Kentucky Becomes First State to Adopt New Medicaid Work Requirement

(THIS ARTICLE IS COURTESY OF TIME NEWS)

 

Kentucky Gov. Matt Bevin announces federal approval of Kentucky's Medicaid waiver in Frankfort, Ky on Jan. 12, 2018
Kentucky Gov. Matt Bevin announces federal approval of Kentucky’s Medicaid waiver in Frankfort, Ky on Jan. 12, 2018
Alex Slitz—Lexington Herald-Leader/AP

By ALANA ABRAMSON

10:50 AM EST

The state of Kentucky has become the first to adopt the Trump administration’s new policy of imposing work requirements as a precondition of receiving Medicaid benefits.

Consequently, residents of Kentucky who are on Medicaid and considered healthy enough to work, must now comply with certain requirements to receive the health care provided by the government program.

The Trump administration announced on January 11 that states could impose work requirements on Medicaid recipients. One day later, the Center for Medicare and Medicaid Services approved a waiver for Kentucky adopting that new policy for the next five years. Under the program, which officially starts in July, Medicaid beneficiaries between the ages of 19 and 64 who do not meet exemption requirements must complete at least 80 hours per month of “community engagement,” which includes work, school, job skills training, or community service. If they do not complete the requirements, Medicaid eligibility will be suspended. The program exempts several categories of recipients, including pregnant women, those diagnosed as “medically frail,” primary caregivers, and former foster care youth.

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“It will be transformational,” Kentucky Governor Matt Bevin said in an announcement Friday. “Transformational in all the right ways, in good ways, in powerful ways.”

More than 2 million people are on Medicaid in Kentucky, according to the Kaiser Family Foundation, which is nearly one quarter of the state’s population. Kentucky was among the 33 states to adopt the Medicaid expansion program that is a cornerstone of the Affordable Care Act enacted under the Obama administration, but Bevin has been seeking to implement these changes since he was elected in 2015.

Bevin also defended the program from criticism that it was essentially punishing lower income people, and insisted that the program will only impact those who are physically able to work. The recipients of the program who are unable to comply with the new regulations, he said, will remain unaffected.

“This idea that somehow we are punishing people, that this will be a detriment to people I think is a huge huge misunderstanding of what people need,” he said, noting that he himself came from a low-income family. “There is dignity associated with owning the value of something you receive.”

 

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Stop Charging Rape Victims for Post-Assault Medical Care

(THIS ARTICLE IS COURTESY OF ‘CARE2’)

 

Stop Charging Rape Victims for Post-Assault Medical Care

34,075 SUPPORTERS
35,000 GOAL

According to current law, you can be billed for medical treatment you received after a rape. Let’s take a moment to let that sink in. Right now, the government allows hospitals to charge rape victims and their private insurers for additional costs after a rape. Thus one’s emotional trauma can often come with a high financial burden.

Currently, the Violence Against Women Act (VAWA), requires states to pay for rape kits. But there are often extra costs that are passed on to the victim. Pain medication, antibiotics, HIV prevention drugs, emergency contraceptives and other treatments aren’t guaranteed by the VAWA and they are not cheap. In fact, in 2013, women victims of rape paid out nearly 1.26 million dollars to cover extra medical costs. That’s nearly $1000 per person.

In no other instance are victims of violent crimes responsible for footing the bill for injuries the incurred. Rape victims shouldn’t be charged either.

The VAWA is up for reauthorization next year and it is time that Congress put an end to this practice by updating VAWA’s language to ensure all rape-related medical expenses are covered by the state.

Please sign this petition to voice your support for an updated VAWA that covers all rape-related medical expenses are covered by the states.

Dear Congress:

The Violence Against Women Act provides victims of sexual assault, rape and violence with the rights they deserve after such a harrowing experience. Yet, I recently learned that rape victims can actually be billed for the medical treatment they require after an assault. This is not the case for other violent crime victims and it shouldn’t be the case with rape victims. Please rectify this by updating the VAWA to ensure the state covers all rape-related medical expenses a victim may incur.

[Your comments here]

Sincerely,

[your name]

Texas House Passes Bill To Make Women Buy ‘Rape Insurance’

(THIS ARTICLE IS COURTESY OF ‘NEWS.GROUPSPEAK’)

 

The most populous Republican state in the country, the good ole’ state of Texas, has passed a bill in the House of Representatives that will essentially force women to buy rape insurance if they seek to have an abortion.

Critics of the bill are calling it especially cruel and a detriment to women’s health in general. If put into law, the bill will take effect as soon as Dec. 1 and force women to buy supplemental plans if they wish to have abortions, even if induced by rape.

Considering the Senate has already passed a very similar measure, and Governor Greg Abbott has already come out publicly showing his support, it’s only a matter of time before the bill gets signed.

“Women and parents will be faced with the horrific decision of having to purchase ‘rape insurance’ to cover them if they are victimized,” Democratic Representative Chris Turner said in a statement. “This is not only ridiculous, but it is cruel.”

“No woman plans to be raped. No parent plans for their child to be a victim of incest.” The idea that a woman would be forced to consider purchasing for herself – or a parent would be forced to purchase for their child – essentially a rape insurance policy should be abhorrent.”

The bill’s sponsor, Republican John Smithee, says it’s not that simple, though.

“It’s a question of economic freedom and freedom in general. This isn’t about who can get an abortion. It is about who is forced to pay for an abortion.”

By that, he means, he doesn’t want opponents of abortion being forced to subsidize it.

But, looking at it a different way, it will force women to completely absorb the costs of abortion. Every male in Texas with an insurance plan won’t have to pay into the pool of funds helping to support its costs. That will cost women more, which is another way for Texas Republicans to make women’s health care more expensive.

Also – if women don’t buy the supplemental insurance, which many lawmakers are betting that they won’t – it will make getting an abortion that much more unlikely.

“This bill takes us backwards,” said Rep. Ina Minjarez, D-San Antonio. “This bill is about denying Texas women their right to a safe abortion.”

Currently, 10 other states ban private insurance plans from covering abortions. Texas is about to be added to that list.

 

Republican Christians: Quit Being Hypocrites, Put Up, Or Shut Up

 

I use the name Truth Troubles for this Blog Site for a reason, it is because in many cases the ‘truth’ can be inconvenient for our ego’s. Politicians are great at telling people they are speaking the truth on a subject matter when in fact only about 1% of what they are saying is actually the truth. You see, that is speaking the truth, they just don’t tell you about the 99% BS that goes along with their version. When you step on the witness stand in a court room you are told to tell the truth, the whole truth, and nothing but the truth so help you God. Folks, that, is the only truth, God’s truth, not some version or percent of it.

 

In November of 2016 ‘we the people’ mainly had two horrible habitual liars to choose as our President, which one was the worse for our Country, that is debatable. Weather the Democratic Party or the Republican Party is the most evil is also easily debatable, personally I have no faith in either of them to ever be truthful with the American people. The Democratic Party and their platform of supporting abortion at will make it impossible for many Christians to vote for a Democrat knowing that they will endorse this policy. Yet this article today isn’t about the Christians who vote for Democrats, today, this article is about the Republican Party and their own ‘unholy’ policies.

 

I say unholy policies because of their own ‘platform’ issues. This newest Republican Tax Plan is a good example of the cold-hearted nature of their base beliefs. This Bill is 1,997 pages long, the reason is simple, there are many items other than changing the Tax Code in that Bill. If it were just a simply straight forward Tax Code Bill how many pages would it be? Really, think about it, should it be more than 2 pages, 5, or maybe 10? How about even 100 pages, you can put a lot of words in 100 pages. In this bill are items like not reimbursing teachers for the supplies they have to buy out of their own pockets so their classrooms can have the basic supplies they need. Also items like stopping assistance to the ‘Meals on Wheels’ program which helps feed the poorest of the poor ‘shut in’s’. Also stopping all the funding for PBS. Stopping many of the Federal Grants for poor kids to help them go to College thus also massively hurting thousands of Colleges and Universities. In this Bill is also massive cuts to Medicaid and Medicare which will cause many millions of Americas poorest people to lose their only Insurance. This will also cause many small hospitals around the Nation to have to close as people will again be having to go to their E.R. services when they get sick or injured and when these people can not pay their bills, the Hospitals will go out of business.

 

The Lord tells us all to be kind and charitable, giving and loving. The Republican Party very plainly caters only to the wealthiest 10% or so of our population. Think about this one fact for a moment please, I was born back in the mid 1950’s, in my lifetime there has not been one single minimum wage increase when there has been a Republican in the White House, not one. Trickle down economics does not work folks. It is like saying that the richest folks will be gracious and allow some of the crumbs to be swept onto the floor so the poor don’t starve to death. And the only reason they allow the crumbs is because the working class is the ones who make the products that make the rich, richer. If the people starve to death it might hurt their profit margins. If you think I am being to hard on some folks just think about the Stock Market for a moment. President Trump likes to talk about how well the Market is doing and that is a good thing folks, but the trouble is that it is a horrible thing for the people who can’t afford massive amounts of those Stocks. When a company lays off hundreds or thousands of employees their Stock value goes up right away. When a company moves out of the U.S. to a ‘Third World’ country for cheaper labor costs, their Stock value goes up right away. When Wal-Mart and Target recently gave all of their employees a raise, their Stock value went down right away.

