Tag Archives: Medicaid

Biden made ‘Obamacare’ cheaper, now sign-up deadline is right here


Midnight on Sunday is the deadline for shoppers to benefit from a particular “Obamacare” join interval, courtesy of President Joe Biden

“We have seen even within the final couple of weeks elevated curiosity in enrollment,” Administrator Chiquita Brooks-LaSure stated in an interview. “If you make protection extra reasonably priced, folks purchase it. What we have to do is to make protection extra reasonably priced.”

Biden’s particular enrollment interval ends at midnight native time Sunday across the nation. The common annual sign-up season will not begin once more till Nov. 1.

Curiosity has been excessive in a few states feeling the scourge of the delta variant. Almost 490,000 folks have signed up in Florida, and greater than 360,000 have accomplished so in Texas.

At a nonprofit service middle in Austin, Texas, greater than 500 folks have enrolled thus far with the assistance of employees and volunteers. Basis Communities well being program director Aaron DeLaO stated the schedule is booked and so they’re working to clear the ready record.

“Particularly with the delta variant, persons are fascinated about their well being a bit extra,” he stated.

The appliance course of will be difficult, requiring particulars about citizenship or authorized immigrant standing, revenue, and family members. That is earlier than a client even picks a medical health insurance plan. Individuals can apply on-line, by way of the HealthCare.gov name middle, or by packages just like the one in Austin.

About 9 in 10 prospects at Basis Communities have chosen commonplace “silver” plans, which value considerably extra however provide higher monetary safety when sickness strikes. “That to me says that persons are actually all for having complete protection,” stated DeLaO.

The Obama-era Reasonably priced Care Act presents sponsored non-public insurance coverage to individuals who haven’t got job-based protection, out there in each state. The ACA additionally expanded Medicaid for low-income adults, an choice most states have taken. The 2 elements cowl about 27 million folks, in accordance with the nonpartisan Kaiser Household Basis.

“Obamacare’s” place amongst authorities well being packages appears safe now, after greater than a decade of fruitless efforts by Republicans to repeal it or get the Supreme Court docket to overturn it. Earlier this 12 months by a vote of 7-2 the conservative-leaning court docket dismissed the most recent problem.

The subsidy will increase in Biden’s COVID legislation have made a tangible distinction. The typical premium paid by new prospects dropped from $117 a month to $85 a month, or 27%, with the extra beneficiant assist. In line with CMS, the median — or midpoint — deductible went from $450 to $50, a discount of practically 90%. Individuals who already had ACA protection may get the elevated assist by going again to the insurance coverage market. Individuals who’ve had a spell of unemployment are eligible for added breaks.

However the enhanced subsidies are good solely by 2022, and Biden is urgent Congress to make them everlasting. An extension appears more likely to be included within the Democrats’ $3.5 trillion home coverage bundle, nonetheless it is not assured to be everlasting, with so many different priorities competing for cash.

About 30 million folks stay uninsured, and a transparent majority could be eligible for ACA plans or another kind of protection. “In the event you construct it they will not essentially come,” stated Karen Pollitz, a medical health insurance skilled with the Kaiser Basis. “Individuals nonetheless have to be made conscious that there’s protection on the market.”

The Biden administration might make progress, however “this cannot be the top of the story,” stated well being economist Katherine Baicker of the College of Chicago.

It stays means too difficult for individuals who juggle low-paying jobs to get and maintain protection, Baicker defined. “There’s each a have to broaden entry to reasonably priced insurance coverage and to raised inform folks concerning the choices out there to them,” she stated.


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Proposed Changes To Social Security Disability Insurance Could Undermine Your Retirement Security, Even If You’re Not Currently Disabled


In November 2019, the Social Security Administration released proposed changes to two programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI and SSI are both rooted in a very simple idea: people who can’t work due to an illness, injury, or other form of disability deserve to live, and nobody can live without money for housing, food, and other basic needs.

Under the proposal, some recipients of SSDI and SSI would have to more regularly prove that their medical conditions haven’t improved. Many SSDI and SSI recipients would be required to take part in a more frequent “continuing disability review” (CDR) that some liken to a medical audit for those already shown to be medically disabled. Public comment closed on these changes on January 31 of this year, meaning we can likely expect the rules to be added to the federal register sometime in 2020. 

