It was a hard fight, but one we’re glad to see turned out the right way. The Medicaid provision was one of the key components of the ACA, but it was put at risk by a Supreme Court decision that left it up to the states to accept or decline the funds. Many states have—but others, like Texas, are refusing, leaving millions without coverage.
In other states, the process is still unfolding:
About half a million people are waiting on the Michigan state Senate, who should vote this week on a state House-passed proposal to accept expanded Medicaid funds. Gov. Rick Snyder has promised to sign the bill into law.
As the state legislature in Ohio debates accepting expanded funds, a new poll shows 63 percent of Ohioans want the expansion, which would cover an estimated 275,000 people.
In Virginia, a commission to study accepting expanded Medicaid funds had its first meeting this week. The next meeting will take place in August.
In New Hampshire, the state House—which supports accepting expanded funds—is working to craft a measure that will be able to get through the Republican-controlled Senate. This may mean a commission will be created to review the issue.
Unfortunately, in Maine, Gov. Paul LePage vetoed a measure to accept expanded funds. The bill, which would cover 60,000 people, passed by strong but not quite veto-proof margins, so the fate of Medicaid in Maine remains unclear.
Sen. Jay Rockefeller (D-W-Va.) introduced the Medicare Drug Savings Act of 2013 that would produce savings without passing on costs to seniors.
The act offers a solution that strengthens Medicare’s fiscal footing while shielding beneficiaries from harmful cost-shifting, unlike most other Medicare proposals we hear about. The Congressional Budget Office (CBO) estimates that restoration of Medicaid-level drug rebates for low-income Medicare beneficiaries would save the federal government $141 billion over 10 years. Here are some critical facts about the bill from the AFL-CIO and other allies:
America’s workers strongly support allowing Medicare to secure lower prices drugs. According to a recent national poll, 85% favored “requiring drug companies to give the federal government a better deal on medications for low-income people on Medicare.”
Implementing Medicare drug rebates is not new law. Upon passage of the Medicare Modernization Act (MMA), millions of older adults and people with disabilities gained access to prescription drug coverage through private plans approved by the federal government, known as Medicare Part D. At the same time, the MMA severely limited the tools available to the federal government to control spending on pharmaceutical drugs in Medicare. In particular, the MMA eliminated rebates offered by pharmaceutical manufacturers for drugs provided to beneficiaries dually eligible for Medicare and Medicaid. Applying Medicaid-level rebates to Medicare drugs simply restores a practice that existed for dually eligible beneficiaries prior to the passage of the MMA.
Restoring drug rebates to the Medicare program is a proven cost saver. Already the Medicaid program benefits from lower drug prices due to federally determined rebates on brand name and generic medications. A 2011 comparison of 100 brand-name drugs under Medicaid and Medicare Part D found that Medicaid rebates required by law reduced expenditures by 45% for the drugs under review. Whereas, Medicare rebates secured by private drug plans reduced expenditures by only 19%.
Pharmaceutical spending on research and development is not at risk. Studies show that research and development investments in particular types of drugs are not directly linked to specific revenue sources, such as Medicaid. These findings, coupled with an examination of industry spending trends, suggest that reinstating Medicare drug rebates will not limit research and development. We reject the argument that pharmaceutical manufacturers will be unable to fulfill their commitment to innovation if the Medicare program is allowed to secure more reasonable drug prices.
Applying Medicare drug rebates will not shift costs to Medicare beneficiaries or employers. Some stakeholders claim that applying Medicaid-level drug rebates for low-income Medicare beneficiaries will increase costs for other Part D beneficiaries, but research supports otherwise. The same research suggests that costs for purchasers outside of Medicare—namely employers— will be largely unaffected if the Medicare rebates are restored.
It felt like someone was playing an April Fool’s joke with the weather, but Working America members in Pittsburgh braved a cold, windy morning to tell Governor Tom Corbett to stop fooling around and accept the federal funds to expand Medicaid.
