Wednesday, November 30, 2016

The Possible Shape -- Of "Medicaid Expansion 2.0" -- Nationwide, In 2017-2018?

Will Seema Verma's likely appointment signal that -- despite the "repeal and replace" campaign rhetoric -- the 45th President's administration will in fact deliver a largely intact version of Indiana's Medicaid expansion program, nationwide?

If so, that would largely be a net-positive outcome, for people of limited means in the US. Of course the version implemented in Indiana included a six-month lockout from coverage, if one was not looking for work (a provision that appeals on an "optics only" basis, to the conservatives -- but actually drives up the overall cost of care).

Even so, it makes plain that supposed HHS Secretary nominee, Dr. Price -- and his putative "repeal" will in practice actually more closely resemble many of the "continuation plan" ideas the Democratic nominee had discussed, as "ObamaCare 2.0". Sweetly ironic -- that.

In addition, this development makes for a suggestion rather broadly, I think, that Mr. Pence's pragmatism -- not Mr. Trump's idealogues -- will actually run most of the domestic policy portfolio. And that may turn out to be a limited victory, for people who believe that at least basic health care is a human right. Here's a bit from NPR's fine reporting:

. . . .Susan Jo Thomas, who heads the Indiana insurance advocacy group Covering Kids and Families, says Verma's contributions to HIP 2.0 made Medicaid expansion possible in a Republican state. "She understood that in order to get expansion in this state, it's more about what is palatable, what can get approved," she says.

Nearly 410,000 people are members of HIP 2.0, according to the latest data from the state.

Policy analyst Joan Alker, with the Georgetown Center for Children and Families, finds it worrisome. "It is a good thing that she has experience with Medicaid and it is a positive that Gov. Pence worked with Ms. Verma to advance a version of Medicaid expansion," she says. "But I think if you look at the totality of the Trump administration's picks today — Congressman Price as well as Ms. Verma — this represents potentially a very damaging and chaotic restructuring of the Medicaid program." Price has advocated severely cutting Medicaid funding, and Alker worries that cuts and more stringent requirements under Verma would mean people will lose the health insurance.

"The Healthy Indiana Plan has occurred in the context of generous federal funding," she says. "And I think some of that is on deck to go away. . . ."

Me? I am not so sure about federal funding cuts (at least in this area). I think when the dust settles, we are likely to learn that Mr. Trump is far more a "spending" government believer, than a tight-fisted conservative. What that means (assuming he can get Congress to go along) is largely a continuation of basic health care, for millions of low income Americans. Once again -- and I am not complaining here -- Mr. Trump says one thing; then does pretty much the opposite of that thing. So, I am smiling this fine morning -- be excellent to one another. . . .


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