Issue: Health

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Thursday, Oct. 12, 2017, in response to the White House’s release of a new executive order on health care:

“This executive order risks turning back the clock to the bad old days when many people were priced out of health insurance just because they got sick. Allowing more insurers to sell plans that don’t cover essential health benefits would weaken consumer protections under the guise of promoting consumer choice.

“These changes could open the door to a wave of ‘cheaper’ plans that cost less because they don’t provide as much coverage. By luring in many healthier people, these plans could undermine protections for folks with pre-existing conditions like cancer and diabetes by sending costs soaring for more comprehensive coverage.

“Recent cuts to the Marketplace enrollment period, enrollment assistance and outreach activities already have created unnecessary barriers for consumers and threaten to reverse gains in health coverage and care. Today’s announcement doesn’t immediately change anything, but it sows even more confusion in the health insurance market just as tens of thousands of Alabamians are getting ready to enroll for 2018 coverage. It’s more important than ever for advocates and leaders across our state to ensure that Alabamians have the information they need to find affordable coverage that’s there for them when they need it most.”

Alabama would lose $27 billion in federal health care funding through 2036 if the Graham-Cassidy health care plan becomes law, according to a new study by Avalere Health, an independent analysis firm. The proposal also would open the door to erosion or elimination of pre-existing condition protections for more than 2 million Alabamians with cancer, diabetes or other medical conditions.

The plan temporarily would divert federal funding from states that expanded Medicaid to cover low-income adults to states like Alabama that have not, but the gains would disappear in 2027. Medicaid expansion in Alabama would generate at least as much new federal money through 2026 as Graham-Cassidy – and likely more, according to research from the University of Alabama at Birmingham.

“Every state would be a loser under Graham-Cassidy, and Alabama is no exception,” Arise Citizens’ Policy Project policy director Jim Carnes said Thursday. “Over time, this bill would wreck our state’s General Fund budget and force enormous Medicaid cuts that would hurt children, seniors, and people with disabilities across Alabama. We urge Congress to reject this harmful plan and work together in a bipartisan way to strengthen our country’s health care system.”

The amendment, sponsored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., would:

• Cost Alabama $27 billion in federal health care funding through 2036.
• Force deep cuts to Medicaid, which covers more than 1 million Alabamians – almost all of whom are children, seniors, pregnant women, or people with disabilities.
• Imperil vital protections that keep coverage affordable for more than 2 million Alabamians with pre-existing conditions.

The risks to Medicaid and rural health care in Alabama

The Graham-Cassidy plan would end both Medicaid expansion for low-income adults and subsidies for individual plans under the Affordable Care Act. (Alabama has not expanded Medicaid, but more than 140,000 Alabamians receive subsidies for individual ACA coverage.) In their place, the Graham-Cassidy plan would give states a block grant that would not increase in response to growing costs or enrollment. The plan also would impose a per capita (or per-person) cap on federal Medicaid funding.

“This bill plays bait-and-switch with Alabama’s federal health care funding,” Carnes said. “The temporary gain wouldn’t be worth wreaking long-term havoc on our state’s health care system.”

At the same time, the Medicaid cap would force Alabama and all other states to pick up an increasingly larger share of health care funding. The result would be either higher state taxes or – perhaps more likely – deep cuts to Medicaid, which covers more than one in five Alabamians, almost all of whom are children, seniors, pregnant women, or people with disabilities.

Such cuts would be devastating for Medicaid patients, and they also would be bad news for rural communities across Alabama, where Medicaid plays a huge role in helping many hospitals and clinics stay open. Closure of those facilities would harm not just Medicaid patients but people with private insurance coverage as well.

The risks to Alabamians with pre-existing conditions

The Graham-Cassidy plan’s threats to Alabamians with private insurance would not end there. The bill also could put essential consumer protections at risk for more than 2 million Alabamians who have pre-existing health conditions like asthma, cancer, diabetes or heart disease.

Under the ACA, insurers are not allowed to charge higher premiums based on an applicant’s health history. The ACA also requires insurance plans to cover 10 “essential health benefits,” including maternity care, prescription drugs and mental health care, and forbids insurers to impose annual or lifetime coverage limits for those services.

The Graham-Cassidy proposal would allow states to seek waivers of those protections for any insurance plan subsidized by block grant funding. States seeking waivers would have to explain how they “intend” to keep insurance affordable for people with pre-existing conditions, but the bill does not set a clear definition of affordability.

If the ACA’s protection against higher premiums based on health status disappeared, many Alabamians with pre-existing conditions could see premiums soar by tens of thousands of dollars a year, effectively pricing them out of the insurance market. And if maternity care, mental health care or other services were no longer deemed to be “essential health benefits,” insurers once again could impose annual or lifetime coverage limits on them – or refuse to cover them at all.

“We can’t afford to return to the bad old days when people were punished with soaring premiums just because they got sick,” Carnes said. “Congress needs to stop trying to undermine consumer protections and start working together to ensure that all Americans can get quality, affordable health care when they need it.”

