The Center on Budget and Policy Priorities' Jessica Schubel explains how Medicaid works, and how the White House is trying to undermine it.
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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Yeah. This is Marquez Brownie Acre, Amphibia hd, and this is Andrew Manga Nellie. We will introduce you to our podcast way, form the new sedition to the Vocs media podcast network, so I've spent over ten years reviewing type Gregson consumer electronics for millions of people on the incubation. to channel and now on the way, form part asked Andrew, and I use that experience to dig even deeper into latest tech for smartphones too. I max to electric cars. So if you're a gadget, lover or attack head or if you just want to figure out whether the latest gadget is worth your harder in cash, give us a lesson sacred fine way, formed the MTV Ftp cats on your favorite, Pakistan ready see over there. Sir Cliff is no longer with us on the weeds, so I've been really missing the opportunity to sort of long out about health care. I was really excited to sit down with Jessica fuel from the centre on budget policy priorities she's an expert on Medicaid, really important, weeds friendly healthcare program that there are a lot of changes happening to aid in the trunk
it really great conversation. I think you tomorrow on a low welcome to another episode of the weeds impacts, media hype, gas network. I met with glaziers. My guest today is just a suitable she's. A senior policy analysed at the centre on budget policy priorities, favorite think tank, a mine, lotta great step out there and just go focuses on Medicaid, which is a very important programme. he's gonna explain it all to us. It's been big. You know that the term demonstration has done a lot on Medicaid waivers things like that. That's like what I want to talk about, but I think is important for people to understand like what we ve been talking about here. So ass liquor, a grey basic question, but what is medicate,
I am happy to answer that. So, just to make sure everybody knows, Medicaid is the health insurance programme for low income people, so I went to establish that aren't. Write offs ever get go it's different from Meda CARE, which is the programme for the early and so Medicaid covers over seventy five million people. I dont think people realise that half of half of the population is action. Kids and another important fact. Factoid of Medicaid is that it's the primary payer for long term services and support. So when your grand concerning the nursing home. They are on Medicaid, as I was talking you know that earlier ago, when my grandmother was in the nursing home, she swore up and down that she wasn't on Medicaid, but actually medicate covers long term care, and that's that was called the dual eligible population, whether that right want speed. Yet for once,
Yeah you further elderly folks can be both Medicare eligible and also medicate eligible, but Social Medicaid comes into existence in their midst, like at the same time as Medicare. They don't have some more names. That's right. They share the same birthday which actually was celebrated last year there fifty four years old and initially it was created on really targeted for low income Americans and as we ve in over the course of its history. There's been kind of many coverage expansions along the way you know. Kids coverage in medications was slightly expanded than we want pregnant women parents and then with the affordable care ACT now, adults right so so the way better care works is like. There's a federal program you get out.
Forehead by being old, and it's the same where we go right right. So medicate is not like the whole point of this waivers conversations. Milk is not like that. So how houses Ceta, yeah, there's an average around in a medic he'd want sphere. Is it saying that if you ve seen one medicate program, you ve seen one medicate programme is so there's two guarantees with Medicaid. I'm you mention that it's a joint federal state partnership, I'm the first guarantee, is coverage. So, if you're eligible for it, you get it in four states on their guaranteed federal dollars. So that's kind of that the to guarantee prong, if you will, with Medicaid the fence, set up our core standard benefit package, a non standard eligibility kind of rubric that states have to follow, but within
it states have a lot of options to design their programmes that mean our best meets the needs of their stay. So you can be more or less generous in terms of your benefits and also more or less generous in terms of your eligibility right. But there is a floor and that's that that's what you have to me in order to get you're here, what we call the federal match, which is a portion of medicate spending that the feds kickin went on? But the reason you might be? Why me? I guess there's more than one reason you might be more generous in them in one, but like you would get more matching federal bowers. If you contribute more state, This way, not necessarily, I mean the way that it is the formula set annually and seascape between fifty and seventy six percent of that of the costs, but what you would get more as if you covered more people like medicate expansion, if you know you'd see more for fun
more federal dollars. If you added a new eligibility group, for example over, so what kind of variants like do we see in in practice like? What's a was a generous state, looking like or in terms of coverage right but like who, who is eligible in a sort of a big, expansion stayed for that narrow one share. So you know now what the affordable care at every state has the option to expand: Medicaid two adults, a two hundred and thirty eight percent poverty. In plain English, that seventeen thousand dollars a year. Unfortunately, in others, fourteen states that have been taken that up I'm a district residents, I'm gonna say that include DC and my count here, safer, counting, there's fifty one states, so thirty seven states have expanded Medicaid so far. So since the enactment of the formal correct, I think when you look at
more progressive state? That's expanded, Ojo. You have to look at kids, I'm pregnant women and generally they are at a higher income level. Then you know the kind of like the moderate level income ashore ogre sober. So this is like classic? U S, welfare ass, he design children are may be held, blame less for the economic circumstances in which they find themselves
so the programme has traditionally covered a wider scope of of children than it has of of adults, and then pregnant women are at a sort of. I don't know how you want to put it, but you know it's like an intermediate yet mean children, adults right of theirs. I, like understanding that, if you want to take care of kids, you have to take care of their mothers while their pregnant at Saint. So what kind of liquid was that? What was the history thou had that come in law? As you said to one, then the programme started and nineteen sixty five. It really focused on in our kids, low income, families like moms but
and expanded to pregnant women and higher income pregnant women is kind of over the years. How things have have progressed and you know they get the standard set of benefits. Medicate is actually the gold standard when it comes to kids coverage provide screen screenings, vaccines, treatment, sofa, kick goes in and has a vision exam and these glasses medicate pays for both the exam. Glasses, and I think we really interesting from the anyways- is that many keyed is in corners of the world that I dont think people realise and schools is actually one of those corners but if Medicaid arm? If there's a medicate enrolled kin in school, needs a vision, screening or maybe needs and speech therapy or physical therapy in order time to learn. Medikit pays for that. How that such a sex or to some of the sort of healthcare services that are offered in school disk
eggs are actually being covered by mitigates. Yeah I mean not to get back into the sea now. How do we intended special education is an funded as robustly as it should and so a medical help, schools actually kind of spread the special education dollars more because they are paying for healthcare services. As part of a child special education programme- okay, so so with regard to children, pregnant women using a more progressive state, will have a higher income cut off to try to make sure that you have, but as far as possible and in short children right, I mean there's also really good evidence that shows that kid's covered by Medicaid, when they're in during childhood are more likely to graduate high school. More likely to grant re College, have better health as adults more likely to have a better paying job pay more in taxes, so there's benefits into, as you were saying, making sure that kids and pregnant
men have and the coverage they need, and so one of the sort of like stylized facts about health insurance in the universe is that covering children is, on average, relatively cheap. Quite an eminent z. There are some children with very very serious health care needs, but typically, when we talk about giving healthcare coverage to a child were talking about doing annual check, ups and vaccines and giving the vision, tests and its stuff that it has a lot of benefits but is in necessarily like super cause Ray it's kinda van, cheap investment, if you ask you ve now makes your kids have the vaccine, so they're not kidding. You know, measles have the glasses that they need, so they can read and that's just gonna make them healthier adults that are able to go to college and get a good ping job, and so it's kind of a cheap investment in their long term development. But this is not what the the easier expansion
rate is about that's about adopt childless. I guess he know it. It doesn't matter. If you have a child or not it's just you are an adult. I've been many benefits right, like housing, assistance, food assistance it's like. If we want to help children, you have to give it our family level, but medical care not like that right leg. You can actually pay for the kids doktor visits, but not my death rights exactly into I think that's. What was so amazing with the affordable care act is that it was actually, if you want to think about it. The first kind of step towards universal coverage. We were laying down the framework for covering every low income American through Medicaid, where and unfortunately in our, we still have ought always to go with those fourteen states that need to expand towards is forging Satan, and that includes
eggs in Florida them big straight. That's right, and so that's I gotta do you know like how much of the uninsured population the? U S is accounted for by this serve like lack of mega expansion with those so there's two million people that will gain coverage if states word on expand renegade and am Florida and Texas make up the majority of those folk were so so that so that the big day there, ok so within. What's this, the peace with the elderly and and long term care because so far we describing its programme for low income people can't it covers more children in some states, its now covering poor adults, but by what yeah? What's up at the old yeah, I think it's gonna take a step back also, I should have mentioned earlier. The way I think about Medicaid is its and provides coverage at every stage of life. Rightly just talked about kids. You know when you are present,
and you get coverage when you're our inner before the advent of the enactment of the affordable, correct, Deanna be apparent, but a covered some adults right now all adults are eligible and then, at the end stage of life right when you are elderly, it covers the nursing home care back of it and there's really cool options that states have to provide long term care in people's homes and communities and there's lots of evidence that show that people want stay in their homes as long as possible and actually do better in their homes and twenty thirteen. The Marquis programme had a miles. Where it's been actually more money on community based, long term care, then in nursing homes. So that's a big, a big! As you know, a lot of people with a long term care benefits are people who you might consider to be some middle class right, re Americans there to help. I'm folks
You know who are may be making a lot about more money during their their kind of working years that they have programmes where, if espoused, for example, needs to go into nursing home, then spouse. It's still com. You know, isn't going to become destitute, meaner by paint you know paying all these long term care bills which are very expensive okay. So what is that? The concept of the waiver in this landscape guess so far. We're describing a piano like America's weird we have. Let us state federal kind of matching things, but you know it makes sense there's money available states, have some flexibility about eligibility and and and benefit design. What what? What is a waiver yeah? So going back to? When I talk to you, about earlier that you know, the federal government sets kind of the floor in terms of benefits and standards, and there is obviously federal law on me. You know that require certain things to be covered and people.
and so what a waiver is? Allow states to kind of break the law in a way and do something different, but you know what The legal standards in approving a waiver is that it has to further the objectives of the many keep programme and the central tenet of medication is to cover low income, p and provide coverage. So what kind of minimums are we are we talking about like? What's that? But the issue so in terms of an alleged billowy and what we are seeing now is that the trumpet Ministry? Japan is using waivers to take coverage away from people, so we ve been seeing work requirements. For example, and you know, there's been some apt.
Mystic news, in the sense that arm recently on the courts, have vacated these work requirement, waivers in Arkansas, Kentucky and New Hampshire, but it unfortunately was a little too late for about eighteen thousand people in Arkansas because they lost coverage of it. But so what's so, it sounds like you're not in favour of public works. Oh let's get him. Can you paint a picture of like what so what's a reasonable waiver requests? I share out: how does it further the goals of the Medicaid programme to say you can go below the minimum benefit level? Well, That's, the million dollar question. That's being decided, and in argued in court meter my perspective is that a good waiver, a waiver that furthers the objectives, is actually expanding coverage
and a good example of this is historically before the federal care states would use these waivers to expand coverage to long from adults that are now being served by the medical experts. so states like Arizona, New York, Massachusetts Wisconsin What all and use these waivers to expand to. You know adults, to low income, adult that don't have kids. What what would you need your wave to be able to do that? I'm it's actually
Our very wonky thing, there's two components of waivers one, is that your waving federal law centrally allowing states do not comply with certain provisions of Medicaid LAW, and the second component is authorizing healthcare costs that would otherwise be Medicaid. Reimbursable, sir, because before the affordable care act, low income, adults, weren't generally eligible format, Kane you needed Special Authority authority for a state to say. Ok can I have some near a federal dollars for covering folks enemies? I guess, if you you know, I like the idea that the left us take over the state legislature somewhere and say we want to take like another rhyme. No single, better healthcare system like they're gonna, want to try to get some of the things we have to raise taxes and do a whole ringing, but but they're gonna want to try it
get some federal money right and so they're gonna have to have to try to write someone a waiver. You know there's lots of smart people. Thinking about that, I guess, depending on how they want to set it up. You know. Medicate could be a factor in that language in that proposal is like the the money, the basically doorways eggs of theirs for our money. It states are getting and you want to do something with health care. Like you, you're gonna alleys want to try to get more money. Sure and the other thing that give going back here and national question about like what's a good waiver and there's really cool things that states are doing to, you know improve health and lower costs through delivery system reform efforts and in other states like New York in California, that are trying to do different payment arrangements to incentivize providers to per
I do know better care at lower costs, and so you know that's kind of in my mind what what a good waiver of is so is it would what it would. What does that mean? That's like a standard set up is like this a list of procedures, and they all have You know payment love, all they get forehead and it doesn't matter by in all of the work, Sir whatever else well in terms of like our kind of more traditional medico, Graham yeah states have flexibility to set their payment rates at Munich, whatever level that they decide. But I think the key thing to remember with that is that they have to be at a high enough level to ensure access, and I think you know, what's really disturbing recently
is that the Trump Administration actually rescinded a rule that was finalized in twenty fifteen. That would make sure on these provider rates are sat high enough to ensure access for folks everywhere to read. This is worth talking about sue. You have private insurance. Usually is so much for things. Many care usually pays a lower rate better than that and takes advantage of the fact that its really egg and then made a K. It varies from state to state, but but the rates are lower than Medicare raids and a lot of doktor, like relatively few providers, can afford to turn away Medicare clients even other taking a discount but like the Medicaid rates, get so stingy that some providers will turn them that, while I think one point I just would like to argue with less our
that seventy percent of doctors actually do except medicate patient. So this idea that in our medicate patients, aren't you know, I don't have access to. Doctors is unfounded, but yes, you're right, medicate does set their payment rates, You know a little bit lower than than met many Karen indifferently commercial coverage but we're saying ready, I mean the state could, or maybe there was a twenty. Fifty rule to say: ok, you have to set at high enough, then add another word, but I soon it's like some percentage of providers are gonna. Take it or yeah we sent actually sent at the kind of like then that action, to services that we were? The United States had to make sure that their rates you know and that access for those particular services were sufficient. That people know Ino had access to these provider,
So now one stingy option would be to like keep all the eligibility rules the same, but just keep putting the rates down. Or in lower and sort of hookers well below and lower. To the extent that in our, I would hope, seem password. look at these and say hey the seams weird, and you know it- see. Might these rates are higher enough to ensure that people can actually find a doctor to go? See? Ok, look! Let's do it egg and then we come back. I want to dive into medicate waivers and work why we live with a lot of noise between the pings, the dings, the emails labelled urgent. That aren't really that urgent, it's hard to cut through the static zero on the things that really matter just like. We can train our bodies to be better running faster or lifting heavier. We could train our minds to stay focused to all the noise we live with step. One download head space hits Mason loaded with guide you meditations, designed to offer a daily dose of mindfulness concessions for every situation like three minute s away
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so which, which states which states have done so. There are six seats, and that have waivers approvals that I mentioned concerning New Hampshire in Kentucky there's, our kind of set on the side. Arizona has we're climate waiver, as does Utah Wisconsin and Indiana. Ok, and so what is, though, that the idea of this is that it will get people to work. That, apparently, is the idea that there is actually evidence recently that from some hovered researchers that took a look at the situation in Arkansas and said actually We don't see any impact on employment, but what
we are seeing is as a higher rate of uninsured folks in Arkansas and where that makes sense. Eighty thousand people last coverage, so so they lost coverage because they were talking about people who are not working had been enrolled in Medicaid, and now they lost coverage and they were not suddenly inspired to go to go get jobs. While I think I end, can you wanna impact that in a couple of ways are still the first one? Is that the majority of many keep any fisheries are in fact working so that the reason for eighty thousand people in coverage has to be more than the then. Just you know, people not working choosing not to work right. There's gonna be in that number. There's people that are working but didn't me the thresholds on Arkansas people have to work eighty hours a month to maintain their cover.
So think about someone that may have seasonal employment and dry or just might be working at store or a restaurant in their hours fluctuate, and they just in that, given money. Just didn't make the eighty our threshold, so therein that eighteen thousand group there working just not eighty hours of that month. The second bucket of people are people that should be exempt from work requirements, so think about folks that have a chronic conditions that makes work just not possible or disability or might be suffering from substance use disorder. They have to get an exemption, but now. There's lots of red tape and I was actually reading a really interesting article up in the conqueror monitor up in New Hampshire, where The woman was trying to get. You know an exemption from her primary care doctor and they
Sorry, you need to go to it to your nurse surgeon together and the nurse surgeon said. No, you have to go to your primary care doktor. So there's lots of red tape and people are getting caught up in that the people that should get exempt from the work requirement were so I mean, if your leg you're an addiction recovery and you have trouble getting job and you need medical treatment and might get better. My for father same reasons, you might also struggle till I get it together. Its exact and I get all your forms exactly and in, and it also extends the third package of folks- and I want to talk about- is people that are working, but we're just really confused about what happens with how to reports there
wars and there is a perfect example of this. A gentleman in Arkansas and Mr Miranda Gall had a job but also had Seo PD, which has arisen, retorted disease and needed Mundus in order to function and go to work. He works eighty hours a month reporter. That's why months and thought he was good to go, didn't need to do any more reporting, you know in any subsequent month, but in fact, you'd have to report each month. He just realized. Ok, so that work, that's actually fastening. So it's so it's like a month to month thing we're like each month you come and say, ham, stork rights and, in his case, Amiens, fascinating, but heartbreaking at the same time, because he went to the pharmacy up his medicine, pharmacists and hey. Sorry, your medical coverage is no longer effective and do want your medicine, but of course it's really expensive, so he said no.
and ended up missing a lot of work and lost his job. So it's the exact opposite of this promise that you know somehow working well. You know how you get cover and give him I think it's important for people to understand that you know when you think about policy is right. You can even serve describe them in the abstract, but they're, not self executing right. So, like you know the other week, I got an angry phone call from my bank because there have been like an auto it of my electrical bill and my balance again below zero and like a bit like, I wasn't actually out of money rain, but I had just like master pray. I had forgotten, which account this thing was from I'd forgotten, where I paid a credit card from and the money was in the wrong ready right, and so you know is
bad. I gotta, you know what my bank yelled at me. I think they charged me five dollars, but is not the end of the war right. I didn't lose health care for a month because I had mess that saw well what's worse in Miss mechanical case. Is he didn't lose health care for distant month, he lost the further as the year were. All what so he couldn't get behind her back onto coverage until January. You now and he lost cover, at some point during the file, so it was more than just a month of of coverage lies and what we did. This come from my. What was the the the idea like what what what what what are state governments that are doing this trend of respond to and quite frankly, I'm not
Were you know, I think it's just this political ideological idea that arm of of personal responsibility- but you know, as I said, you know, work requirements are showing but there's money increase employment Ino in Arkansas, where they have actually been implemented. So I mean this goes back just sort of old disputes in american welfare policy. Where did you suddenly? We ve got Madame another's episodes of the weeds. As you know, there used to be a family should dependent children programme. There was a lot of controversy. There was a big welfare reform and you know I think the the thinking of the Clinton administration there at least, was that there was a special politics of cash benefits right and that cash benefits to non.
Working people, we're gonna, be politically vulnerable, but that in kind assistance you know, might be more sort of sustainable ride, the idea being that nobody is like, and it isn't going to the doctors and fine raids they're gonna? You could take money and my go. I don't know why, but you know by some beer ride haven't party You go to the doktor when you're sick, primarily red zoo, can be. the digital universe in which your livelihood is like getting medicate re. Anything, that's part of the room during the nineties during US economic buffer reform period, Medicaid was actually kind of divorced from
on the other. In our assistance programmes that help low income families- and so you know, I always view Medicaid as its health insurance and we should treat it as such and you know imposing work requirements it was on pressing TED, I'm in our actually, during the last year of the Obama Administration CMS the federal agency that oversees medicate, and denied work requirements in Arizona and New Hampshire, saying going back to the to the beginning that work requirements don't further the objectives of the Medicate programme, which is the standard under which you know the feds have to review medicate waiver proposals, but so that this is even if it doesn't generate extra employment, it does save
money right. I mean if, if ie, if eighteen thousand people in Arkansas wind of losing Medicaid, benefits whether that's because they're not working because of paperwork problems, because whatever ride like that's a that, the savings on the step, but yes, but that eighteen thousand people that no longer have coverage, and so when you talk to maybe hospitals and doctors there now having to treat people that no longer have insurance, so their uncompensated care costs are going terrorize. So it's just going somewhere else in the system, meaning that the in our hospitals and doctors are going to have to eat a because no one has coverage anymore and Edgewood just adjusted to be clear on this, because we were starting by talking about the sort of Benny Universes of of Medicaid. This is for adults. Sierra ahead set this the set the stage here. This is for the expansion adult so those adult without kids,
make up to seventeen thousand dollars a year answer that helps explained like what is this list of states where these are like kentuckian organs on particular right or very politically conservative states that, unlike many of the other conservative states, actually did the medicate expansion right cause, like I think. Sometimes you know you can hear. Oh there's this site Kentucky work requirement thing and that's like. Ah, these Kentucky politicians must be you know, unusually evil or something, but it does actually arise at the fact that Kentucky did the expansion, whereas, like Mississippi in Alabama, have it like they did. They don't even have a population they can take benefits away from that. That's right yeah. They just simply have an expanded their one of the fourteen. That of yet yet to take up this option, Kentucky organs or had democratic governor swayed when they first expanded
he has said. This has been like a way to do a partial walk back of that expansion yeah, I think, particularly in Kentucky, is case and because Kentucky really the gold standard in our in terms of having a great system of e in our able to use. One therefore will correct took a fact in January of Troy. routine and they did everything ray and now you know you're, seeing kind of, as you said, a roll back of notches work requirements, but the other kind of restrictive policy that the trumpet ministries
There's really moving forward on is hiking up premiums for low income people, and so you see that in Kentucky easier in Arkansas and some of these other in our red states, how does that work so ugly, this government programme, it's gonna, give you health insurance. If your poor, why would have a premium while it it generally for most people it it doesn't under? This is why you need them. The waiver right,
do something different to break a kind of federal law and that in that respect, and so you now to be fair, the abundant instruction did allow states to impose minimal premiums on on the expansion population. But what we're seeing is that the Trump administration is not only charge letting states charge more, but there also charging even poorer people these premium, so the wood, the Obama administration. This was part of the sort of political negotiations over expansion of remember incorrectly right leg, it first they had thought okay. This is such a generous deal.
All the states are going to do it and also there was this claw back provision that was supposed to really really make them do at re, but then the young, the Supreme Court, like throughout the claw back Fang. I then the political resistance was, I think, bigger than they had anticipated right yeah. So so they came up so they reached compromises in some places where they said. Okay, like we will let you do some of these changes, premiums and and stuff like that, that's right, but it is,
always and either the guiding star in the IRAN. Restoration was trying to get as many people covered as possible, and so in that constant. In that context the compromise was okay. Well, you know allow you to test these new kind of models. So long as you know, coverage is expanding rapidly. They ve got the push ample was like Obama wanted states. Do medical expanse writes a lot of Republicans. Didn't wanna do medicate expansion, so he was making the right. I mean Indiana
then Governor Pence, expanded, manikin and but also in a kind of made a deal with the abandonment shaken to do something. Different didn't have work requirements, though at that point, but so, but the the head of CMS is so. My pens brought over from India Right right was a what what's happening exactly with the premium. So, as I said, there are just letting states charge higher amounts and kind of like going to reach folks further down the poverty line. And what happens when you do? I mean to some people, I guess they spend more money. The state save sick or, I guess, collect setbacks revenue, but I mean to do. People does not sign up yeah, that's exactly right. There is a robust body of research that shows that premiums deter people from beginner getting care and.
but you're, seeing as people just not enrolling into the programme or not going to the doktor, so it it's really not an effective tool for six years right, but but I mean I guess then again just like the look of falling back on the politics. I mean this. Is this they that same tug of war random and you have an administration that is not invested in Medikit expansion happening and you have that same imperative to like not expand from the non expended states enter and apparent back elsewhere. Yeah me, I would say the same
Fred then am champion and shaken. Not only doesn't support expansion but they're really trying to take coverage away from people, which is what worse meaner, seeing what the worker crimes wait until June. No, you said the what what are this kind of prospects for stopping us and in court, and I felt the whole idea of like you could just way you I don't know like the great society programs out of existing is the law. It was like a little new to me. Went when they started coming up, but a couple years ago yeah, I will say that not everything in the Meda Ii Programme is up for grabs right, so just to set your mind Everything is now on the table to tv. You know waved in terms the litigation with the work requirements, as I mentioned in the court's vacated, the waivers in Arkansas Kentucky New Hampshire Vessel
your car and what we re and Sarah that the next round is coming up in October for oral arguments so well wells see what happens in October. Eleventh is the day actually other, but so this is gonna. We gotta see whichever Albert's thinks. I would imagine that it would go up that far yet wetware right, and so you don't do something that you you, on the internet, if you, if you who go around, is there's a there's, a conservative view that all this medical staff is like nonsense and medical doesn't like actually doesn't help yeah, that their claims that those folks are using it's just false, and there is a robust body of evidence showing the opposite. I think
You know, I'm not personally, was very upset and to see that the Supreme Court in our main medicated expansion, effectively optional, it did kind of Crete. This natural experiment right, sir we're seeing all these studies are showing what the changes in state said: expanded relative to those that didn't and were seen manikin expansion is saving lives and there's a recent report. Our dead said: if the fourteen states had expanded over fifteen thousand lives would be saved. I don't know that's a pretty compelling statistic, re yeah, because this is so so that this country can come from this old things are happening in Org right ready. I forget exactly why it happened with a grin money or something and ate it, so they they had a randomize who was gonna get Medicaid it wasn't they ran out of so they used a Medicaid waiver and
you now again going into the weeds of waivers? There is this thing called budget neutrality, which means that states can to the federal government can spend more than it would absent the waiver of and so well. Organ was trying to do was provide additional benefits to folks, but they had to stay within. This budget needs quality limits, and so they INA created a prioritized list of benefits, and so you know that's the study that you're referring to that but so they what they wound up doing a lottery hand behind every lottery. There's a good research opportunity right and this one showed that there was not a like a change and in Health Oak Xray, then, maybe so, but the body of evidence that we spend seeing her past couple of years with medication expansion points. Otherwise we are seeing improvements in health outcomes.
