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Senate Bill Makes It Harder for States to Maintain — Let Alone Raise — Their Medicaid Spending

Sat, 24 Jun 2017 13:32:33 +0000

The Senate health bill not only shifts huge costs to states by capping and cutting federal Medicaid funding — thereby forcing states to raise taxes or cut other areas like education to maintain their Medicaid programs — but makes it harder for states just to sustain their current Medicaid spending by restricting state taxes on health care providers. Every state except Alaska uses provider taxes to help finance Medicaid. (See Table 1.)

Senate Bill Still Cuts Tax Credits, Increases Premiums and Deductibles for Marketplace Consumers

Sat, 24 Jun 2017 03:02:35 +0000

The House-passed health care bill (the American Health Care Act) slashed subsidies that help people afford individual market coverage, increasing out-of-pocket costs by thousands of dollars for people who get their coverage through the Affordable Care Act (ACA) marketplaces.

In Case You Missed It...

Fri, 23 Jun 2017 22:03:21 +0000

This week at CBPP, we focused on health care, the federal budget and taxes, food assistance, and jobs.

Senate Health Bill Deepens Medicaid Cuts for High-Cost States

Fri, 23 Jun 2017 20:16:18 +0000

The Senate Republican bill to repeal the Affordable Care Act would (like the House bill) fundamentally restructure Medicaid by converting its federal funding to a “per capita cap” that would grow more slowly than actual Medicaid per-beneficiary costs, and states would likely have to make even deeper cuts to Medicaid services and eligibility under these caps beginning in 2025.  Now we’ve learned that the Senate bill would penalize some states with Medicaid costs above the national average even more.

Senate Bill Would Effectively Eliminate Medicaid Expansion by Shifting Hundreds of Billions in Expansion Costs to States

Fri, 23 Jun 2017 18:49:49 +0000

Like the House bill, the Senate health care bill that Senate Majority Leader Mitch McConnell unveiled June 22 would effectively eliminate the Affordable Care Act’s (ACA) Medicaid expansion in 31 states and the District of Columbia, leaving millions of low-income adults uninsured.  

U.S. Immigrants With Lawful Status Couldn’t Buy Marketplace Coverage Under Senate Plan

Fri, 23 Jun 2017 18:30:40 +0000

To enroll in health plans sold in the Affordable Care Act (ACA) marketplaces, individuals must verify that they are U.S. citizens or have an immigration status that allows them to live in the United States. The Senate health bill would close the door to many immigrants with lawful immigration status who want to buy insurance plans in the marketplaces. It goes even further than the already harsh House-passed bill to repeal the ACA in preventing people who are in the United States lawfully from obtaining health insurance.

To Protect Children, Senate Republicans Must Drop Medicaid Per Capita Cap

Fri, 23 Jun 2017 16:25:51 +0000

The Senate Republican health bill, like the House-passed bill, would convert Medicaid to a per capita cap, but it would cut Medicaid even more deeply and pose an even greater threat to coverage for all Medicaid beneficiaries — including children.

Affordable Care Act’s Medicaid Expansion Benefits Hospitals, Particularly in Rural America

Fri, 23 Jun 2017 15:29:07 +0000

Hospitals in states that expanded Medicaid coverage to low-income adults under the Affordable Care Act (ACA), particularly those in rural areas, have fared significantly better than hospitals in non-expansion states, based on recent published and unpublished research by the Urban Institute.[1]  Since 2013, uncompensated care costs have fallen by 1.7 percentage points more, and Medicaid revenue as a share of total revenue has risen by 2.9 percentage points more, in hospitals in expansion states than those in non-expansion

Commentary: Once Passed, Medicaid Cuts Won’t Be Easily Reversed

Thu, 22 Jun 2017 14:35:44 +0000

Once Congress both changes Medicaid’s basic structure and enacts large annual savings, those cuts are highly unlikely to be reversed. In fact, those structural changes would create a political dynamic that could lead to even larger cuts in the future:

Harsh Tradeoff at Core of GOP Health Bill: Keep Medicaid Expansion or Cut Taxes for Wealthy?

