Daily on Healthcare: States press ahead with reshaping Obamacare Medicaid expansion

STATES PRESS AHEAD WITH RESHAPING OBAMACARE MEDICAID EXPANSION: Several state legislatures this week are working on major changes to Medicaid — both expansions and reductions — underscoring the significance of elections and politics for healthcare coverage. In all cases, lawmakers are working under the condition of uncertainty regarding whether legal and regulatory restrictions ultimately wipe out their efforts.

In Kansas, the state House today is expected to have a final vote to advance the Medicaid expansion that is allowed under Obamacare, and that is a priority for Democratic Gov. Laura Kelly. The expansion is expected to cover 150,000 more low-income people at a cost to the state of between $33 million and $47 million a year — after the federal government picks up 90 percent of expenses. The expansion would roll out in 2020, and it’s not clear yet whether the Senate will give it the green light. Medicaid expansion in Kansas was stopped before, when Kelly’s predecessor, Republican Gov. Sam Brownback, vetoed the expansion in 2017.

Republicans on Wednesday were successful in altering the expansion by requiring that families pay premiums and by banning Medicaid from covering abortions. The abortion provision does not have exemptions for rape, incest, or when a woman’s pregnancy threatens her life. The bill moving through the legislature also adds a “trigger” law in case the federal government ever dials back its share of Medicaid expansion funds.

Meanwhile, legislation moving through the Iowa Senate would require certain Medicaid beneficiaries to work or train for work as a condition of being allowed to stay on the program. The state hasn’t done a full analysis about how many people would be impacted, but an estimated 70,000 of those who received coverage because of Obamacare’s Medicaid expansion might have to comply. The state would have to bring in more workers to run the program, which would cost an estimated $5 million in its first year and $11.9 million in its second.

A federal judge is expected to issue a ruling on the legality of work requirements in Arkansas and Kentucky by the end of the month. Depending on how narrow or broad the ruling is, it could put a stop to other state programs that are kicking off this year, but legislatures may continue to press ahead if the case is appealed.

In Idaho, where voters approved Medicaid expansion through a ballot measure in November, the state House is advancing a bill that would also tie work requirements to the program and would make people who are above 100 percent of the federal poverty level go onto the Obamacare exchanges. The arrangement of the latter program allows the federal government to pick up the costs of medical coverage, but it means that low-income customers will likely have to pay for some of the cost, in the form of co-pays or deductibles, when they seek care.

States are moving ahead on these so-called “partial expansion” arrangements even though they haven’t been approved in any state yet. The Trump administration would need to authorize the plan, and both conservative and liberal policymakers fear what would happen if states were allowed to shunt more residents off of Medicaid. Conservatives are concerned that the remaining non-expansion states would begin to consider expansion — as is happening in Georgia, for instance — and proponents of keeping the status quo don’t want states that fully expanded to look to scale back. Massachusetts, Arkansas, and Utah have all asked for the administration to approve a partial expansion.

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HHS SUED OVER MEDICAID WORK RULES IN NEW HAMPSHIRE: The National Health Law Program, New Hampshire Legal Assistance, and the National Center for Law and Economic Justice on Wednesday sued the Department of Health and Human Services on behalf of Medicaid recipients who would be affected by New Hampshire’s work rules.

The lawsuit is similar to the ones in Arkansas and Kentucky, and accuses the Trump administration of taking authority that it doesn’t have. New Hampshire’s work rules, which are otherwise set to take effect in June, require beneficiaries to work 100 hours a month as a condition of staying enrolled in the program. The lawsuit also seeks to strike down the state’s effort to take away retroactive coverage, a provision that allows people’s medical bills to be paid if they enroll in Medicaid after they received care.

NIKKI HALEY TO SPEAK AT ANTI-ABORTION GALA: Nikki Haley, the former United Nations ambassador for President Trump, will speak at the 12th annual Campaign for Life gala for the anti-abortion Susan B. Anthony List. The event is set for June 3 at the Andrew Mellon Auditorium in Washington, D.C.

Haley signed a 20-week abortion bill into law when she was governor of South Carolina and, during her time with the U.N., she supported the Mexico City policy that prevented global aid organizations from referring patients to abortions.

“At the United Nations, America is often in the minority when we stand up for our values, but we proudly stand strong for them anyway, because it’s the right thing to do,” Hayley said in a statement. “At home, the Susan B. Anthony List reminds us of the importance of staying true to our values, and no value is more sacred than the right to life. On late term abortions in particular, America is too often falling short of our own values.”

NATIONAL ACADEMIES RECOMMENDS EXPANDING OPIOID TREATMENT: Not enough heathcare providers know how to work with people who have addictions and regulations are getting in the way of prescribing medications to treat addiction, according to a report published Wednesday by the National Academies of Science, Engineering, and Medicine. The drugs in question, which include methadone, buprenorphine, and extended-release naltrexone, help to curb withdrawal symptoms.