 

Most of us know that many of the largest American companies are flooded in cash right now and that this cash is sitting in offshore banks. This is not illegal if they have followed all of the existing laws in their putting it there, in fact that is quite smart of them. If the CEO’s weren’t taking advantage of these loopholes their stock holders would vote them out of a job. I have heard several times on different news programs where Executives have commented that they have no place to invest this money so they are just hanging onto it as they are looking for better ‘deals’. So, this talk about caring about the wages and living conditions of the working class is really just a bunch of BS. If these companies were paying better wages and benefits to their workers then the whole economy would prosper. If the government actually raised the taxes on the major companies and closed off all of their built-in loop holes then the Nation could invest in our Nations roads, bridges, city infrastructures, education system and health care system.

 

The Democratic Party has lots of its own sins but as I said this article today is about some of the sins of the Republican Party and the Christians who keep putting their ‘Name, their stamp of approval’ to them. If you are a Christian and you are a voter and you choose to vote for any Republican then it is your Christian duty to insist that the Republican politicians start acting like God-fearing Christians or make it very plain that they no longer have your vote. Charity, kindness, love, compassion are staples of the teachings of Jesus Christ. Folks, the teachings of the Republican Party are exactly the opposite of the teachings of Jesus! So, if you are a Christian and your are a voter, start acting like you know and care about the teachings of Christ and force the hand of these Republican politicians. Either that or simply quit supporting them, otherwise we are nothing but a hypocrite, we are not a follower of the teaching of Christ!

The Unneeded Poor WILL BE Exterminated

The Unneeded Poor WILL BE Exterminated

 

In this article today I am going to write it as a proverbial ‘Devils Advocate’. What I mean by this is that this is not something that I want to happen yet I am making the argument to you that it is very much a possible reality as the human race continues to degenerate.

 

When it comes to politics I am an ‘Independent’, neither a Democrat nor a Republican. I believe that both of those major parties are about as crooked at the top levels as they can find a way to be. When you are a person like Hillary or Bill Clinton or a Trump or a Bush I believe that they have proven themselves to be the type of people who will do anything to win or to enrich themselves. In the past day or so thousands of documents dubbed the ‘Paradise Papers’ have surfaced showing how the super wealthy cheat their country and their people out of tax revenues. Last year the same type thing happened with the ‘Panama Papers.’ These documents show that not only are many of the ‘super wealthy’ cheating on their taxes, they also show how intertwined they are with world leaders, government officials, and the super huge global companies as they all seek to scratch each other’s backs in their efforts to get even richer.

 

Back in the mid-1970’s you used to hear people talking on the radio and TV how with the ‘new technologies’ how people were only going to be only having to work 4 day weeks because the machines will allow us to get as much done in 4 days as was currently being done in the 5 day work week. How foolish these ‘talking heads’ were. If you are the employer why would you give up the chance to make an extra 20% each week by giving your employees an extra day off? Especially if your company is on the Stock Exchange, your stockholders would quickly replace you. The business world, especially those on the Stock Exchange are only concerned about one thing, higher profits. If you have ever paid any attention at all to the stock market, you should have noticed how little these people think of the people who are actually making the products. When two companies merge the value of the stock goes up. Why, because the next thing that will happen is the new Board of Directors will be getting rid of many ‘unneeded’ employees. Doing this means that the company will take those wages as pure profit, increasing the value of its stock. When a company decides to get rid of employees, the stock value goes up. When a company breaks a Union, the stock value goes up. During these events, you should also have seen that the Board of Directors salaries and bonuses go up. When a company moves their production factories to a ‘third world’ country where they can fire all of their American workers and get child slave labor to do all the production, stock values, and executive compensation goes up.

 

The world as you know has a population growth that is unsustainable yet at this same time machines and robots (AI) are taking more and more jobs away from workers. From a business standpoint, having machines replace human workers is a very wise thing to do, and it increases your stock value and the bosses salaries and compensation. If they invest in machines they can get rid of the overhead cost of having human employees. Think about it, no more salaries to pay, no benefit packages to pay like Workers Comp, vacation pay, health insurance, retirement benefits, paid sick days, you can’t be sued by a computer, no OSHA regulations to adhere to. Folks, the list goes on and on.

 

Our planet has about seven billion people on it right now, look at the slave labor around the world right now, from Africa to Asia to the Middle-East and yes, here in the U.S. also. Is slave labor legal in a lot of these countries? No, but it still goes on. You may say why, why does it still go on but the answer is simple, pay as little for the labor as possible to increase the profits at the top and to the stockholders. You may say now wait a moment, slaves don’t cost anything but this is not totally true. Slaves still have to get some food and some water or they will die or become too weak to do the work. The more slaves you have in the ‘waiting room’ the less you have to supply to each one each day. Why, because it is in your financial best interest if all of the ‘extras’ die. If the ‘extras’ aren’t dying fast enough on their own, you assist them.

 

If the Earth has seven billion people but can only sustain six billion people because there is no way to produce enough food, what happens to the extra billion people? Who do you think are going to be the ones that are starved to death? Hint, it is not going to be the super rich who basically own everything, it will be the poorest of the poor who will be eliminated. During the early Republican Primaries last year a former ‘Speaker of the House’ Newt Gingrich spelled out the perfect Republican ‘wish list.’ As you probably know the majority of the Republicans in the Congress and the Senate, and this President wants to cut the national deficit by cutting programs like food stamps to the poor and cutting way back on Medicare, Medicaid, meals on wheels, school lunch programs and Social Security. Folks, who need these programs the most? Mr. Gingrich in a TV program last year went even further. Mr. Gingrich consider all of these programs to be ‘welfare’, yet he went further, he called military retirement pay, VA disability compensation and the VA itself ‘welfare’ programs and he said that all of these ‘Welfare’ programs need to be eliminated. There was one thing that he did not include in his list of welfare programs, that was Congressional, Senate, and Presidential retirement pay and benefits, go figure. He has been receiving taxpayer-paid benefits for decades, but I guess that doesn’t count.

 

Back in the 1950’s the top end national tax rate was 90%, during that time the U.S. was able to build city infrastructures, a National Highway program unequaled in the whole world as well as thousands of new bridges and dams. Now, our roads, bridges, dams, and cities are falling apart, why is this? Now the top end tax rate has been 35% and the President is pushing a top end tax rate of 20%. This is at the same time that corporations are swimming in cash and as they say, with nowhere to spend it. About six months ago, I think it was on CNN, that they reported that U.S. companies have about 13 Trillion Dollars sitting in offshore accounts. So, what do these Republican lawmakers want to do, take even more money out of the economy and give it to these same folks who are destroying our country from the inside? It is also these same benefactors who are filling the pockets of these same evil politicians.

 

Back in the late 1940’s and early 1950’s in China Chairman Mao put a starvation policy in place against the citizens of China. The reason was simple, 500 million people are easier to control than one billion people. Folks, these are just things that I have seen, heard, and read throughout my 60+ years. You don’t have to agree with anything that I have written in this article today, but I hope that I have been able to at least get you to think about these issues.

 

 

 

 

 

Breast Cancer Deaths Drop Nearly 40% In the U.S.

(THIS ARTICLE IS COURTESY OF TIME.COM)

 

Breast Cancer Deaths Drop Nearly 40% In the U.S.

12:04 PM ET
TIME Health
For more, visit TIME Health.

Efforts to improve screening and access to treatment for breast cancer are making a difference nationally, according to the latest figures from the American Cancer Society.

From 1989 to 2015, deaths from the disease dropped by 39%, which translates to 322,600 lives saved from breast cancer. The latest numbers continue a steady downward trend for breast cancer deaths over the past few decades.

In some states, the death rates from breast cancer among white women and black women are equalizing, suggesting that access to screening and treatments are more evenly distributed in those parts of the country.

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But the data still show that black women have the highest death rates from breast cancer nationally. Among black women, the death rate was 42% higher than among white women from 2011 to 2015. Other studies have documented that black women tend to be diagnosed with more advanced-stage cancers, which are harder to treat and have higher mortality rates. Aggressive triple negative cancers that are deadlier are also more common among this group of women.

MOREI Treated Breast Cancer for Years as a Doctor. Then I Was Diagnosed

The overall drop in mortality is a positive sign suggesting that wider mammogram screening and improved treatments for the disease are helping women survive breast cancer. Yet in the U.S., breast cancer remains the most commonly diagnosed cancer among women and the second deadliest. During her lifetime, a woman has a one in eight chance of developing the disease. Ensuring that more states start to equalize access to screening and treatments is critical to sustaining the decline in deaths, say the authors.

