In a report issued on Monday, a commission created to combat drug addiction recommended that President Donald Trump declare the opioid crisis a national emergency. The Commission on Combating Drug Addiction and the Opioid Crisis, formed via an executive order Trump signed in March, is chaired by New Jersey Governor Chris Christie, and is co-chaired by a bipartisan group of governors and health professionals.

In its interim report–a final review is due in October–the commission said its “first and most urgent recommendation” is for Trump to deem the crisis a state of emergency. The report continued:

Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life. It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.

More Americans die from drug overdoses than from car accidents or gun violence. According to the Centers for Disease Control, 142 Americans die each day from a drug overdose; 91 die from an opioid overdose. In 2015, opioids like Percocet, Oxycontin, heroin, and fentanyl were responsible for nearly two-thirds of all drug overdose deaths. The trend is on the rise: Since 1999, according to the CDC, the number of overdose deaths linked to opioids has quadrupled.

The commission–which includes Republican Governor Charlie Baker of Massachusetts and Democratic Governor Roy Cooper of North Carolina–recommended a number of other reforms. It asked Trump to waive the barriers that keep patients at addiction treatment facilities from qualifying for Medicaid services. The commission wrote: “This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.”

Regardless of what the Trump Administration decides to do, states are beginning to tackle the opioid epidemic on their own. Earlier this year, the governors of Arizona, Florida, Virginia, and Maryland declared a state of emergency for the epidemic. But if the federal government declared the opioid crisis a state of emergency, would that make a tangible difference?

“It’s really about drawing attention to the issue and pushing for all hands on deck,” Michael Fraser, the executive director of the Association of State and Territorial Health Officials, told the New York Times. “It would allow a level of attention and coordination that the federal agencies might not otherwise have, but in terms of day-to-day lifesaving, I don’t think it would make much difference.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post Should the Trump Administration Declare the Opioid Crisis a National Emergency? appeared first on Law Street.

In 2015, the United States spent a staggering $3.2 trillion on health care, or nearly $10,000 per capita–amounting to 17.8 percent of U.S. gross domestic product. Health care is one of the most expensive components of the federal budget, and health spending comes in a variety of different forms, including major public programs, direct subsidies, and a number of different provisions in the tax code.

While big insurance programs like Medicare and Medicaid tend to be the focus of most health care discussions, and account for most of the spending, the government provides and subsidizes health care in ways that many might not realize. Given the rising prominence of the health care industry in our budget and in our economy, it’s important to look at the current role played by the federal government. Read on to see how the government provides and incentivizes health insurance coverage and how much these efforts cost.

Government Health Care Programs

Two government programs account for a large portion of health care spending, and federal spending in general. Medicare and Medicaid are two entitlement programs that together account for roughly 25 percent of the federal budget. In 2016, the U.S. government spent a net total of $588 billion on Medicare, the health insurance program covering all Americans over the age of 65. Federal spending on Medicaid, which provides health insurance to people with disabilities, the elderly, children, and people with low incomes, totaled $368 billion last year. Because Medicaid is a federal-state partnership, states also account for a notable portion of health care spending. In 2016, federal funding covered about 63 percent of all Medicaid spending, excluding administrative costs. The remaining 37 percent, or about $204.5 billion, was held by the states.

It’s worth noting that along with Social Security, Medicare and Medicaid are the largest mandatory spending programs–spending that is built into existing laws and is not subject to annual appropriation bills. Forecasts predict that these programs will grow as a share of the federal budget in the coming years as the Baby Boomer generation retires. In its most recent forecast, the Congressional Budget Office (CBO) predicts, “outlays for mandatory programs increase as a share of GDP by 2.4 percentage points from 2017 to 2027–mainly because of the aging of the population and rising per capita health care costs. Social Security and Medicare account for nearly all of that increase.” Last year, Social Security amounted to 4.9 percent of U.S. GDP and spending on major health programs amounted to 5.4 percent of GDP.

In addition to Medicaid and Medicare, the government provides subsidies for people with incomes between 100 and 400 percent of the federal poverty level and who do not get health insurance through their employer. According to the CBO, the government spent $42 billion in 2016 on subsidies and other costs related to the individual insurance market.

The video below from the Brookings Institution gives an overview of health care spending trends over the past several decades:

The Tax Code

While the various provisions of the tax code that encourage individuals and companies to buy health insurance might not sound all that interesting, tax policy is a crucial part of the current health care system, and accounts for a significant amount of spending, or more precisely, foregone revenue.

Employer-provided Insurance

The government uses the tax code to encourage and discourage a wide range of behaviors. To encourage individuals and businesses to do certain things, the government uses tax expenditures, more commonly known as tax breaks. These provisions in the tax code forego tax revenue when people or businesses engage in certain activities. The largest of the existing tax expenditures deals with health care spending by employers. Specifically, the tax code excludes all spending toward employees’ health care premiums from taxation. This exclusion encourages employers to provide certain benefits to their employees because they can use pre-tax dollars to do so–if the same amount of money was given to employees in the form of traditional wages, it would be taxed. The exclusion is projected to cost about $260 billion in 2017, based on what the government would otherwise receive in payroll and income taxes. That annual cost makes the health care exclusion the third largest health care program, following Medicaid and Medicare.

The tax exclusion of employer provided health care dates back to World War II and emerged almost accidentally. In an effort to control inflation, the federal government froze wages, which prevented companies from paying their employees more. Instead, employers took advantage of an exception that applied to certain benefits–they started providing health insurance plans. Then in 1954, the IRS determined that payments toward employee health insurance are exempt from taxation. Over time, employer-subsidized health care became quite common, and today, most Americans get health care from their employer or a close family member’s employer.

While the tax exempt status of employer-provided health care has become particularly popular and politically durable–efforts to eliminate or even cap the tax benefits have not gotten very far–many economists believe that it has a distortionary effect on the health care system as a whole. The most frequent criticism of employer-subsidized health care is that it can spur growth in medical costs. Because premium payments are excluded from taxation, employers are incentivized to offer very generous health insurance plans instead of simply paying their employees higher wages. Economists argue that if more of the cost burden was placed on consumers when they use medical services, they would try to reduce those costs by searching for lower prices and avoiding unnecessary care. But when most of the cost of health care is masked by generous insurance plans, there is little incentive for individuals to cut costs.

Other criticisms of employer-subsidized health care focus on concerns about equity and progressivity. People with high incomes are more likely than those with lower incomes to benefit from health-related tax expenditures, of which employer-subsidized health care is by far the largest in value. Moreover, the nature of the tax exclusion makes it more valuable to people with high-incomes than those lower on the income scale. Because income tax is progressive–those with higher incomes pay higher tax rates–pre-tax money spent on health care is worth more to those with higher incomes because it would otherwise be taxed at a high rate. In 2015, about 45 percent of all benefits from health tax expenditures went to individuals with incomes in the top 20 percent, while just 0.5 percent of all benefits went to those in the bottom 20 percent.

Efforts to eliminate or curtail the tax preference for employer-sponsored health care date back to Reagan’s presidency, but few have made any notable progress. One notable exception is what’s known as the “Cadillac tax,” which was a part of the 2010 Affordable Care Act. The Cadillac tax, formally known as the high-cost plan tax, sought to rein in health care cost growth by discouraging employers from providing extremely generous health insurance plans. Health insurance premiums payments in excess of $10,200 for an individual or $27,500 for families will face a 40 percent excise tax. The tax was originally scheduled to take effect in  2018 but was pushed back to 2020 after widespread opposition in 2015. Both businesses and unions strongly protested the tax, which may be one issue that both Republicans and Democrats can agree on. While it is still scheduled to go into effect in a couple years, questions about its fate loom as recent health care legislation would push its implementation back even further.

Conclusion

Peter Fisher, a former under secretary at the Treasury Department, once famously advised, “Think of the federal government as a gigantic insurance company […] with a sideline business in national defense and homeland security.” When you look at the federal budget, you can see that Fisher’s comments are rooted in an important truth–health insurance is one of the most expensive aspects of the federal budget.

The government plays a large, if sometimes unnoticed, role in the American health care system. From major programs like Medicare and Medicaid, which together add up to roughly one-quarter of the entire budget, to tax provisions that encourage employers to provide insurance to their workers, the government has a hand in nearly everyone’s insurance. Rising health care costs have led to notable budgetary issues in the long term, particularly as the American population ages, which have led some to argue that entire programs need to be revamped to keep spending sustainable. While many agree that health care spending has gotten unusually high in recent years, actually controlling costs has proven challenging.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post How Much Does the Government Spend on Health Care? appeared first on Law Street.

Senate Republicans unveiled a revised draft of their new health care bill Thursday, the chamber’s second crack at repealing and replacing the Affordable Care Act. The new draft, released at a closed-door, Republican-only meeting Thursday morning by Senate Majority Leader Mitch McConnell (R-KY), contains an amendment aimed at the Senate’s most conservative members. Only two Republicans can oppose the bill for it to still pass, though as of Thursday, a handful have expressed deep reservations about the proposal.

The revised legislation largely resembles the initial Senate plan which was released last month. Medicaid would still face steep cuts, a provision that has led many moderate Republicans from states that recently expanded Medicaid to oppose the bill.

Perhaps the most striking change to the bill is an amendment courtesy of Sen. Ted Cruz (R-TX), one of the Senate’s most conservative members. The so-called Cruz Amendment would permit insurance companies to offer plans that fail to meet certain Obamacare regulations, as long as they concurrently sell plans that do. Critics of the amendment, which was presented in the document in brackets–meaning it is liable to change–say it would hike care costs for sick people.

Under the revised plan, two taxes on the wealthy imposed by Obamacare would remain in place, as would a tax on health executives’ pay. The measure would also infuse a $112 billion “stability fund,” aimed at lowering premiums, with an additional $70 billion. Addressing lawmakers’ concerns about the ongoing opioid crisis, the bill earmarks $45 billion toward combating drug addiction.

Still, McConnell and Sen. John Cornyn (R-TX), the majority whip, must corral enough “yea” votes in a caucus with a cacophony of competing voices. There are moderates, like Sen. Susan Collins (R-ME), who have objected to the Republican bill at every turn. On Thursday afternoon, Collins tweeted, “Still deep cuts to Medicaid in Senate bill. Will vote no on MTP. Ready to work w/ GOP & Dem colleagues to fix flaws in ACA.”

And then there are heels-dug-in conservatives who viewed the initial bill as not being far enough to the right, like Sen. Rand Paul (R-KY) and Sen. Mike Lee (R-UT). Lee, who previously advocated for the Cruz Amendment, would like to see more details before signing off on the revised bill, according to a spokesman. The Congressional Budget Office, a non-partisan budget analysis agency, is reviewing two versions of the bill–one with the Cruz Amendment, one without.

Many senators have expressed reservations that the bill, which will likely be debated next week, will even be considered.

“I don’t even know that it’s going to get to a vote,” Sen. John McCain (R-AZ) told Politico. Appearing on Fox News on Thursday morning, Cornyn, the man responsible for ensuring the bill garners the requisite number of votes, said: “If you vote ‘no’ on this bill, it essentially is a vote for Obamacare because that’s what we’re going to be left with.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post Senate Republicans Release Revised Health Care Plan appeared first on Law Street.

As Republican Senators prepared to release a version of their new health care legislation on Thursday, a group of protesters gathered outside Senate Majority Leader Mitch McConnell’s office. But many of them were eventually physically removed from the scene.

