Most Americans — and even most Republicans — don’t buy the Trump administration’s argument that its primary aim in allowing states to add Medicaid work requirements is to pull more people out of poverty.
Instead, more people believe the GOP-led administration is mainly motivated by a different goal — to cut Medicaid spending by reducing enrollment in the health program for low-income Americans, according to a poll released this morning by the Kaiser Family Foundation.
Just 33 percent of respondents said the primary goal of work requirements is to give people a hand up out of poverty by motivating them to find jobs, while 41 percent said it’s to whittle down the Medicaid rolls, thereby lightening the financial load for states and the federal government.
Democrats were more likely to believe work requirements are aimed at lowering enrollment rather than poverty reduction, by 42 percent to 26 percent. But a striking share of Republicans also felt that way, too. Almost equal shares said the point is to shrink Medicaid (40 percent) rather than lower poverty rates (42 percent).
The findings suggest the public doesn't really believe the messaging from top Health and Human Services officials who are working with states to add more enrollment requirements to Medicaid, a program whose enrollment has grown steadily in recent decades and got a big boost when many states expanded it under the Affordable Care Act. Some states -- like Arkansas and Wisconsin -- are asking the Trump administration to approve waiver requests to allow them to institute requirements for Medicaid recipients for the first time.
Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has argued that work requirements will motivate low-income Americans to become more self-sufficient by finding employment.
“Our nation should always give our utmost attention and care for Americans most in need,” Verma wrote in a Washington Post op-ed last month. “As such, we must allow states, who know the unique needs of their citizens, to design programs that don’t merely provide a Medicaid card but provide care that allows people to rise out of poverty and no longer need public assistance.”
Likewise, Health and Human Services Secretary Alex Azar has called work requirements “a pathway out of poverty.”
The dramatic growth in Medicaid enrollment and spending has been a long-rehearsed refrain by conservatives critical of the program — and some Republican governors, who have complained it’s consuming an ever-greater share of their state budgets. Indeed, Medicaid claimed 19.7 percent of states’ general funds in 2015, up from 14.4 percent two decades earlier, according to a December 2017 report by the Medicaid and CHIP Payment and Access Commission.
But idea of reducing poverty certainly is better messaging for the administration than simply cutting Medicaid enrollment, as officials consider requests from eight more states to set up requirements for enrollees to either work or volunteer for their benefits to continue.
There's a range of ways beneficiaries could satisfy the work requirement -- and there are a number of exemptions, including for the disabled and those caring for small children. But critics charge that work requirements would shed some people from the Medicaid rolls simply because of the extra bureaucracy and documentation.
Yet given the fact that most Medicaid recipients who can work already do, it’s unlikely the requirements would do much to diminish state payments on Medicaid costs. Not even conservative health policy wonks who want to slash the program’s spending believe work mandates will move the needle by much.
“There is still a very large entitlement question that work requirements are not going to solve on their own,” said Nina Owcharenko Schaefer, a senior fellow for health policy at the conservative Heritage Foundation. “I don’t think it’s going to change the longer-term trajectory for the Medicaid program.”
But the Republican governors of Indiana and Kentucky, the two states who have so far convinced HHS to approve work requirements, are also sticking with the anti-poverty argument as they try to sell the changes to their residents.
Indiana Gov. Eric Holcomb said he hopes the requirements will help fill nearly 90,000 jobs available in his state. “This gateway-to-work initiative is going to help connect HIP members to the very training they need to take that next step up, so that our state can fill that pipeline,” Holcomb said when Indiana’s waiver was granted Feb. 2.
Kentucky Gov. Matt Bevin responded similarly when his state secured waiver approval in January, saying that “this is a program that will allow people to rise up out of poverty.”
Of course, placing more requirements on Medicaid enrollment and reducing government spending on the program aren’t necessarily incompatible goals. But even if it were possible to diminish Medicaid spending with work rules, it would be wrong to use them simply to drive away people from the program, said Bill Pierce, senior director at APCO Worldwide.
“I think just simply attaching this program to requirements to help you out of poverty is not a bad idea,” Pierce said. “Now, if you’re using it as a club, it’s wrong — that’s all there is to it.”