Pediatricians say Florida hurt sick kids to help big GOP donors

(THIS ARTICLE IS COURTESY OF CNN)

 

Pediatricians say Florida hurt sick kids to help big GOP donors

Updated 12:03 AM ET, Sat August 19, 2017

St. Augustine, Florida (CNN) When he was 11 years old, LJ Stroud of St. Augustine, Florida, had a tooth emerge in a place where no tooth belongs: the roof of his mouth.

LJ was born with severe cleft lip and palate, which explained the strange eruption, as well as the constant ear infections that no antibiotic could remedy.
With her son in terrible pain, Meredith Stroud arranged for surgeries to fix his problems.
But just days before the procedures were to take place, the surgeons’ office called to cancel them.
Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn’t take it.

Doctors: 'Trick question' hurt sick kids

Doctors: ‘Trick question’ hurt sick kids
LJ wasn’t alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children’s Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.
The state moved the children to other Medicaid insurance plans that don’t specialize in caring for very sick children.
Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn’t find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.
“He was in pain every day,” Stroud said. “I just felt so helpless. It’s such a horrible feeling where you can’t help your kid.”
LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children’s Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.
The doctors aren’t just worried; they’re angry.
First, the data analysis the state used to justify switching the children is “inaccurate” and “bizarre,” according to the researcher who wrote the software used in that analysis.
Second, the screening tool the state used to select which children would be kicked off the program has been called “completely invalid” and “a perversion of science” by top experts in children with special health care needs.
Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn’t automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.
Finally, parents and Florida pediatricians raise questions about the true reasons why Florida’s Republican administration switched the children’s health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.
“This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics.
Experts outside Florida are also disturbed that the children were switched out of CMS, a program that’s served as a model for other states for more than 40 years.
“CMS is well-known and well-respected,” said Dr. James Perrin, professor of pediatrics at Harvard Medical School. “It’s one of the earlier programs to build in assurances that these kids get the kind of care they need.”
“These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “This is really very troubling.”
Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children’s health care.
“The process in Florida was particularly abrupt and poorly executed,” he said.
Mara Gambineri, a spokeswoman for the Florida Department of Health, said that “at no time (during the insurance switch) did children go without medically necessary services.”
State officials, including a spokesman for Governor Rick Scott’s office, initially declined to comment directly on the pediatricians’ and parents’ concerns that the children might have been switched to benefit contributors to the Republican Party of Florida. On Friday, after this story was published, the Florida Department of Health released a statement asserting that such a claim “is 100 percent false.”
“The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs,” Gambineri wrote in an earlier email. “The department remains committed to providing quality health care services to Florida’s children with special health care needs.”

A mother’s anguish

In spring 2015, LJ’s mother received a phone call from a nurse at the Florida Department of Health.
Stroud had no idea that one word she would say to that nurse — just one single word — would cause her son months of pain and suffering.

Meredith Stroud's son, LJ, was born with cleft lip and palate. He lost his Children's Medical Service coverage when he was 11.

The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.
Despite his birth defect, LJ goes to school and plays with friends, so she answered no.
Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.
LJ was one of 13,074 Florida children kicked off CMS — that’s about one in five children in the program — as a result of the telephone survey, according to a presentationtestimony and a letter from Florida’s top health officials.
Stroud thinks back to her answer to the nurse’s question about limitations.
“That question’s not fair,” Stroud said of the one that got her child kicked off CMS. “What [the Florida Department of Health] did was totally wrong.”
“It was a trick question,” she added.

Pediatrician: ‘A truly duplicitous question’

Experts agree with her.
“I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids,” said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.
What Florida did was “completely invalid,” added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.
The pediatricians explained that many children with serious and chronic medical conditions — such as cleft lip and palate, HIV, diabetes and cystic fibrosis — are often able to do things other children can do. However, they still require extensive and highly specialized medical care.
The question the Florida Department of Health nurses asked — “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” — would lead to disqualifying children who truly have special medical needs from a program designed for them, said Stephen Blumberg, associate director for science at the National Center for Health Statistics and one of the world’s leading experts on the epidemiology of children with special health care needs.
Question No. 3

“Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

“You would get false negatives. Your conclusion would be that a child does not have special health care needs when, in fact, the child does,” he added.
Gambineri, the Department of Health spokeswoman, said it no longer uses the survey that resulted in 13,074 children being removed from CMS.
“It is unfortunate the negativity surrounding this issue is a continued topic of inquiry, as the department and our stakeholders have put in a significant amount of time and effort to move past this issue for the benefit of the children we serve,” she wrote.

Six pediatricians from across Florida gathered to tell CNN their concerns about children losing CMS coverage. They accuse the state of hurting sick kids to help big GOP donors.

But pediatricians in Florida point out that many children who were removed from Children’s Medical Services using the controversial questionnaire were never put back on.
“This was a truly duplicitous question,” said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. “It was a trick question.”
“It’s a perversion of science,” said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children’s Hospital.
Goldhagen added that he was speaking for himself and not the institutions where he works.
“It was a scam job,” added Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee who said that dozens of her patients with diabetes were removed from the program.

Dr. Nancy Wright, a pediatric endocrinologist, says dozens of her patients lost their coverage on Children's Medical Services. "For the children with diabetes that I work with, it was a disaster," she said.

“They really tried their darnedest to kick the kids out of CMS,” added Dr. Carrol Fenn, an orthodontist in West Palm Beach. “They’ve messed up kids’ lives.”
“They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing. How can someone in an office make a decision like that?” asked Dr. John Obi, an adjunct clinical professor in plastic surgery at the University of Florida, who operates on children with cleft lip and palate.
“I congratulate whoever came up with that question,” he added wryly. “If you want to exclude virtually anybody, that’s the way to do it.”

Johns Hopkins expert: ‘I’m speechless’

Christina Bethell’s team came up with that question — and she’s furious.
Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. She and her team spent many years and millions of dollars coming up with the right questions to accurately identify children across the United States who might have special health care needs.
The list of questions — known as the Children with Special Health Care Needs Screener — is publicly available on the Hopkins website. Many state and federal agencies use it to help decide which children might benefit from special health services.
The Florida Department of Health, however, used the questions to do something completely different: to kick children out of a program.
That’s scientifically invalid, Bethell said. Using the questions that way — especially the question about limitations — would lead to denying children with special health care needs the services they require.
“I’m speechless,” she said.
To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins — the Children and Adolescent Health Measurement Initiative — to support the children’s removal from CMS.
“I feel really manipulated,” she said.
She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.
“I’m angry,” she said. “And I’m crestfallen for these families.”

Grave consequences for Florida children

The Shabanehs in Tallahassee are one of those families.
Aref Shabaneh, 8, is blind, and his sister, Yasmeen, 11, is severely visually impaired. Their mother, Reema Shabaneh, says they were kicked off CMS in 2015.

Aref Shabaneh lost his Children's Medical Services coverage in 2015. He is blind and reads in Braille.

Shabaneh says she told the Florida Department of Health nurse that they didn’t have limitations.
“Aref wants to do everything by himself,” she said. “He can play ball with friends. The ball has a bell, so he can hear it coming.”
After they were kicked off CMS, Shabaneh said, she couldn’t find an ophthalmologist on the new insurance plan willing to care for her children.
“I was so scared,” she said.
When Jennifer Rodriguez received the phone call from the Department of Health nurse, she said, she told the nurse she didn’t know how to answer the question about limitations. Her son, Alejandro, suffers from a congenital heart defect, asthma and kidney problems. Sometimes, his heart races and he has trouble breathing, but other times, he feels up to playing soccer with his friends.
“When I tried to explain the answer, she cut me off and said she was just doing her job and needed a yes or a no,” she said.
Rodriguez says she answered that her son, who was 10 at the time, did not have limitations. He then lost his CMS coverage.
“It makes me angry, because you would think that since he’s seeing a cardiologist, a nephrologist, a urologist and an asthma doctor, they would see he’s not your average child,” she said.
LJ, Alejandro and the Shabaneh children filed lawsuits and were put back on CMS. They were represented by the Public Interest Law Center at Florida State University.

Alejandro Rodriguez wears a nebulizer mask to help him breathe. After he filed a lawsuit, the state put him back on Children's Medical Services.

Many Florida pediatricians say their patients also suffered when they were taken off CMS and put on other Medicaid plans. The doctors say those other plans typically have fewer pediatric specialists than CMS, which specializes in caring for very sick children.
Dr. Lisa Cosgrove, a pediatrician in Merritt Island, Florida, said she had a difficult time finding an orthopedist to treat a 6-year-old with a broken elbow who had been taken off CMS. The girl ended up having surgery later than she should have and now can’t extend her elbow all the way.
She said a baby born with a clubfoot also suffered because she couldn’t find an orthopedist willing to take the baby’s plan. The baby couldn’t have the necessary casts to twist the foot back into place and may need surgery, Cosgrove said.
Dr. Elizabeth Curry, a pediatrician in Port St. Joe, Florida, said that last year, she took care of a baby whose eye wiggled back and forth involuntarily, which can be a sign of a brain tumor.
Curry said it took her more than a month to find an ophthalmologist willing to take the baby’s Medicaid plan — and the doctor she finally found was three hours away, in Pensacola.
Fortunately, the baby turned out to be fine.
“This child could have had cancer. That’s a kid who should have seen a doctor right away,” Curry said. “I feel terrible for these children. It makes me so angry.”