in a reduced, our racial disparities, pretty growing cancer treatment. You know one of the interesting facts that I find about. Medicaid expansion is that it's actually improving people's credit score and that's because having coverage reduces medical dat and medical bankruptcy, so improve credit score is actually helping these in a low income. People of mortgages and car payment. So again, going back to her. Medicaid is in little corners, the world that you didn't know about, who knew medicated mortgages where it again You mean, I always do think that's important, because even in these, these, this organ study that I've heard of firm from conservatism in it does show that improve the financial while being families got it and if you think about insurance in general, eminent insurance is a financial product right, obviously with health insurance like ultimately the goal
to get useful medical care, but there. But the financial value is not like a trivial thing that you would wave on them and I think all the time I have I have four year old son and you know like all four year olds, he has been to the doktor of like a bunch of times, and I bet if you went through some like science counterfactual, you would see that it has actually not had a meaningful impact and gives cause like you know. God bless like he's. Had good fortune and lighting hasn't had any medical problems and he's gone too, while these check ups and they keep saying. Oh your fine, But it's not like my fall back to having like. If I'd had a less generous insurance, passive we'd had higher. Compliments are higher deductibles. I wouldn't have just been like that. No pediatrician, you like, I would have spent more more money right or if I was too poor to afford it. Then I might not have gone, and I would have been incredibly stressed out
we re all that time right and so it's like being able to go to a doctor when it seems appropriate and not have that bankrupt. You is like a really useful thing. Over and above the value of treatments said that sick people were see ray and to your point about having means said, pay, maybe a higher co payment, and you know, there's lots of research that shows that copies and Medicaid am deter people from going to the doctor. What so it's kind of that pushing pull. Do I pay my rent or do I pay for my kids? You know prescription right. Let me this has been like a big. What I mean I don't know. I feel it has been a kind of like back and forth in the thinking on their sunlike were people over consuming
Health care, or you know, since it should be at the Madrid thanks to expansion, we now get to compare right health outcomes in Arkansas, Verses, Texas, Texas gets those are bordering state, yes of Louisiana, verses, Alabama read an end so, and so what? What? What are you? What are we? What have we seen on that? That that you really point people too? It has been brought up Louisiana. They have this really great dashboard each month they up data and show how many people got cancer screenings and how many averted dasset. You know they projected because of these cancer tree of screenings. How many people now access to you, no blood pressure on us and to lower their their height their hypertension. So it's it. We are seeing that coverage matters and coverage is actually helping people and improving their health. So that's been. A sort of
I mean this again, a big it's, a political issue in Louisiana is again. The conservative state has a democratic governor he's, like trial run for real action once the sort of so do it, but also what what does it do to state finances ride? Like I mean I assume, like always with you. No programme for aid is like it sounds nice, but this this costs a lot of money to Yale LAW as we started after the show. Here we talked about how it's a joint federal state programme, so the feds kicking a portion of a mannequin funding for medication and expansion is a really great deal first states because the feds kickin ninety percent much higher than like the regular
ray in which they, they Japan, so states urging on the hook ten percent of of cost, which is not to say that it's not you know a meaningful amount of money for states, but I think what s really interesting is that we ve seen expansion, help state budgets and on one example, is that states are able to offset costs from state programmes, as you know, were treated behavioral mental health issues or the criminal justice system, for example, somewhere and schools as The stock of earlier so we're seeing that Medicaid and many he'd expansion are really help is helping state budgets and kind of moving the money around we often ask me of prosecuting the mob is like the movies. Well
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so another aspect of this has been controversial right some states. First me in and you Tom Idaho, there were states that had done expended on ballot in it. And then the governors aren't doing it yeah it's kind of our pricking test, we were in the will of the voters as being overturned by state legislatures. I think you know the great example you just mentioned. You tie the initiative passed in November the alarm. Kirsty policymakers got together during the winter time and completely changed and rolled back with the voters wanted
So now we are seeing you. Tar only cover a portion of the Medicaid expansion population, which is covering fifty thousand people fewer people and costing the state more money because they're not able to get that ninety percent In a federal, but so what happened? Army, like literally they just like, got together and passed a law that over road the initiative? Yes, weapons, hurry, nice Ok version of it so a bit and something similar happening in Maine, but now they avenue Governor ride so right is also removed.