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AHH: Arkansas lawmakers added premium requirements to their state's Medicaid program with the idea that recipients would place greater value on their coverage more by having skin in the game. Yet just 20 percent of the 63,000 enrollees on the hook for premiums actually pay them, Kaiser Health News's Phil Galewitz reports. And Arkansas isn't the only place where Medicaid recipients disregard the new requirements, which some states added when they expanded Medicaid under the Affordable Care Act.
“Tens of thousands of Medicaid enrollees in four other states that added premiums during the past four years — Indiana, Michigan, Iowa and Montana — have also opted not to pay, according to state records,” Phil writes. For example, in the first half of last year fewer than half of Michigan Medicaid recipients who owed a premium — about 77,000 of 175,000 — paid it. Phil provides a few other examples:
—Indiana locked about 10,000 enrollees out of Medicaid for six months for failure to pay in 2016.
—Iowa disenrolled more than 14,000 Medicaid enrollees from January 2016 to September 2017 for failure to pay a $10 monthly Medicaid premium, though they could re-enroll at any time.
—In Montana, 2,884 adults with incomes over the poverty level were dropped from the Medicaid rolls in 2017 for failing to pay a premium.
OOF: Librarians have become an unlikely group fighting the national opioid abuse epidemic. Many major cities have started training librarians to use naloxone, the potent anti-overdose drug, the New York Times’s Annie Correal reports.
Last year, the Philadelphia Inquirer wrote about one librarian who had revived several people. After reading the story, Rep. Sean Patrick Maloney (D-N.Y.) introduced the Lifesaving Librarians Act, which would provide federal grants to give libraries in high-intenstiy drug trafficking areas access to naloxone. “While it seems shocking to be finding heroin at the public library — that’s where we are,” Maloney told the Times. “This is an all-hands-on-deck situation.”
“The bill reveals just how much libraries, which are open to the public and welcome homeless people, have had to cope with the crisis: Library workers in towns and cities across New York describe finding used syringes and glassine envelopes in doorways and patrons slumped over in bathrooms,” Annie writes. "But the bill has also ignited debate about whether librarians, like police officers and emergency medical workers, should administer naloxone."
OUCH: Police investigators are bewildered as they work through strange circumstances surrounding the missing-person case of Timothy Cunningham, a CDC researcher in Atlanta who vanished several weeks ago, shortly after a discussion about why he had been passed over for a promotion, The Post's Alex Horton reports.
Cunningham was last seen leaving work on Feb. 12, telling colleagues he was not feeling well, Atlanta Police Maj. Michael O'Connor told reporters. The 35-year-old had spoken to his sister by phone before arriving at work that day, and then called his mother at 9:12 a.m., presumably on his way home, O'Connor said. His mother did not pick up, and Cunningham did not leave a voice mail.
That was the last time the epidemiologist made known contact with anyone, setting in motion what would become a perplexing investigation. "Police have searched nearby woods with dogs, canvassed hospitals and jails, reviewed cellphone records, looked in cemeteries and even flown over the immediate area with a helicopter looking for signs of life — or worse," Alex writes. "Authorities said they do not suspect foul play but that they have not yet ruled it out, either. Cunningham's family and Atlanta CrimeStoppers have teamed up to offer a $10,000 reward for information leading to an arrest, just in case."
—Yesterday, President Trump surprised lawmakers during a bipartisan summit over guns by backing a number of gun control measures. Trump signaled he would implement an executive order to ban “bump stocks" and called on Congress to send him “one terrific bill” to reduce gun violence, improve background checks, arm qualified school officials, increase the age for gun purchases and keep guns away from mentally ill people.
Our colleagues Mike DeBonis and Seung Min Kim point out that combining several proposals in such a bill “could complicate the legislative outlook for such a contentious issue. Congress is already struggling to clear a relatively noncontroversial measure meant to simply improve the reporting of key information to a federal background-checks database.”
During the meeting, Trump didn't hold back from directly criticizing Republican lawmakers in the room. During an exchange with Sen. Pat Toomey (R-Pa.), Trump criticized the resistance to raising the age to buy assault weapons to 21 in a universal background check bill by Toomey and Sen. Joe Manchin (D-W.Va.).