Dr. Elizabeth Curry, a Florida pediatrician, says some of her patients didn't get the treatment they needed because the state had removed them from Children's Medical Services.

Because of problems like these, switching the children’s insurance “was a complete dereliction of Florida’s responsibility to children,” said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.
Gambineri, the spokeswoman for the Florida Department of Health, said the children didn’t suffer as a result of the switch, because the insurance plans they were moved to were “more than capable” of caring for them. She added that even before the 13,074 children were switched, those plans cared for tens of thousands of children with special health needs.
Other pediatricians agree that plans besides CMS have done a good job of caring for these very sick children.
The other plans “do a pretty good job with our families,” said Dr. Karalee Kulek-Luzey, medical director of the Pediatric Health Care Alliance, a group practice with multiple locations in the Tampa area. “They’re working really hard.”
“For the most part, they do a good job,” said Dr. Michael Freimark, a pediatrician in Plantation, Florida.
“We have a good relationship with the plans,” said Dr. Michael Gervasi, president and chief executive officer of the Florida Community Health Centers, a large medical practice with offices in several counties. Most of the time, he said, the plans take care of the children’s needs, but if there’s ever a problem, his practice contacts the plan, and they fix it.

Aref's older sister, Yasmeen Shabaneh, was also was removed from Children's Medical Services. She has a vision condition so serious that even a minor bump could cause her retinas to detach.

Florida’s ‘outreach’ to experts

In January 2016, about eight months after the Florida Department of Health started to move the 13,074 children out of CMS, Jennifer Tschetter, then the department’s chief operating officer, testified before the state legislature. She said that the decision to use the Hopkins screening tool was made “in consultation with … national experts.”
But it remains unclear who those experts were.
Tschetter, who has since left state government, did not respond to phone calls and emails seeking comment.
Gambineri, the Florida health department spokeswoman, said the department did “research” into what Louisiana, California, Texas and New York “were doing and experiences they had in regard to clinical eligibility for children with special health care needs.”
When asked for the names of individuals Florida consulted in those states, Gambineri didn’t respond.
Gambineri added that “outreach” was made to the federal Health Resources and Services Administration.
An official at that agency said she spoke with a Florida health official.
Dr. Marie Mann, senior medical adviser in the Division of Services for Children with Special Health Needs at the federal agency’s Maternal and Child Health Bureau, said she spoke with Stannard, who works for the Florida Department of Health.
Mann says she told Stannard she couldn’t give her any guidance.
“I told her I was not in a position to provide advice,” Mann said.
Mann said she suggested that Florida health officials reach out to Daniel Armstrong and Dr. Jeffrey Brosco, director and associate director respectively of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.
“We will make sure they’re both involved in this review process,” Stannard wrote back to Mann in an email obtained by CNN under the Freedom of Information Act.
CNN asked Gambineri, the department spokeswoman, whether the department ever reached out to Armstrong to review and make recommendations on using the telephone survey to screen children out of CMS.
“Not to our knowledge,” Gambineri answered.
“I played no role in the decision-making process related to the use of the tool for the Children’s Medical Services program,” Armstrong wrote in an email to CNN.
Brosco said he told the Department of Health that in his opinion, a child should not be kicked off CMS based on a parent’s answer to the question about the child’s limitations.
“I gave them my feedback, and they said, ‘thank you for your work,’ ” Brosco said.
In July, Brosco was named the Florida Department of Health’s deputy secretary for CMS.

Christmas shopping at the Florida Mall

Despite the lack of support from the very experts they’d consulted, Florida health officials forged ahead with using the phone survey to disqualify children from CMS.
They had a schedule to stick to.
In November 2014, state officials set out to “go live” with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.
Before implementing the surveys, the officials gave themselves 21 days to “solicit feedback from the field” about the questions they would ask the parents.
One of the first things they did was to ask one of the state’s most experienced pediatricians to leave a meeting.
It was St. Petery, who at the time was the executive vice president of the Florida chapter of the American Academy of Pediatrics and who has an encyclopedic knowledge of Medicaid rules and regulations. He’d served as interim director of CMS for six months during the mid-1970s.
He’d also been a thorn in the side of the state Department of Health for years. He’d been instrumental in a lawsuit that accused the state of failing to reimburse doctors properly in the Medicaid program and to ensure that children receive adequate care.
His side eventually won that lawsuit, and the American Academy of Pediatrics gave him a prestigious award for being “a tireless advocate for children’s health and well-being.”

Dr. Louis St. Petery, a pediatric cardiologist and frequent critic of Florida's health policy, was asked to leave a state meeting where Children's Medical Services screening was discussed.

On December 13, 2014, St. Petery showed up at the Department of Health meeting. It was for the regional medical directors of CMS, the group of pediatricians who help run the program. St. Petery wasn’t one of the directors, but he’d been attending their meetings for many years in his role with the Florida chapter of the American Academy of Pediatrics.
St. Petery said that just before the meeting started, Tschetter, then the department’s chief operating officer, approached him.
“She said, didn’t I want to go Christmas shopping at the Florida Mall?” St. Petery remembered. The mall was adjacent to the conference center in Orlando where the meeting was taking place.
St. Petery said he told Tschetter that he hates shopping, especially around the holidays, and wanted to stay at the meeting.
“I protested. I asked her, is this meeting not in the sunshine?” he said, referring to Florida’s Sunshine Law, which gives the public the right to access most government meetings.
“After she told me for the third time to leave, I decided not to create a scene,” he said.
St. Petery got up and left.
Other doctors watched the action, stunned.
“We were all kind of shaking,” said Dr. Barbara Rumberger, one of the CMS regional medical directors who attended the meeting.
After St. Petery departed, health officials explained that they would start screening children off of CMS. Their justification: a new analysis showing that half the children on CMS might not belong there.
There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

A ‘totally inaccurate’ analysis

By Florida law, a child can be in CMS only if he or she has a “chronic and serious” condition requiring health care “of a type or amount beyond that which is generally required by children.”
The analysis Tschetter presented showed that about half of the children on CMS had lower than average risk scores, an assessment of how much a patient uses health care services.
Tschetter called these results “surprising.” By legislative mandate, children on CMS are supposed to have health needs greater those of other children.
“The analysis made clear, certainly to the department, that we were not meeting legislative direction: (that) the children in the plan have both chronic and serious health care conditions,” Tschetter told legislators. “It was clear to the department that something had to be done, because complying with legislative direction is certainly not optional.”
But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.
“It’s totally inaccurate,” said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.
Gilmer’s software, which is used by dozens of state Medicaid programs, tracks patients’ diagnoses and their prescription drug use to calculate risk scores for each individual.
After viewing Florida officials’ analysis of the data, he said they made two errors when they calculated that half the children on CMS had below-average risk scores.
First, he explained that his software relies on doctors’ diagnoses, and Florida failed to account for the fact that doctors frequently don’t document a child’s full diagnosis in the medical record. For example, if a quadriplegic child goes to the doctor because of bedsores, doctors often write down the reason the child came in — the bedsores — instead of the more serious diagnosis of quadriplegia.
Second, he said, Florida did the wrong calculation for disabled children, who represent 40% of the patients on CMS, according to Mallory McManus, a spokeswoman for Florida’s Agency for Health Care Administration.
He said his software compares disabled children with each other. Even the ones who fall in the lower half of the risk-score spectrum still have serious and chronic illnesses, he said, such as HIV or heart failure.
He said that what Florida did was akin to assembling a group of people who are over 7 feet tall and calling the bottom half of that group short.
Gilmer called Florida’s analysis “kind of bizarre” and said he was disappointed to see his software “misapplied” by the Florida Department of Health.
Spokeswomen for the Florida Department of Health and the Agency for Health Care Administration did not respond directly to Gilmer’s criticism.
Gambineri, the health department spokeswoman, said that the department no longer uses the screening method that it used in 2015 and that parents can ask to have their children re-screened at any time.
“Our mission is now and has always been to provide the best health care possible to the populations that we serve,” McManus wrote in an email.