Wed, 21 Jun 2017 19:12:15 +0000

The House-passed bill to repeal and replace the Affordable Care Act (ACA), which the emerging Senate Republican health bill is expected to largely resemble, would lavish tax cuts on the wealthy and pay for them by cutting provisions that help millions of people afford health coverage and care.[1]  New state-by-state estimates from the Urban Institute on the impact of ending the ACA’s Medicaid expansion in the 31 states and the District of Columbia that have adopted it make the tradeoffs at the heart of the GOP health bill even cl

Taking Stock of Individual Market Rate Filings

Wed, 21 Jun 2017 15:21:36 +0000

Today’s the deadline for insurers to provide the Centers for Medicare & Medicaid Services (CMS) with the preliminary list of plans they intend to offer in the Affordable Care Act (ACA) marketplaces for 2018. While insurers can (and frequently do) revise their plan offerings and premiums, CMS will soon have a preliminary snapshot of marketplace competition around the country.

The State of ACA Marketplaces: Making Sense of Individual Market Rate Filings

Wed, 21 Jun 2017 15:04:53 +0000

Below are links to state fact sheets.

Research Note: Sectoral Skills Training Programs for Low-Income Workers Can Yield Sustained Earnings and Employment Gains, New Evaluation Finds

Tue, 20 Jun 2017 19:19:30 +0000

Sectoral-based skills training programs that offer work-related supports can yield sizeable, sustained gains in employment and earnings for low-income workers with the most difficulty finding jobs, the Economic Mobility Corporation’s rigorous evaluation of Project QUEST finds.[1] As cities continue adapting to the economy’s decades-long shift from manufacturing to service- and technology-driven sectors, public investments in programs that boost economic mobility and prepare workers for in-demand industries are crucial.

Senate Bill’s Medicaid Cuts Would Be Even Deeper than House Cuts

Tue, 20 Jun 2017 18:56:20 +0000

As we explained yesterday, the emerging Senate health bill would reportedly lower the annual increase in state Medicaid funding under a per capita cap to the general inflation rate starting around 2025, which is well below the House-passed bill’s already inadequate growth rate. That means states would have to absorb much deeper cuts in federal Medicaid funding over the long run than under the highly damaging House bill.

2018 Funding Without a Map

Tue, 20 Jun 2017 18:27:26 +0000

The House Appropriations Committee has begun to consider its 12 appropriations bills to fund the government in fiscal year 2018, but without first unveiling or approving a plan to allocate total appropriations among the 12 bills. Thus, the committee is considering individual bills without first setting its overall priorities and debating how funding for one bill affects the funding available for the others — a particularly important issue given that overall funding under the current austere annual caps falls short of meeting the full range of national needs.

Bipartisan Governors’ Health Priorities Conflict with GOP Bill’s Key Provisions

Tue, 20 Jun 2017 18:06:41 +0000

The National Governors Association (NGA)’s Health Reform Learning Network issued its shared priorities for health reform legislation today, and they sharply conflict with core features of the House-passed health bill to repeal the Affordable Care Act (ACA) – features apparently built into the emerging Senate health bill as well.

Trump Budget’s Deep Cuts to Block Grants Underscore Danger of Block-Granting

Tue, 20 Jun 2017 15:18:18 +0000

President Trump’s 2018 budget aims some of its largest cuts at existing block grant programs.

Senate Reportedly Considering Even Deeper Medicaid Cuts Under Per Capita Cap

Mon, 19 Jun 2017 19:58:03 +0000

Senate Republican leaders are reportedly considering lowering the annual increase in state Medicaid funding under a per capita cap below the House bill’s already inadequate rate starting around 2025. That means states would have to absorb even deeper cuts in federal Medicaid funding than under the House bill — which would cut federal Medicaid spending by $834 billion over ten years and slash enrollment by 14 million by 2026, relative to current law, the Congressional Budget Office (CBO) estimates.

