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Medicaid Expansion: Arkansas And Other States Cut Deals With Feds For Alternative Plans

Medicaid Expansion: Arkansas And Other States Cut Deals With Feds For Alternative Plans

By Michael Collins, The Commercial Appeal (Memphis, Tenn.)

WASHINGTON — If Gov. Bill Haslam is searching for clues about what kind of deal Tennessee might be able to cut with the federal government to expand Medicaid, he should look just across the Mississippi River.

Arkansas was the first state to get a federally approved waiver allowing it to use Medicaid funds to buy private insurance for low-income residents. At least two other states — Iowa and Michigan — also have won federal approval to use the money for alternative programs tailored specifically to their needs.

Several other states, including Tennessee, are negotiating with the U.S. Department of Health and Human Services for permission to set up state-specific health insurance programs instead of expanding traditional Medicaid.

“Once Arkansas got its waiver in place, that sort of signaled to other states that were reluctant to expand (Medicaid) that there was some other kind of opportunity to be had,” said Nicole Huberfeld, a professor of health law at the University of Kentucky.

Haslam has been in discussions with the federal government for months to win approval for a Tennessee-specific plan to expand Medicaid coverage, which is a key component of President Barack Obama’s Affordable Care Act. Under the health care law, the federal government would pay 100 percent of the expansion costs in the first three years.

Haslam’s office and federal officials said last week those discussions are still underway.

“HHS is working with the state to explore options that improve care and lower costs in the Medicaid program,” said Fabien Levy, a spokesman for the federal agency

Publicly, Haslam has talked only in broad terms about what he is pursuing. He wants Tennessee to be able to use the federal money to buy private insurance for low-income residents instead of expanding traditional Medicaid. He also wants to require co-payments for some of those insured so they will have a personal investment in their health care decisions.

Both are components of Arkansas’ plan, which the federal government approved last September after seven months of discussions.

Faced with a lack of political appetite to expand traditional Medicaid but with an obvious need to insure thousands of low-income residents, Gov. Mike Beebe and the Arkansas legislature eventually settled on a private-option plan. Federal money that would have been used to expand traditional Medicaid is used instead to buy private insurance for qualifying residents. To be eligible, enrollees must earn below 138 percent of the federal poverty level, or $15,900 for someone who is single. Some co-payments are required on a limited basis.

Between 200,000 and 250,000 Arkansans are eligible for coverage under the program, which took effect Jan. 1. As of late March, some 233,000 had already completed applications. More than 121,000 already are getting coverage.

“There is definitely significant interest — you could tell by the number of people who applied for coverage,” said Amy Webb, spokeswoman for the Arkansas Department of Human Services.

Iowa, which won federal approval for its own private-option plan last December, also uses Medicaid expansion money to help low-income residents buy private health insurance. Under the agreement with the federal government, beginning in 2015, the state will be allowed to charge modest premiums to people who earn between 50 percent and 133 percent of the federal poverty level. The premiums can be waived if the insured person follows certain prescribed healthy behaviors.

Roughly 85,000 people already have signed up for insurance under the program, which took effect Jan. 1, said Amy McCoy, spokeswoman for the Iowa Department of Human Services. An estimated 150,000 people are expected to sign up within three years.

Michigan’s plan, approved last December and effective April 1, expands Medicaid eligibility to up to 133 percent of the federal poverty level and requires co-payments and income-based premiums that can be reduced by making healthy lifestyle choices. Enrollees must make an appointment with a primary care physician within 60 days of signing up and come up with a health-incentives plan, such as quitting smoking or exercising more.

Michigan residents have a lot of chronic health issues, such as obesity, so “we wanted to do something that was a little more beneficial to the health status of our residents,” said Angela Minicuci of the Michigan Department of Community Health.

Photo: joetta@sbcglobal.net via Flickr

New Jersey Official Denies Withholding Disaster Aid

New Jersey Official Denies Withholding Disaster Aid

New York (AFP) – Embattled New Jersey governor Chris Christie’s second-in-command Monday flatly denied allegations she and Christie threatened to withhold money for Hurricane Sandy relief as a political quid pro quo.

These latest allegations of political strong arm tactics add to the increasing scandal surrounding the governor, after aides were accused of manufacturing traffic jams as revenge against another mayor who refused to endorse the governor’s re-election bid.

Over the weekend, Hoboken mayor Dawn Zimmer, a Democrat, said Lieutenant Governor Kim Guadagno told her Christie could withhold relief money for her city unless she approved a redevelopment plan he supported.

“The lieutenant governor pulled me aside and said essentially, ‘you got to move forward with the Rockefeller project,'” Zimmer told CNN Sunday, referring to a planned 40-story office tower and commercial development in Hoboken.

But Guadagno said Zimmer’s recounting of their conversation was “not only false but it’s illogical.”

Speaking at a news conference related to a Martin Luther King Day event, Guadagno said the allegations do not stand up to “scrutiny, when all of the facts are examined” and flatly denied any relief funding was tied to approving a separate project.

“Standing in Union Beach as we are today, with some of the mayors whose towns were devastated by Sandy, and also being a Sandy victim myself, makes the mayor’s allegations particularly offensive to me. The suggestion that anyone would hold back Sandy relief funds for any reason is wholly and completely false,” she insisted.

