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Missourians to Vote on Medicaid Expansion as Crisis Leaves Millions Without Insurance



ST. LOUIS — Haley Organ thought she had everything figured out. After graduating from a small private college just outside Boston, she earned her master’s degree, entered the workforce and eventually landed a corporate job here as a data analyst.

Life seemed to be going as planned until the national retailer that Organ worked for announced furloughs during the coronavirus pandemic. After nine weeks of mandatory leave, the 35-year-old was laid off. The company gave her a severance package and put an expiration date on her health insurance plan.

“I haven’t slept the whole night since about March,” Organ said earlier this summer. “I can’t turn my brain off, just worrying about everything.”

Organ filed for unemployment, adding her claim to more than 40 million others nationwide since the pandemic took hold in mid-March, according to the Department of Labor. That’s about 1 in 4 U.S. workers. As a result of the unemployment crisis, millions of people lost access to their private health insurance plans at a time when they might need it most.

Medicaid, the federal and state health insurance program for people with low incomes or disabilities, could have served as a safety net for Organ if she lived in one of the 38 states that have opted to expand under provisions of the Affordable Care Act. But in Missouri, Republicans who control both the governor’s office and the legislature have said the state cannot afford its share of the cost of expansion and have been adamant foes of the ACA, helping lead a lawsuit now before the U.S. Supreme Court that may nullify the law.

That opposition by state leaders has meant adults like Organ who don’t have dependent children or specific disabilities cannot qualify for Missouri’s Medicaid program — even if their incomes are well below the poverty line.

“This is literally the first time in my life I’ve had to worry about health care coverage,” Organ said. “It’s kind of been a rude awakening for me.”

Voters in Missouri will decide Tuesday whether to expand eligibility for MO HealthNet program (Missouri’s Medicaid program) to provide insurance to more than 230,000 additional people in the state, including many who find themselves newly struggling for health coverage amid a national health crisis. More than 700,000 initial unemployment claims were reported in Missouri from mid-March through the first week of July.

If Medicaid expansion passes in Missouri, coverage for those newly eligible people would begin in 2021. Advocates for the measure say Medicaid expansion would also create jobs, protect hospitals from budget cuts and bring billions of federal taxpayer dollars back to the state.

Missouri is the latest red state to try expanding Medicaid with a ballot measure to circumvent recalcitrant legislatures. Oklahoma approved a measure June 30.

But Missouri’s Republican Gov. Mike Parson, who has said he opposes expanding Medicaid, moved the ballot measure from the general election in November to the primary election on Tuesday. Democrats criticized the shift, noting that fewer voters traditionally turn out for the primary and suggesting it could be easier to defeat in August. The ongoing threat of COVID-19 could also keep some voters away from the polls.

In a statement, Parson said changing the election date will allow the state to prepare for the potential cost of expansion. But an analysis from Washington University in St. Louis suggests that expanding the program could save the state money by lowering the amount it must pay for uncompensated care and bolstering efforts to prevent certain diseases, thereby reducing treatment costs to the state. Under the terms of the Affordable Care Act, the federal government picks up 90% of the coverage costs for newly eligible enrollees, as compared with the 65% it pays for people who qualify under regular Medicaid rules.

Backers of expansion are cautiously optimistic that Missouri voters will approve the measure Tuesday, heartened by Oklahoma’s win last month and positive polling.

For people who qualify for the current Medicaid program, enrollment is open year-round, which means people can apply when needed.

“That’s why we call them safety-net programs,” said Jen Bersdale, executive director of Missouri Health Care for All, a group that has advocated for Medicaid expansion since 2012. “When you get dropped from a job, dropped from insurance, they are there to catch you until you’re back on your feet.”

Amid the pandemic, Medicaid already appears to be helping people newly out of work. In 22 states, Medicaid enrollment increased by an average 5% from February to May, according to Georgetown University Health Policy Institute data. Newer data for May in those same states suggests enrollment growth is accelerating.

Even without expanding the program, Missouri leads the group with an 8.8% increase since February in total Medicaid enrollment. While economic recessions often contribute to increasing Medicaid enrollment, the early spike in Missouri could signify reenrollment of a large number of people, mostly children, who had been dropped from the program two years in a row. A federal rule blocks disenrollment during the pandemic.

