The state of Maine has long been on the leading edge of welfare reform. Under Governor Paul LePage, it has reformed its food-stamp program by promoting work, resulting in former enrollees’ more than doubling their incomes the following year. Maine has also worked tirelessly to find and prosecute welfare fraud, going after those who steal limited resources from the people who most need help.
These efforts, combined with Maine’s rejection of Obamacare’s Medicaid expansion, have allowed the state to make the truly needy a priority. But Maine’s not slowing down. Continue reading
One of the most significant yet underreported outcomes of ObamaCare is its impact on the truly needy. Before ObamaCare, our country maintained a safety net that was reserved for our neediest neighbors. The Medicaid program, for example, primarily served poor children, seniors, and individuals with disabilities.
But ObamaCare’s Medicaid expansion sought to change this. It sought to transform a safety net into an open-ended, free-for-all welfare program for non-disabled, working-age adults, the overwhelming majority of whom have no dependent children at home. Every penny spent on this new population is a penny that can’t be spent on the truly vulnerable. That’s just a fact.
Many of these individuals – nearly 600,000 nationwide – currently sit on Medicaid waiting lists, hoping to get additional services that states say they need but, due to limited funding, states can’t afford. Literally, states have said, “You need this service but we do not have the adequate funding to provide it for you.” As a result, these individuals sit and wait. Many of them will die before they ever get the care they need.
Some might call that rationing. At best, it is misprioritization. Continue reading
Late Monday, House GOP leaders released several changes to the American Health Care Act, the House’s vehicle for partially repealing and replacing ObamaCare. The amendment would eliminate enhanced funding for new Medicaid expansion states and reducing funding for new enrollees in existing expansion states, starting in 2020. These are both critical steps to protect limited dollars for the truly needy and music to the ears of conservatives who have rightfully raised concerns that the AHCA would not roll back ObamaCare’s failed Medicaid expansion.
But the amendment doesn’t stop there. It would also allow states to create TANF-style work requirements for most non-elderly able-bodied adults on Medicaid (pregnant women, parents with children under six years old, and 20 year olds in school would be exempted in states that chose to accept the work requirements). And while a food stamp-like work requirement is preferable, this is certainly a step in the right direction.
Work requirements are an essential part of any replacement plan that comes out of D.C. Without work requirements in place, individuals have no incentive to increase their incomes or leave dependency. They actually face a massive disincentive to do just that. Continue reading
Policymakers in the Land of Lincoln have some important work to do this year to preserve limited state resources for the truly vulnerable. Stopping the enrollment of able-bodied adults in Illinois’ Medicaid expansion program, and instituting work requirements for able-bodied adults in Medicaid are necessary to safeguard the program for Illinoisans most in need of services.
A Medicaid enrollment freeze waiver can preserve resources for truly needy Illinoisans
To stop Medicaid expansion enrollment, Illinois policymakers should ask the Trump administration for an enrollment freeze waiver. The program is devouring state tax dollars that could go to help Illinois’ truly needy residents, including the 18,000-plus Illinoisans on Medicaid’s Prioritization for Urgency of Need for Services waiting list. An enrollment freeze waiver would allow state officials to stop the hemorrhaging of Medicaid dollars and begin to immediately prioritize truly vulnerable Illinoisans once again.
Medicaid work requirements can prevent the safety net from becoming a poverty trap
But that’s just the beginning of what Illinois officials must do to reform the state’s overgrown and unsustainable Medicaid system. The state should also request a waiver to institute work requirements for all able-bodied adults in Medicaid. Medicaid’s safety net has become a web that traps too many Illinoisans in dependency. But with the requirements in place, the truly vulnerable and taxpayers will find much-needed relief. Equally important, enrollees will be better able to transition to self-sufficiency.
Currently, Illinois’ Medicaid program is operating as a welfare trap – a system that encourages individuals to remain in dependency indefinitely and penalizes them if they try to leave. There’s perhaps no better proof of this phenomenon than the number of Illinoisans who are in the Medicaid program and not working at all.
According to the most recent data from the U.S. Census Bureau, less than one-third of all able-bodied, working-age Medicaid enrollees in Illinois work full time. By contrast, nearly 36 percent don’t work at all.
In addition, according to data from the Department of Healthcare and Family Services, nearly 54 percent of able-bodied adult enrollees in the Medicaid expansion reported no income at all in 2015. Continue reading
Illinois’ Medicaid program has spiraled out of control. Since opting to expand Medicaid through Obamacare, the state has enrolled roughly 650,000 able-bodied adults – nearly twice as many as the state said would ever even qualify, much less enroll. Over that same period, 752 truly needy Illinoisans have died on a waiting list for medical treatment. And with a large Obamacare bill due in less than a month, policymakers should start working now to put the brakes on this nightmare.
Thankfully, simple, tested and effective policy solutions exist to the challenges facing the state. By freezing enrollment in its Medicaid expansion program, Illinois can immediately begin protecting resources for its truly vulnerable citizens and help Illinoisans currently trapped in welfare get back on the path to independence. In addition, lawmakers would immediately provide much-needed relief to overburdened state taxpayers.
Enrollment freezes are simple: Rather than pulling the plug on the expansion program overnight, the state would allow current enrollees to stay for the time being, but would stop enrolling new members. This allows lawmakers to gradually wind down the program over time, but immediately free up resources for the truly vulnerable.
Illinois was one of the first states in the nation to accept ObamaCare’s Medicaid expansion. But since its launch, the program has spiraled out of control, blowing through enrollment projections and putting Illinois’ most vulnerable residents at risk.
In fact, the very same day the General Assembly voted to implement ObamaCare’s Medicaid expansion two years early in Cook County, lawmakers also voted to implement cuts to traditional Medicaid, costing Jake Chalkey of Streator, Ill., access to critical seizure medication.
As enrollment continues to climb, these cuts may be a sign of what’s to come. Continue reading
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.
In state capitols across the country, health care lobbyists and consultants are pushing a relatively unknown provision of the Affordable Care Act (ACA): Section 1332. According to some proponents, these waivers will “turbocharge state innovation” and will provide states with an “exit strategy” from the ACA. But is the hype true? Will Section 1332 waivers be as truly transformative to our health care system as suggested?
As policy practitioners who work daily with state policymakers around the country, we have seen proponents be overly dismissive—or perhaps even unaware—of the large practical and political challenges surrounding the implementation of these waivers. A serious, objective examination of the new Section 1332 federal guidance sparks far more questions than answers for policymakers. Continue reading