Nearly 49 of every 50 children in Alabama had health coverage in 2016, according to U.S. Census data released the week of Sept. 12, 2017. Alabama’s share of uninsured children fell to 2.4 percent last year, far below the national average and an improvement on the state’s 2015 rate of 3.1 percent.

A huge piece of the credit for those recent coverage gains belongs to Medicaid and ALL Kids, Arise Citizens’ Policy Project executive director Kimble Forrister said Thursday. Together, the programs cover nearly 800,000 Alabama children who live in households with low or moderate incomes.

“All children deserve consistent, appropriate health care, and Alabama does a good job of helping them get it,” Forrister said. “Medicaid and ALL Kids help kids stay healthy so they can learn, play and thrive. It’s essential to ensure these programs have the funding they need to continue providing health coverage for our most vulnerable residents.”

Alabama’s low rate of uninsured children stands out even more when considering that nearly one in four children (or 24.3 percent) in the state lived in poverty last year. That rate was the sixth highest in the country and far worse than the 19.1 percent national rate. Overall, 17.1 percent of Alabamians lived below the poverty line in 2016, and 9.1 percent of the state’s residents lacked health insurance.

Congressional decisions in the coming weeks will shape the future of Medicaid and ALL Kids for years to come. Federal funding for the Children’s Health Insurance Program (known as ALL Kids in Alabama) is set to expire Sept. 30 unless Congress renews it. And a health care plan offered by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., would impose Medicaid funding caps that would force deep cuts to coverage for children, seniors, and people with disabilities over time.

“Children’s health care is too important to be left up to chance,” Forrister said. “We urge Congress to protect Medicaid and ALL Kids and work together in a bipartisan way to make health care more accessible and more affordable for all Americans.”

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Thursday, July 27, 2017, in response to Alabama Medicaid’s announcement that it will pursue an “alternative” to the regional care organization (RCO) reform plan:

“Alabama Medicaid’s decision to end its effort to develop homegrown managed care through regional care organizations is a disappointment but not a surprise. We’ve seen the Legislature’s support for the plan wane since it passed unanimously in 2013, as expectations for its budgetary impact shifted. Medicaid policy changes promised by Congress and the White House after the November election further clouded the prospects for RCO success.

“From the start, Arise has believed that strong consumer oversight is an essential component of Medicaid reform. That’s why we’ve worked hard with our partners at the Disabilities Leadership Coalition of Alabama to fulfill the consumer engagement role spelled out for us in the RCO law. We regret that this innovative, collaborative experiment has run aground, but we welcome the opportunity to apply those same consumer-focused principles in whatever alternative reforms Medicaid pursues.

“State ‘flexibility’ for Medicaid is a hot topic in Washington right now, and RCOs were a good example of state-based decision-making about health care delivery. But ‘flexibility’ cannot be a code word for undermining the basic promise of Medicaid by cutting essential benefits, shortchanging health care providers or taking away coverage from children, seniors, pregnant women, and people with disabilities across Alabama. Medicaid is the backbone of our state’s health care system, and we must keep it strong.”

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Tuesday, July 25, 2017, in response to the U.S. Senate vote to begin limited debate on repealing the Affordable Care Act:

“The Senate’s 51-50 vote to fast-track a health care plan before even deciding which plan to consider was beyond reckless, but this process is far from over. Senators should oppose any bill that would increase insurance costs for struggling families or send us back to the bad old days of limiting benefits and discriminating against people with pre-existing conditions. We especially urge lawmakers to reject cruel cuts to Medicaid, which provides essential health coverage for children, seniors, pregnant women, and people with disabilities across Alabama and across the country.

“Every health care plan that Congress has considered so far this year would send out-of-pocket costs soaring and would leave millions more Americans, including tens of thousands of Alabamians, without health coverage. If ‘higher costs and a higher uninsured rate’ is your answer on health care, you’re asking the wrong question.

“The Senate should take a deep breath and work together in an open, thoughtful, bipartisan way to preserve the Affordable Care Act’s consumer protections, reduce insurance costs and extend quality, affordable health care to all Americans.”

Arise Citizens’ Policy Project executive director Kimble Forrister issued the following statement Tuesday, July 18, 2017, in response to the collapse of U.S. Senate efforts to “repeal and replace” the Affordable Care Act:

“The defeat of the Senate’s awful health care bill was a victory for Alabama families. This cruel plan would have gutted Medicaid, which provides essential health coverage for children, seniors, and people with disabilities in every corner of our state, to pay for huge tax cuts for rich people and big corporations. It would have hammered rural hospitals and nursing homes while sending insurance costs soaring for many older Alabamians. And it would have sent us back to the bad old days of limiting benefits and discriminating against folks with pre-existing conditions.

“Powerful advocacy from everyday people across Alabama and across the country stopped the bad Senate bill in its tracks. We urge senators to stop trying to repeal the Affordable Care Act and start trying to make it work better for everyone. Our lawmakers should work together in an open, thoughtful, bipartisan way to strengthen the ACA, reduce insurance costs and extend quality, affordable health care to all Americans.”