The rally was organized by ADAPT, a national disability rights organization, according to CNN. In their statement, the protesters said that they are “demanding [McConnell] bring an end to attacks on disabled people’s freedom which are expected in the bill.”

So, the majority of protesters were either advocates for those with disabilities or those directly impacted by a handicap, according to USA Today. Instead of calling their protest a “sit-in” they referred to it as a “die-in,” demonstrating their belief that the GOP health care bill would put many Americans in grave danger without dependable health care.

ADAPT’s statement also noted that the protest took place on the 18th anniversary of Olmstead v. L.C. – the Supreme Court decision that recognized disabled people’s right to live in communities rather than institutions.

After President Donald Trump took office and vowed to repeal the Affordable Healthcare Act, the Republicans have been trying to craft their own version of the bill. They faced harsh criticism from both sides of the aisle for their secrecy regarding the bill’s contents before unveiling it on Thursday.

Citizens nationwide were offended by both the process surrounding the creation of the bill and the contents of the bill itself. So, the protesters felt it was incumbent to voice their concerns to one of the most powerful Republicans in Congress.

While the protests remained mostly peaceful, Capitol Police were called in at some point and began to forcefully remove protesters despite their constitutional right to protest the government.

Capitol Police are physically removing protesters who are staging a “die-in” in front of McConnell’s office pic.twitter.com/8BU0dW63VI

— Andrew Desiderio (@desiderioDC) June 22, 2017

The police force ultimately arrested around 20 people, many of whom were either on respirators or confined to wheelchairs, according to the Huffington Post. Custodians also had to be sent to the hallway in order to clean up blood, according to Daily Beast reporter Andrew Desiderio.

The group took particular exception to the proposed cuts to Medicaid. At one point the crowd began chanting: “No cuts to Medicaid, save our liberty!”

“No cuts to Medicaid, save our liberty.” Group chants in front of @SenateMajLdr‘s office. pic.twitter.com/fVJpufMDgC

— Jessica Smith (@JessicaASmith8) June 22, 2017

The health care bill has to be voted on by the Senate and go back to the House, so it will likely be modified. But the violence that these protesters faced at the hands of Capitol Police is upsetting. Instead of having their voices heard, they had their free speech stymied and were physically injured.

Josh Schmidt

Josh Schmidt is an editorial intern and is a native of the Washington D.C Metropolitan area. He is working towards a degree in multi-platform journalism with a minor in history at nearby University of Maryland. Contact Josh at staff@LawStreetMedia.com.

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The Congressional Budget Office announced in March that the American Health Care Act, the measure created to dismantle the Affordable Care Act that Senate Republicans worked to fast track their own version of on Thursday, will cause the number of uninsured Americans to increase by 14 million in 2018, nearly doubling the figure from 2015. While we don’t know yet what the Senate version will look like, it’s likely that millions will lose their insurance. Among those that have been preparing for the drop since then are crowdfunding platforms such as GoFundMe and YouCaring.

“Whether it’s Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase,” Dan Saper, chief executive officer of YouCaring, told Bloomberg. “It will drive more people to try and figure out how to pay health-care needs, and crowdfunding is in its early days as a way to help those people.”

Sites have seen increases in the number of medical-related fundraisers and donations over the past few years, to the point where that category makes up a significant portion of both sites. In 2015, GiveForward, which was recently acquired by YouCaring, reported that almost 70 percent of all its fundraising campaigns were medical, averaging a fundraising goal of $7,500 per campaign.  Since 2010, GoFundMe has raised over $2 billion on its site and $930 million went to medical campaigns.

While some may find the American reliance on crowdfunding to pay off medical expenses to be troubling, GoFundMe CEO Rob Solomon finds it industry-defining. He has said that medical fundraising “helped define and put GoFundMe on the map” and helped accomplish the goal of becoming a “digital safety net.”

That safety net might need to grow wider because of the AHCA’s Medicaid plans. Preliminary results of a study done through the University of Washington/Bothell found that most personal medical fundraisers done through GoFundMe came from people living in states that chose not to expand Medicaid under the ACA, like Texas. The Huffington Post reported that even moderate Republicans are backing provisions that would eventually cut off federal matching funds for the law’s Medicaid expansion, which 31 states have taken advantage of.

This applies to more than just those who receive insurance through Medicaid, however. According to an NPR, Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health study, 26 percent of adults in the U.S. said they have serious financial problems due to health care costs, with 44 percent of them having to set up a payment plan with their provider. Additionally, the Kaiser Foundation found one in five of all working-age Americans with insurance reported having problems paying medical bills.

Saper believes in the potential of this safety net. He stated that medical crowdfunding is “highly, highly scalable and has a ton of runway. The growth rate of the industry is showing that this can absolutely be an impactful safety net for a lot of individuals and communities to help each other.”

But the current crowdfunding model has repeatedly proven that it is far from equipped to handle the campaigns of every person who could use one. Just over one in 10 health-related online campaigns reached their goal, according to a study at NerdWallet, and the study done at Bothell found that 90 percent of the campaigns they followed failed to reach their goal, only reaching 40 percent of what they asked for on average.

Dr. Edward Weisbart, who chairs the Missouri chapter of Physicians for a National Health Program, mentioned that a lot of these missed goals can be attributed to a sort of fatigue donors feel over time as they receive more and more requests to donate.

“When you get your first request, you probably give a high amount. But as you get besieged and realize how common these requests are, donations will go down. We can’t keep on giving to everyone who asks,” she said to Bloomberg.

Even when people do give, they’re more likely to give to the campaigns with stories that touch our hearts or are just outright extraordinary, according to the creator of GoFraudMe, a website that exposes fraudulent campaigns on GoFundMe, Adrienne Gonzalez. For example, two of the “most active” campaigns on Generosity.com are one raising money for a woman who was struck by lightning, and one for a woman hoping to cover “co-pays, travel expenses, food, lodging, essentials” as she takes care of her 19-year-old daughter who is awaiting a kidney transplant.

What this could create is droves of uninsured individuals all vying for donations toward their medical expenses, hoping that their story wins in a competition of moral equivalency in the minds of donors. As dystopian as this sounds, this would not necessarily be the worst scenario for crowdfunding sites. GoFundMe receives 7.9 percent for donation and processing fees, plus 30 cents per donation, according to its website, meaning it has received $158 million in revenue from its total donations, and just under $75 million from medical campaigns alone.

Saper is well aware of these figures and seemingly sees that there’s profit in helping people raise money for their medical expenses.

“We rely on voluntary contributions from donors [to run the company], so our big thrust now is how do we get the word out about it,” he said. YouCaring has ramped up its marketing and operations teams in preparation for a new wave of customers that will use that site as a platform to broadcast their need for help paying medical bills because the system in place will soon abandon them, if it hasn’t already.

Gabe Fernandez

Gabe is an editorial intern at Law Street. He is a Peruvian-American Senior at the University of Maryland pursuing a double degree in Multiplatform Journalism and Marketing. In his free time, he can be found photographing concerts, running around the city, and supporting Manchester United. Contact Gabe at Staff@LawStreetMedia.com.

The post Crowdfunding Sites Could Benefit Immensely from the AHCA appeared first on Law Street.

Over the years, many states have tried to attach different conditions to public assistance programs for low-income Americans. These conditions include things like work requirements, which limit benefits to people who are currently working or actively pursuing employment, and drug testing, which limits benefits to people who are not currently using illegal drugs. Both of these policies have been in the news lately as Republicans at the state and national level seek to move assistance programs in a more conservative direction.

While many tend to refer to welfare as if it’s a single government program, assistance to low-income Americans generally comes through the tax code and a hodgepodge of programs administered at the state level. While a wide range of tax credits and public programs make up the American safety net, discussions of drug testing and work requirements typically focus on a handful of programs. Read on for an overview of the programs that are typically targeted for these requirements and what recent proposals would mean for them.

Conditions and Public Assistance Programs

Both drug testing and work requirements are important components of the ongoing debate over welfare policy. Many public assistance programs have work requirements built into them due to policy changes in the 1996 welfare reform legislation. And while some efforts to impose drug testing requirements have been blocked by the courts, according to the National Conference for State Legislatures, at least 15 states have passed legislation requiring public assistance applicants or recipients to be drug screened. These conditions have different implications for people based on how they relate to specific forms of public assistance. Here’s a look at four of the most discussed programs:

Supplemental Nutrition Assistance Program (SNAP)

The Supplemental Nutrition Assistance Program–previously referred to as food stamps and now known as SNAP–already has some limitations but the debate re-emerged last year as states started reimposing work requirements after getting waivers following the recession. The 1996 welfare reform law placed stringent requirements on able-bodied adults without children. The law only permits these adults to receive benefits for just three months every three years when they are not either employed or in a job training program for at least 20 hours per week. As a result, the vast majority of people who receive SNAP benefits are either employed or have dependent children. While lawmakers at the state level have called for drug testing requirements, federal law currently does not allow it.

In addition to work requirements, several lawmakers have called for limitations to be placed on what people can use SNAP benefits to buy. Proponents of these restrictions argue that people shouldn’t be able to use publicly funded programs to buy things like sugary drinks or expensive food like lobster. But opponents argue that these decisions are best left to individuals, and limitations on what you can buy already exist–for example, SNAP recipients cannot buy alcohol or prepared foods with their benefits. Moreover, they note that such rules may further stigmatize the use of the program, which has been a crucial means of preventing food instability for a large number of Americans.

Temporary Assistance For Needy Families (TANF)

TANF is one of the few antipoverty programs that provides direct cash assistance, rather than in-kind benefits. The TANF program is administered by the states, which are given a federal block grant each year. Because of its funding system, states have a significant amount of control over how the block grant funds are used as well as the conditions that are tied to benefits. As the name suggests, TANF benefits are typically limited to families with children and have a duration limit. All benefits are also tied to work requirements. While states can define exactly who is eligible for assistance, work requirements are part of the underlying law–states face a funding penalty when their TANF work participation rates are below what is defined by federal law.

State-level flexibility has also led many states to implement drug testing requirements for TANF recipients. However, courts have found that states do not have an unlimited authority to require drug screening. A Florida law requiring all TANF recipients to be drug tested was struck down in court because suspicion-less testing requirements amounted to an unconstitutional search. What set Florida’s law apart from similar laws in other states was its breadth–requiring all recipients rather than focusing on those suspected of drug use.

The law was also not cost effective while it was in effect–the state spent more reimbursing people for drug tests than it would have if it had given them benefits without screening. More generally, critics of efforts to attach conditions to public assistance programs tend to cite the unnecessary administrative costs that come with determining a person’s employment and drug use status.

Medicaid

Medicaid, the health insurance program for low-income Americans, has been a recent target for both work requirements and drug testing. A recent letter from the Department of Health and Human Services to the states indicated that the Trump Administration would give more flexibility to states to impose work requirements for people in the Medicaid program. Wisconsin plans to take its Medicaid program in an even further conservative direction, imposing drug screening requirements, work requirements, and time limits for those receiving benefits. Under Wisconsin’s proposal, applicants would need to fill out a questionnaire and, based on their responses, could have to undergo drug screening. If they test positive, they will be diverted into a drug treatment program and if they decline treatment they will be denied benefits altogether. As the Trump Administration signals that states will have more control over the administration of Medicaid, we can expect to see additional states propose conservative changes to Medicaid, but legal challenges may be just as likely.