Even some Missourians already on Medicaid are worried about the ballot measure not passing. Without expansion of the program, Sally Terranova fears that her 16-year-old son, Colin, will be ineligible for Medicaid when he ages out of the kids’ coverage at age 19. He was diagnosed with Type 1 diabetes in 2016.

Terranova is concerned that her son wouldn’t be able to afford the insulin he needs without insurance. She worries even more when she hears stories about diabetics rationing their insulin.

“It’s bad enough he has this illness hanging over him,” Terranova said. “But he can live a good life and be healthy if he has access to health care.”

That’s one reason Terranova, 39, hopes to land a job with good benefits when she finishes graduate school in a year and half. She has studied social work for the past four years, so she understands the challenges low-income families face.

Terranova had moved from New York to Missouri to give her son a better life. They’ve called St. Louis home for 10 years, but the single mom is contemplating another big move for her son’s health. She’s thinking of going this time to a state that has already expanded the program.

Organ, whose health insurance expired in July, is now one of the lucky ones. She just got a new job and will get new health insurance when she starts next week. Still, she’s hoping the Medicaid measure will pass, as she now appreciates more than ever how much it could mean for others who have lost their jobs and lack coverage amid the COVID-19 pandemic. Instead of heading to a polling place Tuesday, though, Organ is planning to vote by mail.

“I’m trying to do everything I can to keep me and others safe,” Organ said. “But I want to make sure my voice is still heard.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


By: Cara Anthony
Title: Missourians to Vote on Medicaid Expansion as Crisis Leaves Millions Without Insurance
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Published Date: Thu, 30 Jul 2020 09:00:59 +0000

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Covered California anuncia una baja récord en las primas para 2021



Las primas para los planes de salud vendidos a través de Covered California, el mercado de seguros establecido por la Ley de Cuidado de Salud a Bajo Precio (ACA), aumentarán un promedio de 0.6% el próximo año, el incremento más bajo desde que comenzó a ofrecer seguros de salud en 2014, dijo la agencia.

El aumento modesto le sigue a un incremento promedio a nivel estatal de 0.8% en la cobertura que comenzó en enero de este añ, que también marcó un récord por lo bajo.

Los cambios en las tasas variarán según las regiones, desde un aumento promedio de 5.6% en el condado de Santa Clara hasta reducciones de 2.1% en el suroeste del condado de Los Ángeles, y 2.6% en los condados de Imperial, Inyo y Mono.

Antes del anuncio, algunos observadores de la industria habían pedido recortes de tasas, ya que este año se ha gastado mucho menos en atención médica regular.

En la primavera, se cancelaron las cirugías electivas por la pandemia de COVID-19 y se han estado reduciendo dramáticamente las citas médicas, y a salas de emergencias y clínicas ambulatorias.

Sin embargo, Peter Lee, director ejecutivo de Covered California, dijo que las compañías de seguros del mercado “están viendo cómo recuperan sus costos de atención médica y están proyectando que en lo que queda del año se pondrán al día con los gastos de salud que pensaron que iban a tener en 2020”, dijo Lee.

Los planes de salud en el mercado habían proyectado aumentos en los costos médicos no relacionados con COVID de 4% a 8% el próximo año y no pensaron que necesitarían un presupuesto adicional para la pandemia, explicó.

El incremento de la tasas ha sido modesto principalmente debido a un aumento de nuevos afiliados “más saludables” tanto durante el período de inscripción regular para la cobertura de 2020 como el período especial de inscripción actual, recientemente extendido hasta el 31 de agosto, para las personas cuya cobertura se ha visto afectada por la pandemia, dijo Lee.

Covered California dijo que un análisis del riesgo médico y la demografía de estos recién llegados mostró que “son más saludables en promedio que las cohortes equivalentes de 2019”.

Otros factores, dijo, incluyen la derogación de un impuesto federal sobre los planes de salud, que redujo las primas de 2021 en un promedio de 1.7%, y un recorte el próximo año en la tarifa de “participación” que los planes de salud pagan a Covered California, del 3.5% a 3.25% de las primas.

Covered California brinda cobertura a aproximadamente 1.5 millones de californianos que compran su propio seguro. Alrededor del 90% de ellos reciben asistencia financiera del gobierno federal o estatal, o de ambos, para ayudar a pagar sus primas. Los planes en el mercado son semejantes a los del mercado abierto, donde las personas compran seguros sin asistencia financiera.