Report: State Medicaid Enrollment Cuts Would Be Steep Under House Bill

Mon, 19 Jun 2017 17:27:30 +0000

Thirty states (including Washington, D.C.) could cut their Medicaid enrollment by up to 20 percent or more due to huge Medicaid cuts in the House bill to repeal the Affordable Care Act (ACA), and twenty of them could each cut theirs by up to 30 percent, new Urban Institute estimates show (see table).

In Case You Missed It…

Fri, 16 Jun 2017 21:15:47 +0000

This week at CBPP, we focused on health care, the federal budget and taxes, state budgets and taxes, and food assistance.

Marketplace Premiums Are In Line With Employer Premiums — and Would Be on Track to Stay That Way Absent Sabotage

Fri, 16 Jun 2017 20:15:14 +0000

Far from reaching “levels that nobody thought even possible,” as President Trump claimed recently , premiums in the Affordable Care Act (ACA) marketplaces are roughly in line with those for employer coverage, an Urban Institute study finds.

Commentary: Turning Back the Clock on Hunger and Malnutrition

Fri, 16 Jun 2017 18:39:34 +0000

Decades of progress on hunger are at a stake as President Trump and some in Congress propose to fundamentally alter and deeply cut the food stamp program.

Rate of Health Care Marketplace Signups Leading to Enrollment Up Slightly Over Last Year

Fri, 16 Jun 2017 15:51:23 +0000

This year as usual, fewer people enrolled in marketplace coverage under the Affordable Care Act (ACA) by paying their first premium than signed up during open enrollment. President Trump cited this normal drop-off to show that the ACA marketplace is in a “death spiral” because, the Administration says, people can’t afford to pay the premiums after they sign up for coverage. In fact, not only is this year’s drop-off not unusual, but it’s a little lower than last year’s, when measured correctly.

Robert Greenstein: Speech Before the City Club of Cleveland

Thu, 15 Jun 2017 21:17:40 +0000

Remarks as prepared for delivery

Good afternoon.

Thank you for that very kind introduction, and thanks to all of you for coming today.  It’s a pleasure to be with you.

I feel a little like I’m coming home.  As a young boy growing up in Philadelphia who loved baseball, I didn’t have a local team to root for in the postseason, since the Philly teams were awful.  In 1954, I was pulling for the Indians in the World Series against the New York Giants, though they fell short that year in large part because of a guy named Willie Mays.

Robert Greenstein: Speech Before the Mt. Sinai Health Care Foundation, Cleveland, Ohio

Thu, 15 Jun 2017 21:03:39 +0000

Remarks as prepared for delivery

Thank you for that very kind introduction.

I’m very honored to be here, with such an esteemed audience of health care leaders, at a time of so much potential change in the field, with so much at stake for millions of people both here in Ohio and across the country.

Automatic Enrollment in Health Insurance Would Be Complex and Difficult to Administer

Thu, 15 Jun 2017 19:18:27 +0000

Some analysts suggest that enrolling uninsured people automatically in an individual health insurance plan, with a chance to opt out, would boost health coverage in a way that would be less intrusive and unpopular than the Affordable Care Act’s (ACA) individual mandate.  And some Republican senators have proposed adding automatic enrollment to the Senate’s version of the House-passed bill to repeal the ACA.  But automatic enrollment would be hard, if not impossible, to administer.  As a result, it would be far less effective than the ACA’s mandate at getting healthy people enrolled in cover

Decoding “Deficit Neutral” Tax Bill: Low-Income Program Cuts Pay for Tax Cuts for Wealthy

Thu, 15 Jun 2017 18:11:09 +0000

As Republicans craft their tax package, with tax cuts that would go overwhelmingly to the wealthy, and consider how they might offset its large cost, a debate has ensued in Republican circles over whether it should be “revenue neutral” or “deficit neutral.” Behind this jargon lies a policy choice with huge consequences for low- and moderate-income families.

Bernstein: Trump’s Budget Wouldn’t Develop the Workforce

Thu, 15 Jun 2017 18:02:09 +0000

The White House has deemed this "workforce development week," but President Trump's budget would drastically cut many job training and education programs and would fail to create new job opportunities, CBPP Senior Fellow Jared Bernstein points out in his latest Washington Post "PostEverything" blog post.

Here are some excerpts from Bernstein's post:

House Republican Health Bill Would Severely Harm Medicaid Managed Care Plans

Thu, 15 Jun 2017 14:56:53 +0000

The bill would cause significant financial harm to Medicaid managed care plans, which serve a large majority of Medicaid beneficiaries. 

SNAP Helps Millions with Disabilities

Thu, 15 Jun 2017 14:19:44 +0000

Some House Republicans are reportedly considering major cuts to SNAP (formerly food stamps) to help pay for tax cuts, and President Trump’s budget proposes major SNAP cuts. So it’s a good time to remind policymakers of SNAP’s essential role in helping low-income people of all backgrounds, including many with disabilities, put food on the table.

Kansas Learned Its Lesson, But Will Other States?

Thu, 15 Jun 2017 13:54:53 +0000

Kansas’ legislature overrode Governor Brownback’s veto last week and nearly fully undid the massive income tax cuts that it enacted five years ago. A Republican-run legislature overruling a Republican governor over the wisdom of big tax cuts has garnered widespread attention. In other states with legislatures that have seriously considered or enacted their own big tax cuts in recent years, local voices are urging that the Kansas lesson be taken to heart. For example:

Medicaid Per Capita Cap Would Disproportionately Harm Some States

Wed, 14 Jun 2017 18:00:23 +0000

It permanently locks in variation in state Medicaid funding.

House ACA Repeal Bill Puts Children with Disabilities and Special Health Care Needs at Severe Risk

Wed, 14 Jun 2017 12:58:49 +0000

These changes to Medicaid would make it especially hard for children with special health care needs, including those with disabilities. 

People of All Ages and Incomes Would Lose Coverage Under House Bill, CBO Data Show

Tue, 13 Jun 2017 19:36:20 +0000

The 23 million coverage loss includes 3 million children. 

SNAP Provides Needed Food Assistance to Millions of People with Disabilities

Tue, 13 Jun 2017 17:46:48 +0000

SNAP provides millions of people with a broad range of functional impairments and limitations with billions of dollars in benefits annually.

Senate Republican Funds to Address Opioid Epidemic Can’t Offset Medicaid Expansion Repeal

Tue, 13 Jun 2017 16:55:05 +0000

Senate Republicans reportedly may try to add funds to address the opioid epidemic to their emerging bill to repeal the Affordable Care Act (ACA).

Contrary to President’s Rhetoric This Week, His Budget Undercuts Workforce Development

Tue, 13 Jun 2017 15:04:25 +0000

President Trump is expected to argue this week that he prioritizes workforce development but, as we’ve detailed here and here, his budget consistently and substantially cuts a range of training and education programs aimed at preparing people for, and helping people secure, good jobs. The Trump budget would:

President Trump’s Budget Would Shift SNAP Costs to States, Increasing Risk of Hunger and Weakening Response to Recessions

Tue, 13 Jun 2017 14:15:19 +0000

The Trump Budget’s Massive Cuts to State and Local Services and Programs

Mon, 12 Jun 2017 20:09:33 +0000

President Trump’s 2018 budget would deeply cut federal funding for programs and services states and localities deliver.

Tracking Reports About the Emerging Senate Bill to Repeal the Affordable Care Act

Mon, 12 Jun 2017 17:51:09 +0000

Despite initial claims that the Senate would start over and develop its own legislation, Senate leaders have said, “the practical matter is that 80 percent of what the House did we’re likely to do.”

If Senate Republican Health Bill Weakens Essential Health Benefits Standards, It Would Harm People with Pre-Existing Conditions

Mon, 12 Jun 2017 14:13:03 +0000

Some Senate Republicans are suggesting that their emerging legislation to “repeal and replace” the Affordable Care Act (ACA) will protect people with pre-existing medical conditions because it won’t allow states to charge such people higher premiums than others who buy the same policies.

In Case You Missed It…

Fri, 09 Jun 2017 21:15:52 +0000

This week at CBPP, we focused on health care, state budgets and taxes, the federal budget and taxes, food assistance, housing, and the economy.

Senate Change to Medicaid Per Capita Cap Could Deepen Federal Funding Cuts

Fri, 09 Jun 2017 18:45:32 +0000

Senate Republicans reportedly will retain the House health bill’s damaging Medicaid per capita cap in their bill, but some of them are considering a change that would “reset” or rebase the annual cap amounts for states every two or three years, a Vox article yesterday suggests.

Leading Economist Touts SNAP’s and EITC's Long-Term Benefits for Children

Fri, 09 Jun 2017 17:02:14 +0000

Access to SNAP (formerly food stamps), the nation’s key food assistance program, during pregnancy and early childhood can improve health — and, for girls, economic well-being—in adulthood, leading economist Hilary Hoynes says in an interview with the Federal Reserve Bank of Minneapolis.

Reported Medicaid Expansion “Compromise” Would Have Almost the Same Effect as House Bill

Thu, 08 Jun 2017 20:54:24 +0000

We explained earlier this week that delaying the end of the Affordable Care Act (ACA)’s higher funding for Medicaid expansion wouldn’t change the long-run effects of the House health bill: states would still have to end their expanded Medicaid programs because of the large cost shift from losing federal funds, and the poor and near-poor adults

Trump Budget Eliminates Housing and Community Development Block Grants

Thu, 08 Jun 2017 20:48:40 +0000

The President’s 2018 budget for the Department of Housing and Urban Development (HUD) proposes the sweeping elimination of flexible programs that states and localities use to rehabilitate and build affordable rental housing, repair and improve infrastructure such as sewers and roads, promote economic development in distressed communities, and provide essential services to low-income youth, seniors, and others.

House-Passed Bill Would Undermine Medicaid’s Critical Role in Rural America

Wed, 07 Jun 2017 19:20:32 +0000

Medicaid, according to Office of Management and Budget Director Mick Mulvaney, “is designed for more of an urban poor population than a rural poor.” In fact, Medicaid plays a disproportionately greater role in providing health coverage in rural areas than urban areas — especially for children and families — a study out today from the Georgetown University Center for Children and Families and the North Carolina Rural Health

Trump’s Bait and Switch on Infrastructure

Wed, 07 Jun 2017 15:40:06 +0000

The Trump Administration has declared this week “Infrastructure Week,” and today the President is expected to portray his agenda as a major new investment in revamping the nation’s roads, bridges, tunnels, and railways. Yet despite calling for a $1 trillion infrastructure plan, the President hasn’t explained how the $200 billion in new, undefined spending in his budget would achieve that goal.

Nick Johnson: Kansas Wise to Undo Failed Tax-Cut Experiment

Wed, 07 Jun 2017 13:46:06 +0000

The Kansas legislature wisely voted to start rebuilding the state’s lagging economy by eliminating unwarranted tax breaks and raising much-needed new revenue to invest in schools and other vital services that will help the state and its people now and in the future. A bipartisan supermajority of both houses recognized the damage that Governor Brownback’s tax cuts have caused and came together to choose a different path. This vote represents a striking repudiation of far-right wing economic orthodoxy and, as such, will influence fiscal debates far beyond the state’s borders.

Anthem’s Ohio Withdrawal Makes Consequences of Marketplace Sabotage Even Starker

Tue, 06 Jun 2017 21:37:07 +0000

For months, insurers, providers, business leaders, state regulators, governors, and experts have warned that uncertainty around whether the federal government wou