How Will the Latest Happenings in Capitals and Federal Courts Impact Cancer Survivors?

It has been a busy summer in the capitols and courts across the country. Here are some highlights of topics that may have a significant impact on the cancer community.

 National News:

  • On July 10th, the President issues an Executive Order that now allows Administrative Law Judges (ALJs) to be selected by political appointees. Wondering what an ALJ does? An ALJ is a judge who presides over trials and decides claims involving administrative law. More than 85% of ALJs in the federal government work at the Social Security Administration, overseeing cases such as denials of Social Security Disability Insurance or Supplemental Security Income. Others work at the Department of Labor and the Department of Health and Human Services, which decides Medicare cases. Currently, ALJS go through a competitive examination and selection process open to all applicants, which ensures that candidates are not only qualified, but will decide cases fairly without partisan interference. Under the Executive Order, the only requirement to now become an ALJ is to be licensed to practice law.
  • The Trump Administration has slashed the grants available to nonprofit organizations across the country that help individuals enroll in health insurance coverage. The government will grant $10 million, down from $36 million last fall, and $63 million in 2016. These navigators are also being required to help people enroll in short-term health insurance plans, which do not comply with the consumer protections offered by the Affordable Care Act (ACA).
  • The Administration is expected to release a final rule on short-term health insurance plans in the next few weeks. The proposed rule allowed people to buy short-term health insurance plans for up to 364 days, where they were previously limited to 3 months. Those in favor of these plans argue that they are less expansive options for health insurance coverage; however, these plans are allowed to deny people with pre-existing conditions, and allowed to charge people with pre-existing conditions more for their coverage, and they are allowed to exclude entire categories of care (e.g., chemotherapy, prescription drugs, mental health care, etc.) The challenge is that consumers are attracted to these cheaper plans, but rarely are they aware of how limited the coverage actually is. In response, some states (e.g., CA, HI, & MD) are acting to protect people with pre-existing conditions.
  • On June 19th, the Department of Labor issued a final rule that expands access to association health plans. This rule changes the definition of “employer” under ERISA to allow more groups to form association health plans and avoid providing certain protections in the Aca to consumers. The advocacy community is concerned about the growth of these plans, as many consumers are unaware of the lack of protections in the these plans, such as allowing plans to charge people with pre-existing conditions more, or deny them coverage entirely. In fact, 95% of health care groups that filed comments on the proposed rule expressed serious concern or opposed it, but the Administration went forward with their plan.Interestingly, many of the business groups who were advocating for these association plans have recently stated that the will not be forming the plans, because it would be too difficult under these rules. Some states are still concerned about how these plans might move people out of the marketplaces, which would increase costs for consumers. California’sSenate has passed legislation to regulate who can enroll in these association health plans and requires them to comply with ACA consumer protections.

 

Washington, D.C.:

  • The D.C. Council has approved an individual mandate, to stabilize the health insurance market. D.C. joins Massachusetts, New Jersey, and Vermont in requiring residents to have health insurance coverage or pay a penalty, similar to the ACA.Because the U.S. Congress has oversight over the District of Columbia, Congress has 30 days to intervene in the law, so this mandate may be repealed as part federal appropriations process.

 

Idaho:

  • A voter initiative to expand Medicaid in Idaho under the ACA will appear on the November ballot. If approved an estimate 62,000 Idaho residents would gain access to health insurance coverage.

 

Nebraska:

  • A voter proposition to expand Medicaid will likely also appear on the November ballot in Nebraska, as advocates have collected enough signatures to qualify.However, Nebraska state legislators have sued to keep it off the ballot. Voters in Utahwill also have the option of voting for Medicaid expansion on their November ballot.  While in Montana, signatures are still being gathered for a ballot proposition to extend their Medicaid expansion which will currently end in 2019.

 

Maine:

  • On the last episode of “Maine’s Medicaid Expansion Saga:”
    • In November, Maine voters approved a ballot proposition to expand Medicaid coverage to an estimated 80,000 Mainers on July 2, 2018. Governor LePage refused to implement the proposition, after previously vetoing Medicaid expansion passed by the state legislature five times.
    • In April, advocacy groups in Maine filed a lawsuit to force the Governor to implement the expansion.
    • In June, the judge ordered the Governor to submit a plan for expanding Medicaid to the federal government. The Governor appealed that decision to the Maine Supreme Judicial Court, claiming that the legislature needed to fund the expansion first.
    • At the end of June, the legislature passed a bill funding the first year of the Medicaid expansion, which the Governor promptly vetoed on June 29th(conflicting with his legal claim).
    • On July 9th, legislators in Maine’s state House failed to override the Governor’s veto.
    • Yesterday, the Maine Supreme Judicial Court heard arguments over whether to allow the Governor to continue to delay filing plans with federal officials to expand Medicaid. Stay tuned for their decision.
    • The Governor’s term ends in January, and the next Governor will likely be left to deal with this issue.
  • As a side note, Maine legislators did manage to override the Governor’s veto of a bill that will allow doctors to recommend medical marijuana to patients for any medical reason.

 

Kentucky:

  • Kentucky has its own Medicaid drama playing out:
    • Kentucky filed a Medicaid 1115 waiver with the U.S. Department of Health and Human Services (HHS) to require Medicaid recipients to work in order to get access to health coverage. This work requirement was approved by the Secretary of HHS. Then the advocacy community filed suit arguing that thisrequirement would threaten access to health care, particularly for older adults and people with disabilities. It is estimated that 1.4 million to 4 million Americans could lose access to coverage if work requirements were imposed nationwide. And the loss in coverage would not be due to a failure to work, but a failure to report compliance to the state.
    • In June, a federal judge in the U.S. District Court for the District of Columbia ruled in favor of Kentucky Medicaid recipients, stating that the HHS Secretary “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.” As a result of this decision, the work requirement did not go into effect on July 1.
    • This court decision also has an impact on other states who are considering work requirements, or have already submitted proposals to HHS (AR, KS, ME, MS, OH, UT, WI), or that already have work requirements approved by HHS (AR, IN, NH). However, HHS is working with the Governor’s office to try to address the court’s concerns to re-approve the work requirements.
    • Kentucky’s Governor is expected to appeal the court’s decision, so stay tuned. This case could reach the Supreme Court, which will have a new member by that time.
    • In the meantime, in response to the judge’s decision, Kentucky’s Governor cut dental, vision, and non-emergency medical transportation coverage for the Medicaid expansion population, effective July 1st. He has also threatened to end Medicaid expansion in Kentucky entirely.

 

 

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Samantha Skelton
ss@triagecancer.org