The Social Security Administration explains that they’re trying to make sure benefits stop as soon as recipients have experienced medical improvement. By increasing the number of CDRs they conduct each year by 18%, they expect to spend $2.6 billion less on disability benefits between 2020 and 2029.

But many people with knowledge of the continuing disability review process say the more frequent CDRs will kick people with serious disabilities off of the benefit rolls, instead of identifying people who are now healthy. Since we already conduct CDRs at a cadence grounded in medical evidence, they argue that increasing CDR frequency just imposes an unnecessary burden on the disabled. 

“Only a small portion of the people that lose benefits will have medical improvement. The majority will be people who were not able to navigate the bureaucratic hurdles unaided,” says Michelle Spadafore, the senior supervising attorney at the Disability Advocacy Project of New York Legal Assistance Group. 

Under current policy, before the proposed CDR changes are made, the Social Security Administration estimates that every $1 spent on CDRs triggers $19.90 in net program savings. By comparison, the more frequent CDRs, according to SSA estimates, would trigger just $1.40 in net program savings per dollar spent on administrative costs, a 14-fold drop in efficiency. “Even by their own calculations, they are going to be harassing people who are unlikely to have medically improved,” says Matthew Cortland, a disabled, chronically ill lawyer.

Why CDRs Cause Disabled Americans To Lose Benefits

“The CDR process is onerous,” says Jennifer Burdick, a supervising attorney at Community Legal Services in Philadelphia, adding that the vast majority of people have to navigate the CDR process without the assistance of a lawyer. When Community Legal Services works with a client on a CDR, it typically takes between twenty and thirty hours, says Burdick, although some cases require up to eighty hours of legal assistance.

The initial paperwork required in a CDR can include up to 15 pages of questions (“It takes two stamps to send it back,” says Burdick). Timely completion of the form poses a particular challenge for recipients whose disability includes difficulty with memory, cognition, or a behavioral health limitation. And that assumes that the recipient even gets the CDR in the mail as they’re supposed to. “I have a client who’s on dialysis, who hasn’t moved, who hasn’t changed her address, but for some reason she never got her CDR paperwork,” says Spadafore. And it’s not uncommon, says Spadafore, for a CDR to arrive when a recipient is hospitalized. If the Social Security Administration can’t make a decision on a CDR due to insufficient evidence, the recipient has only 10 days to request that their benefits be continued while the case gets more scrutiny. 

“I’m personally very concerned about the fact that a population that has already established that they have very severe disabilities is being asked to go through the process more frequently,” says Burdick. 

Continuing disability reviews typically require the recipient produce new medical records showing that their health status has stayed the same or worsened. A person’s benefits can be terminated if her doctors aren’t timely about sending medical records, or even if the doctor’s notes from appointments weren’t sufficiently detailed. “I have four people on staff whose entire job is hounding [healthcare] providers to submit medical records,” says Burdick.  

While the Social Security Administration will also request records on recipient’s behalf, Spadafore says, minor hiccups often derail the process. For example, if a records request is sent to the individual doctor a patient sees, rather than to the hospital where the doctor is practicing, the request will go unanswered, and the Social Security Administration will cut off the recipient’s benefits after making a second attempt to reach the provider, citing a lack of evidence.

In one important way, both Burdick’s clients and Spadafore’s clients are unusual: they found the help of an attorney at a non-profit that provides free legal assistance to low-income people. In a more typical case, Americans with disabilities are navigating the CDR process alone. When they lose their sole source of income, the consequences are dire. 

How This Could Impact You, Even If You’re In Good Health Today

While some Americans have lifelong disabilities, debilitating medical conditions often arise in our fifties or sixties, after (and sometimes, as a direct result of) decades of hard work. According to data from the Center on Budget and Policy Priorities, more than one in four young workers will qualify for Social Security Disability Insurance before reaching the full retirement age. Americans between the ages of 60 and 66 are 14 times as likely to currently be on the SSDI rolls as Americans between the ages of 30 and 34.

Disabilities that first arise in middle age or old age vary. They can include severe carpal tunnel syndrome (which can make it impossible for you to type or work with your hands), debilitating arthritis, cancer, vascular dementia, kidney failure, and fibromyalgia, among a wide range of other conditions. 

