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Adding work rules to expand Medicaid is a false choice, activists say

A lot has changed since Virginia’s gubernatorial race last November yielded the highest voter turnout in 20 years. Then, health care moved people to the polls, as casting ballots at the time meant extending health care to 400,000 people. Despite historic Democrat gains, Republicans maintained control of the state house. Now, Medicaid expansion is subject to unprecedented conditions.

The Affordable Care Act (ACA) sought to expand Medicaid eligibility to people making up to 133 percent of the federal poverty level nationwide, but a 2012 Supreme Court decision ruled that this was unconstitutionally coercive of states, making Medicaid expansion optional.

Today, Virginia, which has a 51 to 49 Republican majority in the House, is one of 18 states that has not expanded Medicaid. Advocates there and in a half-dozen more states are trying to change that in 2018. With the Trump administration recently approving Kentucky’s Medicaid work rules, conservative lawmakers in non-expansion states hope to follow suit, saying they’ll only give in to expansion if work requirements are part of the package. This conditional support is leaving advocates — who, in Virginia, helped galvanize enough voters for Democrats to pick up 15 seats — feeling wary.

VIRGINIA ORGANIZING Medicaid rally on 2/08/18
CREDIT: SARAH GUNTER

Thousands of people in states that have opted out of expansion have fallen into a “coverage gap,” which refers to uninsured people who make too much to qualify for Medicaid but too little to meet the minimum income requirement for subsidized insurance on the Obamacare exchanges. In Virginia, about 400,000 people fall into this coverage gap, adding to the urgency of the fight for Medicaid expansion in 2018.

“We are going to keep being the force pushing for straight expansion,” said Virginia Organizing’s Brian Johns. “Let’s not bargain with ourselves.” Johns’ group held the first of 12 Medicaid expansion rallies last Thursday evening; his group and a handful of others are continuing to apply pressure this legislative session.

“If your position is to pass straightforward Medicaid expansion without work requirements or other reforms, then you will be responsible for the failure to provide health care coverage to more Virginians,” said Speaker of the House Kirk Cox (R) in a letter to Gov. Ralph Northam (D). Cox said his House Republican caucus will only support Medicaid expansion if Democrats agree to impose work requirements on the current Medicaid population. While the Democratic Caucus is pleased that Republicans are open to talking about Medicaid expansion this session, they aren’t happy with the conditions. Adding work rules or any other restriction could trip consumers, and also the governor’s office says administrating the requirement will cost $10.5 million in the first year.

Lawmakers have until February 18 to decide whether they’ll tackle Medicaid this session; that’s when the legislature will release its budget, which could set aside money for the project. Activists are demanding lawmakers pass a straightforward expansion bill, with no strings attached, as “this conversation around work requirements is yet another way to stigmatize and demonize people who are trying to make ends meet,” said Anna Scholl of Progressive Virginia. “[There’s] nothing fundamentally wrong or immoral with being poor,” she said. This is why work rules are a nonstarter.

CREDIT: VIRGINIA ORGANIZING

“I think Republicans suffered historic loses last November and they were seen as the party to keep people from getting health care,” said David Broder, president of a 3,000-member union of home care providers. Many of these providers fall into Virginia’s coverage gap, so he mobilized them to vote in the last election. “If that’s the path that goes down [this legislative session], they’ll see the same thing in 2018 and 2019 and so forth.” Republicans only kept control of the legislature by a coin toss.

State laws dictate the means by which a state can expand Medicaid. To do so, voters need to stay mobilized. The last state to expand Medicaid was Maine. Residents were only able to expand Medicaid after winning a ballot initiative, as the governor was not supportive of expansion. Before Maine, was Louisiana, which was able to expand Medicaid only because a supportive Democratic governor was elected; and he signed the order on his second day in office. Advocates are encouraged by these efforts, including those in Utah, where they are seeking to bypass the state legislature to expand Medicaid.

“Look at Maine — I think you are going to see the same thing in Utah,” said Utah Decides Healthcare‘s RyLee Curtis. “You are going to see the political will of the people.”  

While Utah Republican lawmakers push legislation that expands Medicaid and imposes work rules, activists are trying to push a straightforward Medicaid expansion. Roughly 100,000 residents fell into a coverage gap.

Credit: Utah Decides
Credit: Utah Decides

Lawmakers are on “a tighter deadline than we are,” said Stacey Sanford of the Utah Health Policy Project, another group advocating for a straightforward expansion. “The initiative has thought of everything whereas these legislative routes don’t even have text yet.”  

The Utah state representative who’s leading the efforts, Robert M. Spendlove (R), has until March 8 to introduce and pass his conservative Medicaid expansion bill, as that’s when the legislative session ends. Utah Decides Healthcare has until April 15 to collect 113,000 signatures to put a straightforward Medicaid expansion on the ballot next November, and so far, they are on track to meet the goal. The ballot initiative is written to supercede any kind of work requirement, said Sanford.

Concessions in health policy are always part of the equation. In fact, the ACA in and of itself is largely seen by progressives as a compromise to single-payer health care. But most activists who spoke with ThinkProgress do not think Democrats should concede to delay tactics yet, especially because Medicaid expansion is very popular. Most activists wouldn’t even entertain the choice of Medicaid expansion with work rules or nothing at all. When Virginia Gov. Ralph Northam tempered his support for Medicaid expansion in an interview, voters reminded him that they elected him last November; he’s since changed his tone. A majority of Virginia voters have supported expansion since 2014. The Utah legislature tried to pass expansion in 2016, as it’s also popular there.

