With the spectacular failure of the Republican Obamacare repeal, it looks as if the healthcare debate in Washington is over for at least the short term. During the debate over the various GOP proposals to destroy the Affordable Care Act, one of the most contentious issues was how those “repeal and replace” bills affected Medicaid. Now it appears that one state is ready to take on the Medicaid issue all on its own.
On August 2 the Maine Department of Health and Human Services filed a request with the federal Centers For Medicare and Medicaid Services, asking for permission to modify the state’s Medicaid program. The request was for a “Section 1115 waiver.” That section of the Social Security Act gives the Secretary of Health and Human Services the power to approve “experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs.” So what does Maine want to do? They want Medicaid recipients to pay for their coverage.
Yes, you read that right. Maine, under batshit crazy Republican Governor Paul LePage, wants low income people who cannot afford to buy insurance to pay for Medicaid.
It should be noted that Maine isn’t the only state to request a waiver for the state’s Medicaid program. In the past states have been barred from asking Medicaid recipients to pay premiums. But after Obamacare increased Medicaid eligibility to 133 percent of the federal poverty level, six states that approved the Medicaid expansion (Arizona, Arkansas, Indiana, Iowa, Michigan, and Montana), requested and were granted waivers to charge premiums to those who became newly eligible for the program. But Maine has not approved Medicaid expansion, which makes it the only state to request the ability to charge people whose income is below the poverty level.
Part of the idea behind requiring Medicaid recipients to pay premiums is to push them toward buying commercial insurance. But if you are eligible for Medicaid, you cannot get a subsidy to buy a policy on an Obamacare exchange. So what happens if you can’t afford your Medicaid premiums and you can’t afford a commercial insurance policy? You wind up without insurance. This is what the Kaiser Family Foundation found:
- Premiums serve as a barrier to obtaining and maintaining Medicaid and CHIP coverage among low-income individuals.
- Even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services.
- State savings from premiums and cost sharing in Medicaid and CHIP are limited.
Every time Republicans try to do something with healthcare, it becomes crystal clear that former congressman Alan Grayson was right — the GOP health plan is “don’t get sick.” And if you do, die quickly. Particularly if you’re poor.