1. SPOTLIGHT ON HEALTH REFORM
Noëlle Porter CONGRESSIONAL RELATIONS SPECIALIST

2. Discussion Block Grants and Per-capita Caps Expansion and Eligibility
Enrollment and Continuity of Benefits
Essential Health Benefits
Barriers to Coverage
Extras and Distractions

3. Block Grants and Per-capita Caps
ARE JUST CUTS TO MEDICAID
Yes – spending still rises over time, but at a MUCH lower rate it would under the ACA reducing in huge losses for the program.

4. Block Grants and Per-capita Caps: Under Proposed Legislation
The Senate Bill, BCRA, cuts almost $800 billion from the Medicaid program over the next 10 years.
These cuts will:
limit populations served, benefits offered (lifetime caps, reimbursements, services, etc.), quality of care, innovation
prevent new enrollees from receiving Medicaid
Most likely raise state taxes to make up for loss of federal funding

5. Block Grants and Per-capita Caps: Under Proposed Legislation
The number in the paper – 22 million lose coverage
The number that matters to ending homelessness:
The CBO estimates that 15 million people will lose Medicaid coverage as a result of these cuts
This is over 10 years – the CBO found too many variables to estimate how many people would lose coverage beyond 2026, although the law would more steeply cap federal spending for the program in the 2nd decade.

6. Expansion and Eligibility
31 states and DC have expanded Medicaid under the ACA
Prior to expansion, Medicaid was available to low-income children, pregnant women, elderly and disabled individuals, and some parents.
The ACA made Medicaid available to anyone who made less than 138% of the FPL.
A few states including Kansas, NC, and VA have made strides toward advancement, but different things have blocked the efforts.
138% = about $16,000/yr

7. Expansion and Eligibility: Under Proposed Legislation
BCRA allows states to maintain expansion eligibility definitions, but federal payments will be significantly reduced by 2020 at the end of a “phase out”
Under the ACA, the federal government pays an open-ended amount to cover all costs for eligible individuals

8. Enrollment and Continuity of Benefits
The ACA also simplified enrollment processes and stepped up outreach efforts (for all states)
The “no wrong door” enrollment system includes paperless applications, electronic verifications, and real-time determinations of eligibility
Outreach and enrollment efforts were increased to encourage people to apply
The regulation of these processes is in jeopardy under the new administration, but there does not appear to be any legislative threat to these changes.

9. Eligibility and Continuity: Under Proposed Legislation
BCRA encourages states to conduct frequent “eligibility redeterminations”
Repeals retroactive eligibility – a signature piece of Medicaid’s 1965 introduction
Repeals presumptive eligibility for expansion populations
This is optional for states, but completing these redeterminations is an almost impossible task for people in unstable situations – checking back in, in-person appts, or constant submission of forms to simply maintain coverage
Patients who present with illness or injury that meet eligibility requirements can retroactively gain Medicaid coverage to pay for their bills – this is NOT an ACA adaptation, but BCRA will repeal it – this could lead to increases in medical bankruptcy and resultant homelessness
Allows “qualified entities,” such as federally qualified health centers, hospitals, and schools, to screen eligibility based on gross income and temporarily enroll eligible children, pregnant women, or both in Medicaid

10. Essential Health Benefits
ALL plans on the health insurance market must include these 10 benefits in order to:
Be affordable
Maximize the number of people with insurance coverage
Protect the most vulnerable
Encourage better care practices
Advance stewardship of resources
Address the medical concerns of greatest importance
Protect against the greatest financial risks
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease
Pediatric services, including oral and vision care

11. Essential Health Benefits: Under Proposed Legislation
Under BCRA, EHBs are eliminated for the expansion population by 2020
This results in a lack of preventative medical care, substance abuse coverage, maternal care, etc.
Lack of preventative medical care leading to:
Mental health crisis
Unnecessary emergency department visits
Lack of substance abuse coverage
Medicaid is covering the opioid crisis across the country
Rise in medical bankruptcy due to increased out of pocket costs
Resultant homelessness from financial crisis
Untreated mental illness or substance use disorders can lead to instability and homelessness (as can untreated physical illness or ballooning costs to treat physical illness).

12. Barriers to Coverage
Examples of these barriers include work requirements, cost-sharing provisions, continuous coverage requirements, or drug testing
Evidence has shown that work requirements impose unnecessary and ineffective barriers to safety nets, but this effect is magnified in a health care application
People in poverty often cannot afford even a $1 premium or regularly submit this payment to maintain coverage
Drug testing as a barrier to substance use treatment has obvious limitations
-Cost sharing/$1 premiums can come with minimum periods of ineligibility if people don’t pay – resulting in months without coverage

13. Barriers to Coverage: Under Proposed Legislation
BCRA will allow states to impose work requirements
Requires people with little to no income to pay for 2% of the cost of their premiums
People who do not continuously maintain coverage will be locked out of coverage for 6 months
Continuous coverage requirements disproportionately impact people in poverty to face more barriers to maintaining their coverage in the first place.

14. Extras and Distractions
$45 billion for opioids
The Cruz amendment (and 2017’s big buzzword: pre-existing conditions)
Defunding Planned Parenthood for 1 year
Congressional exemption
This PALES in comparison to the $800 billion cut from Medicaid – the nation’s number one payer for addressing the opioid crisis
The Cruz Amendment – one plan must be ACA-compliant, all the others can be “junk plans” – this will drive up the cost for the one plan, effectively pricing sick people out of coverage and eliminating protections for people with pre-existing conditions – The CBO does not even consider these plans to be insurance
Side note: Senate may vote without a CBO score – this is terrifying, and should heighten the importance of advocacy
“What Medicaid does do is allow Planned Parenthood to provide contraception, cancer screenings and STI tests to 1.5 million patients in the public safety net at some 650 health centers for no cost. About two-fifths of the organization’s $1.3bn annual budget derives from public funding. Without the reimbursements Medicaid provides, a spokeswoman for the Planned Parenthood said, an unknown number of those centers will have to close.”
Just a note to tell you what Congress really thinks of these revisions – they’ve made themselves exempt.