MEDICAID ENROLLMENT FORECASTED TO RETURN TO 71 MILLION

Medicaid enrollment is being significantly affected because of the expiration of the continuous enrollment condition authorized by the FFCRA. Since April, millions of people have been disenrolled from the program. Simultaneously, millions of others have either re-enrolled or enrolled in the program for the very first time. 

State data shows that roughly 9.5 million people have been removed from Medicaid since enrollment peaked last April. This trend suggests that Medicaid should go back to its pre-pandemic program size of 71 million members after the unwinding.

Churn in enrollment has long been characteristic of Medicaid. Before the pandemic, an estimated 1 million to 1.5 million people dropped off Medicaid rolls each month.

Many individuals are being disenrolled within a condensed timeframe during the unwinding process. In some states, the situation has proven to be more severe than expected.

The Biden administration at first projected that approximately 15 million individuals would lose coverage during the unwinding phase. However, their estimate was conservative compared to the present data. According to KFF, disenrollments are expected to surpass 17 million, with procedural issues accounting for 70 percent of these instances.

However, roughly two-thirds of the 48 million Medicaid beneficiaries who have undergone eligibility reviews thus far have successfully had their coverage renewed, while about one-third have lost it.

There are, however, significant variations in how enrollment is being affected among states. For instance, Oregon only disenrolled 12 percent of its beneficiaries. KFF reports that 75 percent were successfully renewed, while the remaining cases are still pending. Oklahoma disenrolled 43 percent of its program recipients during the unwinding phase, renewing coverage for only 34 percent. About 24 percent of cases are still pending.

States have varied eligibility requirements, with some implementing policies that make it much easier for members to remain enrolled. For instance, in Oregon, children can remain on Medicaid until the age of 6 without needing to reapply, while all other individuals receive up to two years of coverage regardless of income fluctuations.

Industry experts have expressed ongoing concern about the sharper decrease in Medicaid enrollment among children contrasted to usual trends. This is especially troubling since children usually qualify for Medicaid at higher household income limits than their parents or other adults. According to the latest data from Georgetown University, over 3.9 million children have experienced a loss of Medicaid coverage during the unwinding. 

Utah is the only state to survey those who were disenrolled and found that somewhere around 30 percent were uninsured. Many others obtained employer health coverage or enrolled in subsidized plans through the ACA.

The termination of the continuous enrollment requirement has caused a tremendous impact on Medicaid enrollment. It marks the most significant health coverage transition event since the first open enrollment period of the ACA. Because of varying eligibility requirements across the country, some states are being affected more than others. As they navigate the second half of the unwinding phase, states must make every effort possible to relay enrollment status changes to their program recipients and ensure that their vulnerable populations do not lose coverage. 

Read more here.

DISCORD AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

Government healthcare reforms along with reducing prescription drug prices have been at the top of President Donald Trump's agenda. A quarrel in between the top health officials at HHS is prolonging the administration's healthcare initiatives.

Over the last year, tensions have been building between HHS Secretary Alex Azar and CMS Administrator Seema Verma. The drama between the two officials could be mistaken for an episode from the reality TV show, The Apprentice. The two health chiefs are in a power struggle over policy; moreover, both are claiming credit for the Trump administration's healthcare policy victories.

According to sources, the drama started when the previous HHS Secretary Tom Price resigned in the fall of 2017. Verma was a possible successor to Price but the president chose to nominate Azar for the job. From that point, the two officials became very competitive with each other to advance the president's healthcare agenda.

After Azar was confirmed, a meeting took place in the oval office where Azar went over his prescription drug-pricing proposal with President Trump and Administrator Verma. Verma emphatically opposed Secretary Azar's plan due to its possibility of raising federal spending and Medicare premiums in 2020. Subsequently, the White House ended up not backing Azar's drug pricing proposal.

At about the same time, Verma had spent months drafting an alternative to the Affordable Care Act (ACA). Secretary Azar struck down that proposal before Administrator Verma could present it to the president. Azar strongly believed that the proposal would have reinforced the ACA rather than abolishing it.

Sources also claim that there have been efforts to marginalize and limit Verma's influence by excluding her from policy meetings. In October, Azar allegedly attempted to keep Verma from traveling with the president to Florida for the introduction of a Medicare executive order which was composed largely in part by CMS. Verma purportedly complained to the White House and was eventually permitted on the plane. In addition, Azar has also been accused of meddling in staffing decisions affecting HHS and CMS.

Officials at the White House claim that the discourse between Azar and Verma has hit such a low that they are now resorting to leaking stories about each other to the media. One of the stories involves a stolen property claim submitted by Verma in 2018. While she was giving a work-related speech in California her jewelry and luggage were stolen from a rental car. She asked for reimbursement from the federal government and the claim was met with objection from Democrats as a waste of taxpayer dollars. The other leak revealed that Verma had hired consultants to boost her reputation utilizing taxpayer dollars. According to a CMS representative, "these recent leaks are part of a targeted campaign to smear the Administrator and undermine the accomplishments of CMS."

On December 11th, the White House chief of staff Mick Mulvaney called Azar and Verma to a meeting at the White House to settle the spat. President Trump was not present at the meeting and according to White House officials, the president still supports Administrator Verma but he also wants the two officials to put an end to the drama. One official said President Trump "doesn't care if they like each other, but they have a job to do." The source also stated that neither of their jobs are in jeopardy.

The tension between HHS Secretary Azar and CMS Administrator Verma has reached new heights and the Trump administration has had enough. Their failure to work together and get along with one another is not only postponing the president's healthcare policies but it has the potential to negatively impact the president's 2020 election campaign. Hopefully, the two chief health officials can set their quarrels aside and recognize that their decisions impact the healthcare of millions of Americans.

To read more, click here.

TEXAS JUDGE ORDERS THE ACA UNCONSTITUTIONAL

The future of the Affordable Care Act (ACA) is at risk after a federal district court judge ruled the law to be unconstitutional. On Friday, Judge Reed C. O'Connor (TX) sided with twenty Republican legislators and ruled the law unconstitutional after congress passed the December 2017 tax bill.

Last years tax bill removed the laws Individual Mandate that penalized taxpayers for failing to have healthcare coverage. Preceding the bill, the Supreme Court ruled in favor of the ACA due to the fact that the mandate was considered a tax and an appropriate power of the Congress. However, Judge O'Connor's position is that the law is no longer constitutional without the penalty.

According to Judge O'Connor, "The Court finds the Individual Mandate "is essential to" and inseverable from "the other provisions of" the ACA." Last week, the ruling was reached while most plans were approaching the close of open enrollment. Despite his order, enrollee's coverage should not be affected and a final decision will not likely be made until it reaches the Supreme Court. Up to this point, the Supreme Court has made two constitutional related rulings to the ACA and this will more than likely be the third.

Soon after, Attorney General Becerra and fifteen other Democrats vowed to appeal the ruling. Becerra stated, "Today's ruling is an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA for healthcare, and on America's faithful progress toward affordable healthcare for all Americans. The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court. Today's misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans."

Senate Minority Leader Chuck Schumer commented, "The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned."

According to legal experts, this effort has very little chance of standing up in court and it will most likely be denied. If the order was supported in the Supreme Court, it would seriously affect the nation's health care system given that the ACA touches nearly every aspect of it.

Read more about Medicaid and the ACA here.