Thank U, Next: The 116th Congress Gets to Work

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The 116th Congress was sworn in at noon on Wednesday, January 3, 2019. The Senate remains under Republican control but the House of Representatives is now firmly in the grasp of the Democratic Party. How the business of legislating flows between the two houses remains to be seen, but it is fair to assume that health policy will be a focus for the new Congress. A Kaiser Family Foundation poll taken before the 2018 midterm election reported that seven in ten voters (71%) indicated healthcare as “very important” in making their voting decision. In comparison, 64% said the same about the economy and jobs, 55% about immigration, and 53% about tax cuts and tax reform.

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The ACA Goes to Court Again (and again, and again…)

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I’ve been enjoying a few days at my parents house after an exam and it’s given me a chance to catch up on the nitty gritty health policy news of the past few months. And hoo boy, is there a lot going on. Congress might be in recess until after the election, but that doesn’t mean things are slowing down in the health policy arena!

Today we’re taking a look at two lawsuits that could have an immense impact on the future of the ACA. The Texas v. Azar lawsuit, which was filed in February 2018 by Texas and 19 other states, builds on the repeal of the individual mandate tax penalty by the Tax Cuts and Jobs Act of 2017. The lawsuit argues that because this tax penalty was reduced to $0 in 2019 by the 2017 tax legislation, the individual mandate will become unconstitutional. Since the ACA is dependent on the mandate, the lawsuit calls for the ACA to be invalidated by the court. After the U.S. Justice Department declined to defend the ACA in this lawsuit, Democratic state attorneys general from 16 states and D.C. were allowed to intervene on behalf of the law.

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Thousands Lose Medicaid as Arkansas Implements First 1115 Work Requirement Waiver

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Source: access.arkansas.gov via Bloomberg News

It’s 7am and I’m sitting in bed with too many beverages (coffee, water, smoothie–gotta get those leafy greens in) and too many tabs open (embryology review, TeamRads, Twitter, and multiple newspaper homepages). And oh yeah, my second anatomy exam is this afternoon.

But what I’m actually stressing about how thousands of low-income Arkansas residents no longer have Medicaid coverage. 

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Legal Timeline of the ACA

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On March 23, 2010, the ACA was enacted into law and quickly plunged into seemingly never-ending, ever-evolving litigation. If you’ve found our site, you’re most likely not a lawyer, which makes it a bit more challenging to understand how we’ve gotten to this point in health law as it regards the ACA. 

Two key points that every individual should know: (1) the requirement that every state expand Medicaid was deemed unconstitutional however, the U.S. Supreme Court (SCOTUS) ruled that states could opt-in to the expansion [34 states including D.C. have expanded Medicaid]; and (2) the individual mandate is constitutional and still the law of the land [the Tax Cuts and Jobs Act repeals the financial penalty for not having insurance, but does not repeal the language of the mandate].

Below are some of the big milestones in the ACA’s legal history.

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The Medicaid Eligibility Game

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Medicaid is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and individual state Medicaid agencies. CMS is an agency within the Department Health and Human Services (HHS), which in turn is overseen by the President. CMS sets program parameters, provides policy guidance, and approves waivers excusing states from certain requirement. CMS issues guidance on eligibility, enrollment, medical assistance, coverage, provider participation, provider payments, cost-sharing, and a host of other policy issues related to the program.

In turn, each state creates a uniform, state-wide medical assistance program that is embodied in a federally-approved state plan. The state agencies are free to make choices within the parameters set by the federal government, often through waivers or creative programming.

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The Basics of Medicaid Benefits

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Medicaid has historically offered pretty decent [officially terminology, of course] coverage, in large part due to federal requirements for comprehensive coverage. Medicaid covers 39% of all children, nearly half of all births, 60% of nursing home and other long-term care expenses, more than 25% of mental health services, and more than 20% of substance abuse treatment.

Additionally, many states offer what are termed “optional” benefits, coverage of services that not required by the federal government. Optional benefits go above and beyond the mandatory benefits required to be provided in every state to every eligible individual receiving Medicaid. Optional benefits include everything from hospice care and transportation services to adult dental care and respiratory care services. The ACA required that all Medicaid plans include prescription drug and mental health/substance abuse treatment coverage as well, further expanding the kind of care a beneficiary can expect to receive under the program. Here is a more expansive look at what mandatory and optional benefits are covered by Medicaid.

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