Given the nature of Medicaid and the health care system in general, even some who support work requirements in principle question their use for Medicaid. Because the government requires emergency rooms to provide care to people regardless of their ability to pay for it, work requirements in Medicaid would not have the same effect as they do in programs that could simply cut off all benefits. This would also mean that more costs are shouldered by hospitals, including public hospitals funded in part through tax dollars, which limits the cost-savings related to pushing people unwilling to work off of public programs.

The video below gives a brief overview of how work requirements would work in Medicaid:

Unemployment Insurance

The Unemployment Insurance program has been around since 1935 and seeks to help the recently unemployed manage their expenses as they look for a new job. The program typically provides benefits, about half of an unemployed person’s previous salary up to a limit, for about 26 weeks in most states. The system is funded by employers on behalf of their workers through state and federal taxes. Federal law says that people eligible for Unemployment Insurance must be able to and currently be looking for work while they receive benefits, although states have the ability to define certain eligibility details.

Unemployment Insurance has been a frequent target of drug testing requirements, but a recent regulatory rollback may have inadvertently made it harder for states to place such requirements on beneficiaries. As a part of the effort to remove a number of regulations put in place under the Obama Administration, Republicans used the Congressional Review Act–a law that allows for the expedited removal of recent regulations under a new president–to scrap a Department of Labor rule outlining who could be drug tested for unemployment benefits. The regulation came out of a provision in a 2012 law that allowed states to drug test individuals before receiving unemployment benefits according to federal regulations. When the regulations were finally enacted, Republicans said they were too narrow, limiting people eligible for the tests to those in a small set of occupations. The rationale was to subject people who would need to pass a drug test for a new job to also be subject to the same tests when receiving unemployment benefits. But the law was contingent upon existing federal regulations, and now that Republicans scrapped the rules that existed, states are now unable to require drug testing absent federal regulations. Writing new rules will take some time, and removing an existing regulation makes it considerably more difficult to pass a new one seeking to accomplish the same thing. As a result, some administrative law experts believe that getting rid of the previous rule may actually set back efforts to enact drug testing requirements.

Conclusion

While there is significant disagreement on the extent to which the government should assist the poor and unemployed between the two major political parties, both Republicans and Democrats tend to agree that the government should do something to help those in need. The primary disagreement stems from how much the government is willing to pay and who is eligible for assistance. Drug testing and work requirements are seen by conservatives as a way to reduce eligibility to people who deserve it and cut costs as a result. Critics say that these requirements add more to the cost of administration than they save in withheld benefits. They also argue that placing these requirements can stigmatize the programs and discourage people who need help from seeking it.

It’s also important to realize how different requirements interact with various programs and how certain funding systems make adding conditions easier at the state level. Block grants, like the one used to fund the TANF program, give states the most flexibility to impose requirements on those receiving benefits, while entitlements tend to need a change in federal law.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post Drug Testing and Work Requirements: Attaching Strings to Public Assistance appeared first on Law Street.

Welcome to RantCrush Top 5, where we take you through today’s top five controversial stories in the world of law and policy. Who’s ranting and raving right now? Check it out below:

Trump Speaks in Saudi Arabia to Kick Off First Foreign Trip

Over the weekend, President Donald Trump set out for his first trip abroad as president. The trip schedule is ambitious, given recent reports that he didn’t particularly want to go. He is also the first president to start his first foreign trip in the Middle East. Yesterday, he gave a speech in Riyadh, Saudi Arabia. He stuck to the teleprompter and many people remarked that he had a significantly more moderate and tempered tone than during the campaign and the first few months of his presidency. He focused on solidarity, and said, “This is not a battle between different faiths, different sects, or different civilizations. This is a battle between barbaric criminals who seek to obliterate human life, and decent people of all religions who seek to protect it.”

#RiyadhSummit #POTUSAbroad pic.twitter.com/WdDEOiV6oS

— Donald J. Trump (@realDonaldTrump) May 21, 2017

Trump also said he was not there to lecture but to offer partnership. Although some people were relieved that he sounded so moderate, others didn’t quite buy it and said it was all for show.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

The post RantCrush Top 5: May 22, 2017 appeared first on Law Street.

Texas has asked the government to give the state back the federal Medicaid money that it gave up when it chose to exclude Planned Parenthood from its family planning program. The request has alarmed women’s health advocates, who worry that if Texas is given access to the money without having to include Planned Parenthood again, it could set an example for other states to do the same thing.

The program Texas wants to fund is an alternative for women’s reproductive health that doesn’t include any abortion providers. It is called Healthy Texas Women and it connects women with providers that offer cancer screenings, contraception, and treatment for diabetes or high blood pressure. It helps women that make up to 200 percent of the poverty line and don’t qualify for Medicaid.

Normally, these types of programs are financed largely by federal money and the rest by the state. But after Texas decided to shut out all providers that offered abortions in 2013, the program had to be completely financed by state money. That is because federal law doesn’t allow states to simply pick and choose which providers it gives Medicaid money to.

Um, no. If you throw women under the bus, you don’t get the money. https://t.co/GLHN6iTsZk

— Scott Wiener (@Scott_Wiener) May 16, 2017

But critics say most women don’t know that Healthy Texas Women even exists. The number of women enrolled has decreased significantly compared to the number enrolled in a previous version of the program in 2015. And the difference is even larger compared to the number enrolled in the state’s Medicaid Women’s Health Program in 2011, when Planned Parenthood was still included. Officials have spent millions of dollars on marketing, but it hasn’t been as successful as expected. Reduced funding also led to many women losing health coverage.

Joe Pojman, executive director for Texas Alliance for Life, said that “low-income women deserve better care than Planned Parenthood is willing or able to provide.” But women are not as sure about that. Jessica Farrar, Democratic Texas State Representative, said earlier in May:

Increased funding for marketing for Healthy Texas Women highlights the simple fact this program has not yet, and never will, replace Planned Parenthood.

And Yvonne Gutierrez, executive director for Planned Parenthood Texas Votes, agreed:

They’ve been trying this for several years, but every time they’ve gone through an iteration of this they’ve not been able to make it work. Why is this taking you so long if it was supposed to be so easy to do this without Planned Parenthood?

A study looking into the effects of removing Planned Parenthood from the state’s health program showed that throughout the following 18 months thousands of women stopped getting long-acting birth control. There was also a 27 percent increase in Medicaid pregnancies. Texas now has the most births in the country: 400,000 babies were born between July 1, 2014 and the same date a year later. Texas also has one of the highest teen birth rates in the U.S.

Now state legislators wants to get the Medicaid funding back for Healthy Texas Women but not be required to include any abortion providers. And considering President Trump’s record on abortion legislation so far, it doesn’t look impossible. “This is a new administration, and we’re looking at what funding opportunities may exist for us,” said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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As the American Health Care Act works its way through Congress, much of the debate has recently focused on issues like health insurance regulation. While that debate reflects important issues, like protections for people with pre-existing conditions, there is another part that would arguably have even larger consequences: the proposed cuts and changes to Medicaid. The AHCA would fundamentally change the funding structure for the safety net program and could have wide ranging effects on millions of Americans who rely on Medicaid for their health care. Read on for an overview of what’s in store for the program that provides insurance to nearly 20 percent of the country.

Who is Affected

Medicaid is the largest health insurance program in the country, which combined with the related Child Health Insurance Program (CHIP), covered nearly 75 million people as of February. Medicaid covers a diverse group of people including low-income individuals and families, people with disabilities, and the elderly.

The video below explores what the Medicaid program is and how it is paid for:

To understand the scope of the proposed changes to Medicaid in the American Health Care Act, it’s important to look at how the bill it’s intended to repeal and replace–the Affordable Care Act, or Obamacare–changed health insurance coverage in the first place. Generally speaking, the Affordable Care Act sought to increase insurance coverage by expanding the Medicaid program–through both increasing outreach and eligibility–while also creating regulated insurance marketplaces and providing subsidies to make health insurance more affordable.

The Medicaid expansion was directed at the lowest income Americans, specifically, people living below 138 percent of the federal poverty level, while insurance subsidies targeted those who were slightly better off but would still have difficulty paying for health insurance, namely those with incomes below 400 percent of the federal poverty level. Regulations also ensured that individuals could buy insurance on public exchanges and that prices couldn’t vary much according to an individual’s characteristics like age, sex, or health status, which was another way to expand coverage to those who were either priced out of the market or denied insurance outright.

While several components of the ACA sought to lower the rate of uninsured Americans, the Medicaid expansion played the largest role in achieving that goal. The AHCA includes important changes for insurance subsidies and regulation–the proposed cuts and changes to Medicaid are considerably larger. The Congressional Budget Office analyzed the effects of the AHCA in March after it was initially introduced and found that overall, the law would reduce the number of people with health insurance by 24 million within 10 years. The biggest chunk of that decrease, 14 million, would come from the proposed changes to Medicaid. While the law would not technically take people’s insurance away from them–states would have to make difficult decisions about enrollment and eligibility–it would amount to a large cut in federal spending on the program. In total, the CBO estimates that the bill would lead to an $839 billion decrease in federal Medicaid spending over the next 10 years.

The AHCA includes two primary changes to Medicaid that would lead to a significant reduction in people enrolled in the program. First, the bill would phase out the ACA’s Medicaid expansion, decreasing the number of people that states would get a high percentage of federal matching funds to cover. Second, it would change the program’s funding model from an open-ended commitment to an amount per enrollee that gradually increases over time.

Ending the Medicaid Expansion

The Affordable Care Act offered states matching funds to insure a large number of people newly eligible for Medicaid. A 2012 Supreme Court decision made the Medicaid expansion optional at the state level, and since then, 31 states and the District of Columbia have chosen to take the federal funds. At first, the government would pay the full cost of insuring these newly eligible enrollees, but over time the government’s share would drop, and by 2020, it would cover 90 percent of the cost of coverage. The matching rate for the enrollees who gained coverage from the expansion is actually higher than the traditional matching rate that states have historically received for those who were already eligible.

The American Health Care Act plans to unwind the Medicaid expansion starting in 2020. While the plan will end up with an estimated 14 million fewer people on Medicaid relative to current law, the AHCA’s passage will not technically take health insurance away from these individuals. Instead, it grandfathers in all newly eligible enrollees who are already in the program by December 31, 2019–allowing states to continue to receive the 90 percent fund matching for those individuals. However, for people who sign up after that point, the funding would drop to regular matching levels. This means that states will likely decide to restrict their program’s eligibility and return to standards that were in place before the Affordable Care Act.

People on Medicaid tend to cycle in and out of the program relatively quickly, which means that even though the AHCA grandfathers in expansion enrollees, coverage numbers are expected to drop fairly quickly after 2020, when states get lower matching rates. The bill would also require people on Medicaid to re-enroll every six months, rather than every year under current law, to maintain their coverage. This requirement could make it easier for people to accidentally have a lapse in their coverage, which could make those who are grandfathered in unable to re-enter the program. Based on how quickly people have cycled out of the program in the past, the Congressional Budget Office estimates that two years after the expansion ends, fewer than a third of those who were grandfathered in will remain on Medicaid. By 2024, fewer than 5 percent will remain. While the federal government won’t technically take people’s insurance away from them, the drop in funding will likely force states to make the difficult decisions surrounding eligibility and enrollment.