Tomorrow, Gov. Corbett will meet with U.S. Secretary of Health and Human Services Kathleen Sebelius to discuss whether or not Pennsylvania will accept federal money provided for in the Affordable Care Act to expand Medicaid. Here in the Keystone State, those funds would expand coverage to more than 500,000 people and a $43 billion boost to our economy. By the numbers alone, it’s clear that only a fool would turn down this immense benefit for our state.
But the numbers don’t tell the most important stories—the stories of ordinary people in Pennsylvania who regularly go without healthcare or are forced to choose which of their family members will be covered due to the enormous costs involved. Several Working America and Pennsylvania Health Access Network members showed up to tell their stories in front of the governor’s office. For them and for all of our members, access to affordable, quality healthcare is a very personal matter.
Member Barb Linville of Ambridge told her story of coming to Pennsylvania in 2004. At the time, she was still looking for work and did not have private health insurance. Fortunately, she was able to obtain coverage through Pennsylvania’s Adult Basic program. This program allowed her to receive potentially life-saving care when a health issue presented itself soon after. Without this program, her family may have ended up in bankruptcy to cover the costs. Unfortunately, Gov. Corbett has since ended Adult Basic, leaving thousands of people like Barb uninsured. Expanding Medicaid would do a great deal to rectify this problem.
Another member, Shelagh Collins, spoke of her difficulty obtaining healthcare because she is currently unemployed. It’s a terrible catch-22: she has health conditions that need to be treated in order for her to be able to find regular work, but without work she is unable to afford that much-needed care. Expanding Medicaid would help people like Shelagh receive the care she needs so that she can once again be a fully productive member of the work force.
Reverend Sally Jo Snyder and the event’s emcee, Working America Field Director Kevin Brokt, hammered home the point that accepting federal funds to expand Medicaid makes sense not only for boosting our economy and improving public health, but also for fulfilling our basic moral obligation to one another.
At the event’s close, members stretched out a portion of an 800+ page petition signed by more than 9,000 Pennsylvanians urging Gov. Corbett to do the right thing and accept the federal funds after his meeting tomorrow. The message to Tom Corbett was loud and clear:
We live in a crazy, ever-changing world, but some things don’t change.
It may be 2013, but Scott Walker is still a terrible governor, and Wisconsin is still suffering under his policies.
Even as new numbers showed the national unemployment rate slipping in February 2013, those same numbers showed Wisconsin heading in the completely wrong direction. Wisconsin is now ranked 44 out of 50 in job growth, and is being outpaced by all of its neighbors:
The new numbers, based on the most accurate current measures available, show Wisconsin with an estimated 2,790,000 non-farm positions as of January 2013 — up 44,600 jobs or 1.6 percent since January 2011 when Gov. Scott Walker took office.
By comparison, Indiana ranked No. 9 with a 3.8 percent job growth rate over the past two years; Minnesota was No. 10 with 3.7 percent growth; Michigan was No. 12 at 3.6 percent; Iowa was No. 24 at 2.9 percent and Illinois No. 30 at 2.3 percent job growth.
Overall unemployment in Wisconsin also rose in January 2013 from 6.7 to 7 percent (February data has not yet been released). The state gained 12,400 private-sector jobs by lost about 10,600 public sector jobs, with a net gain of only 1,800.
A study by the University of Missouri makes it abundantly clear that opting into Medicaid expansion would be positive for the Show Me State’s economy, including the creation of more than 24,000 jobs in 2014 alone.
Let’s quickly review: Because of the Supreme Court decision last summer, states can choose to not participate in the Medicaid expansion found in the Affordable Care Act, which makes Americans at or below 138 percent of the federal poverty level eligible for Medicaid and provides the billions in federal dollars needed to insure them. Many leaders of both parties have opted in; some, like Texas Gov. Rick Perry, still stubbornly refuse.