Pediatrician: ‘We were just irrelevant’

Pediatricians say that by the time the Department of Health meeting was held at the Orlando conference center at the end of 2014, they felt like Florida was dead-set on screening a large number of children off CMS.
They said state officials didn’t listen to their concerns, even though they were stated repeatedly, both in person and in writing.
At the meeting, health officials asked the pediatricians to tell them what was on their minds, according to Rumberger, one of the doctors who was there.
She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.
The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.
“She said, ‘We’re going to park these. We’re putting these ideas in the parking lot for some time, and we’re not talking about these things today,’ ” Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.
“We were all amazed at what they did,” she added.
A few months later, the state held a series of telephone conference calls with the same CMS regional medical directors.
“They didn’t ask us ‘What do you think?’ or ‘Do you have any suggestions?’ ” Rumberger said. “It was just ‘This is how we’re going to do it.’ It was clear they didn’t want to have a free discussion.”
“It appears to be a very conscious decision to not get input and not receive any dissension,” said Goldhagen, the professor of pediatrics at the University of Florida. “We were just irrelevant.”
Dr. Rex Northup, another CMS regional medical director and associate professor of pediatrics at the University of Florida College of Medicine, agrees.
“It was like, ‘When we want your opinion on a given topic, we’ll let you know, and we’ll provide that opinion to you,’ ” Northup said, adding that he speaks for himself and not the university or any other institution.
Several doctors present on those conference calls said they voiced their concerns anyway.
There’s no record of these concerns. According to the Florida Department of Health, no minutes were taken of these phone conferences.
CNN asked the Florida Department of Health about the meeting where St. Petery was asked to leave and about doctors’ complaints that the state steamrolled through a screening tool that would harm sick children.
“When CMS began the process of implementing a new screening tool in 2014, the department may have underestimated the need for stakeholder input and the time required to obtain feedback and ensure our community was comfortable with the mechanisms for determining clinical eligibility,” responded Gambineri, the Department of Health spokeswoman.
She added that the department has “engaged our stakeholders using several methods” including public meetings to solicit input from patients, parents and providers and “remains open to feedback and input in order to best serve children with serious and chronic medical conditions.”
True to its schedule, the state started screening children off CMS in May 2015.
Florida pediatricians repeatedly told the state that it was hurting sick, vulnerable children.
In August 2015, Goldhagen, Rumberger, Northup and 11 other doctors with positions at CMS wrote a letter to a Department of Health official saying the screening process was “flawed” and was removing too many children.
The doctors did not receive a response, Goldhagen said.
Two months later, St. Petery wrote to Department of Health officials, sharply criticizing the use of the screening tool.
He said he never received a response, either.

Dr. Elizabeth Curry, examining Micah Creamer, says she wrote to the Florida Agency for Health Care Administration, expressing her concerns about patients being kicked off Children's Medical Services, but the agency didn't respond.

Curry, the Port Saint Joe pediatrician who practices in a rural area of the Florida Panhandle, said she also complained to the state’s Agency for Health Care Administration about children being kicked off CMS, along with other issues affecting children on Medicaid.
She said the agency worked with her on some of the other issues but didn’t respond to her complaints about the children being taken off CMS.
“Our Agency has been in contact with the provider and is working with the health plan to resolve what issues might be resolved,” wrote McManus, the agency spokeswoman.
Curry said she took her complaints even higher.
“I even called the governor’s office once and left a message,” she said. “I admit that I finally gave up. I’m just trying to take care of my patients.”
Pediatricians interviewed for this story said they felt pressure from the state not to speak to the media about the removal of the children from CMS.
On November 15, 2016, Dr. John Curran, then the Florida Department of Health’s deputy secretary for CMS, said on a conference call that a CNN reporter was working on this story, according to several doctors on the call.
That evening, a department official wrote an email to the doctors who’d been on the call. It advised these pediatricians that prior to responding to media inquiries, they should contact the department’s communications director.
“I’m going to be so fired for saying all these things,” Rumberger said.
But she and other pediatricians say they’re speaking up because they feel that the Department of Health hurt children because they didn’t listen to their concerns.
They say it could be because pediatricians don’t tend to have millions of dollars to donate to political campaigns.
But insurance companies do.

‘Like a plot in a Carl Hiaasen novel’

All of this — the telephone survey, the question about limitations, the analysis that’s been called flawed — leaves many Florida parents and pediatricians suspicious about why the state wanted to take 13,074 children off CMS and why it worked so hard and so quickly to do it.
Switching the children from CMS to the other Medicaid plans didn’t save taxpayers money, according to McManus, the agency spokeswoman.
The doctors wonder, then, whether the inspiration for the change was political: to send taxpayers’ dollars to generous donors to the Florida Republican Party.
CMS is a public program; it’s not owned by a private insurance company.
When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.
“I knew it had to be about money,” said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. “This sounds very believable for Florida, and I’m from Florida.”
“When this was all unfolding, I told my office manager, ‘I feel like we’re in a plot in a Carl Hiaasen novel,’ ” she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.

Dr. Nancy Wright, a pediatric endocrinologist, says she thinks the state's motivation for taking patients off Children's Medical Services "appears to be about money. ... It's clearly not medical."

The companies that own the nine insurance plans contributed $8.6 million to Florida Republican Party committees from 2010 to 2014, according to an analysis done for CNN by the National Institute on Money in State Politics, a nonpartisan nonprofit group.
Here’s a breakdown of how much money each insurance company with a Medicaid contract contributed to Florida Republican Party committees from 2010 to 2014:
  • $5.9 million from Blue Cross and Blue Shield of Florida. Florida True Health is an affiliate of Blue Cross and Blue Shield of Florida. At the time the money was contributed, Florida True Health owned 40% of Prestige Health Choice, which has a Medicaid contract with the state of Florida. In 2015, Florida True Health purchased Prestige outright.
  • $90,000 from Simply Health, which owns a Medicaid plan called Better Health.
  • $849,433 from Miguel Fernandez, the former chairman of Simply Health. In addition, Fernandez donated about $1.3 million to Scott’s Let’s Get to Work political action committee from 2010 to 2014.

Insurance companies’ outsize contributions to Florida Republicans

Nearly all states pay insurance companies to insure some of their Medicaid patients; this is not unique to Florida.
And insurance companies often contribute money to state political parties. That’s not unique to Florida, either.
What is unusual is the size of the contributions, even for a large state.
Take UnitedHealthcare, an insurance giant with business in all 50 states. From 2010 to 2014, United contributed $442,500 to Florida Republican Party committees, according to the National Institute on Money in State Politics.
The company’s next largest contribution to any other state political party was $145,000 to California Democrats — less than half the Florida amount.
Humana, another insurance company with a national reach, gave substantially more money to Florida Republican Party committees than to any other state political party committees.
From 2010 to 2014, Humana donated $482,815 to Florida Republican Party committees. Its next largest contribution was $213,823 to Florida Democrats. The next largest contribution after that was $22,000 to the Illinois GOP, less than one-20th the size of the contribution to Florida Republicans.
Blue Cross and Blue Shield of Florida gave Florida Republican Party committees $5.9 million from 2010 to 2014 and gave Florida Democrats $1.8 million. The next largest contribution after that from any other Blue Cross and Blue Shield company in the United States was $730,696 from Blue Shield of California to Democrats in that state — about one-eighth the size of the contribution to Florida Republicans.

Florida’s payments to the insurance companies

Nearly all states pay private insurance companies monthly premiums to insure Medicaid patients. It’s become big business.
The Florida Department of Health declined to say how much it paid the private insurance companies to insure the 13,074 children when they were switched out of CMS.
“If they got 13,000 new kids, (it’s) that times however many dollars per member per month,” St. Petery said. “I think that’s a lot of money when you start talking about that many kids.”

LJ Stroud sued the state of Florida to be put back on Children's Medical Services. He has now had the procedures that he needs.

These children came from CMS, a Medicaid program for sick children, and the state pays insurance companies more money to care for such children.
This is how it works, according to McManus, the spokeswoman for the Florida Agency for Health Care Administration.
Florida takes a look at all the people who’ve signed up with an insurance company and calculates a risk score for that group based on factors such as the age of the enrollees in the plan and their health conditions.
A plan with the lowest risk score has a “typical population” and might be paid a rate of, for example, $320 per person per month, McManus said. A plan with sicker enrollees might have a risk score that’s twice as high and so would be paid $640 per person per month, she added.
The numbers can get even higher from there.
“The state will pay a pretty good rate for these children,” said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.
“They could get paid thousands more per month for a child with serious medical needs,” said Steve Schramm, founder and managing director of Optumas, a health care consulting group.
“The enhanced reimbursement may be 10 times what the insurance companies get for a well child,” said Goldhagen, former director of Florida’s Duval County Health Department.

Yasmeen Shabaneh sued Florida and was placed back on Children's Medical Services.

Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.
“Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.
Pediatricians questioned whether such outsize political donations were an attempt to gain influence and favor with Florida’s Republican administration, which orchestrated the transfer of the children out of CMS and to the private companies.
“It certainly raises a lot of suspicion and concern,” said Northup, the associate professor at the University of Florida College of Medicine.
“Why would they make contributions in the hundreds of thousands and the millions to Florida Republicans? Why would they be so uniquely committed to Republicans in Florida? It gives one pause,” he added. “If you follow the money, at the very least, it’s worrisome.”
“It’s the left-hand-washing-the-right-hand kind of business,” said Dr. Joseph Chiaro, who was Florida’s deputy secretary of health from 2005 to 2011. “It breaks my heart.”
Six Florida pediatricians gathered in Orlando to tell CNN their concerns. They practice in rural, suburban and urban areas. Some of them are Republicans, and others are Democrats.
They said they feared that big donors had influence on the state’s decision-making process and that in many cases, the children suffered as a result.
“I don’t see this in writing anywhere, but my impression is, this was a way for political payback at the expense of the sickest of the Medicaid children,” St. Petery said.
“It just comes back to money or power. It’s not about health care for the children,” said Wright, the pediatric endocrinologist in Tallahassee.
“Just follow the money,” said Colaizzo, who runs a rural health care clinic in Pahokee, Florida.
State leaders “don’t give a damn about the kids. They don’t give a damn about the families,” said Dr. Marcy Howard, a pediatrician in Crystal River, Florida.

State officials and insurance companies respond

State health officials did not respond directly to the pediatricians’ concerns that campaign contributors had influence over Republican leadership’s decision to take the children off CMS.
“The Statewide Medicaid Managed Care program was designed to provide comprehensive care to recipients through high quality health plans with a payment structure designed to ensure that plans paid an appropriate rate based on the health conditions of those enrolled in their plan,” McManus, a spokeswoman for the Florida Agency for Health Care Administration, wrote in an email.
“The program currently covers more than 2 million of Florida’s children, offers the strongest provider network and access standards in program history, and provides families with a choice of high quality, nationally accredited plans so that they can choose the plan that best suits their needs, including specialty plans for those who qualify.”

Alejandro Rodriguez also sued the state of Florida and was placed back on Children's Medical Services.

CNN reached out to officials at all nine insurance companies. Two responded.
“WellCare contributes to a variety of organizations that shape health care policy, including the Florida Republican Party committees, the Democratic Party committees and those without political affiliation,” wrote Alissa Lawver, a spokeswoman for WellCare. “The company also discloses and publicly reports all political contributions on its website above and beyond the requirements of state and federal law. As a provider of managed care, WellCare is committed to partnering with the state of Florida to provide access to quality, affordable health care solutions for the state’s most vulnerable populations. We maintain a robust provider network and offer comprehensive care management services to create personalized, coordinated care plans to help improve and maintain the health of families and children across the state.”
She added that WellCare has accountability to Florida’s Agency for Health Care Administration, “which provides careful oversight of the state’s Medicaid program to ensure all members, including children that transitioned from Children’s Medical Services, receive access to the right care, at the right time and in the most appropriate setting.”
Ethan Slavin, a spokesman for Aetna, said the company makes “donations to campaigns for both major political parties to support and address issues that impact our customers and members.”
He added that “we are required to meet state rules and regulations regarding our network of health care providers and are consistently compliant with those requirements” and that “we regularly work with our members, health care providers and the state of Florida to move children with special health care needs into the Children’s Medical Services program, when appropriate and in the best interest of our members. Our integrated care management program regularly identifies these children and assists in this process.”
Miguel “Mike” Fernandez, founder and former chairman of Better Health, said he had contributed several million dollars to both Republicans and Democrats. He added that states move Medicaid patients into the care of private companies so they can “move the risk off their financial books.”

A victory for Florida families

Many pediatricians use strong language to describe their anger and frustration with the Florida Department of Health and what it did in 2015 to the 13,074 children.
“This has just been a nightmare, and we’re still experiencing the fallout,” said Dr. Toni Richards-Rowley, treasurer of the Florida chapter of the American Academy of Pediatrics.
“It’s disgusting,” said Cosgrove, the pediatrician in Merritt Island. “It’s all about money and not looking out for the children.”
“Honestly, it makes me want to puke,” said Lida Sarnecky, nurse manager of the team at the University of Florida that takes care of children with cleft lip and palate.
“In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’ ” she said.
By June 2015, some Florida parents had had enough.
Five children, including Alejandro Rodriguez, and Yasmeen and Aref Shabaneh, sued the state Department of Health to get it to stop using the telephone questionnaire to take patients off CMS, claiming that the state Department of Health hadn’t gone through formal rulemaking procedures.
The children won.
The state didn’t fight the ruling. Instead, it came up with a new way to screen children for the program — one that doesn’t rely on a telephone survey and takes into consideration a child’s diagnosis.

Aref Shabaneh lost his Children's Medical Services coverage when his mother told the state he didn't have limitations. "Aref wants to do everything by himself," she said.

Many parents and pediatricians assumed the state would soon reach out directly to parents to let them know they could reapply to have their children put back on CMS.
They were very wrong.
Five months after the judge’s decision, St. Petery, the Tallahassee pediatric cardiologist, implored the secretary of the Department of Health to reach out to parents.
To St. Petery, the reasoning was obvious: A judge had said that the state had violated the law. Reaching out to the parents was a way of correcting wrongdoing.
The state had a notice on its website about the ability to be rescreened for CMS, and at a meeting with state legislators, a department official had given out a phone number parents could call. But St. Petery knew that busy parents of very sick children might not attend official state meetings or notice pages on government websites.
“I would hope that you would consider notifying each of the parents of those 13,074 children that the tool by which their child was screened out of CMS has been declared invalid, and that they have the right to appeal that decision,” St. Petery wrote to Dr. John Armstrong, then secretary of the Department of Health and the state surgeon general.
Armstrong wrote back that doing so would violate federal regulations, since the children had been switched to other Medicaid insurance plans.
“Federal regulations prohibit direct marketing to children currently being served by another managed care plan,” he wrote back to St. Petery.
CNN was unable to reach Armstrong for comment. Gambineri, the Florida Department of Health spokeswoman, said he “is no longer employed by DOH.”
Not satisfied with Armstrong’s response, St. Petery sought help from US Rep. Kathy Castor, a Democrat from Tampa. Castor took his concerns to the federal Centers for Medicare and Medicaid Services.
On March 23, 2016, an official at that agency sent an email to Justin Senior, then the Medicaid director at Florida’s Agency for Health Care Administration. CNN obtained the email under the Freedom of Information Act.
In that email, the federal official explained to Senior that federal regulations do not prohibit Florida from reaching out directly to families.
“To clarify, 42 CFR 438.104 does not prohibit marketing,” wrote Jackie Glaze, associate regional administrator for the Division of Medicaid and Children’s Health at the Centers for Medicare and Medicaid Services, citing a federal regulation.
More than a year later, on July 24, 2017, the Florida Department of Health sent a letter to parents letting them know that their children could be screened to get back on CMS. The letter was sent to 6,081 parents whose children were removed from CMS and put on another Medicaid plan and were still on that plan and financially eligible for Medicaid, according to Gambineri, the Florida health department spokeswoman.
That letter was sent nearly two years after the judge’s decision. Pediatricians say they’re angry it took that long to directly let parents know about the possibility of getting back on CMS.
Gambineri said there was concern that parents might get confused.
“It was originally thought to be, and still is considered a risk, in terms of confusion and disruption to families, to send a letter because they have had rescreening available since 2015,” Gambineri said a few months before the letter was sent out.

Nelson Mandela and Mr. Rogers

Now that LJ Stroud is back on CMS, he’s a happy, strapping 13-year-old who loves to play football and horse around with his brother and sisters in the family’s backyard in St. Augustine.
But his mother looks back on the dark days in 2015, after her son was switched off CMS, when she says he would lie on the couch in pain, unable to get the surgeries he needed.
It’s not just her son’s physical pain that makes Stroud angry; it’s his emotional pain.

Since LJ Stroud was placed back on Children's Medical Services, he's been able to play football again.

When LJ was on CMS, Stroud says, he received excellent care and was a contented, well-adjusted child, never thinking of himself as different despite his birth defect.
But she says that when he was in pain because he couldn’t have surgery, he started to feel sorry for himself.
” ‘Why did God make me this way?’ ” she says he asked. ” ‘Why can’t I be like my brothers and sisters?’ “
When she hears about how top Florida officials have spoken with pride of what they did to her son and to more than 13,000 other children, she becomes livid.
Last year, Armstrong, then Florida’s surgeon general and secretary of health, made a presentation to the Florida Children and Youth Cabinet, a panel created by the state Legislature to promote children’s welfare.
Declaring that the Department of Health “cares about every child in Florida,” Armstrong explained how the state removed the 13,074 children from CMS.
Armstrong’s presentation quoted two great advocates for children, Nelson Mandela and Fred Rogers.
First, he quoted Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”
And he quoted Fred Rogers, the star of the children’s television show “Mister Rogers’ Neighborhood”: “Anyone who does anything to help a child in life is a hero to me.”
Stroud struggles for words to describe what she thinks of Armstrong quoting these two champions for child welfare.
“It’s just — it’s just disgusting,” she said. “I feel my blood boiling just thinking about it.”