It’s worth noting that politics are an important variable here, so estimating coverage changes can be more of an art than a science when the actions of state legislatures are involved. It’s likely that states will react to a decline in federal funding by reducing the number of people eligible for Medicaid benefits. They may even do so preemptively, as they know that their funding will soon be reduced. Generally, the law will sharply reduce federal funding for Medicaid, but changes will be determined at the state level as they start to shoulder more of the costs.

A New Funding Model

In addition to phasing out the Medicaid expansion, the AHCA intends to dramatically change the funding system for Medicaid. Currently, Medicaid operates as an entitlement program, meaning that the federal government has an open-ended commitment to pay for a large share of the program’s costs. This means that if more people enroll in the program, as is often the case during economic downturns, the federal government continues to bear much of the increase in costs. Similarly, if the cost of medical care increases significantly, as it has been for several decades, the federal commitment increases accordingly. The entitlement nature of Medicaid has been a target of Republicans for decades; however, this is the first attempt to restructure the program while Republicans maintain control of all three branches of government.

Under the AHCA’s per capita cap system, states will get a certain amount per person enrolled. Those amounts will vary based on the different groups eligible for Medicaid to avoid giving states an incentive to shift enrollment to lower costs. For example, the system is designed to prevent states from being pressured to drop enrollment for the elderly or disabled because they may cost more than children. Each year, the per capita cap will increase along with the changes in medical care services component of the Consumer Price Index, which tracks inflation. The medical services component is known as CPI-M. The per capita system will make funding responsive to enrollment changes, but if certain Medicaid costs outpace the overall cost growth for medical services, states will need to pay the additional amount. Generally speaking, shifting to a per person allotment will amount to a significant cut in overall Medicaid spending. The Congressional Budget Office anticipates that Medicaid costs will grow by 4.4 percent per year while CPI-M will grow at just 3.7 percent annually over the next 10 years.

Additionally, the amended AHCA allows states to opt for a block grant rather than a per person cap. This would give states a grant based on their Medicaid population and would give them a considerable amount of freedom in terms of how to use that funding. Proponents say that this would allow states to experiment with funds in order to find new ways to keep costs down and deploy spending more effectively. However, critics argue that a block grant could mean states could be forced to cover fewer people or services than under the per capita cap model, and considerably more so than the current law. This is because block grants would not respond to increases in eligibility, for example due to a recession, and like the per capita model, it would not respond to cost increases that result from new or more expensive types of care. States could charge enrollees more for their care and they could cap enrollment, which could mean even those who are eligible may not be able to join the program.

How it would Change Medicaid

To illustrate how different the system would be under a per capita cap, economists at the Kaiser Family Foundation ran the numbers for Medicaid outlays from 2001 to 2011 to see how tying funds to CPI-M would affect spending. The KFF finds that federal spending would have been $195 billion below actual spending during that period, which would amount to a drop of about 7 percent. Importantly, these changes have very different consequences for the costs involved in covering the different eligible groups in the Medicaid program. For example, spending tied to CPI-M would have been 6 percent lower than actual spending when it comes to the health care costs for the disabled, but it would have been 15 percent lower for children on the program. In both of these cases, states would have had to shoulder more of the costs, but the difference is considerably larger due to faster growth in child health care costs. There is also a lot of variation between states in terms of what they pay for the average Medicaid enrollee. In fact, spending varies so much per person, that 13 states would have actually seen an increase or no change in their overall funding if it was anchored to CPI-M. However, 37 states and the District of Columbia would have seen their funding drop. And for 26 of those states, the drop relative to existing law would have been larger than 10 percent.

Subsequent amendments to the AHCA–after the initial Congressional Budget Office analysis–increased the per capita spending for the blind, elderly, and disabled to CPI-M plus one percentage point. Those changes amount to an estimated $41 billion in additional spending over the next 10 years, according to revised CBO projections. While $41 billion is a significant increase it may not be in the scope of the overall cuts–instead of reducing Medicaid spending by $880 billion, the amended law is projected to drop spending by $839 billion. While the Kaiser Family Foundation estimates mentioned above are based on CPI-M, and AHCA increases that rate slightly for certain populations, its calculations remain instructive.

Critics of the plan argue that the proposed per capita spending caps would limit states’ ability to respond to changes and could leave them on the hook for a lot of spending if certain costs grow faster than overall medical inflation. And because these caps will effectively result in spending cuts relative to the current law, it will ultimately leave states with less funding while also reducing their responsiveness to cost changes. An example of where this could be a problem is in Medicaid’s role in addressing the opioid epidemic. Many people who joined the program after the Medicaid expansion were previously uninsured and did not have access to addiction treatment. Moreover, the entitlement nature of the program allowed the program to respond to costs related to the epidemic. This is important given the program’s role in treatment–in total, Medicaid and CHIP, the related health insurance program for children, cover thirty percent of the U.S. population dealing with opioid addiction.

Conclusion

The American Health Care Act includes a number of adjustments to the current health care system, but the most wide-ranging might be the proposed cuts and changes to the Medicaid program. President Obama’s health law led to a large increase in Medicaid enrollment and the AHCA would roll much of that back while going even further to change the funding structure of the entire program. Taken together these changes amount to an $839 billion spending cut over the next 10 years and 14 million fewer people with health insurance.

Advocates of the bill argue that it will rein in Medicaid spending levels to a more sustainable course while granting states the ability to experiment and cut costs. Critics argue that it will dramatically increase the number of people without insurance by reducing federal funding for Medicaid while not offering alternatives to those who can’t afford insurance. As Senate Republicans begin to work on their own version of the health care bill, these wide ranging changes to Medicaid will likely be an important part of the debate.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post How the American Health Care Act Plans to Dramatically Change Medicaid appeared first on Law Street.

The debate over government funding of Planned Parenthood is seemingly never-ending. During last month’s controversy over repealing and replacing the Affordable Care Act, talk of defunding Planned Parenthood–essentially ensuring that Medicaid funds cannot go to the health provider service–was a common refrain. Defunding Planned Parenthood, advocates say, would ensure that taxpayer money is not used for abortions.

People who disagree with defunding Planned Parenthood have a consistent response to that proposal–that federal money cannot be used for abortion services because of something called “the Hyde Amendment.” Read on to learn what the Hyde Amendment is, its history, and what exactly it requires.

The History of the Hyde Amendment

In 1973, the Supreme Court ruled on Roe v. Wade. With a 7-2 decision, the court ruled that a woman’s right to an abortion is protected by the Fourteenth Amendment. That decision legalized abortion in the United States, although states still have control over certain aspects–like at what point in a woman’s pregnancy abortion can be restricted.

The 1973 Supreme Court ruling in Roe v. Wade that legalized abortion in the United States set up the debate between pro-choice and pro-life advocates that is still being waged today. Between 1973 and 1976 various attempts to prevent Medicaid funding from being used for abortions were introduced and failed. But in 1976, the Hyde Amendment was introduced by Congressman Henry Hyde. It was not any sort of standalone law, but rather a rider attached to the 1977 fiscal year’s Labor, Health and Humans Services Appropriations Bill.

There was a lot of back-and-forth and disagreements between the House and the Senate, and the measure went through a number of revisions before it was successful. Language that made exceptions for abortions in the case that the mother could die without the procedure was inserted, removed, and inserted again.

But eventually the provision known as the “Hyde Amendment” was passed in 1977. In essence, it prohibited any use of Medicaid funds for abortion, unless the life of the mother was endangered. The passage of the Hyde Amendment was seen as a big win for the growing pro-life movement, but because it’s a rider attached to an appropriations bill, it needs to be re-passed every year.

Legal Challenges

After the Hyde Amendment was passed, its legality was almost immediately challenged. The Reproductive Freedom Project, the Center for Constitutional Rights, and Planned Parenthood, representing health care providers and a pregnant Medicaid patient, obtained an injunction 40 minutes after the provision went into effect. Federal Judge John F. Dooling Jr. granted the injunction, setting off a legal battle that made its way to the Supreme Court. SCOTUS sent the case back to Dooling, who kept the injunction in place for that year.

While the Hyde Amendment worked its way through the legal system, it also underwent revisions in Congress. Because it needs to be passed again through an appropriations bill each year, there’s plenty of room to edit and refine the language. Eventually, language that allowed for exceptions in the case of rape or incest were added.

Harris v. McRae 

In 1980, the Supreme Court officially weighed in on the legality of the Hyde Amendment in the case of Harris v. McRae. Cora McRae was a pregnant Medicaid patient who challenged the legality of the provision. The court was asked to weigh whether the Hyde Amendment violated the right to privacy, the right to Due Process under the Fifth Amendment, or Freedom of Religion under the First Amendment. In a ruling neatly split by ideology, the court decided that the Hyde Amendment violated none of the above. According to Oyez:

The Court held that states participating in the Medicaid program were not obligated to fund medically necessary abortions under Title XIX. The Court found that a woman’s freedom of choice did not carry with it ‘a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.’ The Court ruled that because the Equal Protection Clause was not a source of substantive rights and because poverty did not qualify as a ‘suspect classification,’ the Hyde Amendment did not violate the Fifth Amendment. Finally, the Court held that the coincidence of the funding restrictions of the statute with tenets of the Roman Catholic Church did not constitute an establishment of religion.

Although the text has evolved slightly over time, it’s similar to the original concept–federal funds through Medicaid should not be used for abortion services. The current text allows exceptions for if a mother’s life is at risk, or if a woman has become pregnant through rape or incest. Despite political majorities changing over time, and other legal cases brought against the provision, some version of the Hyde Amendment has passed every year since 1977.

Modern Day: H.R. 7

Recently, the Hyde Amendment has made it back into the news again, in the sense that there are moves being made to render it permanent. H.R. 7, also known as the “No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act” would codify the already-existing provisions in the Hyde Amendment and make the restrictions on federal funding permanent. It would also prevent women who are on military insurance or work for the federal government from using their insurance for abortion services.

The House of Representatives passed H.R. 7 on January 24, 2017 with a 238-183 vote. It’s unlikely to pass the Senate (similar bills passed the House in recent years and were not passed by the Senate) but if it does, it seems likely that President Donald Trump would choose to sign it.

Arguments for and Against the Hyde Amendment

There are plenty of arguments for and against the Hyde Amendment, many of which are tied to the general debate over abortion. The following lists are by no means conclusive. But like abortion, the Hyde Amendment remains incredibly controversial.

Arguments for the Hyde Amendment 

Advocates of the Hyde Amendment argue that it saves lives. The 40th anniversary of the original passage of the Hyde Amendment was in September 2016, and it was celebrated as having “saved two million lives” since its passage. Advocates argue that cutting funding for abortion prevents women from having abortions. Although it’s obviously difficult to quantify how many women would have sought abortions had they been able to, pro-life advocates estimate that if the Hyde Amendment was repealed, abortion rates would increase by roughly 25 percent.

Another argument in favor of the Hyde Amendment is that it is supported by the American public. Polling on the issue has varied widely–in fact, both supporters and detractors of the Hyde Amendment regularly make this argument–but it’s true that certain polls have indicated Americans are not in favor of using Medicaid funds for abortions. A Politico poll conducted in October 2016 found that 58 percent of voters are not in support of using Medicaid funding for abortion.