“You know why? Because you’re afraid of the NRA,” Trump told Toomey.
From The Post’s David Nakamura:
Trump to lawmakers on his weekend lunch with NRA officials: "They have great power over you people. They have less power over me. What do I need them?"— David Nakamura (@DavidNakamura) February 28, 2018
This reaction from Sen. John Cornyn (R-Tex.) is telling, shared via Mike DeBonis:
Sen. Jeff Flake (R-Ariz.) praised the president’s support for raising the minimum purchase age. He tweeted that he and Sen. Dianne Feinstein (D-Calif.) had introduced a bipartisan bill on the matter:
Glad to see @realDonaldTrump so supportive of raising the minimum age to purchase an assault weapon from 18 to 21. @SenFeinstein and I just introduced a bipartisan bill to do just that. Let's bring it up for a vote and get it to his desk without delay. https://t.co/3wT4kTHqzc pic.twitter.com/msAK6KWbBg— Jeff Flake (@JeffFlake) February 28, 2018
Trump also explicitly mentioned “confront[ing] mental health” and called for confiscating guns from people who are mentally ill (before even going to court in what is a clear violation of due process, as our colleague James Hohmann writes today.)
From HuffPost’s Jennifer Bendery:
"Joe, you have to fix mental illness." -- Trump to Joe Manchin— Jennifer Bendery (@jbendery) February 28, 2018
Good luck, senator!
"We have to do something about the mentally ill not being able to buy a gun," Trump said. "They have so many checks and balances that you could be mentally ill and it takes you six months before you prohibit it."
Later Trump referenced warning signs ahead of the shooting in Parkland, Fla. "Take the firearms first and then go to court," he said. "Like in this crazy man’s case that just took place in Florida. He had a lot of firearms. They saw everything. To go to court would have taken a long time...[T]ake the guns first, go through due process second."
But some on Twitter cautioned Trump against over generalizing about people with mental illness:
From BuzzFeed News’s Sarah Mimms:
Sen. Chuck Grassley says he wants to Trump to be cautious on suggesting taking guns away from all with mental health issues "because there's a lot of people that have mental health issues that are not dangerous to themselves or to others."— Sarah Mimms (@SarahMMimms) February 28, 2018
CNN’s Daniella Diaz points out some context:
President Donald Trump: "You have to fix mental illness."— Daniella Diaz (@DaniellaMicaela) February 28, 2018
BUT only about 3% to 5% of violent acts can be attributed to individuals living with a serious mental illness, according to the US Department of Health and Human Services.https://t.co/NEZjk0bSAu
What will happen following the freewheeling session with lawmakers is not so clear, our colleagues Mike, Seung Min and Anne Gearan write: "Trump sent so many mixed signals about what he envisioned for a package on firearms and school safety that he left Democrats gleeful and Republicans tight-lipped amid doubts that Congress would produce any legislation."
First in The Health 202: A bipartisan group of six senators are asking health-care payers and providers for advice on how to improve price transparency, with the aim of crafting legislation that could actually pass Congress. Sen. Bill Cassidy (R-La.) is leading the effort, along with GOP Sens. Chuck Grassley (Iowa) and Todd Young (Ind.), and Democratic Sens. Michael Bennet (Colo.), Tom Carper (Del.) and Claire McCaskill (Mo.).
In their letter sent yesterday, the senators asked for input on a range of questions, including who should be responsible for providing pricing information, who should share the information with consumers, what information is not currently available to the public that should be, and whether all-payer claims databases could play a role in increasing price and quality transparency.
"Real world experience and evidence-based policies from health-care stakeholders and experts will be important to craft a policy that most positively affects consumers and involves best practices from providers and states," they wrote. "We are launching a bipartisan effort to increase health care price and information transparency to empower patients, improve the quality of health care and lower health care costs."
--A few more goods reads from The Post and beyond:
- The U.S. Chamber of Commerce holds an event on combating the opioid crisis.
Watch a summary of President Trump's meeting with lawmakers about mass shootings, in three minutes:
Here's what you should know about an assault weapons ban:
This is what each side of the gun debate wants: