CHN: Tuesday Elections Deliver Blow to Medicaid Work Requirements

Opponents of Medicaid work requirements received good news with several Election Day outcomes this past Tuesday. In Kentucky, which has been at the forefront of efforts to impose the work requirements, Democrat Andy Beshear apparently defeated incumbent Gov. Matt Bevin by about 5,000 votes. Bevin is contesting the vote, and under the Kentucky constitution, it is possible for the state legislature to step in to decide the outcome.  That leaves the outcome uncertain, but Beshear is making plans to assume office.

Bevin had been a strong proponent of the work requirements, even though his own office estimated that the new rules would have caused more than 90,000 Kentucky residents to lose access to Medicaid. An analysis conducted by the Georgetown University Center on Children and Families found that nine of the top 10 rural counties nationwide with the highest percent of adults on Medicaid are in Kentucky, and enrollment of adults in these counties ranges from 45 to 50 percent. (The tenth county with a high percent of adults on Medicaid is in neighboring West Virginia.)

On Wednesday, Joan Alker, the Center’s executive director, tweeted that Bevin’s margin of victory in those nine Kentucky counties appeared to have diminished compared with four years ago.

Beshear, a strong proponent of both the Affordable Care Act and of Medicaid expansion, has vowed to rescind the Kentucky work requirements during his “first week” in office. The work requirements have not yet been implemented after a U.S. district court blocked them.

Other good news for opponents of work requirements came from Virginia, where Democrats will control all branches of government for the first time since 1993. When Virginia Gov. Ralph Northam succeeded in pushing Medicaid expansion through the Virginia House of Delegates and state Senate in 2018, it came with a price: to go along with the expansion, Republicans, who narrowly controlled both legislative chambers, insisted on attaching a scaled-back version of the work requirements to the legislation. Now, Democrat legislators say, they plan to repeal the requirements altogether.

Meanwhile, in D.C., health care advocates continue to work on health care legislation in three very different but important areas.

First, advocates are waging a No Surprises: People Against Unfair Medical Bills campaign. The campaign, which reports that one out of every five emergency room visits results in an out-of-network medical bill that in some cases can run into the thousands or tens of thousands of dollars, seeks to pass legislation to rein in this abusive and extremely harmful practice. The campaign is backed by a number of CHN member groups and allies, including Families USA, AFSCME, Americans for Financial Reform, Health Care for America Now!, National Partnership for Women & Families, Public Citizen, and Voices for Progress.

The campaign is circulating an organizational sign-on letter. The letter asks congressional leadership to include legislation addressing surprise billing in any end-of-the-year spending package.

Second, advocates are urging Congress to approve a package of health care-related funding extensions that currently are set to expire on Nov. 21, along with funding for the rest of the federal government. The extensions cover such areas as Medicaid funding for Puerto Rico and other U.S. territories, a juvenile diabetes program, and community health centers.

Third, advocates continue to push for legislation to lower the cost of prescription drugs. H.R. 3, which has cleared three different House committees, could come to the House floor for a vote as early as this month. However, its fate in the Senate is uncertain. Senators are pursuing their own legislation, which is being sponsored by Sen. Ron Wyden (D-OR) and Sen. Chuck Grassley (R-IA). That legislation passed the Senate Finance Committee with support from both Republicans and Democrats; the White House this week indicated its support for the Senate approach.

The key difference between the House and Senate versions? The House bill, backed by Speaker Nancy Pelosi, would allow Medicare to negotiate prescription drug prices. It would levy steep taxes on drug manufacturers who refuse to accept a Medicare price keyed to what’s paid in other economically advanced countries. President Trump has at times supported Medicare negotiations, but the House bill goes farther than the White House now prefers, offering support for the Senate bill and opposing the House version for its lack of Republican support.

The Senate bill, while not granting Medicare negotiating power, does have some selling points for health care advocates. It would, for the first time, limit what seniors have to pay out of their own pockets for prescription drugs. It also would require drug companies to pay rebates to Medicare if they hike prices beyond the inflation rate.

Medicaid work requirements
Prescription drugs