 states have approved Medicaid expansion, two states—Maine and Virginia—are in the works to implement expansions, and three states—Idaho, Utah and Nebraska—could potentially approve Medicaid expansion this year. Why is Medicaid expansion important to travelers? Simply put, hospitals in states that expand Medicaid can expect to see a new influx of patients looking for care on a regular basis which can affect seasonal staffing needs. A Commonwealth Fund study in 2015 found that 4 out of 10 primary care physicians who accepted Medicaid saw an increase in patients after expansion coverage took full effect. Additionally, studies have shown that hospitals in expansion states have much healthier budgets, which can leave more money on the table for hiring and retaining temporary or permanent staff. According to an analysis by the Kaiser Family Foundation, expansion hospitals saw “significantly improved hospital operating margins.” These factors don’t completely guarantee that facilities in expansion states will overflow with traveler needs, but it can help prevent razor-thin hospital budgets and get executives thinking about how to ease the burden on their permanent staff. What’s happening in states with plans for Medicaid expansion? Maine Medicaid was supposed to be available to newly eligible Maine residents on July 2, but a series of appeals and heated courtroom battles have kept expansion in limbo, leaving more than 70,000 without coverage. At the heart of the issue is Republican Gov. Paul LePage, who has vetoed Medicaid expansion efforts six times in office. Mainers approved Medicaid expansion through a referendum vote with a 59 percent voting majority in 2017, but LePage refuses to submit a plan to the federal government until sufficient state funding—under his terms—is found. LePage was ordered by a Superior Court justice to submit a plan in June, but his administration appealed the ruling to the Maine Supreme Court, saying they did not have to file a plan during the appeal process. Arguments for the appeal took place on July 18, but the court has yet to make a decision. You can view a more detailed timeline of the events leading up to the court hearing by clicking here. Idaho Advocates in Idaho successfully petitioned and gathered 75,314 verified signatures to add a Medicaid expansion measure to the ballot this November. The petition met both state requirements to qualify the ballot measure, gathering at least 56,192 verified signatures that represented at least 18 of Idaho’s 35 legislative districts, according to Ballotpedia. Utah Utah Gov. Gary Herbert signed a bill on March 27, 2018, for partial Medicaid expansion, directing the state to seek federal approval to expand Medicaid to 100% of the federal poverty level. The bill stipulated using the ACA enhanced federal match rate and adding a work requirement for the expansion population. To date, the Center for Medicare and Medicaid Services (CMS) has not approved waivers to access the match rate until Utah approves a full expansion. In the meantime, Utah expansion advocates garnered enough petition signatures to add a competing bill to November ballots that would approve a full expansion. Nebraska Similar to Idaho and Utah, Nebraska advocates have submitted a petition to add a Medicaid expansion initiative to the midterm election ballot this fall. Supporters filed more than 133,000 signatures on July 5, but the Secretary of State office is still verifying the signatures. At least 84,908, or more than 60 percent, of the signatures need to be valid for the initiative to make the ballot.