In Missouri, the expansion would open up eligibility to 159,260 additional Missourians in 2014 alone. Because currently there are so many in Missouri without health insurance – roughly 15 percent of the population, or as many as 900,000 people – we are currently seeing reduced productivity, increased cost to public programs, increased private insurance premiums, and increased stress on emergency programs (uninsured folks using the ER as their health care).
But factor in Medicaid expansion, allowing at least a chunk of that 900,000 to afford insurance for the first time, and those problems start to inch down. In addition, with the federal money rolling in to pay for the expansion, health care companies will immediately need personnel. The University of Missouri study estimates that in 2014, we’d see 5,094 new jobs in nursing and care, 3,208 news jobs in retail, 2,905 new jobs at private hospitals, 2,108 new jobs in home care, and a host of other areas. They estimate a total of 24,008 Missouri jobs created in 2014.
Democratic Gov. Jay Nixon announced late last year that Missouri would be participating, calling it “the best thing to do for our state.” With the expected employment windfall, and newfound medical security for thousands of Missourians, it’s a no-brainer, right?
Some extremist members of the Republican-controlled legislature, unfortunately, have other ideas.
One House committee has already rejected the expansion bill supported by Gov. Nixon, while Rep. Jay Barnes (R-Jefferson City) has offered an alternative. He calls it “market-based” Medicaid expansion: instead of expanding eligibility to 138 percent of the poverty level (which he described as part of the Obama’s “left wing ideology”), he’d stop at 100 percent. Oh, and he’d pare down eligibility for children, leaving out 44,000 Missouri children.
Let’s put aside the morally bankrupt idea of kicking thousands of children of low-income parents off their health insurance. Even if Rep. Barnes’ bill went into law, under the guidelines set forth in the Affordable Care Act, Missouri probably still wouldn’t be eligible for the federal funds they need to do any of this in the first place, unless the Obama Administration made an exception.
So in other words, Rep. Barnes’ “alternative” proposal is not an alternative at all – it’s a roundabout way of scuttling Medicaid expansion completely.
Let’s not be fooled by Barnes’ political theater. Medicaid expansion does not have to be a partisan issue, as Republican Govs. Christie, Martinez, McDonnell, Kasich, and Scott have shown. This is about allowing the most vulnerable among us to have the medical security we all deserve – not to mention putting thousands of Missourians back to work.
During President Obama’s second inaugural address yesterday, he affirmed we’re stronger when we work together:
But we have always understood that when times change, so must we; that fidelity to our founding principles requires new responses to new challenges; that preserving our individual freedoms ultimately requires collective action. For the American people can no more meet the demands of today’s world by acting alone….No single person can train all the math and science teachers we’ll need to equip our children for the future, or build the roads and networks and research labs that will bring new jobs and businesses to our shores. Now, more than ever, we must do these things together, as one nation and one people.
He also lifted up working peoples’ shared belief in a robust social insurance system.
We do not believe that in this country freedom is reserved for the lucky, or happiness for the few. We recognize that no matter how responsibly we live our lives, any one of us at any time may face a job loss, or a sudden illness, or a home swept away in a terrible storm. The commitments we make to each other through Medicare and Medicaid and Social Security, these things do not sap our initiative, they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.
Our journey as a nation is not complete until we achieve equality and economic opportunity for all.
For our journey is not complete until our wives, our mothers, and daughters can earn a living equal to their efforts. Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law—for if we are truly created equal, then surely the love we commit to one another must be equal as well. Our journey is not complete until no citizen is forced to wait for hours to exercise the right to vote. Our journey is not complete until we find a better way to welcome the striving, hopeful immigrants who still see America as a land of opportunity; until bright young students and engineers are enlisted in our workforce rather than expelled from our country. Our journey is not complete until all our children, from the streets of Detroit to the hills of Appalachia to the quiet lanes of Newtown, know that they are cared for, and cherished, and always safe from harm.
It was 47 years Ago today that President Lyndon Johnson signed into law the two bills that created Medicare and Medicaid, guaranteeing health care coverage to retirees and people in poverty.