One, governor mills, started expansion and they're they're moving forward; ok, so so, but but before I let you go, you know I, like ass people, come in what what? What? What should? I have asked you care. What were we miss here, while I think the one thing that we didn't talk about, other it's been a topic on your show is that the law suit that's going on in Texas that were completely overturn the affordable care act? That is an excellent point we didn't mention. So if, if, if I can just talk, what would happen to Medicaid. That would be great yeah, yeah yeah. No, actually I we should remind people in case you haven't. You haven't seen earlier discussions of of our friend MRS Lawsuit, the theme here, is that the affordable care ACT contains the individual mandate, which lying time american politics fans will remember and
the Supreme Court ruled that the mandate was a constitutionally permissible exercise of taxing power. Then in the twenty seventeen corporate tax cut Bell a eliminated, the penalty that the way they did it to qualify for budget reconciliation rules was they set the penalty to nothing. So the theory is with the penalty at nothing. It is no longer a tax, but it still on the books. So it is now an unconstitutional non tax and also it is inseparable from the rest of the law, so provisions that are completely unrelated go away and that's her again medicated rights. Anything tier
wonderful explanation of vote of the arguments here. I think many opponents of the fordable correct, even they even agree that this is crazy and the administration took the unheard of staff in not defending the affordable, correct, a federal law and instead is arguing that it should be overturned, and I think you know, there's kind of two to buckets than I kind of Wanta. Just talk about. One is just the impact that's gonna have on people right, I'm not kind of a private insurance market place person. But I will just five that twenty million people are groundless coverage, that includes people, medicate expansion and those that are by coverage on the Obama CARE work at voicing. What's what's the balance of that? Yes, so thirteen million are medicate, expansion will join. You hear this easier: lawsuit is gonna cost one million people insurance as planned. early Merrick. Parliament, primarily Medicaid, I'm in
so going to allow ensures to go back to denying care. Or charging people more money if they have a pre existing condition, but I think the other two components I want a flag that was released to Medicaid people is that it could roll back coverage for kids and so one point. Five million kids could potentially lose their Medicaid coverage However, this bold, the Fordable CARE Act actually expanded on eligibility for kids as part of that core eligibility requirements for the states have, and you know some of these kids might be able to be covered and other insurance programmes. Lake chip, which is the children's health insurance program, that kind of sits on top
medicate shoulders. If you will, but under chip, they have a narrow benefit package and its eye has higher cost sharing. So it's not as good as an option for these children as Medicaid and the second group, I run a flag our elderly and people with disabilities, so the affordable CARE Act arm had a lot of different programmes and options for states to move towards more community based long term care. We talked about that earlier and all of those options. What would go away, and so that would mean seniors and people with disabilities would have would would be, may be forced to go back to the nursing homes for care instead of staying in their homes and the second kind of other bucket, if you will of of impact that this lawsuit would have on medicaid- is that it would just tree in unbelief
the ball mass. Yes, so I'm the affordable care act, modernize and streamlined. How states do eligibility conduct eligibility, determinations and Medicaid the feds, the states millions of dollars. Updating I t systems too, to accomplish this streamlining effort and if the affordable characters overturned state will have to go back to a very old and complicated way of deterring medicate eligibility, I'm not even sure. If they can, you know resuscitate
world. I t systems, so I'm not sure how states are gonna administer their programme of twenty million people Devereux losing coverage, chaos throughout the rest of the system, right, anarchy disaster casting our right. Ok. What would that reassuring thought? Thank you very much. A feeble said, our budget policy priorities, and thanks as always to our sponsors and to our producers, every gold and the weeds will be back on Tuesday.
Transcript generated on 2021-09-10.