Even some pro-choice individuals are in favor of the Hyde Amendment, arguing that regardless of their personal or political beliefs on abortion, taxpayer money should not be involved. For example during the 2016 election, Senator Tim Kaine, in contrast to his running mate Hillary Clinton, was supportive of the Hyde Amendment. Kaine “stood with” Clinton’s efforts to repeal it, but said he was personally in support of the measure.

Arguments Against the Hyde Amendment

Critics of the Hyde Amendment point out that it is specifically intended to target poor women and women of color who rely on Medicaid. Hyde’s own statements when he introduced the measure provide some fodder for that point of view. He stated: “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the (Medicaid) bill.” Advocates of repealing the Hyde Amendment point out that an abortion is expensive to pay for out-of-pocket, so many women who rely on Medicaid don’t have that option.

Those who support repealing the Hyde Amendment also point out that restricting access to abortion doesn’t necessarily lead to less abortions, but it leads to more unsafe abortions. They also point out that women who want an abortion but aren’t able to obtain one are more likely to fall into poverty than a woman who is able to. And given that many women who seek abortions already have at least one other child, that can be dire for entire families. Of course, traditional pro-choice arguments come into play when discussing the Hyde Amendment–including that women’s healthcare shouldn’t be a political decision.

Conclusion

Given that the Hyde Amendment comes up almost every time there’s discussion about “defunding” Planned Parenthood, it’s important to understand exactly what it does. The Hyde Amendment, like the abortion debate as a whole, is complicated, convoluted, and confusing. First introduced shortly after the landmark decision in Roe v. Wade, the language has evolved over time, but one thing has been consistent–it prohibits federal funding from being used for abortions. Given public opinion, as well as the Hyde Amendment’s longevity thus far, it seems likely that it will remain in place for the next few years.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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While on the campaign trail, President Donald Trump repeatedly vowed to “repeal and replace” the Affordable Care Act (commonly known as “Obamacare”). However, his first attempt at dismantling the federal statute crashed and burned before a single vote was even cast due to divisions among conservative and moderate Republicans on Capitol Hill. If passed, Trump’s health care bill would have slashed federal funding to Medicaid.

Now, in the wake of the embarrassing defeat, Trump’s fledgling administration is still looking to give the American people a better option for health care. Some experts believe this could still come in the form of reforms to Medicaid and Medicare, which have historically been mired in controversy.

So, lets take a look at how these health care programs, both enacted in 1965, have evolved over the years. How has the Affordable Care Act affected them? And what is the fate of these programs if a new health care bill is finally passed?

What is Medicaid?

Medicaid is a social health care program for certain individuals and families in the U.S. with limited income and resources. It was created through the Social Security Amendments of 1965–signed into law by President Lyndon B. Johnson–under Title XIX of the Social Security Act. It essentially acts as government insurance for those who are unable to pay for traditional health care costs.

The federal government matches state spending on Medicaid to enable states to provide medical assistance to residents who meet their individual eligibility requirements. While the program is jointly funded by state and federal governments, it is managed at the state level. Thus, every state has an immense amount of autonomy in determining who is eligible for the program. Since 1982, all 50 states have participated in the program–despite not being required to do so.

The Affordable Care Act (ACA) significantly expanded Medicaid eligibility, extending coverage to adults under 65 years of age who have incomes up to 133 percent of the poverty line, as well as making it available for low-income adults without dependent children. However, the Supreme Court’s ruling in National Federation of Independent Business v. Sebelius determined that states did not have to agree to the expansion. Thus, many states have continued to stay at pre-ACA funding and eligibility levels.

As a whole, Medicaid provides a variety of services for some of America’s most vulnerable populations. According to the National Council for Behavioral Health, Medicaid is the single largest payer of mental health services, paying for 25 percent of all mental health care and 20 percent of all addiction care. Four out of 10 children are treated under Medicaid, and a study published in Women’s Health Issues found that almost half of the 4 million births each year in the U.S. are covered by the program. Medicaid also often covers the costs of nursing homes and other long-term care options for elderly patients.

Medicaid Structure Explained

While poverty is a primary requirement for Medicaid eligibility, it alone does not qualify citizens for the program. Other categories, such as pregnancy, age, and disability, may also qualify a citizen for Medicaid eligibility. Interestingly, Medicaid also provided the largest portion of federal money for people with HIV/AIDS until Part D of Medicare was implemented (but more on that later). In most states, adults who receive Supplemental Security Income benefits (a federal income supplement program) are automatically enrolled in Medicaid. While state Medicaid programs are required by federal rules to cover comprehensive dental services for children, coverage for adult dental services is optional and oftentimes limited.

Some states choose to utilize the Health Insurance Premium Payment Program (HIPP). Under HIPP, a person under Medicaid is eligible to have private health insurance paid for by the Medicaid program. Essentially, the state pays the private insurance premiums for beneficiaries. States may also combine administration of Medicaid with other programs, such as the Children’s Health Insurance Programs (CHIP), for ease.

What is Medicare?

Medicare, in contrast, is a single-payer social health insurance program specifically for those aged 65 and older that has been administered by the federal government since 1966. With President Lyndon B. Johnson at the helm, Congress enacted Medicare in 1965 under Title XVIII of the Social Security Act. Medicare provides health insurance to some individuals under the age of 65 with disabilities as determined by the Social Security Administration. For example, any individuals with end stage renal disease or amyotrophic lateral sclerosis (ALS) are eligible for Medicare.

Those who have worked and paid into the system through payroll tax are eligible once they reach age 65, regardless of income or medical history. Currently, there are a number of private insurance companies across the U.S. under contract for administration of Medicare. It is funded primarily through payroll taxes, general revenues, and premiums paid by Medicare beneficiaries.

In 1966, Medicare spurred racial integration, by making desegregation of waiting rooms and hospital floors a condition of receiving Medicare funds. According to David Barton Smith, a professor emeritus in health-care management at Temple University, nearly 2,000 hospitals had integrated by July 1966 in order to remain connected to federal money for the program. Although some hospitals resisted integration, and those who complied found ways to restrict multi-bed rooms, Medicare still played an important role in integrating the nation’s hospitals.

Medicare Structure Explained

Structurally, Medicare is complicated. There are four parts: Part A, hospital and hospice insurance; Part B, medical insurance; Part C, Medicare Advantage plans; and Part D, prescription drug plans. Hospital and hospice insurance covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medical insurance under Part B is optional, and helps insured members pay for services and products that are not covered under Part A–usually outpatient care. Patients who miss their initial enrollment period for Part B incur a lifetime penalty of 10 percent per year on the premium.

Medicare Advantage plans under Part C are Medicare plans sold through private insurance companies. These plans are required to offer coverage that meets or even exceeds standards set by Original Medicare. However, they do not have to be identical in covering every benefit. These are considered “capitated” health insurance plans, which is a payment arrangement that pays a physician or group of physicians a set amount for each enrolled person assigned to them for a particular period of time, whether that person seeks care or not. The difference between Part C plans and Original Medicare is likened to the standard HMO versus non-HMO plan decisions other citizens make.

Finally, Part D covers prescription drug plans. It was created in 2003 under the Medicare Prescription Drug, Improvement, and Modernization Act and went into effect in 2006. Anyone with Part A or Part B is eligible for Part D, though the coverage is not standardized. Plans choose which drugs to cover, though they must cover at least two drugs in 148 categories and cover substantially all drugs in six protected classes (including antidepressants, antipsychotics, anti-convulsants, immuno-suppressants, as well as cancer, AIDS, and HIV drugs).

Medicaid and Medicare under the ACA

Medicaid was expanded extensively under the ACA. Currently, 73 million people are enrolled in Medicaid, and roughly 11 million are covered under the program because of the ACA expansion. States who chose to reject the Medicaid expansion are slowly facing the consequences of that decision. Reports issued by the Urban Institute, Lewin Group, and Rand Corp. have stated that these states are slated to lose billions of dollars–money that their own residents have paid in federal taxes.

The ACA expansion also made a number of changes to Medicare; many provisions were specifically designed to reduce the cost of Medicare. It was designed to help Medicare patients afford their prescription drugs by closing the Part D coverage gap, often referred to as the “donut hole,” by year 2020.

Furthermore, premiums under Part B and Part D were restructured; as a result, the wealthiest people with Medicare had their contributions increased. More oversight, stronger standards, and provider screenings were also enacted to prevent Medicare fraud and abuse.

What’s Next?

According to a recent Pew Research Center survey, 60 percent of Americans feel that the government should be responsible for ensuring everyone has health insurance. This number increased from 51 percent last year and has now reached its highest point in roughly a decade. Those on the other side of the argument–individuals who believe the government has no responsibility to provide health insurance for all–do, however, believe that the government should continue Medicaid and Medicare.

Following the death of Trump’s heath care bill that would have repealed and replaced the ACA, some states are looking to see if participating in the federally-funded Medicaid expansion is a lucrative path to take. As of last count, 19 states have opted out. Some contend that an expansion of Medicare may be a way to improve upon the ACA. Potentially lowering the age of eligibility of Medicare to 50 may also make private individual health more affordable. Moreover, offering Medicare as an option on health insurance exchanges could bring in younger people, reducing Medicare’s overall average costs by not just insuring those who cost the most to insure.

In contrast, there is also the option of implementing a full single-payer healthcare program, considered “Medicare for All”–a system that Senator Bernie Sanders has advocated for immensely. Under a single-payer system, any links between employment and health insurance would cease, as well as expanding the net for people over 65 to all Americans. Thus, the entire spectrum of care for every American citizen would be covered: primary, vision, oral, mental health, and more. Instead of paying a premium to for-profit insurance companies, Americans would merely pay a tax and employers would also pay taxes through payroll. Senator Sanders is poised to reintroduce the single-payer plan in the Senate, on the heels of the failed Republican ACA repeal attempt.

Conclusion

Despite the problems with the current health care system, such as rising premiums and fewer choices for citizens, Medicaid and Medicare have arguably been success stories in their more than 50-year history. Providing insurance and health care to the country’s most at-risk populations–the poor, the disabled, and elderly–is something to be lauded. What lies ahead for the programs, however, is up in the air until a new health care reform bill is passed.

Nicole Zub

Nicole is a third-year law student at the University of Kentucky College of Law. She graduated in 2011 from Northeastern University with Bachelor’s in Environmental Science. When she isn’t imbibing copious amounts of caffeine, you can find her with her nose in a book or experimenting in the kitchen. Contact Nicole at Staff@LawStreetMedia.com.

The post The Evolution of Medicare and Medicaid in America appeared first on Law Street.

On Monday, the government’s official nonpartisan prognosticator, the Congressional Budget Office, weighed in on the newly-crafted House Republican health care bill. The projections, while not exact, paint a fairly stark picture: by 2026, the CBO report says, 52 million Americans would be uninsured, 24 million more than if Obamacare were to remain in place. The report does offer some teeth for more hardline conservatives who called the Republican plan “Obamacare Lite,” in that it would shave billions of dollars off the federal deficit.

The Trump Administration rejected the CBO report–and it sought to undermine it even before it was released–and Democrats highlighted its uninsured figures as proof that the GOP plan does nothing for ordinary Americans.

“We disagree strenuously with the report that was put out,” said Tom Price, the secretary of health and human services. Price added that the report does not account for regulatory steps he will take, or supplemental legislation Republicans will put forth in the coming weeks.