The new laws led to a dramatic decline in poverty rates among senior citizens and a broadening of health care coverage for the most vulnerable people across the country. It’s a major accomplishment that’s worth celebrating—and protecting.
The Strengthen Social Security campaign has a great set of reports coming out that detail how these laws affect each state. That’s not just a set of statistics—that’s parents and grandparents, friends and neighbors who have basic health care coverage.
Unfortunately, the debate over Medicare isn’t settled. After all, Rep. Paul Ryan, the Wisconsin Republican who chairs the budget committee, has targeted the guarantee of Medicare for demolition. The proposal Ryan wrote—the proposal which passed the U.S. House this year and which Mitt Romney has endorsed—would replace Medicare with a voucher system that would radically shift costs towards retirees and drastically cut Medicaid. Ryan has pulled the Republican Party hard to the right with his zeal for privatization—and Medicare and Medicaid, two critical safety nets, are the next target of his crusade to “radically curtail the government’s role in protecting citizens from life’s misfortunes.”
And one key piece of moving us towards health care access that’s truly universal is the Medicaid expansion in the Affordable Care Act. It would save lives by giving coverage to millions who currently fall through the cracks. That’s now under threat from governors like Florida’s Rick Scott, Texas’ Rick Perry and Wisconsin’s Scott Walker, who put a much higher value on scoring ideological points than they do on expanding health care coverage.
So it’s a very happy 47th birthday for Medicare and Medicaid—but we’re going to have to fight hard to make sure they get to see 48.
Governors like Rick Scott of Florida and Nikki Haley of South Carolina have made a big show over the past week of refusing the Medicaid expansion funds provided by the Affordable Care Act—a critical part of the law that would provide coverage to millions of uninsured people in poverty.
The excuses they’ve given for shunning the money, however, ring hollow. A recent study by the Urban Institute suggests that the Affordable Care Act will actually save states money, undercutting Republican governors’ arguments against accepting the Medicaid expansion. The savings come from the expansion of what is covered by the federal government and from cutting back the cost of uninsured people who need emergency care.
Much of the state savings we project depend on the Medicaid expansion. It’s essential to reducing uncompensated care; it’s a key piece shifting mental health costs from the state to the federal government; and it’s essential for other state savings as well.
According to the study, Wisconsin—where Scott Walker has declared he won’t accept these new funds—could save $3.7 billion over the rest of the decade. Iowa, where Gov. Terry Branstad has announced his intention to refuse the Medicaid expansion funds, could save $1.9 billion over that period.
Indeed, analysts have called the Medicaid expansion funding an “unbelievably good deal” for states. Nevertheless, many governors are plowing ahead with their refusal, spurning the chance to provide hundreds of thousands of their constituents with health insurance. And sadly, some states rejecting Medicaid expansion funds—like Florida and South Carolina—have among the highest rates of uninsured people in the country.
How many people are affected by this decision? This great interactive map explains how many people would lose out if their state governments turn down Medicaid expansion funding. There are more than 160,000 people in Wisconsin who will go uncovered if Walker follows through on his threat to cast Medicaid expansion funds aside. Iowa has more than 110,000 people who will go without coverage as a result. And in Florida, where Rick Scott has made opposition to the Affordable Care Act his signature crusade, an estimated 1.5 million people would be left uninsured by his decision.
Those aren’t just numbers on a chart. Those are human beings who are struggling, and who are just as likely to break a leg, catch the flu or develop cancer as anyone else. To the governors refusing Medicaid expansion, however, they seem to be nothing more than collateral damage of an attempt to make a political point. And as the Urban Institute study suggests, they don’t even have “we can’t afford it” as an excuse.
When we fought to pass the Affordable Care Act into law—a long, tough, and ultimately successful fight—we fought because we thought that everyone should have the chance to get health insurance, and that nobody should have to fear being wiped out by a medical problem. Governors like Walker, Scott and Branstad are putting that goal at risk.
