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Midterm election boosts Medicaid expansion, but challenges remain

This is a Kaiser Health News story.

Medicaid — which has been a political football between Washin..

This is a Kaiser Health News story.

Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesdays election.

Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures.

Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020.

Medicaid proponents also were celebrating the Democrats takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people.

“Tuesday was huge for the Medicaid program,” said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. “The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect.”

But health experts caution that GOP opposition wont fade away.

David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. “I see this as a turning point in ACA politics,” he said. Still, he added‚ “its not inevitable.”

Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities.

The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest.

GOP opposition has left about 4.2 million low-income Americans without coverage in various states.

“Its not over until its over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. “But the trend overall has been to increasing implementation and increasing coverage.”

Montana Fails To Endorse Funding

Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program.

In addition, Democrats secured the governors offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it.

Current and incoming Republican governors in Utah and Idaho said they wouldnt block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase.

It wasnt a clean sweep, however, for Medicaid on Tuesday.

In preliminary results, a ballot issue to fund Montanas Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products.

The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so.

Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected.

Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements.

“There are some people in the state who may not have disabilities but need some help to access coverage,” she said. “I think we can pass something without people having a gap in coverage. … That will be a priority.”

“It was never our intent to simply sunset the expansion and have it go away,” she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes.

Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along.

But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the states sales tax, just over a penny for a $10 purchase.

Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the states ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage.

“I think it showed there was a clear need for it,” he said. The legislature likely wont block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps.

Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom lines because it cuts down on uninsured patients and uncompensated care.

“The broad population does see the value of Medicaid,” she said. “They saw it as a loss by their states not to accept the federal funds,” she said.

Despite the victories, Burke said, advocates should not assume other states such as Florida, Texas and Tennessee will follow suit.

“I dont see a radical shift, but it moves us closer,” she said.

Fertile Ground For More Referendums

If advocates press for more referendums, Florida might be a tempting target. More than 700,000 adults there could become eligible, but the campaign would likely also be very costly.

Jonathan Schleifer, executive director of The Fairness Project, which financed the ballot initiatives in Maine in 2017 and the four states this year, refused to say which states would be targeted next.

The group is funded by the Service Employees International Union-United Healthcare Workers West, a California health care workers union.

“The GOP has been bashing the ACA for nearly a decade, and voters in the reddest states in the country just rejected that message,” Schleifer said. “Its a repudiation and a tectonic shift in health care in this country.”

“There is fertile ground” for more such ballot votes, said Topher Spiro, vice president for health policy at Center for American Progress, a liberal think tank. “It is clear that public opinion is on the side of Medicaid expansion and the election results merely confirm that.”

“This will build momentum for expansion in other states,” he added.

The election results also could have consequences on efforts by states to implement work requirements for Medicaid enrollees.

New Hampshire and Michigan — which expanded the program but recently won federal approval to add controversial work requirements — could revisit that additional mandate as a result of Democrats winning control over both houses of the legislature in New Hampshire and the governors office in Michigan.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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Officials investigating 252 possible cases of polio-like illness AFM

Officials are now investigating 252 cases of possible acute flaccid myelitis (AFM), including 90 con..

Officials are now investigating 252 cases of possible acute flaccid myelitis (AFM), including 90 confirmed cases in 27 states, according to the Centers for Disease Control and Prevention.

The number of cases under investigation by the CDC is up 33 from last week, and the number of confirmed cases rose by 10, Dr. Nancy Messonnier, the director of CDCs National Center for Immunization and Respiratory Diseases, told reporters Tuesday.

Acute flaccid myelitis is a condition that has polio-like symptoms such as partial paralysis. The virus mostly affects children and young adults. The CDC said they do not know why the condition is impacting these individuals, but many believe it is caused by viruses. The CDC emphasized it remains a rare condition and said there have been no reported deaths from AFM so far in 2018.

The typical symptoms of AFM are similar to those of a severe respiratory illness, along with a fever, but then progress into neurological symptoms. Some patients with AFM feel weakness in their arms or legs, a loss of muscle tone or slower reflexes.

Some patients may also exhibit facial droop or weakness, difficulty moving their eyes and drooping eyelids or difficulty with swallowing or slurred speech. The most severe symptom is respiratory failure.

Messonnier said the CDC doesn't yet have enough information to definitively say what causes AFM and are casting a wide net for information. Part of that is studying the long-term health of AFM patients. Scientists are also looking for a pathogen in AFM patients' spinal fluid, but haven't yet found a pathogen that's a clear cause, she said.