The bar for receiving SSDI is high: only 23% of applicants are initially approved, and another 12% of applicants are approved on appeal or under reconsideration. 

Qualifying and staying qualified for SSDI is extremely important for older Americans with chronic health conditions — even for Americans who worked as white-collar professionals, who might have considerable savings and private disability insurance. That’s because, after a two year waiting period, Americans who receive SSDI also qualify for Medicare, regardless of their age. Without Medicare eligibility, paying for healthcare in your 50s when you’re too sick to work, and no longer have employer-provided health insurance, can be prohibitively expensive. 

Because Medicare and Medicaid eligibility for people with disabilities is tied to SSDI and SSI respectively, more frequent CDRs will mean some disabled adults also lose their health insurance, a clearly life-threatening proposition. Losing Medicare or Medicaid can mean showing up to a pharmacy and finding that drugs that previously had a $1 copay now cost $1,200. 

Older Americans Are Targeted 

In the proposed rules, the Social Security Administration highlights a population they plan to target for more frequent CDRs: older Americans who received a “step five” determination of disability. A judge can make “step five” determination of disability if, after reviewing a particular American’s work experience and physical limitations, they conclude that there is strong evidence that person is unemployable. 

A typical “step five” recipient might be someone in his 50s or 60s, who worked throughout his life as a construction worker or a janitor. He develops a physical condition that causes him to lose his job. That same physical condition might not make it impossible to work at a computer in an office — but because of his age, and limited education, a judge concludes that employers wouldn’t view the person as qualified for more sedentary work. Judges are only allowed to consider these “vocational factors” — things like a disabled person’s level of education — if the person is 50 or older, a recognition that younger workers face less age discrimination, and have more time to go back to school or gain new qualifications.

As Linda Rothnagel, an attorney at Prairie State Legal Services has written, targeting step five recipients for more frequent CDRs “is troubling and potentially discriminatory, particularly on the basis of age.” 

Speaking about the “step five” population specifically, Burdick said, “Most of my clients are getting worse, not better, since you’re adding on age-related problems.” She added that the decision to target these older recipients appears to lack any medical or legal justification.

Death By a Thousand Cuts

Raising the frequency of CDRs is just one example of recent pullbacks to disability insurance. In 2017, the Social Security Administration decided that they would put more weight on the opinions of government-employed doctors, who perform quick evaluations, as opposed to the patient’s own doctors, who have seen the patient’s condition evolve over the course of years.  These government-employed doctors, says Cortland, often aren’t in the best position to evaluate a patient’s medical condition, adding as an example that “it’s not uncommon that someone with a gastrointestinal condition gets sent by the Social Security Administration to an orthopedic specialist for their physical.” And now, separate from the CDR proposal, the Trump administration is also considering changes to how older Americans are assessed for disabilities, raising the age at which “vocational factors” can be considered from 50 to 55. President Donald Trump’s 2020 fiscal year budget, proposed in March 2019, suggested cutting $25 billion from Social Security, of which $10 billion would be cut from SSDI, although many of the recommendations Trump made in the budget proposal have not been implemented. 

Still, making disabled Americans repeatedly jump through bureaucratic hoops strikes many advocates as particularly punitive. “I can’t stress enough what the consequences will be,” says Spadafore. “I’ve seen a lot of changes come down the pipeline of Social Security over the last decade, and this one is most alarming.” 


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Trump Will Deny Visas to Immigrants Who Don’t Have Well being Insurance coverage


Picture: Chip Somodevilla (Getty)

Poor, uninsured immigrants will likely be denied visas to enter the US beginning subsequent month, the White Home introduced Friday.

Donald Trump signed a proclamation declaring that beginning Nov. 3, if an immigrant can’t show they’ve their very own medical insurance or the cash to buy it, they won’t be allowed to enter the U.S, in keeping with the New York Instances.

It’s the most recent transfer by Trump to disrupt the U.S. immigration system, and will threaten the hopes of households making an attempt to carry their spouses or mother and father to the US, the Related Press reviews.

And with the ability to qualify for Medicaid or Obamacare for medical insurance protection received’t lower it, as AP explains:

The proclamation says immigrants will likely be barred from getting into the nation except they’re to be coated by medical insurance inside 30 days of getting into or have sufficient monetary sources to pay for any medical prices.


