The Trump administration is readying the next phase in its ongoing project to put a lasting conservative stamp on the country’s Medicaid program for low-income people.
Tomorrow, Seema Verma, administrator for the Centers for Medicare and Medicaid Services, will send a letter to every state Medicaid director inviting them to apply for permission to draw down federal funds in a radically new way — a way Republicans say will rein in unsustainable spending but that Democrats argue could hurt vulnerable Americans.
Under this new “block grant” approach, states could trade away an entitlement program that expands and contracts depending on how many people need it. In exchange, they’d receive a fixed federal payment for able-bodied adults in the program and freedom from many of Medicaid’s rules, my Washington Post colleague Amy Goldstein reports.
“The offer represents the second — and boldest — step the Trump administration has taken to redefine the nation’s largest public insurance program, a cornerstone of the social safety net created as part of President Lyndon Johnson’s Great Society of the mid-1960s,” Amy writes.
Stakeholders have been invited to the Department of Health and Human Services at 10:30 a.m. on Thursday for an hour-long event rolling out the new guidance. The event is titled “Transforming Medicaid: A New Opportunity for Better Health.”
The move is sure to spark yet another fierce debate over the aims of Medicaid and how available and accessible the program should be. The program now covers about 75 million people — more than 1 in 5 Americans — after the Affordable Care Act made it available to people earning up to 133 percent of the federal poverty level.
During her three years as CMS administrator, Verma has spoken frequently about reshaping Medicaid in a way that encourages people to become self sufficient so they’re able to move off it faster.
Two years ago, Verma issued an invitation to states to apply more requirements for enrolling in Medicaid. In that guidance letter, she said states could get permission for the first time to require able-bodied low-income Americans to work, volunteer or engage in job training to qualify for the state-federal program.
Critics say the work requirements have resulted in people losing coverage despite needing it. Of 10 states CMS has given approval to implement these requirements, virtually all have found their requirements blocked in federal court or on hold. Proponents and critics alike expect CMS's new block grant guidance also will also face court challenges, Amy reports.
“Our legal team will be carefully assessing the enforcement and litigation options with respect to the guidance document,” said Jane Perkins, legal director of the National Health Law Program, a plaintiff in the work requirement cases.
Sen. Bob Casey (D-Pa.):
.@SecAzar before you move forward with your unlawful Medicaid block grant plan and threaten the health care of millions, I’ll remind you that I am still waiting for answers to questions I raised back in October. I’ve attached my original letter in case you misplaced it. pic.twitter.com/tH50nx7mR6— Senator Bob Casey (@SenBobCasey) January 27, 2020
Rep. Bill Pascrell Jr. (D-N.J.):
Reminder that this week trump and his corrupt flunkies are going to announce plans to gut Medicaid.— Bill Pascrell, Jr. (@BillPascrell) January 26, 2020
In the past week republicans have made clear they want to destroy Medicare, Social Security, *and* Medicaid. These are their priorities. https://t.co/lHuGHkzZrx
Medicaid block grants are a longstanding GOP priority. Congressional Republicans included the concept in 2017 legislation to repeal and replace the ACA, although they were never able to pass those bills. Block grants have been a goal for Verma ever since she helped lead changes to Indiana’s Medicaid program.
“Within the administration, Verma has consistently argued for states to be allowed greater flexibility in running Medicaid,” Amy writes.
Here’s how Medicaid funding works right now. The federal government provides each state with a set percentage, typically between 50 and 70 percent, of however much it costs the state to insure everyone eligible for the program.
There’s wide variation among state Medicaid programs; poorer, conservative-leaning states tend to run leaner programs while wealthier, liberal-leaning states add on benefits beyond the minimum required by the federal government.
Under the block grant model, states would get a fixed pot of funds. If those funds ran out, they’d have to cut services or restrict enrollment.
Drew Altman, president of the Kaiser Family Foundation:
You might not know it from the political debate about the program, but Medicaid has become a very popular program with the public and efforts to cap and cut it (in the name of state flexibility)could spell political trouble for proponents.https://t.co/muaoBvDXcI— Drew Altman (@DrewAltman) January 26, 2020
Joan Alker, executive director of the Center for Children and Families at Georgetown University:
This is a good week to review why Medicaid block grants are a threat to families health. Current funding structure has flexibility for states to respond to the unknown - block grants don’t. Example #1 new viruses emerge routinely and can cause epidemics... https://t.co/viLPBmabvl— Joan Alker (@JoanAlker1) January 27, 2020
Individuals inside and outside the administration told Amy that the new option for states to ask for a block grant is focused on able-bodied adults, excluding more vulnerable populations such as pregnant women, children or people with disabilities.
Even so, there appears to be broad skepticism — even among conservatives — that block grants won’t pass legal muster.
“Joseph Antos, a health-care scholar at the conservative American Enterprise Institute, said that the part of Medicaid law that allows states to get exceptions from the program’s usual rules does not allow federal health officials to waive the formula that defines the share of money that the federal government and states provide,” Amy writes.
“Anything that sounds like a block grant,” Antos told her, “can’t be done.”
AHH, OOF and OUCH
AHH: Six countries have confirmed human-to-human transmission of the coronavirus virus, and cases in China continue to rapidly spread.
“But so far, the mortality rate is less than the rate of other severe respiratory coronaviruses. In China, where 5,974 people are infected, 132 have died,” our Post colleagues Lena H. Sun and Lenny Bernstein report. “That is a high rate, but far less than the fatality rate of SARS and MERS. And countries like the United States that quickly began screening travelers, isolating sick people and tracing their contacts have just a handful of cases. There have been no fatalities outside China.”
