Forbes: The Next Big Thing In Health Care

By Josh Archambault and Nic Horton

Why should the exact same treatment for pneumonia cost $5,000 in one building and $124,000 in another? Or the exact same infusion drug for a chronically ill patient that requires them every six weeks cost $14,000 per shot in one setting, but $28,000 down the street? Why should patients have to pay so much more, simply based on where they park their cars? The answer is simple: they shouldn’t.

But the black box of pricing leaves patients in the dark. As a result, the financial futures of too many American families are in jeopardy as their paychecks fail to keep up with skyrocketing health care costs.

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Forbes: NE’s Medicaid Expansion Plan Puts Truly Needy In Danger

Co-authored by Nic Horton, Jonathan Ingram, and Josh Archambault

Nebraska legislators are currently considering another plan to bring Obamacare’s Medicaid expansion to the Cornhusker state. The proposal would create a new welfare program, dubbed the “Transitional Health Insurance Program,” for more than 130,000 able-bodied adults, costing taxpayers nearly $15 billion over the next ten years.

Nebraska policymakers have rejected all previous attempts to expand Medicaid under Obamacare. With expansion costs exploding in other states and federal funding now on the chopping block, it’s clear that their decision was the right one. And nothing in this new proposal should give them reason to reconsider. In fact, the latest plan, modeled after Arkansas’ “Private Option,” is Nebraska’s worst expansion proposal yet.

This model has failed to deliver on its promises everywhere it has been tried and would cost taxpayers billions of dollars more than a traditional expansion. In fact, Iowa has already scrapped its own version of this model and Arkansas’ expansion is scheduled by law to terminate later this year. Worse yet, the plan would also prioritize welfare for this new class of able-bodied adults over services for the truly needy. Continue reading

Forbes: First-Of-Its-Kind Study Shows The Power Of Work

Co-authored by Nic Horton, Jonathan Ingram and Josh Archambault 

For too long, thousands of Kansans have languished in welfare, without hope of a better life. But thanks to one simple policy change, many Kansans are now on the path to a better life.

Under federal law, all able-bodied, childless adults in the food stamp program are required to work or train for work at least 20 hours per week. But with help from the Obama administration, most states have been waiving those requirements in recent years. Last year, for example, more than 40 states waived these critical requirements, fostering a culture of long-term dependency.

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But in 2013, Kansas Governor Sam Brownback bucked the trend and instructed state officials to reinstate work requirements and time limits for able-bodied adults. Within three months, half of all able-bodied adults on food stamps had cycled off the program. Enrollment is now 75% lower for this group of adults than it was before work requirements took effect. Continue reading

Forbes: UT Proposes Sick Tax To Pay For ObamaCare

By  Nic Horton, Jonathan Ingram, and Josh Archambault Mr. Horton is a Policy Impact Specialist, Mr. Ingram Research Director, and Mr. Archambault a Senior Fellow at the Foundation for Government Accountability

After the legislature blocked his Obamacare Medicaid expansion plans in 2014 and 2015, Utah Governor Gary Herbert (R) began working with legislative leaders to negotiate some kind of “compromise” to expand the program to more than 100,000 able-bodied adults. Although the deal is being negotiated in secret, some details have been leaked to the public.

According to the few specifics made public, the biggest component of the negotiated framework is to levy a new “assessment” on medical providers in Utah to help pay for the state’s share of expansion. But the so-called assessment is simply a new Obamacare tax on the sick that will not only raise health care costs for all Utahns, but add significantly to the national debt. Continue reading

Forbes: AK Lawmakers Hire Star Lawyers to Stop ObamaCare Expansion

By Jonathan Ingram, Nic Horton, and Josh Archambault — Mr. Ingram is Research Director, Mr. Archambault is a Senior Fellow, and Mr. Horton is Policy Impact Specialist, at the Foundation for Government Accountability.

Alaska Governor Bill Walker (I) announced in mid-July that he was moving forward with plans to unilaterally expand Obamacare in the state. As we’ve previously written here at Forbes, Walker’s expansion plan is not only bad policy, it’s also likely illegal. Now, a courageous group of Alaska lawmakers – led by Senate President Kevin Meyer and House Speaker Mike Chenault –  are standing up to Gov. Walker’s attempted end-run around the legislature and hiring an all-star legal team to block Walker’s illegal actions.

Walker’s Unilateral Obamacare Expansion Violates Alaska Law

Alaska law clearly prohibits the governor from expanding Medicaid to any “additional groups … unless approved by the legislature.” This means that Gov. Walker could only expand Medicaid to a new class of able-bodied childless adults if this coverage group was already authorized by state law. Continue reading

Forbes: Governors Are Reducing Dependency

By Jonathan Ingram, Nic Horton and Josh Archambault — Mr. Ingram is Research Director,  Mr. Horton is Policy Impact Specialist and Mr. Archambault is a Senior Fellow at the Foundation for Government Accountability.

Governors across the country are leading a new welfare reform revolution. From Maine to Indiana to New Mexico, bold leaders are making common-sense changes that will preserve the safety net for the truly needy.

As this revolution continues to spread across the map, state policymakers need to know these policy changes – restoring work requirements for able-bodied adults without kids on food stamps – are already having transformative results for enrollees and taxpayers.

Work Waivers Foster Dependency

Although federal law requires able-bodied childless adults on food stamps to work or search for work, 42 states partially or fully waived that requirement in 2015. These waivers allow able-bodied adults to stay on the food stamps rolls indefinitely, regardless of whether they’re looking for work.

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It’s no surprise, then, that able-bodied adults are staying on food stamps longer than ever, costing taxpayers and the truly needy who rely on the food stamp program for survival.

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Forbes: Restoring Work Requirements Is Important Fix For Food Stamp Crisis

By Nic Horton, Jonathan Ingram and Josh Archambault

Over the last several years, even as the economy has started to improve, more and more Americans have become trapped in the food stamp program, now called the “Supplemental Nutrition Assistance Program” or SNAP.  In 2013, food stamp enrollment and spending hit all-time highs.

But a new report from the Foundation for Government Accountability provides governors and legislators with a roadmap to reverse this trend. The first step: getting able-bodied adults work-oriented and eventually off of welfare.

Able-Bodied Childless Adults Drive Food Stamp Explosion

So what’s causing the rise in food stamp dependency?

One key contributor is the growth in able-bodied childless adults on the program. Between 2000 and 2008, the number of able-bodied childless adults receiving food stamps hovered at or below one million.

But by 2013, a record-high 4.9 million able-bodied, childless adults were receiving food stamps. Federal spending on food stamps for these able-bodied adults skyrocketed to more than $10 billion in 2013, up from just $462 million in 2000.

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Forbes: AR’s ‘Health Independence Accounts’ Are Making Obamacare Worse

By Jonathan IngramNic Horton and Josh Archambault Mr. Ingram is Research Director, Mr. Horton a Policy Impact Specialist, and Mr. Archambault a Senior Fellow at the Foundation for Government Accountability

Arkansas’s Obamacare Medicaid expansion has been a costly misadventure. The expansion has been so misguided in fact, that lawmakers voted earlier this year to end it, effective December 31, 2016.

That hasn’t stopped state bureaucrats from scurrying to institute a new component of expansion that makes the program even worse. Under this plan, some enrollees are asked to contribute nominal amounts to new “Health Independence Accounts,” or HIAs, which were supposed to mirror health savings accounts.

But these new HIAs are nothing like real health savings accounts and were destined to fail from the beginning. Now that the program is up and running, the evidence is mounting: so-called “independence” accounts are actually reducing enrollees’ “skin in the game,” and costing even more money for taxpayers.

Arkansas legislators meet in the House chamber at the Arkansas state Capitol in Little Rock, Ark. (AP Photo/Danny Johnston, File)

Health Independence Accounts Are Nothing Like Health Savings Accounts

Under this new Obamacare Medicaid expansion tweak, enrollees above the federal poverty line are “required” to make monthly contributions to HIAs. But the truth is that this “requirement” is more like a mere suggestion. If enrollees refuse to contribute to their accounts, they aren’t removed from the program.

These suggested contributions start at just $10 per month. But unlike real health savings accounts, Private Option enrollees will not use funds in their HIAs to pay for their own medical care. Instead, the money will simply sit in enrollees’ accounts until they leave the program. At that point, they can take the money with them and use it toward other health care costs. Continue reading

Forbes: AR DHS Director Misled Lawmakers On Obamacare Waiver

By Jonathan IngramNic Horton and Josh Archambault Mr. Ingram is Research Director, Mr. Horton is Policy Impact Specialist, and Mr. Archambault is a Senior Fellow at the Foundation for Government Accountability.

Arkansas bureaucrats are wasting millions of dollars providing Medicaid benefits to people no longer eligible for the state’s Obamacare expansion. But is that just the tip of the iceberg?

Last month, internal e-mails from the Arkansas Department of Human Services surfaced, revealing that the state had never bothered to verify that individuals enrolled in Obamacare’s Medicaid expansion were still eligible for benefits. According to data provided by state officials, this is costing taxpayers up to $20 million each and every month.

We previously questioned why the state hadn’t started the redetermination process yet – which should have begun months ago. After all, federal law requires states to verify Medicaid enrollees’ eligibility at least once per year.

