Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!
115th Congress, 1st session
128th Maine Legislature, adjourned
Friday, September 15, 2017
Am I the only one who was caught off guard (and delighted!) by how warm it’s been this week? I do this really fun thing where I check the current weather/forecast multiple times per day, and the INSTANT I look away from it, whatever information I saw there disappears from my brain. I’m like a weather goldfish.
Looks like Congress got most of its newsworthiness out of its system on Wednesday, because I don’t have much new to add since then. There are not, as far as I know, any major new developments on the CHIP or FQHC bills; I don’t think there’s been significant shifting on Cassidy-Graham; and, as far as I knew when I went to bed last night anyway, we do not yet have single payer.
But it’s worth taking a few minutes to talk about Cassidy-Graham, because I have so missed writing paragraph after flabbergasted paragraph outlining the various ways in which Congress seems determined to stick it to millions of Americans and the states in which they live.
What, exactly, would Cassidy-Graham do? Great question. What it would do is take all of the Medicaid expansion money, and the tax credits and subsidies under the ACA, and lump it all together – then shove bundled payments at a state and go “GOOD LUCK FIGURE SOMETHING OUT.”
It would eliminate the individual mandate: it would also obliterate all of the consumer protections and guarantees under the ACA. It leaves it up to states to figure out how to use that lump sum to “provide health coverage”, along a few possible paths, some of which read like a greatest-hits list of the failed policies of yesteryear (who’s excited to reopen high risk pools?!).
But – and here’s the crazy part – those are only the nightmarish bullet points that the bill’s supporters tout as good things. If you dig in, you see how radical and insidious this thing really is.
- It completely upends the individual market, which benefits from the coverage and subsidy guarantees under the ACA currently;
- It says nothing about making sure that low-income individuals get the help they need to actually afford anything;
- By block granting funding (which means giving states a fixed lump sum), it guarantees that states are left on their own to come up with the money if they have to react to a public health crisis or a natural disaster;
- It cuts federal assistance to states by hundreds of billions of dollars between 2020 and 2026;
- It requires states to kick in a significant matching portion from their own budgets – in other words, paying to get our allowance;
- And – here’s my favorite part – in 2026, it just ends. I guess they think their plan is so amazing that everybody will be immortal and #diseasefree4eva by then? …or something?
So, you know, the same old same old of “we don’t think it’s the federal government’s job to keep our people alive and well”, with a brand new splash of “and you better figure this out in nine years because we are closing up shop.” To be honest with you, words like “radical” or “extreme” don’t begin to accurately describe this.
We now know the hit that Maine’s navigator programs are going to take from the Trump Administration’s seemingly spur-of-the-moment decision to gut ACA outreach and education funding. Remember, Maine has two navigator grantees: the county action programs (aka CAP agencies), and the Maine Lobstermen’s Association. Looks like MLA’s funding will remain the same, and the CAP agencies lost $70,000, which is a little more than 13% of their total funding.
I (sarcastically) just love how the Administration, by design or by accident, waited until arguably the worst possible moment to make this capricious, petty decision. First they chop the entire open enrollment period in half, then they wait until navigators are deep into planning for the next open enrollment period and suddenly blurt out “wait we’re gonna cut you guys too!” Then they let all funding for the program lapse (because one grant year ended before they made any decision on this year’s funding, let alone getting the checks out the door), and then made these ridiculous calculations based on…well, it still isn’t clear to me what they based the decisions on.
In other state news, there actually are a few things that I should have highlighted on Wednesday, but I got too wrapped up in the national stuff.
First, Maine DHHS is embroiled in one scandal after another.
You may remember that earlier this year, the Office of the Inspector General of the federal Department of Health and Human Services issued findings that Maine-DHHS has failed to investigate almost all “critical incidents” involved adults with developmental disabilities who are in community-based care. The state, state lawmakers, OIG, providers, and advocates are now locked in a battle over how to respond to that report. The state’s attitude seems to be “whine that they are being treated unfairly and then do nothing.”
Meanwhile, the Bangor Daily reported that, in the midst of the devastating opioid epidemic, Maine-DHHS is refusing to release statistics that they have compiled around overdose deaths, which could provide critical information and insight into overdoses. Doesn’t seem like an especially helpful stance to take in the middle of this crisis.
On a different state note, new national census data that shows that Maine’s uninsurance rate has stagnated, while the country as a whole is covering more people than ever before. I can’t say I’m all that shocked by this (“I’m not mad, I’m just disappointed”).
To be fair, one of the reasons I’m not surprised is because Maine did an amazing job at finding and signing people up during the first few open enrollment periods. We were consistently in the absolute upper tier of states as far as signing up eligible enrollees. That is inevitably going to slow down over time, as you start having to work harder to reach the folks that haven’t been reached up to this point for whatever reason.
The other is that, oh yeah, we still haven’t expanded Medicaid. The BDN article I linked to just above here points out that there are around 106,000 people in Maine who still don’t have coverage. Estimates show that as many as 70,000 people in Maine could be eligible for coverage if we expand Medicaid. Now, not all of those 70,000 would be included in the 106,000 number who don’t have coverage – there’s a small, narrow slice of individuals who would be eligible under expansion who are currently on the Marketplace – but the vast, vast majority of those who would benefit from expansion have nothing right now. They don’t qualify for MaineCare and they don’t earn enough to get help from the Marketplace.
As a reminder, though, Medicaid expansion is on the ballot this November – it’s question 2. And the campaign to pass Medicaid expansion is looking for health care providers who are willing to endorse and be a part of the campaign. So if you’re a health care provider who fits that bill, follow this link to fill out the endorsement form and get more info from the campaign.
Would you like to know more?
There’s yet more evidence that the Trump Administration’s gleeful desire to blow up the ACA from within is having a serious effect on both premiums, and the numbers of people who will be enrolling in coverage. This time, it’s another CBO report showing that, yes, there are consequences to these actions, and they impact real people.
Finally, I have a fun one to close out today: a song about wonky health care policies! An old friend of mine, Halley Elwell, is a wonderfully gifted singer-songwriter. She was also, years ago, part of one of those “high risk pools” that some conservatives seem to think are the best thing since sliced bread. She knows exactly how they (don’t) work. So earlier this year, at the height of the repeal-and-replace rush, she wrote a catchy summer tune called “High Risk Pool”. You can listen to it on her Bandcamp page here. The whole song is great, but here’s my favorite piece of the lyrics:
This view is to die for
Sweatin’ all through the night
Poor chumps tryin’ to get in
To the sickest event
It’s goin’ down like a snakebite
Until next time, friends, I remain,