In Focus: Refundable Tax Credits

Jul 20, 2017  |  PERMALINK »

Repealing the ACA is Still a Bad Idea

By Suzanne Wikle

Following the latest collapse of the Senate proposal to “repeal and replace” the Affordable Care Act (ACA), Senate leadership has revived the idea of simply repealing the ACA. The repeal would be effective in 2020, leaving two years for Congress to craft a replacement. However, Congressional Republicans are no closer to developing a viable ACA alternative than they were six months ago, and a repeal-only bill would destabilize the insurance markets and put health care at risk for millions.

The Congressional Budget Office (CBO) estimates the repeal bill would cause 32 million people to lose health insurance by 2026, which would mean more uninsured people than before the ACA. And the impact would be immediate, with 17 million people becoming uninsured in 2018—a mere five months away. The bill would end the ACA’s Medicaid expansion in 2020; in 32 states (including D.C.) this provision has covered 11 million low-income Americans who work hard but struggle to make ends meet

”Repeal and delay” is not a new idea, it’s just the latest grasp for a “win” by Senate leadership. Originally floated in January, it was quickly dismissed because of the harm it would cause to both individuals and the health insurance market. It should swiftly be rejected again for the same reasons.

The CBO has issued an updated assessment of last week’s Senate repeal and replace bill, which confirms that it would leave just as many people uninsured as the previous version. Senate Republicans have also released yet another version of their bill. The “sweeteners” in these bills designed to reach wavering Senators are far less than the deep holes in state health care budgets that would be left by the Medicaid cuts.  Instead of continuing to hunt for the needed votes to pass their disastrous and unpopular bills, Republican leaders should start over. Seventy-one percent of Americans favor a bipartisan effort to improve the ACA, and the support for repealing the ACA is at an all-time low.

Congress has some clear steps for truly improving our health care system. For starters, Congress can extend the popular and crucial Children’s Health Insurance Program (CHIP), which provides health insurance to eight million kids, before it expires on September 30. Beyond CHIP, Congress can make real improvements in increasing health insurance access and affordability by offering assistance to low-income workers who have trouble affording the cost of employer-sponsored insurance for families, which would fix the so-called “family glitch.” In addition, Congress could fulfill its promise to insurers to make cost-sharing reduction payments and also incentivize additional states to expand Medicaid. At the same time, they should continue to reject any proposals that would cut Medicaid or increase the total number of people without insurance in the United States.

The people have spoken loudly and frequently: they want affordable health care and they want to preserve Medicaid. It’s time that Congressional leaders listen. 

Jul 19, 2017  |  PERMALINK »

In Midst of Health Care Turmoil, States Step up for Immigrant Children

By Lena O’Rourke

The future of federal health policy feels uncertain right now—but for low-income children the need for high-quality health insurance has never been more urgent. Because governors, lawmakers, doctors, teachers, and parents all know how important health insurance is for the wellbeing of children, they want strong policy that provides coverage to children. So despite the partisan bickering at the federal level and the ongoing national conversation on health reform, an increasing number of states are using the flexibility they already to have to cover more children.

States are taking action because they know that having health insurance leads to better access to care, lower financial burden on families, and better health outcomes. When compared to those without insurance, Medicaid recipients are significantly more likely to have a usual source of care. And people with Medicaid are just as likely to have a usual source of care as those with private insurance. Simply stated, children need health coverage to thrive. Yet, many immigrant children must wait up to five years to get basic health care assistance due to restrictions established in 1996.

States understand that the benefits of health coverage to children are immeasurable. When children have coverage they can get needed services—and their families no longer worry about financially crippling medical bills. States benefit by having healthier children who are ready to learn and stay in school, who can access preventive services, such as immunizations, and who will contribute in the workforce as taxpayers.

Many people in the states know this and are looking for ways to support all their children because it improves their health today and into the future. And they are succeeding: in the last month we have seen two more bright spots of expanded coverage for children.

This week, Oregon will enact the bipartisan “Cover All Kids” legislation that will expand access to affordable health care for more than 17,000 immigrant children.  This was the result of a multi-year advocacy campaign led by the Oregon Latino Health Coalition and joined by 100+ organizations. These children will now be able to get coverage regardless of their documentation or immigration status. And they are joining California, Washington, New York, Illinois, New York, Massachusetts and the District of Columbia, all of which have already made this commitment. 

The Nevada legislature also voted this month to allow lawfully present immigrant children to enroll in Medicaid, dropping the ill-informed five-year ban on these kids getting access to coverage.  Once implemented, Nevada will join 31 other states (including the District of Columbia) that have used this authority to expand coverage to immigrant children.  Nevada estimates that 5,000 lawfully present immigrant children will become eligible for Medicaid.

Notably, an amendment to the Nevada legislation does allow the state to reinstate the five-year coverage ban if federal financing for Medicaid and the Children’s Health Insurance Program (CHIP) is slashed. Nevada will receive the enhanced federal CHIP matching rate—a substantial investment of state and federal funds. This underscores again the importance of rejecting federal efforts to dramatically and permanently reduce federal Medicaid spending. Cuts in spending would force states to eliminate coverage for vulnerable children and take a step backward in the equitable delivery of health care for lawfully present children. In the meantime, we applaud Oregon and Nevada for making a smart investment in the future of their children—and their state. 

Jul 13, 2017  |  PERMALINK »

New Senate Health Care Bill Isn’t Really “New”; Still guts Medicaid and risks coverage for millions

By Suzanne Wikle

After failing to garner support for their first health care bill the Senate Republican leadership has released a new bill, tweaking the language in an attempt to pick up additional votes without making any substantive changes that would increase access to meaningful coverage. As CLASP has stated before, the Senate bill cannot be “fixed.” It needs to be scrapped.  Instead we should have a thoughtful dialogue about how to increase access to affordable health care for all, including those who are working low-wage jobs and struggling to make ends meet.

The new proposal still slashes Medicaid, resulting in a dramatic loss of coverage, and placing extreme burden on state budgets. The independent Congressional Budget Office estimates that the previous version of the Senate bill would have caused 15 million people to lose Medicaid coverage by 2026, and the new bill has no changes aimed at preventing this loss of coverage.

Proposed changes to how Medicaid is financed – both through a per capita cap or a block grant – are a significant cost shift to states. Under the previous bill, states would receive 35 percent less funding for Medicaid over the next 20 years. This would cause states to reduce benefits (such as prescription coverage), create waiting lists for care, and raid other parts of their budgets to help fill the void of federal Medicaid dollars. Postsecondary education funding is likely to be the victim of shifting more Medicaid costs to the states. Additionally, the bill maintains many other provisions that would gut Medicaid, a critical safety-net program for poor seniors, children, and persons with disabilities.

The changes to the bill that supporters claim would make health care affordable would only enable people to buy “bare bones” coverage. Such coverage would not provide what most people need in order to seek primary and specialty care, manage chronic conditions, or receive behavioral health care.  Moreover, because healthy people are more likely to choose such minimal coverage, this is likely to result in much higher premiums for those who need more comprehensive coverage.  While the bill removes some tax breaks for the wealthy that were in previous versions, it retains many others, and expands the opportunity for the well-off to use health savings accounts as tax shelters.

Touted as repealing and replacing the Affordable Care Act (ACA), in reality this bill is a smokescreen for eliminating health care for millions of hard-working but struggling Americans – including many who were covered under Medicaid before the ACA became law. Many senators have rightfully voiced their concerns about gutting Medicaid and maintaining important provisions in the private market (like protecting people with pre-existing conditions). The new bill does not resolve those concerns and should be swiftly rejected.   

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