July 18, 2024

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How two states reveal a deeper divide on insuring kids’ health

7 min read

Good morning. I’m Daniel Chang, a KFF Health News correspondent in Florida, where it’s hurricane season and homeowners’ insurance companies are fleeing the state. Send your Sunshine State tips to [email protected].

Today’s edition: Democrats are making a push to repeal a federal law from 1873 with high stakes for abortion access. State Medicaid agencies want to preserve policy changes they made during the unwinding process. But first …

Different states, different takes on paying the tab for children’s coverage

Arizona and Florida lawmakers saw trouble ahead for children in 2023, with states slated — as the covid-19 pandemic waned — to resume disenrolling ineligible people from Medicaid.

So, legislators in both states voted to expand a safety net known as the Children’s Health Insurance Program, or CHIP, which covers those 18 and younger in families that earn too much for Medicaid.

Florida Gov. Ron DeSantis (R) and Arizona Gov. Katie Hobbs (D) signed the bills into law last year, giving their state Medicaid agencies the green light to apply to federal regulators to raise the family income limit for CHIP eligibility.

But while Arizona’s plan hewed to Biden administration policies, such as keeping eligible children enrolled in CHIP even with unpaid premiums, Florida’s proposal ignored those coverage protections; the state has removed at least 22,000 children from CHIP for unpaid premiums since the rule banning such disenrollments took effect Jan. 1.

Clearly, there is a divide, said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured. “It simply may be between the policies of the Trump administration and the Biden administration.”

These differences are also evident in the context of the 2024 presidential election. Former president Donald Trump has suggested he is open to cutting federal assistance programs if elected to a second term, while the Biden administration has taken steps to make it easier for low-income Americans to keep their health coverage.

The flexibility for states to design different CHIP programs is a big reason Republicans and Democrats have supported the federal initiative since 1997, when it was signed into law, Tolbert said.

But how Arizona and Florida have handled CHIP premiums underscores key ideological differences on the government’s role in subsidizing health insurance for children.

The Sunshine State ultimately sued the Biden administration over its unpaid premium policy, but U.S. District Judge William Jung dismissed the case May 31, saying the matter was up to federal regulators to decide.

Sara Lonardo, a spokesperson for the federal Department of Health and Human Services, said in an email that the Biden administration says the law requires states to give children in CHIP the same coverage protection as kids in Medicaid — continuous enrollment for 12 months, even if the premium is not paid.

“No eligible child should face barriers to enrolling in CHIP or be at risk of losing the coverage they rely on to stay healthy,” Lonardo said.

However, Florida officials have said on social media and in legal filings that the state’s CHIP plan is “a bridge from Medicaid to private insurance,” intended to get families used to premiums, cost sharing and the risk of losing coverage when they miss a payment.

Research shows the cost of premiums can block many families from obtaining and maintaining CHIP coverage even when the cost is low.

“Premiums are more about an ideological belief that families need to have skin in the game, rather than any practical means of paying money to support the program,” said Matt Jewett, director of health policy for the Children’s Action Alliance of Arizona, a nonprofit that promotes health insurance coverage for kids.

DeSantis’s office, Florida’s Medicaid agency and Florida Attorney General Ashley Moody’s office did not respond to questions about CHIP — or if Florida will appeal the court decision.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.

Democrats seek to repeal Comstock abortion rule

New this a.m.: Democrats are pushing to overhaul an 1873 federal law that bans abortion-related materials from being mailed, fearing a future Trump administration could invoke the Comstock Act to restrict access to the procedure nationwide, The Post’s Dan Diamond and Caroline Kitchener scooped.

“There is a very clear, well-organized plan afoot by the MAGA Republicans to use Comstock as a tool to ban medication abortion, and potentially all abortions,” said Sen. Tina Smith (D-Minn.), who plans to introduce legislation today to repeal the 151-year-old law’s abortion provisions. “My job is to take that tool away.”

Sens. Elizabeth Warren (Mass.) and Catherine Cortez Masto (Nev.) and other Democrats have signed on to the legislation, which was crafted in consultation with the Justice Department, according to Smith’s office. Rep. Becca Balint (D-Vt.) will introduce companion legislation in the House, and she said in an interview that she had support from the lower chamber’s Democratic leaders.

Yes, but: Not all Democrats agree repealing the Comstock Act should be an election-year priority, fearingit could divert voters’ attention from existing efforts to protect abortion access. Some advocates also doubt its chances in a divided Congress.