Survey after survey shows the public wants corporations to stop sending jobs overseas and hopes the federal government takes action to get jobs back to this country, as demonstrated in a recent compilation of polling data by Ruy Teixeira at the Center for American Progress Action Fund.
Ninety percent said keeping jobs in America was either one of the most effective steps (59 percent) or a very effective step (31 percent) that the government could take to improve the economy. The 2011 Pew Mobility survey also showed the “Keep jobs in America” option was ranked first out of 16 possible steps the government could take to make sure people don’t fall behind economically.
Similarly, in an August 2010 Allstate/National Journal survey, 70 percent thought it was either extremely (39 percent) or very (31 percent) important to reduce the number of outsourced jobs in order to help the U.S. economy recover from the recession. A poll later that year showed that 67 percent thought outsourcing played a major role in high unemployment, compared with 28 percent who thought it played a minor role and 4 percent who thought it played no role at all.
Meanwhile, Mitt Romney splits hairs between the definitions of “offshoring” and “outsourcing” to cover the fact that his corporate success depended upon doing a lot of both.
So what’s his solution to the nation’s jobs crisis?
His solution is the same “austerity” policy pushed by congressional Republicans, which economists say is a key reason for too-slow job creation. As economists Sarah Ayres and Heather Boushey write:
According to an analysis by the Center on Budget and Policy Priorities, “by 2022, if the [federal] budget had to be balanced while taxes were cut,” which is Romney’s goal, “the proposals would require cutting entitlement and discretionary programs other than Social Security and core defense by more than half.”
Specifically, the Center for Budget and Policy Priorities estimates that Romney’s proposals would deplete Medicare, Medicaid and the Children’s Health Insurance Program by $3.4 trillion over the next 10 years. In addition, the nonpartisan think tank says that, under Romney’s plan, compensation payments for disabled veterans would be cut by one-quarter, and 13 million people struggling to put food on the table for their families would be kicked off the Supplemental Nutrition Assistance Program.
As we discussed yesterday, the next health care fight will need to be at the state level, where state legislators and governors will have the option to accept or turn down funding for a major expansion of Medicaid. This expansion is a major piece of how the Affordable Care Act expands coverage, so this is a critical question.
The Kaiser Foundation has been keeping track of which governors are claiming that they’ll just flat-out refuse the Medicaid expansion and the federal funding that comes with it. They’ve done the math, and in the states where governors like Scott Walker and Rick Scott have refused, an estimated 1.4 million people will go without coverage as a result. That’s a shocking number of people to be denied coverage over a policy choice made mostly out of spite.
Think Progress has a great graphic showing where different states stand on the question of Medicaid expansion. Many Republican governors have been rushing to declare that they’ll deny the expansion. Yesterday, for instance, Iowa Gov. Terry Branstad promised to “fight it in every way we can.”
This provision is already increasing coverage. Five states and the District of Columbia have already taken the Affordable Care Act’s Medicaid expansion—and more than 500,000 people now have coverage as a result. Meanwhile in Texas, with a huge uninsured population, the Medicaid expansion is in doubt.
There are other ways that Republican governors can throw a wrench into the implementation of the Affordable Care Act. For instance, they can refuse to set up the exchanges, which are the marketplaces in which people are going to be able to buy insurance.
It is worth noting that this isn’t really about budget impact. Jonathan Cohn notes that the costs to states are negligible for the first few years and small thereafter, while the effect of the Medicaid expansion on a state’s poorest people—and its hospitals and doctors—is large. Nevertheless, he worries that a combination of “fanatical devotion to anti-government philosophy [and] cold indifference to their most vulnerable constituents” will lead these governors to follow through on their threats.
Among the thousands of people we visit every week, health care is a major concern. And they understand how important it is for everyone to have access to affordable health coverage. For these governors and their allies in Washington, however, Sen. Mitch McConnell summed it up this weekend: 30 million uninsured people are “not the issue.” They just don’t think that it’s the government’s job to worry about it.
We need to make sure they know that, indeed, making sure everyone has health care is their job, and they need to get to work.