A Christie spokesman, Colin Reed, issued a statement to various media outlets late Saturday denying Zimmer’s charges, accusing Zimmer of playing “partisan politics.”

The statement said $70 million in federal funds had already approved for Hoboken with more potentially to come.

Christie was credited with decisive leadership when Hurricane Sandy slammed into the East Coast in October 2012, hitting New York and New Jersey particularly hard.

He also had a reputation for being the kind of pragmatic Republican who could work across party lines, and could garner national support from Democrats, as he has in his majority blue state of New Jersey.

Christie was forced last week to admit his staff lied to him about their role in blocking commuter traffic onto a major bridge in an act of political retribution against the Democratic mayor of Fort Lee.

The scandal is being investigated by federal prosecutors.

After the “bridgegate” scandal came to light, Christie fired a top aide, Bridget Kelly, and was seeking to put the matter behind him when the new allegations surfaced.

The larger-than-life Republican seen as a frontrunner for his party’s 2016 presidential nomination, said he had been “embarrassed and humiliated” by the alleged dirty tricks, which, he said at a marathon press conference last week, he had no knowledge of.

In an interview published by Yahoo Monday, the governor suggested his presidential ambitions had not been squelched by the scandal, saying he felt “readier” to be president than when the same question was asked in 2011.

He said his experience since the “bridgegate” accusations first broke had been “awful.”

“I’m trying to get my arms around an awful situation,” he told Yahoo, “and understand it, and then address it, and then resolve it.”

The interview was conducted Friday, before the latest accusations came to light, including a separate allegation by Democratic Congressman Frank Pallone, who said he wants Christie investigated over claims he improperly used tax payers’ relief funds for personal political gain in the run-up to his 2013 re-election.

Polls show Christie with widespread support both in his state and across the nation, but some polls show him taking a hit in the wake of the bridgegate scandal.

AFP Photo/Jeff Zelevansky

Message To Obama: Go Big, Long, And Global

WASHINGTON — President Obama has only one option as he ponders a world economy teetering on the edge: He needs to go big, go long and go global.

Obama should not be constrained by what the tea party might allow subservient Republican leaders in Congress to do. He should state plainly, eloquently and in detail what he thinks needs to be happen. Neither history nor the voters will be kind to him if he lets caution and political calculation get in the way.

Going big means immediate action to boost the economy, even though this will increase the short-term deficit. His proposals to continue the payroll tax cut, extend unemployment insurance and enact patent reform are good, but not enough.

The federal government needs to come to the aid of state and local governments again; the budget cuts they are being forced to make are precisely what the economy does not need now. We must find ways of boosting spending as quickly as possible on roads, bridges, transit and other building projects, including a new program to rehabilitate the nation’s dilapidated schools. And the administration needs to do far more to resolve the mortgage mess, which is holding back consumers.

Over the last week, big investors and business leaders have largely stopped talking about budget balancing and started issuing panicky calls for the world’s governments to step up to the challenge of avoiding a second recession by spending more money. They know that austerity is the wrong medicine right now.

Note well: It’s not only liberals in the United States and social democrats in Europe who are pushing to stimulate the economy. Calls to do so are also coming from the heart of the capitalist system.

At the same time, Obama should put forward a plan of his own to close the long-term deficit. He should not be hemmed in by his negotiations with congressional Republicans to get the debt ceiling raised. They don’t hold the nation’s credit hostage anymore. He should lay out exactly what he would do and abandon his practice of making pre-emptive concessions to his opponents.

That means Obama should not be shy about urging eventual tax increases, particularly on the wealthy. And let’s be clear: these would not be immediate tax hikes; they’d kick in a year or two from now.

Any plausible plan should include at least $2 trillion to $2.5 trillion in new revenues over a decade. Obama, who loves to quote financier Warren Buffett, should follow Buffett’s lead on this. Writing in The New York Times last week, Buffet proposed that “for those making more than $1 million — there were 236,883 such households in 2009 — I would raise rates immediately on taxable income in excess of $1 million, including, of course, dividends and capital gains. And for those who make $10 million or more — there were 8,274 in 2009 — I would suggest an additional increase in rate.”

“My friends and I,” he added, “have been coddled long enough by a billionaire-friendly Congress.” Buffett, bless him, puts the lie to the foolish idea that we need fewer tax rates, which pamper the very wealthy by taxing them at the same rates as the upper middle class. We need additional tax rates for the truly rich.

A carbon tax, partly offset by tax cuts or rebates for middle income and poorer taxpayers, could provide additional revenue. And we need to do still more to contain health care costs without hurting those who can’t afford insurance, and without voucherizing Medicare.

But our problems are not all made-in-America. This is a global problem requiring a global solution. Europeís debt mess and its weird political structure — a common currency without an effective common government — helped trigger the near-panic we’re in. Even China’s growth rate shows signs of slowing.

World leaders came together in 2009 and stopped the slide toward depression. Obama should take the lead in bringing them together to act in concert again.

Ah, but won’t congressional Republicans block as much of this program as they can? That’s the wrong question. The point is to insist on a rational plan and to challenge the political system to act rationally. Most economists and business people not blinded by ideology believe we need short-term stimulus and long-term fiscal balance. Obama should explain what needs to be done and then fight for it. It’s the only way it will have any chance of happening.

E.J. Dionne’s email address is ejdionne(at)washpost.com.

(c) 2011, Washington Post Writers Group