In the United States, federal health officials held a news conference to assuage concerns. Health and Human Services Secretary Alex Azar said: “Americans should know that this is a potentially very serious public health threat, but, at this point, Americans should not worry for their own safety.”
But the White House did warn it could suspend all China-U.S. flights if the outbreak becomes a bigger threat to the United States, our Post colleague Luz Lazo reports.
— Rep. Diana DeGette (D-Colo.) announced top federal health officials will meet with lawmakers in a closed-door briefing tomorrow to discuss the latest on the virus.
DeGette, chairwoman of the House Energy and Commerce subcommittee on oversight and investigations, requested the meeting, which will be open to all members of the full committee.
“This is an extremely deadly virus that’s spreading rapidly around the world,” she said in a statement. “We need to know exactly what the administration is doing to prevent the spread of this dangerous virus here in the U.S. — and what, if any, additional resources they need to protect the public’s health.”
OOF: The Democratic Majority for Israel, a Democratic super PAC, plans to air an attack ad that uses Sen. Bernie Sanders’s heart attack to target the presidential hopeful ahead of the Iowa caucuses.
The ad, which will air in Iowa, features six voters from the state and argues that Sanders (I-Vt.) would be “unable to defeat Mr. Trump in the November general election, citing the senator’s heart attack last year, his left-wing ideology and his liberal policy positions as evidence that he would be too risky a choice for primary caucusgoers focused on winning back the White House,” the New York Times’s Lisa Lerer and Sydney Ember report.
“I like Bernie, I think he has great ideas, but in Michigan, Pennsylvania, Iowa, they’re just not going to vote for a socialist,” one voter says in the spot. Another voter specifically refers to “concerns about Bernie Sanders’s health considering the fact that he did have a heart attack.”
“The Sanders campaign is aware of the ad: Faiz Shakir, Mr. Sanders’s campaign manager, sent an email to supporters on Tuesday warning them that Mr. Sanders was being targeted with negative ads in Iowa,” Lisa and Sydney report.
OUCH: The Food and Drug Administration sent a warning letter to the Purell parent company scolding its claims that the hand sanitizer can prevent diseases such as Ebola, norovirus and MRSA.
The warning targets the marketing efforts by the company, Gojo Industries, related to its alcohol-based gels, foams and sprays. “Some of the statements that drew the FDA’s ire outlined in the warning appear to have been removed from Gojo and Purell sites since the FDA sent its letter on Jan. 17,” The Post’s Kim Bellware reports. “The FDA called out claims on Purell’s website that the products were proved to ‘reduce student absenteeism by up to 51%’ and another that touted Purell as a solution to germ-infested athletic environments, where it could help to reduce MRSA and VRE by 100 percent.”
The letter, which calls on the company to “correct the violations,” also referred to language in its marketing that suggested viruses such as Ebola are easily killed by alcohol, the products’ key ingredient, and that claimed the World Health Organization and the Centers for Disease Control and Prevention recommended the use of such products during an outbreak.
“Those claims, the FDA wrote, indicate Gojo intended for customers to use its products to eliminate Ebola, flu and other diseases despite there being no studies that prove such antiseptics can produce the results Gojo implied,” Kim adds. “Gojo told The Washington Post it took immediate action after receiving the FDA’s letter.”
HEALTH ON THE HILL
— As the coronavirus spreads, Sen. Elizabeth Warren (D-Mass.) released a proposal for ways to contain and treat infectious diseases if she’s elected.
The Democratic presidential hopeful’s plan calls for boosting funding for agencies that tackle pandemics, including the CDC, the Department of Health and Human Services and the State Department; bolstering resources for health departments, health-care providers and frontline workers; and establishing a global health team that would “get the right expertise to the center of an outbreak before it becomes an epidemic.”
“Diseases like coronavirus remind us why we need robust international institutions, strong investments in public health, and a government that is prepared to jump into action at a moment’s notice,” Warren’s campaign said in a Medium post detailing the plan. “When we prepare and effectively collaborate to address common threats that don’t stop at borders, the international community can stop these diseases in their tracks.”
— A group of 20 Democratic state attorneys general joined a multistate amicus brief in a case challenging restrictive abortion laws in Missouri.
The last abortion clinic in the state, the Planned Parenthood of St. Louis, and Colleen McNicholas, its chief medical officer, have filed a suit to overturn state measures that restrict the procedure.
“Nearly 50 years ago, the courts ruled that women across the country have the right to control their own bodies, but nearly every day since anti-choice legislators have tried to impose their personal beliefs on the wills of millions of women nationwide,” New York Attorney General Letitia James said in a statement. “… We will not allow Missouri, nor any other state to undo all the progress we have made by restricting access to safe, legal abortions.”
California Attorney General Xavier Becerra, who also joined the brief, said in a statement: “No government, state or federal, has the right to make personal decisions for a woman about her body or her healthcare. Missouri’s anti-choice laws are blatantly unconstitutional and leave women in Missouri with no option within the state for safe, legal abortion care. We will continue to stand with women and the Constitution to protect their access to comprehensive healthcare.”
— And here are a few more good reads:
- The House Energy and Commerce subcommittee on health holds a hearing on “Improving Safety and Transparency in America’s Food and Drugs."
- The House Veterans’ Affairs Committee holds a hearing on “Caring for Veterans in Crisis."
- The Senate special committee on aging holds a hearing on the Society Security impersonation scam.
- The Senate Veterans’ Affairs Committee holds a hearing on “Pending Legislation and Nomination."
- Politico hosts an event on “Navigating the Health Care Maze."