President Trump’s Healthcare Speech: Full Of Ignorance And Outright Lies

(THIS ARTICLE IS COURTESY OF POLITIFACTS)

 

Fact-checking Donald Trump’s health care speech

PolitiFact Live for June 29, 2017

With the future of the Senate health care bill hanging by a thread, President Donald Trump pressed Republican senators to fulfill their party’s seven-year promise to get rid of Obamacare.

Flanked by families Trump said had suffered under the Affordable Care Act, he said, “So far, Senate Republicans have not done their job in ending the Obamacare nightmare.”

Many senators remain in the dark as to what piece of legislation they will be voting on. Trump spoke only of passing a bill to repeal and replace the sweeping health care law without endorsing a specific bill.

Here are some of his statements and the fact-checks we’ve examined in the past.

“Obamacare has broken our health care system. It’s broken. It’s collapsing.”

While Trump has often said that Obamacare is collapsing, the first part of that statement goes further to say that the law has broken the entire health care system. This is not accurate.

The reality is that much of the care people receive continues as before, and by some measures, the system is on better footing than before. Hospitals, for example, spent about $6 billion less between 2013 and 2014 on care for which they received no payment. So-called uncompensated care fell mainly in states that expanded the Medicaid program to all poor adults, according to a study by the Kaiser Family Foundation. That bottom line improvement made hospitals more financially stable.

As for the individual insurance market, the part of Obamacare that Trump has said before is in a death spiral, we have rated statements like that False.

The latest assessment from the Congressional Budget Office, the nonpartisan analytic arm of Congress, is that the overall market is stable and would remain so for the coming decade.

The CBO said even though premiums have been rising, most of the people who buy through the government-run insurance exchanges are protected by the subsidies that are built into the law.

“The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.”

That said, as recently as July 12, the Kaiser Family Foundation found that 38 counties in the country are at risk of not having a single health insurance provider in 2018.

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“Obamacare has broken our health care system. It’s broken. It’s collapsing.”
“They (senators) can now keep their promise to the American people to provide emergency relief to those in desperate need of help, and to improve health care for all Americans.”

Trump makes it sounds like aid would be readily available to struggling health care consumers. The “emergency relief” in the Senate bill would actually go to insurance companies and state governments. While some of the money would help individuals, most of the benefits would be indirect and might take time to come together.

The Senate bill contains $182 billion designed to keep premiums down and encourage insurance companies to continue to sell policies in more local markets. The money comes in two pots.

The first is $50 billion over two years that insurance companies could request from the federal government to offset losses. In theory, this protection would reduce the risk to carriers and lead to lower insurance premiums.

Another $132 billion would be spread out over a number of years and would go to the states. States could use this money to pay the premiums for people in high risk pools. They could also provide additional premium subsidies and pay hospitals, doctors and other health care providers.

The precise impact of this is difficult to predict. Premium subsidies would tend to push premiums down. At the same time, the Senate bill gives insurers more flexibility to charge more to older policy holders. That, coupled with higher deductibles and other out-of-pocket expenses, could produce uneven effects.

According to the Kaiser Family Foundation, “older, lower-income people generally would see the largest increases; younger and more affluent people would see decreases in many locations.”

“The Senate is very close to the votes it needs to pass a replacement. The problem is we have zero help from the Democrats. They’re obstructionists.”

Trump is correct that zero Democrats support Republican efforts to repeal and replace the Affordable Care Act. But blaming Democrats for Senate Republicans’ failure to pass legislation doesn’t tell the whole story.

Because the GOP holds 52 Senate seats to Democrats’ 48, Democrats would be powerless to stop a united GOP caucus from passing legislation to dismantle Obamacare. In fact, Republicans could afford to lose two members and still pass the bill, with Vice President Mike Pence casting the tie-breaking vote.

The truth is Senate Republicans have been unable to agree on a replacement package that reconciles divisions between its more moderate and conservative members.

Defections by four GOP senators effectively killed the repeal-and-replace plan on July 17. The following day, a more modest repeal bill was doomed after three Senate Republicans came out in opposition.

Later in his speech, Trump appeared to acknowledge the difficulty of reaching an agreement given Senate Republicans’ slim margin of error.

“The Democrats aren’t giving us one vote, so we need virtually every single vote from the Republicans,” he said. “Not easy to do.”

The bill provides “more flexibility for states to administer Medicaid to better serve their poorest citizens.”

The Senate bill would fundamentally change Medicaid financing. Instead of the open-ended commitment it is today, the program would be put on a budget. States could choose to receive federal dollars based on a per-person formula, or they could take the money as a block grant. Either way, many federal rules would disappear, and states would gain the flexibility to spend Medicaid dollars as they see fit, as Trump said.

On the other hand, Washington would be much less generous with states than it is today. Medicaid spending would continue to rise, but at a much slower rate. The CBO estimated that by 2026, states would be getting 26 percent less than they would if the law remained the same. The cumulative difference over the next 10 years would be $756 billion.

This proposal has driven a wedge in the Republican ranks, dividing senators from states that want to preserve as much of the Medicaid funding as possible — essentially in states that expanded Medicaid — from those who feel the current system puts them at a disadvantage or simply spends too much.

Trump suggests Republicans will let ACA market collapse, then rewrite health law

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

Power Post

Trump suggests Republicans will let ACA market collapse, then rewrite health law

 July 18 at 10:52 AM
President Trump predicted Tuesday morning that Republicans may wait for the federal insurance market to collapse and then work to broker a deal to rewrite the nation’s landmark health-care law.In a series of tweets, Trump blamed the demise of a months-long effort to rewrite the Affordable Care Act on Democrats “and a few Republicans,” but he suggested that the drive to overhaul the law was not completely over.

“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” he tweeted. He added in a separate tweet: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”

Trump’s latest comments appeared likely to intensify the current political uncertainty on Capitol Hill, where GOP leaders were debating what to do next, as well as raise anxiety among insurers that must commit to staying on the federal health exchange within a matter of weeks.

Republicans are reeling after two more GOP senators declared their opposition Monday to the party’s plan to overhaul the nation’s health-care system, likely ending their quest to make good on a GOP promise that has defined the party for nearly a decade and has been one of Trump’s top priorities.

Two Senate Republicans oppose health-care bill, jeopardizing vote
The U.S. Senate’s healthcare overhaul appears to be in trouble after two more Republicans say they oppose a revised version of the bill. (Reuters)

Senate Majority Leader Mitch McConnell (R-Ky.) opened the Senate on Tuesday morning touting his latest plan — to vote on a pure repeal, with a two-year delay, by taking up the House’s health-care bill. But while conservatives and Trump have been pushing for such a repeal as a last resort, it appeared unlikely that the vote would succeed.

Two Republican senators, Susan Collins (Maine) and Shelley Moore Capito (W.Va.), expressed opposition Tuesday to the repeal-only option, apparently burying it.

“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

“This doesn’t have to be the end of the story,” McConnell said. “Passing the repeal legislation will allow us to accomplish what we need to do on behalf our people.”

McConnell said the Senate would next take up “a repeal of Obamacare combined with a stable two-year transition period.” He said that President Barack Obama had vetoed such legislation before but that “President Trump will sign it now.”

While he noted that the measure had overwhelming support among Republican senators in 2015, the Senate leader also acknowledged that his party has suffered a political setback.

“I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful,” he said. “We will now try a different way to bring the American people relief from Obamacare.”

Republican Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements Monday declaring that they would not vote for the revamped measure. The sudden breaks by Lee, a staunch conservative, and Moran, a McConnell ally, rocked the GOP leadership and effectively closed what already had been an increasingly narrow path to passage for the bill.

They joined Sens. Rand Paul (Ky.) and Collins, who also oppose the latest health-care bill. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the ACA. All 46 Democrats and two independents are expected to vote against it.

Lee supports the idea of moving ahead with a straight repeal of the existing law, and his spokesman, Conn Carroll, said Tuesday he would back a motion to proceed on a bill that would achieve that aim. But many centrist Republican senators have said they oppose dismantling key aspects of the ACA without an immediate replacement, given that roughly 20 million Americans have gained coverage under the law.

The confusion over next steps highlights the predicament now faced by Republicans, who have made rallying cries against Obama’s 2010 health-care law a pillar of the party’s identity. They may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.

Meanwhile, Trump and other Republicans will confront a Republican base that, despite fervent support for the president, still seeks a smaller federal government and fewer regulations.

All of these forces remained vexing factors Monday as senators bailed on the bill. And no evident solution was offered by the White House — which has been limited in its sale of the GOP plan — or from McConnell, for how to bring together a party in which moderates and conservatives are still deeply divided over the scope of federal health-care funding and regulations.

In many ways, the leadership plan did not go far enough for those on the right, but was too radical for GOP centrists. It scaled back some key ACA requirements and made deep cuts over time in Medicaid, but preserved popular provisions of the law such as a ban on denying coverage to consumers with costly medical conditions.