The report explains why the Republican plan, which, among other things, would scrap Obamacare’s mandate that Americans buy insurance or face a penalty, could cause the number of uninsured Americans to skyrocket. “Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties,” the report said, “and some people would forgo insurance in response to higher premiums.”

Premiums under the Republican plan would start off higher than Obamacare–rising by 15 to 20 percent in 2018 and 2019–but would plummet by 2026, when premiums would be 10 percent lower than the current rate. And, despite concerns that the Republican plan would destabilize the insurance market, the CBO estimates that the plan would “lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.”

The immediate effects of the Republican plan could be devastating. Next year, the CBO estimates, the expected number of uninsured people could be 14 million more than under the current law. Medicaid, a target of the Republican plan, also called the American Health Care Act, would take a hit too. The number of Medicaid beneficiaries would drop by 17 percent by 2026, with 14 million less people covered by the program. In a boon to conservatives who lamented the AHCA as “Obamacare 2.0,” the CBO projects the plan would save $337 billion, largely as a result of less entitlement spending.

The CBO, a nonpartisan body whose current director was chosen by Republicans in 2015, is not considered a soothsayer; it is more of a meteorologist: largely accurate but never perfect. For instance, it initially projected Obamacare to insure 26 million Americans in 2017. Last year, the body revised that prediction to 15 million.

Two House committees passed the Republican health bill last week, and by the end of the month, the entire House is expected to vote. Some Republicans, like the members of the House Freedom Caucus, have called for a bill further to right. Others have expressed worry that its cuts to Medicaid are too deep. Some Republicans in the Senate have also hinted they might not support the bill. On Monday, after the report was released, Sen. Susan Collins (R-ME) said the report “should prompt the House to slow down and reconsider certain provisions of the bill.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post What You Need to Know About the CBO Report on the GOP Health Care Bill appeared first on Law Street.

After seven years of nonstop handwringing, GOP lawmakers have finally made some progress in their promise to undo the Affordable Care Act. On Monday, House Republicans unveiled two draft laws that, taken together, provide a sketch for what the future of health care in America will look like. There is still a long way to go: hardline conservatives in the House have already admonished the new GOP health care plan for not changing enough; some GOP Senators have expressed reluctance to pull back Medicaid too much; and, of course, Democrats will be pushing back hard while the Republican-controlled Congress tries to push its new health care vision. Here is what you need to know.

What Won’t Change?

Though Obamacare has been the target of much Republican ire over the past seven years, some of the law’s most popular tenets would remain unchanged under the new law. For one, young adults can remain on their parents’ health plan until the age of 26, so many millennials can breathe a sigh of relief. In addition, in what was one of the ACA’s most lauded achievements, insurers will not be able to turn a customer with preexisting conditions away, or charge them more. Critics say that retaining these Obamacare staples while overhauling other elements is untenable. Remember, the GOP plan revealed on Monday is a rough draft, sure to go through many edits before any laws are actually changed.

What Will Change?

Mainly: tax credits. Income-based tax credits will still be part of the plan, but they will be phased out over time. Instead, tax credits will shift to an age-based model. Under 30? You’re eligible for $2,000 per year. Sixty or older? You could be eligible for as much as $4,000. Families would also receive more. Another change: in lieu of the mandate–Obamacare imposed a tax on the uninsured–insurers can levy a 30 percent increase on premiums if your insurance lapses.

Medicaid would be significantly altered under the Republican plan. Essentially, the federal government would pay a per-person cash allotment to individual states. The amount given would be determined by different categories of a state’s residents: children, elderly, people with disabilities. Mirroring the Republican ethos, the plan takes a bottom-up approach (states have more flexibility) rather than a top-down one (the federal government calls the shots). In addition, Planned Parenthood could stop receiving federal funding for one year.

The changes to Medicaid could be a step too far for some Republicans. In a letter to Senate Majority Leader Mitch McConnell (R-KY), four GOP Senators expressed their concerns. “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” Senators Rob Portman (OH), Shelley Moore Capito (WV), Cory Gardner (CO), and Lisa Murkowski (AK) wrote.

What Happens Next?

More handwringing and, most likely, Republican infighting. In the coming days, two House committees, Ways and Means and Energy and Commerce, will review the plan. House Speaker Paul Ryan (R-WI) has said he hopes to get the full House to vote on the bill by the April 7 recess. The legislation faces a rocky road ahead. A number of House caucuses, including the Tea Party stalwart the Freedom Caucus, have branded the new health plan as “Obamacare Lite” and “Obamacare 2.0.” Whether hardline conservatives will squeeze more of their priorities into the final bill remains to be seen.

And of course, it is highly likely that no Democrats, in the House or the Senate, will support the plan. Rep. Nancy Pelosi, the Democratic leader in the House, had this to say about the newly revealed Republican plan: “Republicans will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

But President Donald Trump, who promised to revamp Obamacare during his first days in office, is confident the plan will pass:

Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!

— Donald J. Trump (@realDonaldTrump) March 7, 2017

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post What You Need to Know About the New GOP Health Care Plan appeared first on Law Street.

On February 17, Maine’s Department of Health and Human Services (DHHS) asked the federal government to approve a statewide ban on the use of food stamps to purchase sugary drinks and candy. In its press release, DHHS representatives argued that banning such purchases would benefit public health and ease the burden on taxpayers. While many welcomed the move, it embodies the way in which conditional government welfare programs patronize and stigmatize low-income people.

The Supplemental Nutrition Assistance Program (SNAP), also known as the Food Stamp program, is a state-administered and federally-funded program designed to help low-income families. Maine’s move to ban candy and soda aside, SNAP is already an example of conditional welfare in that benefits can only be used to buy foodstuffs from approved vendors. Rather than providing unconditional benefits for low-income families to spend at their discretion, conditional welfare programs like SNAP undermine the autonomy of low-income people by imposing parameters on how they are allowed to use their benefits. Governments rationalize the conditions imposed on welfare recipients, but these rationalizations are often unjustified. Ultimately, conditional welfare is motivated by a cultural and institutional mistrust of low-income people.

The press release from Maine’s DHHS justified the prospective ban on the grounds that soda and candy lack nutritional value and that eliminating the option to buy soda would reduce obesity amongst SNAP recipients. However, the assumption that simply improving nutritional content of the food one eats will improve one’s weight is not that well supported by evidence. While poor nutrition can affect certain health outcomes, the American Medical Association and the National Institute of Diabetes and Digestive and Kidney Diseases agree that caloric content, not nutritional content, of food overwhelmingly determines one’s weight.

In 2010, a professor of human nutrition at the University of Kansas made headlines when he lost 27 pounds in two months by cutting his calorie intake and restricting his diet to Twinkies, Doritos, and Oreos. Of course, being thin is not equivalent to being healthy and there are many positive health outcomes associated with improving nutritional intake. Nonetheless, simply banning the purchase of some items will do little to reduce obesity, nor ensure those on food stamps will diversify their nutritional intake.

Misguided Calculations

After drawing a tenuous prediction that the prohibition of sugary foods will cause a reduction in obesity rates, the press release notes “Over $700 million is spent in Maine on obesity related medical expenditures and more than a third of that paid for by taxpayers in the Medicare and Medicaid programs.” This, of course, implies that low-income individuals are disproportionately responsible for Maine’s obesity problem and that they disproportionately contribute to the healthcare costs associated with obesity.

However, according to data from the Kaiser Family Foundation (KFF), the average low-income Mainer generates an effectively equal amount of “obesity related medical expenditure” as the average Mainer who is not reliant on Medicare or Medicaid. Over 269,000 of 1.33 million Mainers rely on Medicaid and over 306,400 on Medicare. When factoring in the 104,000 dual eligibilities, KFF’s data shows that nearly 35 percent of Maine’s population relies on these health aid programs.

Therefore, just under two-thirds of the Maine population that is not low-income makes up about two-thirds of Maine’s “obesity related medical expenditure.” The assertion made in this press release is likely grounded in the misguided and simplistic belief that poorer Americans are more likely to be obese. In reality, obesity is a relatively constant cause for concern across all income brackets.

Unconditional Help

Obesity is no doubt an issue in Maine and throughout the country. While the state’s move to eliminate sugary products from its food stamp program may have been well intentioned, it is but one example of how conditional welfare disproportionately blames low-income people for public problems that are largely unrelated to economic status. Such misguided rationalizations are often used to justify patronizing conditional welfare programs.

While limiting the autonomy of beneficiaries is seen as a way of ensuring government funds are spent properly, doing so not only unjustly stigmatizes welfare recipients, it often undermines the efficacy of each dollar spent on welfare. Conditional welfare assumes that because one is in need of welfare, they are unfit to have discretion over how they spend money.

Research has shown that unconditional cash transfer and welfare programs are far more effective means of improving recipients’ conditions. In 2003, Brazil introduced a program known as Bolsa Familia under which poor families were eligible to receive direct cash transfers. While Bolsa Familia did impose some conditions on families (requiring children of recipient families be vaccinated and attend school), each family was free to spend their cash transfer as they saw fit. The program was considered a huge success, helping to reduce poverty and inequality nationwide.

Maine’s effort to ban the purchase of candy and soft drink with food stamps awaits approval from the United States Department of Agriculture (USDA), which is the federal agency in charge of overseeing SNAP.

Callum Cleary

Callum is an editorial intern at Law Street. He is from Portland OR by way of the United Kingdom. He is a senior at American University double majoring in International Studies and Philosophy with a focus on social justice in Latin America. Contact Callum at Staff@LawStreetMedia.com.

The post No Food Stamps for Sweets: Unjust Welfare Conditionality appeared first on Law Street.

The Texas Health and Human Services Commission issued a final notice on Tuesday to Planned Parenthood that the health services provider will be barred from receiving Medicaid funds. Planned Parenthood said 11,000 women who seek treatment in 34 clinics across the state will be affected. The ruling is set to go into effect 30 days from when it was issued, unless a federal court denies the state’s move.

The group, which receives about $4 million each year in Medicaid funding, signaled that it will pursue an injunction in federal court. President of the Planned Parenthood Federation and Planned Parenthood Action Fund Cecile Richards, called the decision a “cautionary tale for the rest of the nation,” and warned that if similar moves are made in other parts of the country, “it will be nothing less than a national health care disaster.”

Federal courts have stepped in to dismiss similar state-level rulings over the past year. Judges stopped attempts to defund clinics in Mississippi, Arkansas, Louisiana, and Kansas. And earlier this year, the U.S. Supreme Court saved a number of abortion clinics in Texas from shutting down. But this has been a drawn-out battle between Texas and Planned Parenthood, and it’s unclear how courts will rule in this case.

In July 2015, an anti-abortion group released covertly filmed and heavily-edited videos that claimed to show Planned Parenthood officials agreeing to sell fetus parts for profit. The group has vehemently waved off the videos as heavily doctored and highly inaccurate. Tuesday’s notice cited the videos as “the basis for [Planned Parenthood’s] termination” from Medicaid. It also said the group fails to provide care “in a professionally competent, safe, legal and ethical manner.”

“Texans expect that when taxpayer dollars are granted to health care providers, it is only to those who demonstrate that the health and safety of their patients come before a profit motive that puts women at greater risk,” said a statement from the office of Texas Governor Greg Abbott, a Republican.

