Business Association Plan Scheme Stopped by Judge, People losing Insurance under Trump, Surprise Doctor Bills Investigated, and Medicaid Work Requirement Blocked!

There is so much health care news to cover. Here's what's important. Trump pushed forming complicated business associations so employers could take advantage of group buying power. Small government? don't think so.

Since Trump became president, Americans are losing health insurance, a big story almost no coverage. Steve Rattner covered sounded the alarm the other day:

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Surprise Medical Bills...Finally, someone Noticed??? This has cost me plenty in the past, so we're finally dealing with this problem. NOTE: This would not be a problem under Medicare-for-all or any other universal health insurance program:

The biggest debate will be what policy solution they settle on to fix surprise bills. Most legislators agree that they want to help patients who end up seeing an out-of-network provider at an in-network facility (and get a surprise bill from that out-of-network provider as a result). Those I've spoken with agree: This is a billing dispute between an insurer and a doctor or hospital. Patients shouldn't be caught in the middle.

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Association Health Plan Con Game: This is the first time I've heard a judge call out con-man Trump for trying to get around the law. NOTE: This again would not be a problem with Medicare-for-all

A federal judge has rejected Trump's attempt to expand association health plans in a 43-page ruling, DC District Judge John Bates said that the Department of Labor's rule oversteps the administration's authority:

1. The rule is clearly aimed at skirting compliance with Affordable Care Act coverage requirements, Bates said in the opinion. "The final rule is clearly an end-run around the ACA. Indeed, as the president directed, and the Secretary of Labor confirmed, the final rule was designed ... to avoid the most stringent requirements of the ACA."

2. Department of Labor deploys a "magic trick" in the way it defines employers and employees to make it fit within Employee Retirement Security Income Act (ERISA) requirements, (giving) owners with no employees ... "both hats," (both owner and employee) as it were. He said the definition borders on "absurdity." "DOL’s explanation is pure legerdemain," Bates ruled.

3. The expansion of association health plans, as critics argue, are plans that amount to "junk" coverage because they're not required to meet ACA coverage standards and lack consumer protections.

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Medicaid Work Requirments Blocked, Designed to get People Jobs: This was a no brainer, yet it did have to go through the legal process. The fact that Kentucky created this program without any research, and then experimented on their citizens without ever tracking how the program affected recipients or on those that lost coverage should tell you a lot about Republicans. NOTE: This would not be a problem with Medicare-for-all or some other national universal plan:

In twin rulings, District Court Judge James E. Boasberg rejected for a second time Kentucky’s attempt to require recipients to work or volunteer as a condition of coverage and blocked a similar rule in Arkansas, which has resulted in more than 18,000 people there losing coverage since last summer ... it had not adequately considered whether it “would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

The Trump administration had asserted that some people in Kentucky who lost Medicaid would gain commercial insurance coverage. But Judge Boasberg appeared skeptical, writing that federal officials “cited no research or evidence that this would happen.”

The Trump Party's Inhumane work Requirements for Medicaid relies on Snail Mail for a reason!!!

Human nature has been weaponized by Republicans, namely Scott Walker, the GOP legislature and Trump Party tribalists.

Who Cares about low tech Snail Mail anymore? Almost everyone I've talked to tosses their mail in the circular file or just stacks it up for later recycling. It's human nature. If it isn't a bill, see ya later. We're also too busy trying clear out or tame our exploding emails accounts.

Republicans know this and are counting on it to purge voter rolls, deny food stamps and drop Medicaid coverage by sending out cards and letters through the mail. Or Republicans never caught on to technology and the public move from paper to online billing and communications. But that can't be it because all responses have to be done online, even if they don't have a computer. It's a con job either way, and it's spreading.

Medicaid Work Requirements sent by Letter: Let's focus on Medicaid. Human nature says that mail gets thrown out, even those nagging notices requiring residents to report work to the state. Republicans are counting on it, and the research bears it out. Excerpt from my WaPo email:

1. As of last month, 5,426 people in Arkansas had not reported their status for June and July. Most of the correspondence about the looming reporting requirements were sent by regular mail, and there was no further outreach ... Some recipients may not have been able to properly read the letter or they could have limited access to a computer or the Internet because all the reporting has to be done online. 

2. There were 12,722 who "did not satisfy reporting requirements," according to state data. The great majority will simply lose coverage because complexity of the policy is difficult to understand. 

3. Writing in Health Affairs this week, researcher Jessica Greene, a professor of health policy at Baruch College, shared exchanges she had in Arkansas: Two-thirds of the Medicaid recipients I interviewed had not heard anything about the new work requirement. 