Algunos expertos en sistemas de salud creen que las aseguradoras continuarán gastando menos en atención médica el próximo año.

Glenn Melnick, profesor de finanzas públicas en la Escuela de Políticas Públicas Sol Price de la Universidad del Sur de California, dijo que los hospitales, especialmente en la sala de emergencias y las visitas ambulatorias, aún no llegan a tener un volúmen de pacientes y procedimientos como tenían antes de COVID y podrían continuar así hasta que haya una vacuna disponible.

Michael Johnson, un analista de la industria de seguros de salud que trabajó como ejecutivo en Blue Shield of California de 2003 a 2015, opinó que “los reguladores deberían estar obligando a estos planes a justificar por qué no están reduciendo las tasas, dado el efecto que hemos visto que la pandemia está teniendo hasta ahora”.

El aumento promedio en todo el estado entre los operadores de Covered California es menor que lo que se ha propuesto en muchos otros estados.

Un análisis de KFF de julio de las tasas propuestas para 2021 en los mercados de 10 estados y el Distrito de Columbia mostró un aumento promedio del 2.4%, con cambios que van desde un aumento del 31.8% por un plan de salud en Nuevo México hasta un recorte del 12% por uno en Maryland.

Los anuncios de tarifas de este año se producen cuando ACA sigue amenazada por una demanda federal presentada por funcionarios republicanos de 18 estados, junto con la administración Trump, con la meta de revocar la ley.

De ganar la demanda, más de 20 millones de personas podrían perder su cobertura de salud y se podrían eliminar las protecciones populares para el consumidor que brinda ACA, incluida la prohibición de discriminar o cobrar más a las personas con condiciones preexistentes como hipertensión o diabetes.

La Corte Suprema planea escuchar el caso en el otoño.

Las 11 compañías de seguros que operan en Covered California este año permanecerán en 2021, y no entrarán nuevas en el mercado. Pero Anthem Blue Cross y Oscar Health Insurance expandirán sus ofertas geográficamente, según informó el mercado.

Anthem ingresará a los condados de Inyo, Kern, Mono y Orange. Oscar se unirá a la competencia en el condado de San Mateo. Muchos de los planes de salud de Covered California están disponibles solo en ciertas regiones.

Kaiser Permanente es el mayor operador en Covered California, con cerca de 526,000 afiliados este año, más de un tercio del total. A Kaiser le sigue Blue Shield of California, con 392,000, y Health Net, con 232,000.

Las tarifas difieren no solo de un operador a otro y de una región a otra, sino también según la edad de la persona cubierta. Las primas también difieren según el nivel de beneficios, desde el nivel de cobertura “bronce” más barato hasta el más alto, conocido como “platino”.

Cuanto menor sea la prima, mayores serán los deducibles y los pagos de coseguro por la atención.

El deducible individual para el nivel de bronce en 2021 se establece en $6,300. Para el nivel de plata, el segundo nivel de cobertura más barato, el deducible individual completo en 2021 será de $4,000, también. Pero muchos afiliados en el nivel de plata están en planes que ofrecen ayuda financiera para reducir su parte de los costos médicos, y eso puede hacer que el deducible para 2021 baje a $75.

Además, numerosos servicios médicos no están sujetos al deducible en los planes de plata, incluidas la atención primaria y visitas a especialistas, análisis de laboratorio, radiografías y otros. En los planes de bronce, las primeras tres visitas de atención primaria no están sujetas al deducible.

Covered California dijo que, en promedio, los beneficiarios del mercado que planean renovar para 2021 pueden ahorrar un 7.3% en las primas al cambiar al plan menos costoso en el mismo nivel de cobertura.

Las tarifas de 2021 están sujetas a una revisión final por parte del Departamento de Atención Médica Administrada y el Departamento de Seguros del estado, pero es poco probable que ocurran cambios significativos.

El período de inscripción para la cobertura 2021 comienza el 1 de noviembre y se extiende hasta el 31 de enero.

Esta historia de KHN fue publicada primero por California Healthline, un servicio de la California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


This story can be republished for free (details).


By: Bernard J. Wolfson
Title: Covered California anuncia una baja récord en las primas para 2021
Sourced From:
Published Date: Tue, 04 Aug 2020 06:51:53 +0000

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Missouri Voters Approve Medicaid Expansion Despite GOP Resistance



Despite strong opposition from Republicans and rural voters, Missouri on Tuesday joined 37 states and the District of Columbia in expanding its Medicaid program. Voters in Missouri approved creating a state constitutional amendment that will open Medicaid eligibility to include healthy adults starting July 1, 2021.

Voters approved expansion by a margin of 6.5 percentage points.

Missouri joins five other mostly conservative states that have passed Medicaid expansion via ballot initiatives — most recently, Oklahoma, on June 30. Most of the remaining 12 states that have not expanded Medicaid are Republican-leaning states in the South.

Nika Cotton, owner of Soulcentricitea, a new tea shop in Kansas City, Missouri, woke to the news on Wednesday morning. Cotton, whose children are 8 and 10, said she will qualify for health care coverage under the expansion.

“It takes a lot of stress off of my shoulders with having to think about how I’m going to take care of myself, how I’m going to be able to go and see a doctor and get the health care I need while I’m starting my business,” Cotton said.

Medicaid expansion, which states have the option of adopting as part of the Affordable Care Act, extends eligibility in the program to individuals and families with incomes up to 138% of the federal poverty level. A family of three, like Cotton’s, could make up to $29,974 to qualify.

The federal government pays for 90% of expansion costs.

As of 2018, 9.3% of Missourians were uninsured. And in 2019, researchers from Washington University in St. Louis estimated that around 230,000 people in Missouri would enroll for Medicaid if it were expanded. The study also showed expansion would save the state an estimated $39 million a year, largely by eliminating the need for other state health spending.

Missouri’s adoption of expansion follows a trend of increasing support in largely Republican states, according to health policy expert Rachel Nuzum of the Commonwealth Fund.

“What we’ve seen in our surveys over the years is when you take the labels off of the policies, when you take the Affordable Care Act label off, when you take Medicaid expansion off, and just start asking people whether or not you think low-income families should have access to Medicaid coverage, the support is overwhelming,” Nuzum said.

Support for expansion came largely from voters in and around Missouri’s urban centers such as Kansas City, St. Louis, Springfield and Columbia. In Kansas City for example, 87.6% of voters backed the measure.

Amendment 2 was rejected overwhelmingly by conservative voters in the mostly rural parts of the state that have the highest uninsured and poverty rates. Voters in McDonald, Morgan and Scotland counties, which have the three highest uninsured rates in the state, rejected the measure by margins of nearly 2-to-1 or greater.

Expansion opponents warned that high enrollment in the program could lead to the state’s 10% share of the costs becoming a significant burden for Missouri, especially when state revenues are down.

“When state revenues fall, it begs the question, how are you going to pay for this?” said Ryan Johnson, in late July. He is a senior adviser for United for Missouri, a conservative policy advocacy organization.

“We’re concerned that they are going to have to raid public education,” he said, “and that’s a disservice to the kiddos who hope to go back to school this fall, the teachers, the administrators and everyone involved in the public education system.”

Responding to declining revenue related to the coronavirus, Missouri’s Republican governor, Mike Parson, recently reduced the 2021 budget by nearly $449 million, with education taking the hardest hit.

Health care experts have said that the economic effects of the pandemic, including high unemployment and lower state revenue, could strain the capacity of state Medicaid programs. However, health care advocates argue that expansion benefits individuals and families struggling as a result of the pandemic, and the influx of federal dollars and the jobs that result from expansion could help the economy.

“If we’re worried about the economy and we’re worried about people working, Medicaid expansion is actually a way to encourage people to work and not have that worry they’re going to lose health insurance for themselves or their families,” said Ryan Barker, vice president of strategic initiatives for Missouri Foundation for Health.

Republican state lawmakers have fiercely resisted Medicaid expansion. The expansion question was placed on the ballot after a petition.

Expansion advocates enlisted the Fairness Project, a Washington, D.C.-based campaigning organization, in developing and executing their campaign strategy. The Fairness Project has been involved in successful Medicaid expansion campaigns in other mostly conservative states, including Maine, Utah, Idaho, Nebraska and Oklahoma.

