New Year, New Policies, A New Push for Medicaid

This year begins with a new Congress, a new President, and a newly revitalized movement to push for housing and health care justice. Get involved by sending us your Medicaid stories, inviting your federal and state policymakers for a site visit, and contacting your federal representatives about the importance of Medicaid. If you missed our January 11 webinar with the National Alliance to End Homelessness on Medicaid Advocacy and Homelessness, you can now view the recording. A special thanks to Keith and Annie for allowing us to share their Medicaid stories in this issue.

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January Roundup

New President

On January 20, Donald Trump was confirmed as the 45th President of the United States. A few days before the inauguration, he made a public statement announcing that he will release a health care plan that promises "Health Care for Everyone." The details are not yet available, but Trump’s top advisor referenced block grants as part of the program, which are also a part of House Speaker Ryan’s “Better Way” budget proposal. 

Confirmation Hearings

Senate committees questioned Ben Carson, nominee for Secretary of Housing and Urban Development (a $49 billion program that oversees housing for over five million low-income individuals), and Tom Price, nominee for Secretary of Health and Human Services (a $1 trillion program that oversees Medicare, Medicaid, ACA implementation, health centers, mental health, and addiction funding, and many other health care programs).

Questions for Carson focused on his views of poverty, social programs, and plans for HUD's role to help low-income families. Carson previously indicated that he wants to cut programs that foster dependency and believes it is best for charities, not the government, to help the needy; however, he didn’t detail these views during the hearing. During the hearing it was clear that Carson understood how housing impacted health outcomes, but he said that his comments on fair housing as a “social engineering scheme” were taken out of context. See video and transcripts from Carson’s hearings.

Tom Price came under fire, especially around his stock trades and vague promises on how to continue coverage after repealing the ACA (from Democrats and Republicans). Price praised health centers but spoke about giving “flexibility” back to the states to impose work requirements and other restrictive measures on adults enrolled in Medicaid. Carson received the necessary votes in the Senate Banking committee on January 24. Price is awaiting confirmation in the Senate Finance committee. After passing out of committee both candidates require a vote in the full Senate to be confirmed in their new roles; those votes are not yet scheduled. Both are expected to receive the necessary votes to be confirmed.

Trump recently nominated former Georgia Governor Sonny Perdue as Secretary of Agriculture, who will oversee the Department of Agriculture, which runs programs impacting public health such as SNAP (food stamps), school breakfast and lunch programs, and rural health grants.

Movement Toward Repealing the Affordable Care Act

Congress passed a budget resolution that allows a filibuster-proof process for moving forward to repeal parts of the ACA, which now would only require a simple majority to pass in the House and Senate. Learn what the budget resolution means for repeal.

Also this month, Republican Governors convened in Washington to discuss maintaining Medicaid, which emphasizes the importance of governors in the push to prevent moving to a block grant or to repeal the expansion provision in the ACA (see Take Action for the importance of contacting your governor).

Finally, President Trump signed an Executive Order on his first day in office that gives the Department of Health and Human Services a direction to cease or delay implementing some aspects of the ACA. Though the implications of the order are unclear, it does not repeal the Medicaid expansion but instead is thought to delay outstanding regulations, grant more exemptions to the individual mandate, approve more Medicaid waivers coming from states, and other administrative actions. More analysis is needed to determine the true impact of this order.

Note that these are the first of many steps in the move towards “repeal” of the ACA, and much is still unknown about a possible alternative or replacement health reform bill (see more about “replace” under What We’re Reading).

On the Horizon

Over the next month the Senate will be busy confirming nominees for Trump’s cabinets picks, and the House and Senate will continue debating the details of next steps on the ACA (either “repeal” and/or “replace”). The Trump Administration will be working on a budget recommendation, set to be released in April and rumored to include massive cuts for entitlement programs, based off the Heritage Foundation’s budget plan that cuts $10.5 billion of funding over a decade. This plan would be much bigger than the proposal from House Republicans' plan from last year that proposed $5.5 trillion in spending cuts. These plans both include significant reductions to low-income programs such as SNAP benefits, repealing the ACA, and capping federal funding for Medicaid.

What We're Reading

• We’re listening to Dan Diamond’s Politico Pulse Check Podcast. Check out his episodes on interviews with one man trying to repeal Obamacare and one man trying to save it and the beginning of Trump’s health agenda (also available on your favorite podcasts app!).
  
• Proposals to Replace the Affordable Care Act
• Caps on Medicaid Expansion Would Give States Flexibility to Cut 
• GOP Governors Who Turned Down Medicaid Money Have Hands Out 
• Medicaid’s Future: What Might ACA Repeal Mean? 
• How Repealing Portions of the ACA Would Affect Health Insurance Coverage and Premiums
• Indivisible: A Practical Guide for Revisiting the Trump Agenda

Medicaid Stories of the Month

“Patients interviewed on what they would have done universally say, 'I would have died–and will die without it' ... I want to scream from the hills that Medicaid isn’t broken; why in the world would anyone want to change it? ... I have a 51-year-old patient with severe joint disease that rendered him incapable of continuing the contract repair job with a major department store he’s held for more than 10 years. He had to leave his position and lost his insurance–and disability payments were not enough to cover the cost of insurance and rent. Medicaid helped him get a joint replacement, and he is thrilled to be able to walk again, finish his physical therapy, and get back to the work he loved ... ACA has been a blessing and opened the doors to better health for the hundreds of patients I have seen. We have a robust program with excellent outcome measures including a hospital readmission rate of under 10% in 30 days.”

– Annie Nicol, FNP, PA
   Director of Homeless Services, Petaluma Heath Center, Petaluma, CA

“Growing up on the West Side of Chicago, I was trying to deal with addiction in my family. Combined with some of the tougher aspects of my neighborhood, it was difficult to try and help my brothers and sisters growing up. Eventually, I even fell into substance abuse and addiction. This led to my becoming homeless. During this time, I was run over by a large flatbed truck, crushing my pelvis. My health issues and addictions kept me in a space where I was stuck. Medicaid helped pay for services to help me heal. The organization that I worked with, Heartland Alliance, used Medicaid to help me with physical therapy, medicine, doctor visits. Eventually I was able to retain my health, kick my addictions and maintain sobriety, and continue to succeed and escape homelessness. For years now, I’ve been sober, happy, and grateful for where I’ve come from–a lot of that is because of Medicaid. Without my health, I wouldn’t be able to maintain stable housing, see my doctor, or continue my healthy lifestyle.” 

– Keith Belton
   Chicago, IL