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Breaking National and State News: What You Need to Know

Over the past week, there have been many news stories related to changes to our health care system that have a significant potential impact on the cancer community.  Here are a few highlights . . .

National News:

  • ACA Ruled Unconstitutional: Those of you who have been keeping up with the news that we have been sharing in the community and in our blog may recall that back in November, a Texas judge ruled that the ACA is unconstitutional. While we are waiting for this case to be heard by the 5thCircuit Court of Appeals, this week, the Trump Administration changed its position and asked the Court of Appeals to strike down the entire ACA. It is expected that regardless of the Appeals Court decision, that the case will ultimately be decided by the U.S. Supreme Court.
    • The potential negative impact to the cancer community, of ruling the ACA unconstitutional, cannot be understated. It is estimated that more than 20 million people would lose their health insurance coverage with the stroke of a pen. For a breakdown of the potential impact, read this article in the New York Times: nytimes.com/2019/03/26/health/obamacare-trump-health.html.
  • Court Rejects Association Health Plan Rule: Last year, the Trump Administration issued a new rule, which expands that availability of association health plans, but also allows them to avoid the consumer protections in the ACA. For example, the rule allows these plans to deny people with pre-existing conditions and impose annual and lifetime limits.
    • This week a court ruled that the Administration could not skirt the ACA protections.
  • Judge Strikes Down Medicaid Work Requirements in Arkansas & Kentucky: A federal judge ruled that the federal government failed to justify adding work requirements and other conditions in Arkansas and Kentucky would advance Medicaid’s basic purpose of providing health coverage. The judge was concerned that more than 18,000 people in Arkansas lost health coverage after the work requirement was implemented, and that it may be the confusing system that is a barrier to coverage. He stated that federal officials “did not consider the health benefits of the project relative to its harms to the health of those who might lose coverage.”
    • KentuckyGovernor Matt Bevin has threatened to eliminate the entire Medicaid expansion program in his state, if the work requirements are not allowed, which may cause 400,000 people to lose health insurance coverage.
    • This ruling comes after the federal government has approved work requirements in these 8 states: Arizona, Arkansas, Indiana, Kentucky, Michigan, Ohio, New Hampshire, and Wisconsin. These states have applications pending to include work requirements: Alabama, Mississippi, Oklahoma, South Dakota, Utah, Tennessee, and Virginia. Maine had their request approved, but the newly elected Governor withdrew the request.
    • A legal challenge to work requirements has also been filed in New Hampshire.
  • Newest Paid Family Leave Proposal:This week we brought you an overview of paid family leave laws and proposed legislation at the state and federal level. Yesterday, a new pad family leave proposal was introduced by a groups of Republicans, led by Senator Marco Rubio (R-Fla.) and Representative Ann Wagner (R-Mo.). The New Parents Act allows parents or a newborn or newly adopted child topull forward one month, two months, or three months of their Social Security retirement benefits in order to finance their time off of work. Nearly all parents earning less than $60,000 would receive leave pay equal to about two-thirds of their wages. When they retire, thepaid family leave recipients could choose to delay their Social Security retirement benefits by three to six months. This bill would also give them the option of having the sum gradually deducted from their benefits over the first five years of retirement. In addition, parents could choose to keep working full-time or part-time and use the extra funds to pay for childcare expenses.

Interesting Data:

  • 4 million children of veterans and 200,000 kids of active military service members get health insurance coverage through Medicaid, roughly 10% of the 37 million children who rely on Medicaid nationwide.
  • New data from the National Health Interview Survey found that 11% of adults and 33.6% of uninsured adults don’t take medication as prescribed, skipping doses, delaying refills, or taking less medicine.
  • Health insurance among employers was largely unaffected by the passage of the Affordable Care Act, although the number of employer-sponsored health plans has been declining for many years.
  • Research published in the American Journal of Public Health found that in states that expanded Medicaid, fewer people reported being unable to work due to a disability, suggesting a link between access to healthcare and a better ability to work.
  • A new survey from the Commonwealth fund found that 12% of adults were uninsured in 2018, but 23% were underinsured. Overall 45% of adults lacked adequate financial protection from medical bills in 2018, whether because they were uninsured, underinsured, or experiences coverage gaps. The biggest group of vulnerable Americans were those in employer-sponsored health plans, particularly those with large deductibles and out-of-pocket maximums.
  • According to an AARP study, 40 million Americans are family caregivers. 1 in 4 are millennials and more than half identify as African-American, Asian-American or Hispanic. Multiple states are trying to provide a tax credit to aging caregivers, including Arizona, Illinois, New Jersey, New York, Rhode Island, and Wisconsin.

 

Florida:

  • In December, CMS approved Florida’s request to eliminate the 3-month retroactive coverage protection for those who are age 21 and over who are eligible for Medicaid. This makes it more likely that someone who has been diagnosed will have to wait for their Medicaid coverage to begin, to start treatment. CMS has also approved these requests from Iowa, Kentucky, Indiana, Arkansas, and New Hampshire.

Idaho:

  • Medicaid Expansion: Back in November, voters approved a proposition to expand Medicaid in Idaho. Last week, the Idaho House passed legislation that would limit the Medicaid expansion approved by 61% of Idaho voters. Instead of expanding coverage to individuals with household incomes up to 138% of the federal poverty level (FPL = $16,753 for an individual), the bill only covers those up to 100% of the FPL. The bill also includes a Medicaid work requirement, requiring most adults to have at least 80 hours of work or community engagement per month. The bill now heads to the Senateand is supported by the Governor.

Kansas:

  • Medicaid Expansion: The Kansas House approved a bill that would fully expand Medicaid to 150,000 people in Kansas. It now goes to the Senate, where it faces opposition, but is supported by the newly elected Governor Laura Kelly.

Maine:

  • Governor Janet Mills signed into law a bill that requires insurance plans sold in Maine to cover the ACA’s essential health benefits and allow children to stay on their parent’s health insurance plan until age 26. The state is trying to protect consumers from federal changes to the ACA’s consumer protections or a court ruling that the ACA unconstitutional.

Michigan:

  • In January, Michigan regulators had to recall marijuana products sold at dispensaries, after they failed lab tests for mold and bacteria, highlighting the concern about the contents of marijuana for sale at locations across the country and inadequate quality and safety regulations.

New Jersey:

  • Death with Dignity Law: This week, New Jersey lawmakers approved the Medical Aid in Dying for the Terminally Ill Act. Governor Phil Murphy has indicated that he will sign it into law, making New Jersey the eighth state to enact a death with dignity statute. Read our recent blog on these laws. Death with Dignity legislation is also pending in
Samantha Skelton
ss@triagecancer.org