“First time I’ve ever heard anything [about it],” a 31-year-old man, who had started a vocational training program the day we spoke, said. “You’d think it’d be on the news or something. I ain’t seen it on the news, and I watch Channel 8 news every night.” 

Others echoed his surprise: “I’ve never even heard of it” and “I can’t believe I ain’t heard something about it on the news.”

4. Green wrote that half of the people she spoke to should have received the letter from Arkansas's Department of Health. Of that group, five weren't sure if they received a letter:

When asked about receiving a DHS letter, a 42-year-old woman said, “I don’t know, I’m going to have to check and make sure [I didn’t receive the letter], because I need my Medicaid card for my sugar pill and my blood pressure pills.” 

A 46-year-old man, who had recently completed an inpatient drug treatment program, kicking a multi-decade drug addiction, wasn’t sure either. “I may have [received the letter]…I’m horrible about opening mail….I probably throw’d it away.” 

Again, it's simply human nature to put off or throw out mail you first perceive as unimportant. Personally, I automatically look for my utility bills and that's it. Some mail looks like it's from the government but isn't. 

As for the people interviewed above...

While the three others did not believe they received the letter, they were all exempt by either working and/or having children in the home, but likely needed to report their hours and exemptions in the portal to maintain Medicaid coverage.

The sad thing is, it will take the loss of life-saving coverage in Arkansas to show how flawed this nasty GOP condition for health care coverage is before it's tossed out in the courts.

A final note: While Republicans cut rules, regulations, and reporting for businesses, they're increasing the paperwork and complexity of social services for the very people they're hired to serve. It would be nice if Democrats started to point this out.

The Trump Country Health Care Divide!!!

This is the big story this week for me. 

The Republican scam that states somehow know how to best manage their own constituents healthcare needs is coming to an end. Seriously, how different are people in Kansas, Texas, or California...ridiculous right? 

Every one of the options below will or would have killed people. Period. Wisconsin may be next...

3 Year Lifetime Cap on Medicaid, after that, you're on your Own: Destroying Medicaid and forcing the poor to wither away and die by withholding life-saving treatments...I know, it sounds insane, doesn't it? But that was the end game all along. Think I'm kidding? From my healthcare email:

The state of Kansas had proposed Medicaid beneficiaries be allowed to remain under the KanCare Medicaid program for a three-year (lifetime) maximum before being dropped, other states including Arizona, Utah and Maine have made similar requests.

Too much for even Republicans, for now anyway...but this is now part of their agenda:

CMS Administrator Verma announced yesterday the agency will reject Kansas’s request ... "We also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them."

But that wasn't the driving force to reject the 3 year lifetime cap...it all about money, not lives:

Several healthcare providers in Kansas this year urged the CMS to deny the state's proposed Medicaid benefits limit, claiming it would significantly increase hospitals' uncompensated-care costs.

"Are there No Workhouses?" Health Care Work-for-free Requirement: The new American value? People are useless and social dead weight if they don't work...it's more Orwellian description; "improving the lives of Medicaid beneficiaries." 

The approval makes New Hampshire the fourth state to institute a Medicaid work requirement. six states with pending applications. “I congratulate Governor Sununu’s commitment to join me in improving the lives of Medicaid beneficiaries by creating a crucial link to work and community engagement,” Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement.

Michigan is pushing the same idea, and it's not to save money:

The bill's Senate sponsors admit that this proposal isn't about saving money; in fact, it'll cost about $30 million a year to administer the program. It's pitched, instead, as a firm-but-gentle hand to those who've become dependent on the teat of government dependency.

Rural Whites exempt from Work Requirements, as GOP finally Establishes U.S. Class System: We always knew urban minority communities were never the "real Americans," so under Republicans rule, the lines are literally being drawn:

In Michigan, people who live in counties with higher unemployment rates — above 8.5 percent — are exempted from the requirement ... rural whiter counties unemployment is higher, get a break while urban areas with a higher share of black residents would still be subjected to them. 

Notice how the Republican co-sponsor of the bill, who hasn't done anything to create jobs in his district, found a way to help - let 'em freeload:

Michigan Sen. Wayne Schmidt (R-Traverse City) represents Cheybogan County, where unemployment is high, around 20.9% ... also represents Chippewa County, where unemployment was about 10.5% ... the residents Schmidt represents are unlikely to be harmed by SB 897 ... This is what's called "political cover." It's also one of the ways legislators skillfully pit urban and rural Michiganders with common interests against each other.

The fact is, if SB 897 causes 20% of Medicaid recipients to lose their benefits as the bill's sponsor, Sen. Mike Shirkey (R-Clark Lake) projects, some of them will die. "Every one of these reasons to deny you healthcare kills people," Paul Propson, CEO of Covenant Community Care in Detroit.