Advocates are gearing up for a fight against a proposed rule from President Donald Trump’s administration that would make major changes to a long-standing immigration law. The “public charge” rule allows government officials to take into account an immigrant’s potential need for government benefits when deciding whether to admit them into the country or grant them legal status. Currently, government officials can only consider an immigrant’s potential for reliance on cash assistance or long-term medical care, but the Trump administration is considering adding a host of safety net programs to the list of what can qualify a person as a “public charge.” The Washington Post’s Colby Itkowitz reports:
The mere suggestion of the expanded policy has already had a “real chilling effect” on immigrants using health-care services, Alberto Gonzalez of the advocacy group Community Catalyst told me. Doctors have “witnessed examples on the ground of people not wanting to access their local providers because they’re afraid if they take their kids for a checkup it will be communicated to the federal government.” … A new report published in the New England Journal of Medicine this month determined that the number of immigrants who wouldn’t access Medicaid and the Children’s Health Insurance Program (CHIP) because of the policy would result in at least one million people becoming uninsured. Gonzalez said mental illnesses may go untreated, kids will miss pediatric visits, and families will forgo preventive care, like cancer screenings. “It will be a public health crisis,” Gonzalez said.
To learn more or get involved, visit the Protecting Immigrant Families coalition’s website.
Auditing the Medicaid audits
The Senate Health and Welfare Committee convened in Baton Rouge on Tuesday for a rare August hearing to review a June legislative audit of the Louisiana Department of Health’s payments to Medicaid managed care companies. Several senators questioned why the legislative auditor, who is supposed to be a nonpartisan actor, took a prominent role in publicizing the audit results in the media in a way that mischaracterized the actual findings. Nola.com/The Times Picayune’s Julia O’Donoghue was there:
Democratic senators on the Senate Health and Welfare Committee criticized [Legislative auditor Daryl] Purpera Tuesday for implying that problems in the health agency’s bill-tracking system would lead to fraud in the Medicaid program and that state health officials weren’t doing their jobs properly. The Senate committee had called a special meeting to address issues brought up in audits performed by Purpera’s staff, but the hearing turned into a referendum on the way Pupera talked to the press about the Medicaid program. Pupera didn’t appear personally at the hearing. His staff responded to questions from the senators for him by saying the media hadn’t framed the audit properly or didn’t understand the nuance of what Pupera was saying.
Many of the issues identified in the audit stem from the state’s abrupt shift in 2012 from a fee-for-service Medicaid model to managed care. Health Secretary Rebekah Gee and state Medicaid director Jen Steele outlined the specific actions the department is taking to address the issues identified:
Some senators on the committee eventually pivoted to whether anything could be done to strengthen Louisiana’s oversight of its Medicaid program, which is managed by five private organizations outside the state government. That $3 billion worth of payments were not tracked properly at least makes the program vulnerable to fraud, even if the audit doesn’t prove it’s actually happening, said Sen. Norby Chabert, R-Houma. “The incident rates are concerning to me,” he said. Health officials said they were doing their best to address weaknesses in their safeguards against abuse. “For a variety of reasons, Medicaid is politicized. These are important findings. We all want to address them,” Gee said.
Bridging the gap between income and rent
The rising cost of housing in the United States has put the squeeze on many low and middle-income families, especially renters. The affordability crisis has given rise to a variety of policy proposals to increase the supply of affordable rental units and reduce zoning restrictions. But for some families, building more rent-controlled units in better neighborhoods will not solve their most basic problem: their income is too low to afford even “affordable housing.” Jenny Schuetz with The Brookings Institution spells out what’s needed for these struggling families:
Reducing zoning constraints and building more market-rate housing will ease affordability problems for middle-class families. But the poorest 20 percent of families don’t earn enough to pay the rent on even modest apartments. Current federal assistance falls well short of helping those families afford a safe, stable, decent place to live: About one in five eligible families receive federal housing assistance. For poor families, the most direct solution to housing affordability is to supplement their incomes. This could be done by expanding existing mechanisms, such as the Earned Income Tax Credit (EITC) or housing choice vouchers, or through a refundable tax credit, as proposed by Senators Harris and Booker. Helping poor families bridge the gap between income and rent will relieve the stress of housing insecurity and enable more children to develop into productive and engaged citizens.
Long-term short-term health plans
A new federal rule that took effect this month expands the maximum terms of short-term health insurance plans from three months to just under one year. In addition, insurers will be able to renew the short-term plans for up to 36 months. The longer duration may give consumers the allusion that they’re buying a comprehensive, year-round insurance plan at a reduced rate. The reality is that these plans are not required to comply with the Affordable Care Act’s consumer protection requirements, meaning they don’t necessarily cover basic health services like prescription drugs or maternity care. Younger, healthier consumers are expected to be most willing to gamble on skimpier health coverage, which will have negative consequences for those who remain in the ACA’s individual marketplace. Emily Curran, Kevin Lucia, Sabrina Corlette, and Dania Palanker write for The Commonwealth Fund’s To The Point blog:
Indeed, the Trump administration expects that as many as 500,000 individual market enrollees will migrate to short-term plans in 2019. Because they will be relatively healthy, their departure will cause premiums in the individual market to increase by a projected 5 percent. This increase will come on top of other projected increases resulting from the repeal of the ACA’s individual mandate penalty and the expansion of association health plans.
One big concern is that some who need and want comprehensive coverage may end up in a skimpy short-term plan because they don’t read the fine print. There are several steps state insurance officials can take to regulate short-term insurance products sold in Louisiana to protect consumers from unscrupulous actors:
As a new market of long-term short-term plans emerges, states need to understand their short-term market in order to protect consumers and maintain a stable individual market. This can begin with an assessment of which insurers are actively marketing in the state. States also may want to ensure that any short-term plan sellers seeking to offer coverage that mimics the 12-month duration of ACA-compliant coverage submit plan designs, rates, and marketing materials for review and approval, as Vermont has done recently. Doing so will allow states to have a firmer understanding of the insurance products being sold to their residents, and will better position them to reduce consumer confusion and monitor for potential fraud.
Number of the Day
7.9 million – Number of U.S. citizen children who could be impacted by the Trump administration’s proposed changes to the “public charge” rule because they live in families with at least one non-citizen. (Source: Center for Law and Social Policy)