The CDC said it sees an uptick in AFM cases every two years, and so far, the curve of the cases being investigated this year looks very similar to that of 2014 and 2016.

Officials don't expect many more cases in 2018 compared to 2016 and 2014, Messonnier said.

The best advice available is to wash your hands regularly, which lowers the chances of getting sick or spreading germs from many of the viruses linked to AFM, and protect against mosquito bites by using repellent, in addition to staying indoors at dusk and dawn.

The CDC said the vaccines your pediatrician suggests are very effective and children should continue to receive them on schedule even though there is no vaccine for AFM. (more…)

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‘Make-a-Wish’ wishes decrease trips to hospital for sick children: Study

A recent study from the Nationwide Childrens Hospital in Columbus, Ohio shows that participation in ..

A recent study from the Nationwide Childrens Hospital in Columbus, Ohio shows that participation in the Make-A-Wish program may give children better quality of life and reduce hospital visits and healthcare costs.

Patients who received a wish were 2.5 times more likely to have fewer unplanned hospital admissions and 1.9 times more likely to have fewer unplanned emergency department visits compared to patients of similar age, gender, disease category, and disease complexity who would also quality for a wish but did not receive one.

What is the Make-A-Wish Foundation?

The Make-A-Wish Foundation is a non-profit organization whose goal is to provide children aged three to 17-years-old who have progressive, life-limiting, or life-threatening medical conditions, with experiences known as “wishes.” These wishes include “I wish to…” “go,” “be (someone for a day),” “meet,” and “have” (i.e. receive gifts.) The foundation is funded by contributions from individual donors, corporations, and other organizations.

What are the goals and mission of the Make-A-Wish Foundation?

The Make-A-Wish Foundation “serves a unique, and vital, role in helping strengthen and empower children battling illnesses.” And, “wishes make life better for kids with critical illnesses.”

How many “wishes” does the foundation grant?

The Make-A-Wish Foundation was founded in November 1980 and the first wish was granted in the spring of 1981 to Frank “Bopsy” Salazar, a 7-year-old who had leukemia. Bopsy had three wishes: to be a fireman, go to Disneyland, and ride in a hot air balloon — all of which were granted to him. Since then, more than 285,000 children in the United States and its territories have benefited from experiencing their wishes. The foundation granted 15,300 wishes last year alone; which means on average, a wish is granted every 34 minutes.

What are the potential benefits of receiving a “wish?"

There is a long-held belief that receiving a wish improves a childs quality of life and potentially improves their familys quality of life, enhances family bonding, reduces stress, increases hope and serves as a distraction from illness. (more…)

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To curb STD rise, doctors treat patients’ partners without an office visit

This is a Kaiser Health News story.

If patients return to Dr. Crystal Bowe soon after taking medi..

This is a Kaiser Health News story.

If patients return to Dr. Crystal Bowe soon after taking medication for a sexually transmitted infection, she usually knows the reason: Their partners have re-infected them.

“While you tell people not to have sex until both folks are treated, they just dont wait,” she said. “So they are passing the infection back and forth.”

Thats when Bowe, who practices on both sides of the North and South Carolina border, does something doctors are often reluctant to do: She prescribes the partners antibiotics without meeting them.

Federal health officials have recommended this practice, known as expedited partner therapy, for chlamydia and gonorrhea since 2006. It allows doctors to prescribe medication to their patients partners without examining them. The idea is to prevent the kind of reinfections described by Bowe — and stop the transmission of STDs to others.

However, many physicians arent taking the federal governments advice because of entrenched ethical and legal concerns.

“Health care providers have a long tradition of being hesitant to prescribe to people they havent seen,” said Edward Hook, professor at the University of Alabamas medical school in Birmingham. “There is a certain skepticism.”

A nationwide surge of sexually transmitted diseases in recent years, however, has created a sense of urgency for doctors to embrace the practice. STD rates have hit an all-time high, according to the Centers for Diseases Control and Prevention. In 2017, the rate of reported gonorrhea cases increased nearly 19 percent from a year earlier to 555,608. The rate of chlamydia cases rose almost 7 percent to 1.7 million.

“STDs are everywhere,” said Dr. Cornelius Jamison, a lecturer at the University of Michigan Medical School. “We have to figure out how to … prevent the spread of these infections. And its necessary to be able to treat multiple people at once.”

A majority of states allow expedited partner therapy. Two states — South Carolina and Kentucky — prohibit it, and six others plus Puerto Rico lack clear guidance for physicians. (more…)

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