Planned Parenthood sued Texas in November 2015, when the state first signaled it would be cutting its access to federal money, a move that was also in response to the controversial videos released a few months prior. That case is still pending. A wider effort to defund Planned Parenthood could come early next year, when President-elect Donald Trump takes office. While he has expressed support for some of the services the group provides, Trump’s appointment for health secretary is Tom Price, a vocal opponent of Planned Parenthood.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post Texas is Ending Medicaid Funding for Planned Parenthood appeared first on Law Street.

For the first time in nearly two decades, the state of Alabama might implement a lottery system in order to pay for basic services that it currently cannot afford.

In a video released yesterday, Alabama Gov. Robert Bentley announced, “the state of Alabama has not and cannot at this time pay for the most basic services that we must provide to our people.”

He continued, “the time has come for us to find a permanent solution. This solution will provide funding that we can count on year after year without ever having to raise your taxes or put one more Band-Aid on our state’s money problems.”

BREAKING:We need your help solving our funding crisis.I’m giving you the opportunity to vote on a Statewide Lottery. https://t.co/BLzE3bOXLP

— Gov. Robert Bentley (@GovernorBentley) July 27, 2016

The lottery could bring in $225 million annually, a steady revenue that would help alleviate the state’s reliance on borrowing money and using one-time money to fill the gap in Alabama’s dismal finances. Bentley said the revenue would be applied to General Fund programs like services for law enforcement, the mentally ill, children, and “those in the most need.”

State lawmakers have tried cutting “wasteful” spending, shifting the management of Medicaid to the private sector, and borrowing money, and a proposed, but rejected, tax plan–but those efforts have still not been enough to fix the financial problem.

Bentley said he wants the voters to decide whether or not a lottery should be implemented to fix Alabama’s financial situation, which means the issue would appear on the Nov. 8 ballot. However, in order for that to happen, the Legislature would have to approve the amendment by Aug. 24 with a three-fifths vote in both the House and Senate.

With less than a month until the date the amendment would have to be approved by, it doesn’t seem like the Alabama governor has made any plans to get the ball rolling. Though he just made the video announcement Wednesday, he has not provided any other details on a special session which would have to be called in order to create the amendment.

State representatives and senators from Alabama took to the proposal differently. Rep. John Knight (D-Montgomery) chairman of the Alabama House Black Caucus, said he was disturbed that Bentley had not talked about the lottery proposal with him or anyone in the Caucus.

“It seems like everything that is being done now is being done behind closed doors,” Knight said.

Acting House Speaker Victor Gaston (R-Mobile) shared those sentiments, saying in a statement, “the governor has not outlined his plan to legislators in any detail, nor, to my knowledge, has he even set a concrete start date for the special session, so it is difficult to comment with so little information at hand.” He continued, “I hope that the governor reaches out to lawmakers over the next several weeks in order to seek their input on any lottery proposal that comes forward and to do the prep work that is necessary for any special session to be successful.”

Others, like Rep. Craig Ford, (D-Gadsden), leader of the Democratic minority in the Alabama House of Representatives, do not believe Bentley’s plan will work.

“A lottery will do nothing for this year’s Medicaid shortfall, and at best will be nothing more than a band aid for the General Fund that will leave us right back where we are now in just a few years,” he said in a statement. “The lottery is a one-shot deal, and a lottery for the General Fund will become, as it has in other states, a victim to legislative shell games; it will become nothing more than a slush fund for legislators.”

.@RepCraigFord says his proposed lottery must fund scholarships, and will not save the state’s budgets: https://t.co/yxGV9vUygK #alpolitics

— AL Reporter (@ALReporter) July 27, 2016

Sen. Quinton Ross (D-Montgomery), minority leader in the Alabama Senate, agrees with Bentley’s lottery proposal.

“These gaming dollars can provide stability and long-term economic streams for many of our General Fund and Education Trust Fund needs.”

Until Bentley schedules a special session, it’s unclear whether or not the lottery will come to the Crimson Tide state.

Inez Nicholson

Inez is an editorial intern at Law Street from Raleigh, NC. She will be a junior at North Carolina State University and is studying political science and communication media. When she’s not in the newsroom, you can find her in the weight room. Contact Inez at INicholson@LawStreetMedia.com.

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With today’s constant access to news and commentary on law, policy, and legislation, voters expect candidates to be “policy wonks.” Bernie Sanders was commended during his presidential bid for his strong socio-economic policy reform proposals. Speaker Paul Ryan is lauded for squeezing out a laborious policy plan while a loud presidential election overshadows congressional action. Yet somehow Donald Trump, the presumptive Republican nominee for president, is running a nearly policy-free campaign.

Now, let’s give this a fair appraisal; Donald Trump has seven published platform points. This pales in comparison to Hillary Clinton’s 32 published platform points. Trump has even published less than libertarian candidate Gary Johnson’s 13 points.

While this might be excusable if his policy proposals were comprehensive and diligently crafted, they are not. Point for point, Donald Trump offers contradictory opinions, fosters disdain for Obama-era policies without offering alternatives, and proposes costly measures without revenue-building measures to offset them. Here are two of the most jarringly unrefined “policies”:

Immigration Reform/The Wall

While Donald Trump claims that his infamous wall along the Mexican-U.S. border will cost $8 billion, construction economists estimate that it will cost at least $25 billion, not including maintenance and surveillance.

Though this won’t be a superfluous expense because Trump promises that Mexico will pay for it. Trump proposes banning undocumented immigrants from being able to wire money to Mexico (an estimated $24 billion per year.) He will then tell Mexico that in order to resume wire payments, that it has to pay for the wall.

However there are two jarring flaws in this plan. Firstly, individuals wiring money to Mexico are not funding the government, but rather family still living in Mexico. Secondly, Mexico–a deeply fragile state currently–would not prioritize $24 billion in diffused money to families over a $25+ billion state-funded project.

Though this isn’t Trump’s only strikingly expensive proposal without a funding plan. Trump also proposes we triple the number of Immigration and Customs Enforcement agents, each with an annual salary of $30,000-$50,000.

Many of Trump’s immigration reform tactics are rooted in isolationist sentiments and labor practices, disguised as job creation. He proposes a temporary bar on granting green cards to force employers to hire authorized citizens, expresses persistent anti-trade sentiments, and falsely cites illegal immigrants as a large source of unemployment for authorized citizens.

To be clear, according to Pew Research unauthorized immigrants only comprise about 5.1 percent of the workforce and work predominantly in occupations like farming, maintenance, and construction. Even if these were widely desirable and growing occupations in the U.S.–which they are not–authorized citizens reclaiming these jobs would not significantly revitalize the middle class as Trump claims it could.

Healthcare Reform

Donald Trump’s ideas on healthcare are some of his most un-established and contradictory. The system which Trump describes is most similar to a single-payer healthcare system. Trump ensures that everybody will have insurance and that the government will pay for it. However he also promises a large, competitive private market.

Above all else, he promises the repeal of Obamacare. However, consider that the Affordable Care Act, a comprehensive multi-thousand page bill, extends healthcare coverage to more than 12 million people. Trump’s healthcare platform contrarily offers little more than supporting the sale 0f health insurance across state lines, support for health savings accounts, and a move to block-granting Medicaid to states.

He also suggests that those who cannot afford private health insurance plans should enroll in Medicaid. However, presently a family of four must make an average of $20-$35k to qualify. Further, in many states income alone doesn’t qualify a family.

Trump would have to support Medicaid expansion to bridge the gap between the current low income Medicaid threshold and the income level families who would strain to afford private insurance. This is contrary to his proposition to block-grant the program to states.

Trump acts as though by scapegoating immigrants and Obama-era policy, he can ignore how glaringly debt-inducing his proposals are. Holding executive power inevitably means holding vision for your party and country. It means planning to renovate, innovate, spend, and save all in future-minded consciousness. Ending each of your thoughts with “Make America Great Again” doesn’t invoke greatness from your policies, vision, or lack thereof.

Ashlee Smith

Ashlee Smith is a Law Street Intern from San Antonio, TX. She is a sophomore at American University, pursuing a Bachelor of Arts in Political Science and Journalism. Her passions include social policy, coffee, and watching West Wing. Contact Ashlee at ASmith@LawStreetMedia.com.

The post Sorry Trump, but “Make America Great Again” Isn’t a Platform appeared first on Law Street.

The U.S. Department of Justice announced Wednesday it is charging hundreds of individuals across the country with committing health care fraud worth hundreds of millions of dollars, in what is being hailed the largest health care fraud bust in U.S. history. Here are the five fast facts you need to know.

1. 301 People Charged in Health Care Fraud Bust

The bust resulted in the takedown of 301 individuals, including 61 licensed medical professionals, 28 of whom were doctors. The charges include various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, aggravated identity theft, and Medicare Part D pharmacy fraud.

Attorney General Lynch called out the alleged perpetrators in the release saying,

They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.

2. $900 Million in False Billings

The DOJ found the defendants to be responsible for a total of $900 million in false billings. The largest portion of fraudulent billings was traced to Florida, where a total of 100 defendants were charged for their involvement in approximately $220 million in false billings for home health care, mental health services and pharmacy fraud. According to the release,

In one case, nine defendants have been charged with operating six different Miami-area home health companies for the purpose of submitting false and fraudulent claims to Medicare, including for services that were not medically necessary and that were based on bribes and kickbacks.  In total, Medicare paid the six companies over $24 million as a result of the scheme.

Defendants in California, Texas, and Michigan are charged with committing more than $100 million worth of fraud in each state.

3. This Was a Joint Effort

Medicaid Fraud Control Units in 23 states and the Medicare Fraud Strike Force in 36 federal districts coordinated with the Justice Department and the Department of Health and Human Services in  the “unprecedented nationwide sweep.”

National Health Care Fraud Takedown Results https://t.co/LQk9OJpzKN pic.twitter.com/HMVFxvFrgd

— Justice Department (@TheJusticeDept) June 22, 2016

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the DOJ and HHS to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs.

4. New Study Identifies 27 Home Health Care Fraud “Hotspots”

The U.S. Health & Human Services Office of Inspector General released a new study in conjunction with the DOJ’s arrests citing 27 geographical “hotspots” in 12 states where health care fraud is committed most often.

Eye on Oversight: OIG identified 27 hotspots for probable home health fraud. Watch the VIDEO. https://t.co/1KPY9RQe6D

— OIG at HHS (@OIGatHHS) June 21, 2016

The states include Arizona, California, Florida, Illinois, Louisiana, Michigan, Nevada, New York, Oklahoma, Pennsylvania, Texas, and Utah.

5. This Recent Bust Helped Pad Federal Authorities’ Record

Since its launch in March 2007, the Medicare Fraud Strike Force has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion. Wednesday’s announcement marks the second time that districts outside of Strike Force locations participated in a national health care fraud bust, and they accounted for 82 defendants charged in this takedown.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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A study published yesterday by the Center for Immigration Studies, or CIS, claims immigrant households collect $1,803 more in welfare benefits than native households–families headed by a U.S. born person–based on data collected in 2012.

Based on a sample size of 22,077 native households and 2,980 immigrant households, the study found that a large portion of the discrepancy in welfare benefits stems from Medicaid dollars, though immigrant households benefited from welfare by slim margins in nearly every other category–cash ($686 to $517) and food ($1,083 to $689). Native households received one dollar more in housing benefits, ($395 to $394.)