The “YES on 2” campaign was supported by a wide range of groups, including the Missouri Chamber of Commerce and Industry, the Missouri Hospital Association, the NAACP, the AFL-CIO and the AARP, among others. And, the coalition forged unlikely alliances, including Planned Parenthood supporters and Catholic Charities of St. Louis, which is operated by the Archdiocese of St. Louis.

YES on 2 campaign material made almost no mention of the Affordable Care Act, which has been unpopular in Missouri, and some of its flyers didn’t use the words “Medicaid expansion.”

Although support for the measure was much lower in conservative rural areas, Fairness Project executive director Jonathan Schleifer said Missouri’s expansion success relied on both activating progressive urban voters and engaging rural voters — though conservative resistance remained a significant obstacle to reforming health care policy.

“I think there’s still a lot of work to do to push back against the hundreds of millions of dollars, the public messages coming from as high as the White House, that there’s something wrong with the Affordable Care Act,” Schleifer said.

Opponents to expansion included Gov. Parson and other Republican lawmakers, Missouri Right to Life, Missouri Farm Bureau and Americans for Prosperity.

In the days leading up to the election, the “No on 2 in August” campaign sent a mailer suggesting that expansion would lead to an influx of undocumented immigrants seeking health care, but undocumented immigrants are not eligible for Medicaid and would not be under expansion, either.

The flyer, which featured a man in a medical mask emblazoned with the Mexican flag, read “Amendment 2 Means Illegal Immigrants Flooding Missouri Hospitals … While We Pay for It!”

The “No On 2 in August” campaign did not respond to requests for comment about the flyer.

Between serving customers on a busy morning on Wednesday, shop owner Cotton said her excitement about expansion was only slightly diminished by having to wait almost a year for it to take effect.

“It’s better late than never,” said Cotton. “The fact that it’s coming is better than nothing.”

This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


This story can be republished for free (details).


By: Alex Smith, KCUR
Title: Missouri Voters Approve Medicaid Expansion Despite GOP Resistance
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Published Date: Wed, 05 Aug 2020 18:40:33 +0000

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Reproductive health care coverage is shrinking due to widespread job losses



The post Reproductive health care coverage is shrinking due to widespread job losses appeared first on Live Insurance News.

The pandemic crisis job losses are especially hard on younger women and women of color.

The immediate economic harm from the COVID-19 pandemic crisis is clearer to see than issues such as shrinking access to reproductive health care coverage.

Young women and women of color are being hit hardest by job losses and therefore coverage loss.

Health plans are linked to employment for approximately half of Americans. This means that any of those 160 million people who lose their jobs also risk losing their health plans and, therefore, their reproductive health care coverage.

As job losses continue rising, a growing number of Americans are finding themselves uninsured. Many of these millions of people will be looking to publicly supported forms of health insurance such as the Children’s Health Insurance Program (CHIP), Medicaid, and government subsidized plans sold through the Affordable Care Act (ACA) exchanges.

This shift in the source of coverage can leave gaps in areas such as reproductive health care insurance.

According to the results of a recent Guttmacher Institute analysis, millions of people will suddenly find themselves uninsured or seeking new providers and programs that support that type of care. They pointed out that as publicly supported programs are asked to serve a rising number of people, they will also suffer broader logistical and financial pressures. These pressures will be piled onto the struggles that have already been building for years as family planning programs and clinics have weakened in the face of reproductive rights opponent political attacks.

The problems will be felt most acutely by the groups most at risk of job loss. Across the United States, young women and women of color are among those most affected. The National Women’s Law Center estimates that 56 percent of total job losses since March have been from women. This is believed to be because women are overrepresented in the types of employment most affected by lockdowns and stay at home orders, such as in restaurants, retail, and part-time, low-paid and tip-supported jobs.

As 13.9 percent of women were unemployed in May 2020 (compared to 11.6 percent of men), and as 16.5 percent of Black women, 19 percent of Latina women, 20.3 percent of women with disabilities and 24.0 percent of women aged 20 to 24 years were unemployed in that same month, these individuals also face losing their health plans and therefore their reproductive health care coverage.

The post Reproductive health care coverage is shrinking due to widespread job losses appeared first on Live Insurance News.


By: Nordstrom
Title: Reproductive health care coverage is shrinking due to widespread job losses
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Published Date: Wed, 05 Aug 2020 09:00:41 +0000

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