Medicaid doesn’t rely. And an immigrant won’t be able to acquire a visa if utilizing the Reasonably priced Care Act’s subsidies when shopping for insurance coverage. These subsidies are paid for by the federal authorities.

To justify its actions, the White Home stated in a press release, in keeping with AP, “too many non-citizens had been benefiting from the nation’s ‘beneficiant public well being applications,’ and stated immigrants contribute to the issue of ‘uncompensated well being care prices.’”

Crew Trump apparently has been engaged on this transformation for months, and its announcement got here as a “shock,” in keeping with the Instances, which referred to as it:

the most recent step in an extended effort by Stephen Miller, the president’s high immigration adviser, and others within the administration, to restrict what they think about the monetary burdens of permitting immigrants into the US.

After years of effort by Mr. Miller, the administration issued a regulation in August that will enable officers to disclaim everlasting authorized standing to immigrants who’re poor. The regulation, which imposes an aggressive wealth take a look at on authorized immigrants, has confronted a number of authorized challenges however will go into impact on Oct. 15 except it’s blocked by a courtroom.

That coverage, often known as the “public cost” rule, says immigrants in search of to reside completely in the US might be denied if officers deem it’s doubtless they are going to be a burden on society by, for instance, being unable to pay for well being care or in search of meals and housing help.

Immigration advocates had been dismayed by Trump’s newest salvo.

“President Trump has didn’t construct a bodily wall alongside the U.S.-Mexico border to discourage unlawful immigrants,” Steve Yale-Loehr, an immigration knowledgeable at Cornell Regulation College, informed the Instances, “however he has successfully constructed an invisible wall to maintain out authorized immigrants.”

“This new try at an immigration ban is as shameless as it’s beautiful,” Doug Rand, a former Obama administration official who’s the co-founder of Boundless Immigration, tweeted Friday, in keeping with AP. “It is going to be chaotic to implement and assured to separate U.S. residents from their authorized immigrant spouses and different shut family members.”


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California sues US over home health worker union dues


Five states have joined forces to try and block a new rule from the Trump administration they say weakens labor unions and their ability to collectively bargain for wages and benefits.

California Attorney General Xavier Becerra, a Democrat, announced the lawsuit on Monday with attorneys general in Washington, Connecticut, Massachusetts and Oregon.

The lawsuit seeks to block a rule finalized last week by the Centers for Medicaid & Medicare Services. Becerra and union leaders say it would ban home health care workers paid for by Medicaid from automatically deducting their union dues and health insurance premiums from their paychecks.

CMS spokesman Jack Cheevers declined to comment on Monday, saying the agency has not seen the lawsuit yet. But in announcing the final rule last week, CMS said “nothing in this rule would interfere with an employer’s ability to make payroll deductions that are required by law or voluntary deductions for things like health and life insurance … and union dues.”

In 2014, the U.S. Supreme Court ruled union dues for home health care workers had to be voluntary, meaning unions could not deduct dues from employees who were not members yet were still covered under the collective bargaining agreement. That same year, former President Barack Obama’s administration issued a ruling clarifying states could deduct dues from paychecks of home health care workers who volunteered to join the union.

The Trump administration reversed that rule, arguing it violated federal law that bans states from diverting Medicaid money to third parties, with some exceptions. But Becerra and union leaders said it is designed to weaken the finances of unions by making it harder for people to pay their dues.

“It is a shameful political attack on home care providers who are largely women and people of color,” said April Verette, president of SEIU Local 2015, which represents more than 385,000 long term care workers in California.

Home health care workers are part of Medicaid’s In-Home Supportive Services program. California has the largest IHSS program in the country, with more than 500,000 patients and more than 470,000 workers.

Becerra noted California and other states could get around this new rule by declining to accept Medicaid dollars for the In-Home Supportive Services program. But Becerra noted for California that would mean forfeiting $6.5 billion in federal tax dollars. California has the largest IHSS program in the country, with more than 500,000 patients and more than 470,000 workers.

“That is not an option in California,” Becerra said. “We have a responsibility to these workers and to the people they care for to fight back when their rights and their health care are at stake.”


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