GILLIBRAND POSITIONS HERSELF FOR NEW HAMPSHIRE PRIMARIES WITH BILL TO LIMIT OPIOID PRESCRIPTIONS TO SEVEN DAYS: Sen. Kirsten Gillibrand, D-N.Y., is pushing legislation, despite pushback from some doctors, to limit opioid prescriptions, a move that could help her woo primary voters in overdose-stricken New Hampshire. The bill aims to combat the opioid crisis by limiting initial opioid prescriptions for acute pain, such as a wisdom tooth removal or broken bone, to seven days. The American Medical Association passed a resolution last year suggesting it opposes a seven-day limit on opioid legislation, though it has not specifically addressed Gillibrand’s bill. The National Association of Chain Drug Stores and The Pharmaceutical Research and Manufacturers of America endorsed Gillibrand’s legislation.

AZAR, GOTTLIEB WARN VAPING CRACKDOWN WILL CONTINUE: A change in FDA leadership will not reduce the Administration’s focus on the youth vaping “epidemic,” HHS Secretary Alex Azar and outgoing FDA Commissioner Scott Gottlieb wrote in a Washington Post op-ed. They call on manufacturers and retailers to step up to keep minors from vaping. If 2019 National Youth Tobacco Survey shows that teen vaping remains high, the FDA is willing to take stronger actions, including banning pod-based vape products all together.

TRUMP LOYALIST REJECTS CNN REPORT: EVERYONE WAS TOLD JOHN MCCAIN WAS ‘SOLID’ ON VOTE AGAINST OBAMACARE: CNN Correspondent Jim Acosta reported that the late Sen. John McCain, R-Ariz., had never promised to vote yes on the 2017 Obamacare repeal, contrary to Trump’s remarks alongside President Jair Balsonaro of Brazil. Chairman of the American Conservative Union, Matt Schlapp rebutted the report, saying that McCain had promised to Trump personally prior to the vote.

“This is not accurate @Acosta,” Schlapp said. “McCain met w me in my office and pledged to support every version of repeal and replace and said he would lead the charge. Everyone was worried he would flip flop when it mattered and well he did on the flight to dc.”

KENTUCKY GOVERNOR SIGNS BILL BANNING ABORTIONS TIED TO RACE, SEX DISABILITY: State law now requires doctors to certify in writing that their patient — to their knowledge — did not want to end her pregnancy over concern about the fetus’s sex, race, color, national origin, or disability. The measure is already facing a federal lawsuit from the American Civil Liberties Union, which argues the state is blocking a woman’s right to the procedure because it disapproves of her reason.

The law is similar to an Indiana one that the Supreme Court is currently considering reviewing, which would weigh into whether to weaken or overturn Roe v. Wade. The ACLU sued Kentucky over another bill that would ban abortion after a heartbeat could be detected, which is roughly between six and eight weeks into a pregnancy.

HHS GIVES $487 MILLION TO STATES, TERRITORIES TO EXPAND ACCESS TO OPIOID TREATMENT: The Department of Health and Human Services released an additional $487 million to supplement first-year funding through its State Opioid Response grant program. With the $933 million in second-year, the total amount of the grants to states and territories this year will be more than $1.4 billion. Funding is meant to expand access to treatment, especially to medication-assisted treatment, which includes methadone.

DESANTIS ROLLS WITH SMOKABLE MEDICAL MARIJUANA, ENDING YEARSLONG DEBATE: Gov. Ron DeSantis, R-Fla., signed a state Senate proposal into law on Monday to legalize smokable medical marijuana, allowing patients to receive 2.5 ounces of cannabis every 35 calendar days. Marijuana-based medication in gel, drops, and capsules have been legal in Florida since the passage of Amendment 2 in 2016, a ballot measure that received 71 percent approval from Florida voters.

KENTUCKY GOVERNOR SAYS HE DELIBERATELY EXPOSED HIS KIDS TO CHICKENPOX: Kentucky Gov. Matt Bevin said Tuesday that he deliberately exposed his children to chickenpox in an effort to make them immune to the disease rather than giving them vaccines. The governor questioned mandating vaccinations, and said that parents should have the option to not vaccinate their children: “This is America. The federal government should not be forcing this upon people. They just shouldn’t.”

The Rundown

The Washington Post Fentanyl drug overdose deaths rising most sharply among African Americans

The Associated Press With black lung fund in jeopardy, taxpayers could foot bill

Modern Healthcare Florida lawmakers lurch ahead with certificate-of-need repeal

Richmond Times-Dispatch Va. officials begin planning new mental health care standards for jails

Atlanta Journal-Constitution Georgia House panel passes Kemp’s health insurance ‘waiver’ bill

Chicago Tribune Recreational Marijuana in Colorado: what the numbers say about health, safety and tax dollars

Calendar

THURSDAY | March 21

House and Senate in recess all week.

March 18-21. National HIV Prevention conference. Program.

10:30 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Overcoming Health Care Challenges in Immigrant Communities.” Details.

FRIDAY | March 22

9:30 a.m. 1775 Massachusetts Ave. NW. USC-Brookings Schaeffer Initiative for Health Policy to present analysis on out-of-network billing. Details.

TUESDAY | March 26

10 a.m. 430 Dirksen. Senate Health, Education, Labor, and Pensions Committee hearing on “Implementing the 21st Century Cures Act: Making Electronic Health Information Available to Patients and Providers.” Details.

10 a.m. 210 Cannon. House Budget Committee hearing on the Department of Health and Human Services budget. Details.

11 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Tracking Federal Funding to Combat the Opioid Crisis.” Details.

WEDNESDAY | March 27

March 27-28. Washington Hilton. Health Datapalooza. Agenda.