December 3, 2017, POLITICO, Rachana Pradhan and Brianna Ehley- Red states ravaged by the opioid crisis are pushing for Medicaid work requirements that could push people out of treatment as they try to get off drugs. Kentucky, New Hampshire, Maine and Indiana are among at least eight GOP-led states seeking federal approval to require Medicaid enrollees to work as a precondition of their health coverage. All four states have been hard hit by drug addiction, which claims 140 lives a day nationally. Governors say they would exempt people with chronic drug problems or severe mental illness from the Medicaid work requirements, but who would qualify and under what circumstances hasn’t been spelt out. Critics fear that many addicts could lose benefits, particularly if they go in and out of treatment, or have relapsed - a not uncommon occurrence. Employers’ resistance to hiring people who have failed drug tests or have criminal records could also put health benefits at risk.
December 3, 2017, The Hill, Nathaniel Weixel- The tax bill that Republicans are muscling through Congress could result in cuts to entitlement spending if it significantly increases the national debt, budget experts say. Republicans say the tax-cut package will lead to economic growth and greater tax revenues, but there are doubts even within their party about whether that growth will come to pass. The Joint Committee on Taxation, Congress’s official budget scorekeeper, estimated the bill would cost $1 trillion over a decade even with economic growth taken into account. Sen. Bob Corker (R-Tenn.) opposed the bill for that reason. As the population ages and health-care costs continue to rise, the fiscal demands on entitlements like Medicare, Medicaid and Social Security are projected to grow. The projected increase in the debt from the tax package could make the situation worse, budget experts say.
December 2, 2017, REUTERS, Yasmeen Abutaleb- The sweeping tax overhaul that passed the U.S. Senate on Saturday contains the Republicans’ biggest blow yet to former President Barack Obama’s healthcare law, repealing the requirement that all Americans obtain health insurance. The individual mandate is meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage to help offset the cost of sicker patients. It helps uphold the most popular provision of the law, which requires insurers charge sick and healthy people the same rates. Removing it while keeping the rest of Obama’s Affordable Care Act intact is expected to cause insurance premiums to rise and lead to millions of people losing coverage, policy experts say.
December 2, 2017, The Washington Post, Amy Goldstein- The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health-care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time. The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’s nonpartisan budget analysts.
December 1, 2017, Kaiser Health News, Phil Galewitz- Two months past its deadline, Congress has yet to fund the Children’s Health Insurance Program, leaving several states scrambling for cash. Lawmakers grappling with the failed repeal of the Affordable Care Act allowed authorization of the program to lapse on Sept. 30. Although CHIP has always had broad bipartisan support, the House and Senate cannot agree on how to continue federal funding. And the Trump administration has been mostly silent on the issue. CHIP benefits 9 million children nationwide and 370,000 pregnant women a year. It helps lower- and middle-income families that otherwise earn too much to be eligible for Medicaid. Like Medicaid, CHIP is paid for with state and federal funds, but the federal government covers close to 90 percent of the cost.
November 29, 2017, Health Affairs Blog, Timothy Jost- Finally, the greatest threat of the tax bill to health coverage may not be the individual mandate repeal, but rather the large deficits built into the tax bill.The CBO estimates that the tax bill would increase the budget deficit by $1.4 trillion over the next decade. The agency predicts that it would not increase the deficit beyond 2027, but that conclusion is based on the individual tax cuts expiring at the end of 2025, which no one believes will happen. Moreover, if the CBO is wrong and fewer than 13 million individuals lose insurance coverage because of the individual mandate repeal, the budget savings of $318 billion the CBO projects from the repeal will shrink and the deficit will correspondingly grow. In fact, the deficits created by the tax bill can only be balanced by massive spending cuts, and the biggest targets for such cuts would be the Medicare and Medicaid programs. Indeed, current PAYGO rules could require sequestration of $25 billion in Medicare funds for the fiscal year 2018 if the tax bill passes, although Congress would most likely waive this requirement. In any event, unless completely unrealistic assumptions are made about future economic growth, the deficits caused by the tax bill would unavoidably result in later attempts to enact deep cuts in Medicaid and Medicare. It is not just the individual market that is at risk.