But the fact that it would reduce federal Medicaid funding and phase out the program’s expansion in 31 states and the District of Columbia rankled several key GOP governors and senators, who feared that their states would be saddled with the unpalatable choice of either cutting off constituents’ health coverage or facing a massive new financial burden.

The opposing pressures have left McConnell in a tough position as he has struggled to find a solution, which is why he has now thrown out the idea of moving to an immediate repeal.

Abolishing several of Obamacare’s central pillars — including the mandate that taxpayers buy coverage, federal subsidies for many consumers’ premiums and Medicaid coverage for roughly 11 million Americans — could wreak havoc in the insurance market. A Congressional Budget Office analysis in January estimated that premiums in the individual insurance market would rise between 20 and 25 percent next year and would roughly double by 2026.

At the same time, according to the CBO, the number of uninsured would spike by 18 million next year and rise to 32 million by 2026.

“For insurers, the worst possible outcome in this debate has always been a partial repeal with no replacement, which is exactly what Congress is about to take up,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, in an email. “Insurance companies would be on the hook for covering people with preexisting conditions, but with no individual mandate or premium subsidies to get healthy people to sign up as well.”

But GOP leaders had no choice but to shift gears after Lee and Moran declared they could not support the party’s current health plan.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations,” Lee said in a statement.

Moran said the bill “fails to repeal the Affordable Care Act or address healthcare’s rising costs.”

The two senators timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by McConnell would not be enough to meet their demands. They joined a pair of GOP colleagues in calling for a complete redrawing of the legislation that would take many months, short-circuiting McConnell’s wish to end the debate this month.

The news threw the effort to pass the legislation into turmoil, with additional Republicans weighing in on Twitter about a flawed process that must take a new direction. Trump tweeted late Monday that “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan.”

Sen. Lindsey O. Graham (S.C.) called for a “new approach” while Rep. Mark Meadows (N.C.) tweeted, “Time for full repeal.” White House aides, meanwhile, said they still plan to press ahead.

The setbacks appear to have left McConnell and House Speaker Paul D. Ryan (R-Wis.) with few good options. Conservatives have suggested moving a bill that would simply repeal the Affordable Care Act and set up a timeline of several years to figure out how to replace it, a politically risky move that also might lack support to pass.

Another move, which McConnell threatened recently, would be to work with Democrats to prop up the insurance exchange markets that have been imploding in some states — which probably would win passage but would infuriate the conservative base that has been calling for the end of the Affordable Care Act.

“Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” McConnell said in a statement released late Monday. He revealed plans to move forward with a vote in the coming days anyway, in some ways daring his Republican opponents to begin debate and open the legislation up to amendments.

Democrats quickly jumped at the opportunity to declare the effort dead.

“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” said Minority Leader Charles E. Schumer (N.Y.). “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health-care system.”

But Ryan showed little interest Tuesday in making common cause with Democrats, telling reporters that House leaders “would like to see the Senate move on something” to keep the repeal-and-replace process alive.

In a closed-door conference meeting, according to several members present, Ryan told colleagues that the ball remains in the Senate’s court and announced no plans for further action on health care in the House. He also urged House members to be patient and not to openly vent frustration with the Senate, the members said.

Publicly, he emphasized that the Senate had “a razor-thin majority” and that passing legislation is “a hard process.”

Republican leaders had returned to the Capitol on Monday still pledging to press ahead with plans to pass a far-reaching overhaul, but the day had begun with uncertainty as the health of Sen. John McCain (R-Ariz.) put the future of the flagging effort deeper in doubt.

In a speech on the Senate floor, McConnell said that he had spoken with McCain on Monday morning and that “he’ll be back with us soon.” The Arizonan is recovering from surgery to remove a blood clot above his left eye that involved opening his skull.

McConnell had delayed action on the health-care bill until ­McCain’s return in hopes that he could be persuaded to vote yes. That hope faded after Lee’s and Moran’s announcements, however, with McCain issuing a statement from Arizona calling for a fresh, bipartisan start.

Senate Republicans have been under self-imposed pressure to complete their work on health care. As they have struggled to show progress, McConnell has said he would keep the chamber in session through the first two weeks of August, postponing the start of the summer recess period to leave time to work on other matters.

Kelsey Snell, Mike DeBonis and Ed O’Keefe contributed to this report.

GOP Healthcare Bill Written For Everyone Except Themselves: They Keep Golden Plan We Have To Pay For

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

New GOP health care bill will determine winners, losers

 July 15 at 2:36 AM
WASHINGTON — Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that’s key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults.

And there are potential unintended consequences for people with employer-provided insurance, currently about 170 million Americans. Allowing individuals to pay premiums from tax-sheltered accounts may create incentives for employers to stop offering coverage, say some independent analysts.

The legislation would put limits on federal spending for Medicaid, a partnership program with states to cover low-income people, the disabled and nursing home residents. The drawback is that state officials could eventually face no-win choices, such as having to pick between paying for coverage for low-wage working mothers and support services for elderly people trying to stay out of nursing homes.

As Senate Majority Leader Mitch McConnell, R-Ky., steers toward debate and votes next week, here is a look at some of the latest changes and major issues:

___

CRUZ’S PLAN

The new Senate bill incorporates the core of a proposal from Sen. Ted Cruz, R-Texas, that would reorganize the market for policies purchased by individuals. As many as 20 million Americans get coverage this way, about half through subsidized markets like HealthCare.gov, created under former President Barack Obama.

Cruz would change basic requirements that Obama’s law imposed on individual plans, including standard benefits such as pregnancy, maternity and newborn care; wellness visits and mental health treatment. The law also requires the same premium rates for sick and healthy people.

Under the Cruz approach, an insurer can offer plans that don’t comply with such requirements, provided they also offer coverage that does. The problem, say critics, is that the healthy would flock to low-premium, skimpy plans, leaving the sick to face escalating prices for comprehensive coverage.

“Healthy people would have opportunities to buy lower-premium, skinnier plans, while people with pre-existing conditions not eligible for premium subsidies could find themselves priced out of insurance,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.

The latest bill includes another $70 billion to help states keep health insurance affordable for older, sicker customers. But it’s not clear how those backstops would work, and the federal funding eventually would end.

Some insurers are worried because of a technical change with huge practical implications: Health plans that enroll healthier customers would no longer have to cross-subsidize those with sicker patients, as is currently required.

“We think it is unworkable,” said Justine Handelman, top Washington lobbyist for the BlueCross BlueShield Association. She predicted skyrocketing costs for taxpayers also, stuck with the bill for sicker patients.

___

EMPLOYER ESCAPE HATCH?

McConnell’s new bill made a major change to tax-sheltered health savings accounts, which was also advocated by Cruz.

Under the bill, health savings accounts could be used to pay premiums with pre-tax money. Under current law, they can only be used to cover out-of-pocket costs, such as deductibles and copayments.

The change is meant to level the playing field for people buying individual plans, as compared to people getting employer coverage. The value of workplace insurance is tax-free for employees and tax-deductible for employers.

But some analysts say McConnell risks undermining workplace coverage.

The upside is that the change might encourage more self-employed people to buy individual health insurance policies. The downside is that some employers may see it as an invitation to drop health benefits, particularly since the GOP also would repeal Obama’s requirement that larger companies provide health care or face fines.

“Allowing individuals to purchase insurance with pre-tax dollars eliminates one of the advantages to employer-provided insurance,” said Elizabeth Carpenter of the Avalere Health consulting firm. “That may lead some employers to consider whether or not they want to continue to offer health insurance.”

___

THE POOR AND THE SICK

McConnell kept some of the Obama-era tax increases used by Democrats to finance expanded coverage. But the money will be going to shore up private insurance, not the Medicaid program. Medicaid accounts for half or more of the 20 million Americans gaining coverage as a result of the Affordable Care Act.

Medicaid covers low-income people, from many pregnant women and newborns, to disabled people and many elderly nursing home residents. The GOP bill would start by phasing out enhanced federal financing for Obama’s Medicaid expansion, adopted by 31 states. Perhaps more significantly, it would limit future federal funding for the overall program. As a result, it’s estimated Medicaid would cover 15 million fewer people by 2026.

The bill would add $45 billion to help states confronting the opioid epidemic pay for treatment and recovery. But that hasn’t swayed the American Medical Association, which points out that people in recovery also need comprehensive health insurance.

Republican governors don’t like the Medicaid cuts, and some have been vocal. About half the states that expanded Medicaid now have GOP chief executives.

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Nevada Gov. Brian Sandoval, a Republican who oversaw a Medicaid expansion, said more than 200,000 people gained coverage in his state.

“You think about 210,000 men, women and children, senior citizens, the drug addicted, the chronically ill,” Sandoval said. “These are people that used to get their treatment in emergency rooms, if they got any treatment at all. I keep going back to the fact that they are living a better quality of life.”

___

Associated Press writer Jennifer McDermott in Providence, Rhode Island, contributed to this report.

Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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