Affordable Care Act Remains Unsinkable

canada goose outlet price Despite dire predictions of its demise, the Affordable Care Act is alive and flourishing as it nears its eighth birthday in 2018. Medicaid is flourishing, too, but with new controversy over pending work requirements. canada goose outlet price

Nicknamed Obamacare after then President Barack Obama, who proposed canada goose outlet online it and signed it into law, the ACA has survived a troubled childhood. Supreme Court saved it from being strangled in its cradle over constitutional issues.

canada goose outlet washington dc Last year the law was on life support as Republican congressional leaders and President Donald Trump tried repeatedly to repeal it. By narrow margins the Senate rejected every attempt. canada goose outlet washington dc

canada goose outlet reviews Still, the ACA prognosis for 2018 seemed bleak when the Trump administration slashed advertising and outreach for Obamacare and halved the sign up period for obtaining coverage through the federal website. canada goose outlet reviews

is finished, Trump declared on the eve of the open enrollment period. dead. It gone. Since the enrollment period was extended in many of these states, full figures are not yet available.

canada goose outlet trillium parka black Obamacare greatest impact has been on Medicaid, the federal state program that provides health care for the poor and disabled. More than canada goose outlet store 74 million people are enrolled in Medicaid, about a third more than when Obamacare began. canada goose outlet trillium parka black

canada goose outlet toronto factory The ACA allows states to provide Medicaid to people making up to 138 percent above the poverty line. Enticed by an incentive that originally provided a full federal subsidy for new enrollees, 31 states and the District of Columbia have expanded Medicaid since the ACA took effect. canada goose outlet toronto factory

canada goose outlet florida Partly canada goose outlet because of this expansion, Medicaid has become the second largest item in most state budgets after education, rising as a percentage of state spending from 20.5 percent in fiscal 2008 to 29.0 percent in fiscal 2017, according to the National Association of State Budget Officers. canada goose outlet florida

canada goose jacket outlet uk Costs increased in 2017 when states were required to assume 5 percent of the costs of new Medicaid enrollees. This will jump to 10 percent in 2020. canada goose jacket outlet uk

canada goose outlet 2015 The increased cost of Medicaid has caused budget anxiety in many states and prompted 10 of them, all with Republican governors, to seek federal waivers allowing them to experiment with cost cutting measures. canada goose outlet 2015

canada goose outlet parka The most controversial of these experiments is a work requirement for Medicaid enrollees, known by the euphemism of engagement. This month the Trump administration allowed Kentucky to impose the first work requirement canada goose outlet jackets in Medicaid history and signaled it would look favorably on similar requests from nine other states: Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin. canada goose outlet parka

canada goose outlet online In Kentucky, Republican Gov. Matt Bevin celebrated the approval of a work requirement as most transformational entitlement reform that has been seen in a quarter of a century while advocates for the poor threatened lawsuits. canada goose outlet online

canada goose factory outlet (Bevin) administration has their chicken and egg story completely wrong they say people need to work to get healthy, Sheila Schuster, a Kentucky health care advocate told The New York Times. canada goose factory outlet

canada goose outlet woodbury all know canada goose outlet canada that health is the foundation from which people go to school, go to work and keep their employment. The administration is not only going backward, but doing it for completely the wrong reasons. countered with Executive Order 2018 040, which orders state officials to terminate the state Medicaid expansion in its entirety if the work requirement is thrown out by the courts. canada goose outlet woodbury

canada goose outlet uk sale Under the Kentucky plan, starting in July, most Medicaid recipients aged 19 to 64 who are not disabled will canada goose factory outlet be expected to work at least 20 hours a week or do an equivalent amount of volunteer work. Pregnant women, full time students, primary caretakers of dependents, homeless people and those deemed medically frail will be exempted. canada goose outlet uk sale

Kentucky, one of only three Southern states to expand Medicaid under the ACA, has been a poster child for Obamacare.

goose outlet canada According to the Centers for Medicare Medicaid Services, Kentucky enrollment in Medicaid and the Children Health cagooseclearance Insurance Program (CHIP) increased by 108 percent from 2013, when Obamacare became operative, to October 2017. This is by far the largest percentage increase of any state, and more than three times as much as the national average increase of 29 percent. census data. goose outlet canada

Total Medicaid enrollment in Kentucky, including children and the elderly, stood at 1.3 million as of October 2017, nearly canada goose outlet sale 30 canada goose outlet nyc percent of the Bluegrass State entire population. These included 650,867 adults, three quarters of whom were added by the ACA expansion.

The Bevin administration estimates that the work requirement would apply to 350,000 of these adults, canada goose jacket outlet although it unclear how many of them are already employed. Nationally, 60 percent of Medicaid recipients are working, according to the Kaiser Family Foundation.

Medicaid has become the nation largest health program, enrolling one in five Americans. Total Medicaid costs in 2016, the last year for which complete figures are available, were $553 billion with 63 percent paid by the federal government and 37 percent by states.

After increasing the federal budget deficit with a tax bill passed by Congress in December, Republicans hope to lower it at the expense of Medicaid and other health care programs. A budget resolution passed by Congress along party lines in October lacks the force of law but provides a window on GOP priorities. All non Medicare canada goose outlet toronto factory health programs, principally the ACA and Medicaid, would see a cut of $1.3 trillion or nearly 30 percent by 2027, according to the Center on Budget and Policy canada goose outlet Priorities.

While Medicaid is a pressing issue, states are more concerned in the short run with the congressional deadlock over CHIP, which provides health care for 9 million children of working parents with income too high to qualify for Medicaid.

Funding for CHIP, created in 1997 with bipartisan support, expired in September and the popular program has become a pawn in the congressional struggle to reach agreement on a budget resolution. Several states official canada goose outlet have warned Congress they cannot fund CHIP on their own after Jan. 31.

Going forward, expect Trump and congressional Republicans to keep the pressure on Obamacare. canada goose outlet store uk The canada goose outlet shop tax bill abolished a provision of the ACA that required most Americans to obtain health insurance or pay a penalty, beginning in 2019. Despite Trump claim that removal of this requirement repealed Obamacare, the ACA remains healthy and in force.

canada goose uk Insurance markets would become even more stable if Congress passes a pending bipartisan bill restoring payments to insurers for discounts they gave low income ACA customers for health policy deductibles and other expenses. canada goose uk

Trump cut off these payments, estimated at $8 billion canada goose outlet uk sale in 2018. During the debate on the tax bill, however, he promised Sen. canada goose outlet new york city Susan Collins, R Maine, that he would sign a bill restoring the payments if it reaches his desk.