Trump’s stance on invoking the Comstock Act remains unclear. Asked about the law in April, Trump said it was a “very important issue” and promised a “big statement” within two weeks. Nearly two months later, we’re still waiting.

Becerra kicks off repro rights tour with senators’ support

As he hits the road this week, Health and Human Services Secretary Xavier Becerra plans to highlight the Biden administration’s efforts to protect abortion access and other reproductive health services after the Supreme Court overturned Roe v. Wade two years ago this month, Dan writes.

“Everyone in America should have access to the health care they need. Period,” Becerra told reporters Tuesday, surrounded by five Democratic senators at HHS headquarters.

One implicit message: the contrast with Trump. While Becerra, as a federal official, could only say so much about Biden’s GOP challenger, the Democratic senators picked up the slack.

“One in three women now live under extreme or dangerous Trump abortion bans,” said Sen. Debbie Stabenow (D-Mich.), alluding to Trump’s appointment of three Supreme Court justices who voted to overturn Roe. “It’s an all-hands-on-deck moment.”

Another goal: Democrats want their message to be broader than abortion.

“We are in this fight to make sure that women everywhere in the United States have access to abortion, access to contraception and access to IVF,” Warren vowed.

Up next: Becerra is set to visit Nevada, Arizona and Colorado this week, and California, New Mexico and Idaho next week. Notably, the Supreme Court is expected to rule this week or next in a case involving Idaho’s strict abortion ban and whether federal law requires hospitals to perform emergency abortions.

Medicaid changes gain momentum post-pandemic

New this a.m.: The rollback of pandemic-era enrollment protections in Medicaid helped prompt states to implement policy changes aimed at simplifying renewal processes for beneficiaries and expanding eligibility for key groups, according to a KFF survey of state Medicaid officials.

Why it matters: Most states are committed to retaining at least some of these changes beyond the unwinding period, reshaping “routine” operations moving forward. Here’s a snapshot:

  • All but four states are interested in retaining waiver flexibilities that streamlined the redetermination process, such as automatic renewals for those without income and extended response times for renewal notices.
  • Forty-one states intend to continue using enhanced outreach efforts, including by involving health plans and community organizations in the renewal process.
  • Thirteen states have adopted or are pursuing multiyear continuous eligibility requirements for young children in Medicaid. Nine other states also cover or are proposing to cover certain adult groups for continuous periods.

Health panel urges interventions for children and teens with obesity

A leading panel of independent U.S. health experts is urging doctors to refer young people with obesity to programs offering guidance on healthy eating, safe exercise and understanding food labels, The Post’s Sabrina Malhi reports.

The U.S. Preventive Services Task Force’s updated guidelines apply to those ages 6 or older with a body mass index (BMI) in the 95th percentile. BMI estimates body fat based on weight and height.

The recommendations align with 2017 guidance, but now the task force advocates moving beyond screening to interventions. Some physicians and obesity experts praised the initiative, but others said the panel’s advice should include the prescription of weight-loss drugs like Wegovy when warranted.

  • New this a.m.: More than half of Democratic women in states with abortion-related ballot initiatives say they are more motivated to vote this November than in past presidential elections, according to a KFF poll.
  • A New York appeals court cleared the way for a proposed amendment to the state constitution that would prohibit discrimination based on pregnancy outcomes and safeguard against government actions that could restrict reproductive care to appear on voters’ ballots in November.
  • The Congressional Budget Office estimates that the U.S. uninsured rate will rise to 8.9 percent by 2034, a shift the nonpartisan bookkeeper attributes largely to increased immigration, the expiration of enhanced American Care Act subsidies and the rollback of pandemic-era Medicaid protections.
  • Nursing homes must conduct facility-wide assessments to determine the staff and resources necessary to meet residents’ needs in accordance with a minimum staffing rule set to take effect in August, according to revised guidance issued by the Centers for Medicare and Medicaid Services.

Rare gene mutation helps people resist Alzheimer’s disease (By Carolyn Y. Johnson | The Washington Post)

The fight for abortion rights gets an unlikely messenger in swing state Pennsylvania: Sen. Bob Casey (By Marc Levy | The Associated Press)

How a network of nonprofits enriches fundraisers while spending almost nothing on its stated causes (By Ellis Simani | ProPublica)

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