Conducted by the conservative, independent public policy analyst Jason Richwine, the study explains the findings as being attributable to the average education level of immigrant families, which is lower than those born in the U.S.

“It is easy to understand why people with fewer skills are more likely to participate in welfare programs, since eligibility for those programs requires a low income,” writes Richwine, whose 2013 study with the Heritage Foundation on IQ differences between immigrants and natives caused quite a stir.

Richwine concluded the study by saying, “the American welfare system has become increasingly focused on buttressing low-wage workers rather than supporting non-workers. Put more simply, welfare and low-wage work go together.”

While this study seems to provide evidence for those who want the U.S. to scale back immigration, claiming that immigration hurts the economy, a separate study by the American Immigration Council highlights the positive effects immigration has on the economy.

Among the findings:

• Based on 2013 figures, immigration increases GDP (by $31.4 billion) and tax revenue (“The average immigrant contributes nearly $120,000 more in taxes than he or she consumes in public benefits”).
• Immigrants are nearly twice as likely to start a business than natives–at a rate of 0.52 immigrant entrepreneurs and 0.27 for natives.
• Between 1996 and 2011, immigrants contributed $62 more per person than natives to Medicare.

As Congress and the next president will surely take a close look at U.S. immigration policy, possibly overhauling it completely or banning those of a certain faith, these studies will surely be used as fodder for both sides in the conversations to come.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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Long-term healthcare institutions for the elderly are now more common than ever in America. There are thousands of nursing homes and residential-care facilities dispersed across the country. As a society, we rely on and trust these establishments to medically treat and handle with care our aging loved ones. Even though these places are instrumental to our healthcare system, nursing home regulations haven’t been widely updated in more than 30 years. That is until this month. The Obama Administration has set out to reform the rules required of nursing homes to qualify for Medicare and Medicaid. As they stand today, the rules aren’t up to speed with the innovative scientific advances and administration of health care. There are also alarming reports of abuse and neglect inside the system. But with promising new laws on the horizon, nursing home healthcare may be getting a makeover.

History of Nursing Homes in the United States

The normalization of nursing homes is a relatively recent development. Demographic and political shifts have created a standard use of these facilities. For many years, elderly citizens turned to almshouses, charitable housing for the sick, impoverished, inebriated, mentally ill, and homeless. The elderly lived in almshouses for a variety of reasons including poverty, disability, sickness, and/or separation from families. The Industrial Revolution started to bring more people into the cities and spread families apart. Many singles no longer had extended families to rely on for support.

At the turn of the nineteenth century, women’s and religious groups started to create specific housing for the elderly. Boston’s Home for Aged Women was created in 1850. Institutions like this generally required substantial entrance fees and certificates of good character. They were a marked upgrade and alternative to the almshouses. Many of these women were widowed or single, and had lived their lived as upstanding citizens. These requirements limited shelter to a small population; the impoverished still mostly resided in almshouses.

As time continued, almshouses started to exclusively aid the elderly. Younger people were removed and sent to specific-needs organizations like orphanages, hospitals, or insane asylums. In 1880, 33 percent of almshouse residents were elderly. By 1923, that number soared to 67 percent.

The almshouses were not places of luxury, but rather were found in extremely poor conditions. In 1992, Abraham Epstein, advocating for pensions, wrote that the almshouse “stands as a threatening symbol of the deepest humiliation and degradation before all wage-earners after the prime of life.” The enactment of the 1935 Social Security Act was in large a movement to remove almshouses altogether; however, elderly residents weren’t solely there due to poverty. Others required daily nursing and medical attention. The money received through pensions was often used to gain access to independent facilities that could provide medical care; however, conditions were not necessarily improved.

In 1955, the Medical Facilities Survey and Construction Act allowed federal support to those in public facilities. Both private and public nursing home residents received federal support. In 1965, Medicare and Medicaid was established, furthering the growth of nursing home facilities. Between 1960 and 1976, nursing homes grew by 140 percent, with 79 percent still private institutions. Through investigations conducted through the 1970s, it was concluded that the conditions were still subpar and not far enough removed from the stigma of historic almshouses.

The 1970s saw the first real regulations for nursing homes. The Office of Nursing Homes Affairs was established in 1971 and authorized to administer nursing home standards. Social Security reforms in 1972 “established a single set of requirements for facilities supported by Medicare and for skilled-nursing homes that received Medicaid.” A plethora of amendments to older acts were enacted as well.

By 2000, nursing home care became a $100 billion industry. Although the standard of care has dramatically increased since the days of the almshouse, it is time for a new round of regulations. The video below, created by the Common Wealth Fund, joins in the effort to improve nursing home quality care.

Nursing Home Care Today

Statistics

There are five, main long-term healthcare services: home health agencies, nursing homes, hospices, residential care communities, and adult day service centers. Approximately 8,357,100 people receive support from these services annually. Nursing homes alone account for 1,383, 700  people in the group, and 63 percent of those are age 65 and older. In 2000, 15 million people required long-term care. Due to Baby Boomers, that number is projected to rise to 27 million in 2050.

For those that reach the age of 65, 69 percent will acquire a disability before they die. And 35 percent will enter a nursing home at some point. One in every eight people over the age of 85 resides in an institution.

Financial Stats

A 2013 report estimates that between $210 and $306 billion is spent on long-term care per year. Most pay a majority out of pocket for assisted living, while Medicaid pays a majority for long-term nursing care and Medicaid pays for a majority of hospice care and short-term skilled nursing facilities. Almost one-fifth of the elderly community will pay more than $25,000 in out-of-pocket costs before they die. And in 2012, 14.8 percent of those over 65 were reported below the poverty line. This is even more significant as the private-pay prices for a private or semiprivate room in a nursing home grew by four percent in 2002. It grew another 4.5 percent in 2012. Lastly, Medicaid spent $83.8 billion on long-term care services in 2003, amounting to approximately one third of all Medicaid expenditures.

Proposed Regulation

There are a host of reasons why the Obama Administration has decided to tackle nursing home care regulations. First and foremost, current regulations don’t consider the advances in science and health care for the elderly. As previously stated, long-term care regulations haven’t been updated in nearly 30 years–consolidated Medicare and Medicaid requirements for long-term care facilities were set in 1989, and haven’t been updated since 1991. Science has seen invaluable progress since then. New proposals are also significant in light of reports over the last decade finding varying degrees of neglect and abuse among nursing care facilities. At the core of it all, current regulations aren’t up to par.

Highlights

The proposal bans facilities from hiring any personnel with a record of abuse and/or neglect, and develops policies that target abuse and/or neglect. Nurses would be trained in preventing elder abuse. Although there isn’t an assigned patient-to-nurse ratio, facilities will have to report staffing levels to Medicare officials for review. Low staffing is a common reason stated by those in the field why patients with dementia are given inappropriate and potentially dangerous antipsychotic drugs. The regulations would also limit the amount of antibiotic and antipsychotic drugs administered, toughen infection control, and reduce hospital readmissions.

It also suggests a baseline care program: a comprehensive plan for each resident created within 48 hours of a patient’s arrival. In addition, a nurse aide, a member of the food and nutrition services staff, and a social worker would be added to those involved in the development of the care plan. The proposal also covers “electronic health records and measures to better ensure that patients or their families are involved in care planning and in the discharge process.”

There are a number of revisions directed toward the personal happiness of the residents. The proposal includes open visitation (similar to hospital regulations) and the ability for residents to choose roommates as these facilities often double as homes. It also mandates the availability of “suitable and nourishing alternative meals and snacks” for residents who would like to eat outside the scheduled meal times. These types of policies create a more comfortable and home-like atmosphere.

A major concern in the long-term care community is enforcement. Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, states that “the biggest problem is that the rules we have now are not enforced. We have a very weak and timid enforcement system that does everything it can to cajole facilities into compliance instead of imposing penalties for noncompliance.” The proposed rules should allow violations to be more easily detected.

Conclusion

As the proposal states, “many of the revisions are aimed at aligning requirements with current clinical practice standards to improve resident safety along with the quality and effectiveness of care and services delivered to residents.” This is a way to ensure that every facility across the nation is legally required to provide equal quality of care to every patient. It is alarming that a comprehensive update to modernize the nursing home care system hasn’t been done in so many years. Residents want to feel safe and happy in their environment, and their families want to feel that their aging elders are healthy and receiving the best care possible.

Resources

Primary

Federal Register: Medicare and Medicaid Programs

Additional

CDC: Long-Term Care Services in the United States

Family Caregiver Alliance: Selected Long-Term Care Statistics

Kaiser Health News: New Regulations Would Require Modernizing Nursing Home Care

Net Industries: Nursing Homes

U.S. Legal: The History of Nursing Homes

White House: Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

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If you are going to a pharmacy for a particular drug, you’re often offered a choice — do you want the name brand or the cheaper generic? Generics have long been lauded for their ability to provide the same benefits to patients while also offering a less hefty price tag; however, recently generics have been getting more expensive, and people are wondering why. Congress announced this week that it’s going to launch an investigation into why the price of generic drugs is rising.

When a drug company develops a particular drug, it gets to hold the patent for approximately twenty years (some nations or jurisdictions give protections for a bit longer). During that period, that company is the only one that can produce that particular drug. After the patent expires, however, other companies can make a “generic” version of the drug.

There are certain regulations created by the Food and Drug Administration (FDA) to make sure that the generic drugs are able to be distributed. The FDA requires that a generic drug has the same active ingredients as the one that it is imitating, but not necessarily the same inactive ingredients (such as coloring). A generic has to perform the same function as the name brand, and it must of course meet the same health and safety standards.

Generic drugs tend to be less expensive than the name brands — and given the high cost of American health care, offer great and affordable options for consumers. However, it seems like the cost of these drugs is increasing. For example, the patent for Ambien, a popular sleep aid, recently expired. Now it’s a lot easier to get a generic version of Ambien for a cheaper price, and more people are able to get the product they need.

A study completed in August discovered that some generic prices have been dropping, while others have been rising almost exponentially. According to the Wall Street Journal:

The prices paid by pharmacies more than doubled for one out of 11 generics. And in a few cases – notably, the tetracycline antibiotic and the captopril blood pressure pill – the cost increases not only exceeded 1,000%, but topped 17,000%…. Yes, 17,000%.

Doctors have reported how troubling this kind of price increase can be in certain generic drugs for the patients who rely on them. Some patients who are on fixed incomes, such as those on Medicaid, may not be able to pay for the non-covered costs of the drugs if prices skyrocket that much. They may try to skip their prescriptions in an attempt to make ends meet. Not only is this obviously problematic for the patients themselves, but it also leads to more emergency room visits and a less healthy society in general.

That brings us to the investigation that Congress is evidently undertaking to try to figure out why exactly these generic prices are climbing so sharply and how to reverse the trend. The analysis is being pushed by Senator Bernie Sanders of Vermont and Representative Elijah Cummings of Maryland. We can all say a lot about the inadequacies of Congress, but this is a good move on its part. It’s really important that we get the prices of generics under control, because price increases like this are almost always passed directly to the consumer. With as many healthcare problems as we have, this is an issue that needs to be nipped in the bud as soon as possible.

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Anneliese Mahoney (@AMahoney8672) is Lead Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

Featured image courtesy of [Chris Potter/Stockmonkeys.com via Flickr]

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Congress to Investigate Rising Generic Drug Costs appeared first on Law Street.