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Department of Human Services Director John Selig (Photo: Log Cabin Democrat)

As we reported at the time, state officials contended that they had received a temporary waiver from the Obama administration, allowing them extra time to perform the eligibility checks. But it turns out that no formal waiver ever existed. Worse yet, a recent follow-up letter from the Obama administration may generate more questions than answers.

No Waiver Existed

After news broke that the state wasn’t performing the required eligibility checks, a number of reporters and lawmakers reached out for a copy of that waiver. Such a waiver would be pretty important – without it, Arkansas would be violating federal law.

But according to internal e-mails and other communications, no such waiver actually existed. Questions about the redetermination process sent state officials scrambling for cover.

That cover came on April 27, 2015, when the Obama administration retroactively approved Arkansas’ delay for all redeterminations that should have been conducted in 2014. The letter states:

[The Centers for Medicare and Medicaid Services] is now providing Arkansas with authority under section 1902(e)(14)(A) of the [Social Security Act] to delay eligibility renewals scheduled for January 1, 2014 through December 31, 2014 for 9 months, until October 1, 2014 through September 30, 2015. The state will continue to act on changes in circumstances, including changes in income.

Obama’s Letter Provides More Questions Than Answers

Unfortunately, this letter provides more questions than answers. First, it says that the Obama administration is now providing Arkansas the authority to delay its eligibility redeterminations. Does that mean that Arkansas was operating without that authority prior to April 27th? It certainly seems that way.

The Department of Human Services also contends that this letter allows them to delay all redeterminations until September 2015. But that is not, in fact, what the letter says. The letter allows them to delay redeterminations due in 2014 “for 9 months.” While a redetermination due on December 31, 2014 would not be due until September 2015 under this letter, one originally due on January 1, 2014 was actually due back in October 2014. This means that all redeterminations originally scheduled between January and August of last year should already have been conducted.

But even more worrisome is that the letter limits the delay exclusively to “eligibility renewals scheduled for January 1, 2014 through December 31, 2014.”It provides zero authority to delay redeterminations that should have been scheduled in 2015. So why hasn’t the state conducted the mandatory redeterminations that were due in January, February, March and April?

The Redetermination Process Should Have Begun Months Ago

Regardless of whether or not Arkansas’ actions are approved by Obama, they should be worrisome to taxpayers everywhere. The state has yet to redetermine eligibility for a single Medicaid expansion enrollee. By now, the state should have re-checked eligibility for more than 170,000 enrollees. Another 70,000 should be due for verification later this year or early next year.

To make matters worse, the Department of Human Services expects that up to 40,000 enrollees are still receiving benefits even though they’re no longer eligible. If those estimates are correct, taxpayers could be on the hook for up to $20 million per month to provide Medicaid expansion benefits to people no longer eligible.

Worst of all, state officials have facilitated this fraud by asking for waivers and continuing to kick the can further down the road. Meanwhile, nearly 3,000 children and adults with developmental disabilities are sitting on Medicaid waiting lists. Some of them have been waiting eight years or more for their needed home- and community-based services. They continue to wait, while Arkansas bureaucrats provide Obamacare welfare to 40,000 able-bodied adults who aren’t even eligible.

Welcome to Obamacare.

This article originally appeared at Forbes on May 11, 2015.

Forbes: Is AR Violating Federal Law By Not Verifying Eligibility For Its Obamacare Expansion?

By Nic Horton, Jonathan Ingram, and Josh Archambault

Arkansas’ Obamacare expansion has been a policy disaster and a political landmine, but supporters may have to add violating federal law to their list of problems. Internal e-mails from the Arkansas Department of Human Services reveal that the state has not bothered to verify that individuals enrolled in Obamacare’s Medicaid expansion are still eligible for benefits. This revelation comes with several legal and policy implications and should serve as a wakeup call to state legislators across the country.

Arkansas Hasn’t Verified Eligibility Of Obamacare Expansion Enrollees

Internal e-mails from the Arkansas Department of Human Services reveal that Arkansas has yet to begin verifying whether individuals enrolled in Obamacare’s Medicaid expansion are still eligible for benefits.

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Federal law requires states to verify Medicaid enrollees’ eligibility at least once per year, and more frequently if the state receives information indicating they may no longer be eligible. But John Selig, director of the Arkansas Department of Human Services, recently admitted that not a single redetermination had ever been done for those enrolled in the Medicaid expansion.

Selig explained that he hopes to begin eligibility verification later this month, but the state began enrolling individuals in the expansion in October 2013 – more than 18 months ago. Really, the state should have already begun checking eligibility. Continue reading