Obamacare had an excellent day on the polls, whilst Trump officers stepped up their assault on this system


Republicans who suppose the American public is clamoring to repeal or roll again the Affordable Care Act have one other suppose coming.

Voters in Maine overwhelmingly enacted Medicaid growth for his or her state Tuesday, overturning a string of 5 successive vetoes by their right-wing governor, Paul LePage. The vote was roughly 60%-40%. Maine thus turns into the 33rd state (together with the District of Columbia) to develop Medicaid below the Affordable Care Act, the primary to take action throughout the Trump administration, and the primary to take action by poll initiative.

Expect extra of the identical in different states the place the Republican political institution has blocked growth, together with Utah and Kansas. LePage, by the way in which, has stated he’ll refuse to implement the coverage mandated by Maine’s voters, however he’s positive to face a combat over his place.

The Maine end result, which is able to deliver well being protection to an estimated 80,000 residents, has different nationwide reverberations. The state’s senior Sen. Susan Collins, a Republican, has been a steadfast opponent of GOP efforts to repeal the ACA in Congress. She additionally has expressed distaste for the House GOP’s thought to fold an Obamacare rollback into its tax minimize measure. The vote again dwelling will solely strengthen her resolve; the possibility she’s going to change her thoughts now needs to be counted at lower than zero.

In Virginia, Ralph Northam was elected to succeed his fellow Democrat Terry McAuliffe as governor, which can imply a renewed push to develop Medicaid there. Northam can be helped by the obvious flip of the state’s decrease legislative chamber, the House of Delegates, from Republican to Democrat (4 key seats are too near name and require a recount). The state Senate stays narrowly Republican and received’t be topic to election till 2019, however its GOP members could need to take an in depth have a look at their opposition to Medicaid if growth comes earlier than them once more.

The election outcomes recommend that the general public strongly favors Obamacare on the whole and Medicaid growth particularly. What’s fascinating about that’s that they got here the very day that Trump’s Medicaid administrator, Seema Verma, unveiled a brand new badault on Medicaid growth that may nearly actually end in fewer enrollees.

Verma’s badault, which got here in a speech to the National Assn. of Medicaid Directors on Tuesday, was backed by some very deceptive statistics and suspect badertions. They’re value badyzing intimately.

Verma’s normal theme was that merely enrolling extra individuals in Medicaid wouldn’t badure they’d get higher care, and may even undermine the care offered to present enrollees. Of the profitable growth of Medicaid rolls below the ACA, she stated, “We will not just accept the hollow victory of numbers covered.”

This is a comment of virtually medieval stupidity. All the proof accessible signifies that having protection below Medicaid produces higher well being, together with psychological well being, than the shortage of protection, in addition to improved household funds. It’s no “hollow victory” by any commonplace.

Verma depicted Medicaid as rife with “problems with access, problems with quality, and problems with program integrity.” She noticed that “more than 1/3 of doctors won’t even see Medicaid patients.”

A few factors right here. First, the proof exhibits that Medicaid sufferers’ entry to care, the standard of their care and their satisfaction with their care are commensurate with that of sufferers with employer-paid protection, and vastly superior to the expertise of individuals with out insurance coverage. It’s true that about 30% of docs received’t take Medicaid sufferers, however that implies that 70% do. The motive for the minority’s resistance, furthermore, is that Medicaid’s reimbursement charges are very low. To appropriate that, Verma’s company ought to elevate the reimbursement charges; elevated acceptance by docs would absolutely observe.

Verma depicted Medicaid growth as a drain on state budgets. But she used extraordinarily misleading statistics. She remarked that Medicaid has grown to “consume” some 29% of complete state spending, diverting state badets from different areas resembling training and financial improvement.” What she didn’t say is that greater than half of that spending is offered by the federal authorities. In different phrases, most of it isn’t coming from state funds for these different functions. The reality was staring Verma within the face: The figures come out of a report by the National Assn. of State Budget Officers that she cited in a footnote to her personal remarks.

Indeed, the Medicaid growth protection is greater than 90% funded by the federal authorities. That’s a remarkably whole lot, and one which has been turned down by 19 states whose political leaders are addled by anti-Medicaid ideology. The voters in Maine plainly perceive how the maths works to their benefit.

The thrust of Verma’s badault on Medicaid growth got here immediately from the right-wing anti-Obamacare playbook. Its theme is that Medicaid growth added “able-bodied” individuals to this system’s rolls, ostensibly on the expense of the “seniors in need, pregnant mothers, children and people with disabilities” for whom this system was created. Medicaid growth, it’s true, added childless adults to those rolls, however nothing about that undermined the care of the opposite beneficiaries.

In any case, the “able-bodied” slam is merely a variation of the “undeserving poor” theme that has been cherished by conservatives for greater than half a century. It was the identical slam retailed by right-wing pundit Ben Domenech on CBS’s “Face the Nation” in June, when he backed it up with an completely bogus statistic (with none pushback by the information program’s moderator, John Dickerson).

Verma shed crocodile tears over the truth that the federal match fee of Medicaid growth prices is greater than 90%, in comparison with the nationwide common of about 63% for conventional Medicaid. “If the match rate is a reflection of the value we place on caring for our neediest citizens, this is backwards,” she informed her viewers.

One can’t argue with that. But right here’s an answer Verma apparently hasn’t thought-about: Cover all Medicaid spending at greater than 90%. That would present that we worth caring for our neediest residents very extremely certainly.

What is Verma’s reply? It’s to position extra obstacles in the way in which of Americans in search of protection below Medicaid. She signaled that the Trump administration can be far more accommodating to states asking to impose work necessities and different mandates on Medicaid candidates. Typically for the Trump administration, she hid this intention behind the phrase “community engagement requirements.”

Let’s be clear: As administrator of the Centers for Medicare and Medicaid Services, it’s not Verma’s job to handle the labor power participation fee, the determine she cited to justify work necessities for Medicaid. Her job is to maximise protection, not place roadblocks in the way in which of enrollment. For her to advocate work necessities for Medicaid is nothing in need of a dereliction of responsibility.

Not solely that, it’s a mirrored image of profound ignorance concerning the Medicaid inhabitants. The truth is that most individuals eligible for expanded Medicaid already are working. Most of the remainder can’t work even when they need to—29% are caring for members of the family at dwelling, 18% are going to high school, 17% are in poor health or disabled, 10% are retired and 20% can’t discover work. Verma’s chatter about “community engagement” is window dressing for her actual intention, which is to chop individuals out of Medicaid.

Verma’s speech signifies that the Trump administration isn’t letting up one bit in its marketing campaign to undermine the Affordable Care Act any manner it may well. But Tuesday’s election outcomes recommend that the bottom is shifting below its ft. Americans like having insurance coverage protection, and more and more they see resistance to Medicaid growth negatively. Trump ought to take notice.

Keep updated with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook web page, or e mail [email protected]

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