Moreover, adding red tape will likely lead to coverage loss, which is the antithesis to Medicaid expansion. In Indiana, when state lawmakers expanded Medicaid, they imposed premiums onto poor people and dropped them if they failed to pay in time. Roughly 71,000 people lost or were prevented from enrolling because of the restrictive policy.

Even so, for some in Indiana, the way the state expanded Medicaid beats the alternative. “If we are asking if the state did better off than having no expansion, then pretty clearly the answer is yes,” Kosali Simon, an economist at Indiana University, told Kaiser Health News.

Families USA Senior Director of Campaigns, Outreach and Engagement Patrick Willard sees this narrative — that states could only expand Medicaid if they impose work requirements — as a false choice. Health care doesn’t need to be conditional because it shouldn’t be a privilege.

“People are making political arguments and trying to create this notion that health care should be a privilege for people and that we should only be providing health care as a reward to people, rather than understanding that we actually need to provide health care to people so that they can work and so that they can take care of their families,” he said.

“I think it is a political argument that is going to run into the fact that it is not allowed by the law,” he added. In fact, three organizations filed a lawsuit last month arguing just that.


Internet firms back congressional vote to restore net neutrality rules

Technology companies including Alphabet Inc and Facebook Inc on Thursday threw their weight behind a congressional bid to reverse the Trump administration’s plan to repeal Obama-era rules designed to protect an open internet.

The post Internet firms back congressional vote to restore net neutrality rules appeared first on Politicus USA.

DHS reportedly weighing rules targeting immigrants who use public benefits

The Trump administration is reportedly considering making it harder for immigrants who use public assistance to become permanent residents, Reuters reported on Thursday. It’s the latest move in a line of actions meant to crack down on documented immigration, in addition to targeting undocumented immigrants.

According to a proposal obtained by the outlet, the Department of Homeland Security (DHS) is set to propose new rules allowing immigration officers to scrutinize and consider the use of certain taxpayer-funded benefits when weighing permanent residency applications. Non-U.S. citizens living in the United States pay taxes and are legally permitted to use many public services. But the new DHS rules would seek to measure that usage, holding any perceived reliance against applicants.

“Non-citizens who receive public benefits are not self-sufficient and are relying on the U.S. government and state and local entities for resources instead of their families, sponsors or private organizations,” the document reads. “An alien’s receipt of public benefits comes at taxpayer expense and availability of public benefits may provide an incentive for aliens to immigrate to the United States.”

Among those benefits are subsidies for utility bills and assistance programs like the Supplemental Nutrition Assistance Program (SNAP), which provides food stamps; the Children’s Health Insurance Program (CHIP); Women, Infants, and Children (WIC), which assists pregnant people and their children; and a number of programs assisting with transportation vouchers, education for low-income children, and even winter heating.

Health care obtained through the Affordable Care Act (ACA) would also be subject to increased scrutiny. Emergency and disaster relief would reportedly be excluded, as well as free and reduced-price school lunches, Medicare, and disability insurance.

Applicants’ credit reports, along with a significant amount of personal information, could also be obtained and used by the government in order to evaluate individual usage of public benefits.

The changes would likely impact hundreds of thousands of people. Permanent residents applying for citizenship would not be subject to the rules, but people applying for permanent status would be considered a “public charge” if they depend on “any government assistance in the form of cash, checks or other forms of money transfers, or instrument and non-cash government assistance in the form of aid, services, or other relief.”

The DHS rules are the latest indicator that the Trump administration intends to crack down on immigration at every level.

The White House has repeatedly targeted undocumented immigrants, railing against sanctuary cities and ramping up deportation measures. In September, President Trump rescinded the Obama-era Deferred Action for Childhood Arrivals (DACA) directive, leaving 800,000 young undocumented immigrants who came to the United States as children in limbo. The administration has also rescinded Temporary Protected Status (TPS) for immigrants from a number of countries — including Haiti, El Salvador, and Nicaragua — leaving hundreds of thousands of people forced to return to countries facing severe domestic turmoil.

The White House has also pushed for a “merit-based” immigration system favoring highly-skilled immigrants, citing the diversity visa lottery program as one example of a system favoring “the worst” immigrants. Experts have criticized and contradicted those claims, as the diversity visa program has merit-based components and makes up a small sliver of the U.S. immigration system more broadly.

But highly-skilled immigrants and those looking to immigrate through official channels have still suffered under Trump, despite the president’s supposed desire to make room for more documented immigration. In April, the president unveiled an executive order targeting the H-1B visa, which goes to highly-skilled workers across a number of sectors, including technology, research, and academia. Last month, sources told McClatchy that DHS had implemented new policies targeting H-1B applicants with pending green card applications. Hundreds of thousands of would-be immigrants — the overwhelming majority of them Indian citizens — could be impacted if those rules take effect, subjecting them to longer wait times, increased scrutiny, and the possibility of being sent home in the interim period.

DHS officials have yet to issue a formal comment on the reported new rules impacting applicants for permanent residency. It is unclear when the policy would take effect, should it be approved.


Judge rules GrubHub properly classified delivery driver as independent contractor

 A few months after hearing closing arguments in the Lawson v. GrubHub case, Judge Jacqueline Scott Corley has ruled Raef Lawson, the plaintiff, was indeed an independent contractor while driving and delivering food for GrubHub. “We’re extremely satisfied with today’s ruling in Lawson v. Grubhub, which validates the freedom our delivery partners enjoy from deciding when, where… Read More