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 Elections Offer Possibility for Medicaid, Health Policy Changes

All eyes are on House elections Nov. 6, says Christopher Condeluci, lawyer and principal, CC Law & Policy, who offered a critique of how the health care sector would be impacted by Democrats winning control or Republicans holding onto power. 
Condeluci’s focus on the House comes as expectations run high for Republicans to maintain control of the Senate. And, even if Democrats stage an upset, their majority would be so narrow as to make the possibility of significant health care legislation remote, he says. 
While most experts like Condeluci do not expect the impact of the congressional votes to hit long term and post-acute care (LT/PAC) providers head on, a new report by Avalere Health said the state gubernatorial races could affect the Medicaid program if a number of governorships shift to Democrats.  ​​
But first to general health care policies that could be affected by the results. In Condeluci’s analysis, if Democrats win majority status in the House, “we have already been told that the House committees with jurisdiction over health care (e.g., the Energy and Commerce, Ways and Means, and Education and the Workforce Committees) will hold a bunch of hearings examining all of the actions taken by the Trump administration over the past two years.”
These hearings would certainly examine issues related to the Affordable Care Act (ACA), like reduced funding for marketing and advertising during the 2018 “open enrollment” period, and cuts in monies for ACA navigators who help consumers with health plan questions.  
There could also be a push by a Democratic House to offer “Medicare-for-All” legislation, since the subject has been a big talking point on the campaign trail. “So, expect a number of Democrats to introduce formal legislation calling for some ‘shade’ of single-payer, and expect the House committees of jurisdiction to hold hearings and ‘mark-ups’ on said legislation,” Condeluci says.
Despite no expectation for any agreement on such actions by the administration or a Republican-led Senate, Condeluci says House Democrats will likely also explore ways to “expand the safety net” (i.e., expand eligibility for Medicaid) and to also expand eligibility for the ACA exchange subsidies.
Of course there is also the chance Republicans “somehow hold onto the majority in the House,” which if that occurs will open the door for more attempts at ACA “repeal and replace,” Condeluci says.
“It would likely take the form of the Graham-Cassidy approach, where Congress would block grant all of the ACA’s federal funds and give the funds to the States (with certain conditions that must be met by the states before they can access the federal funds),” he says. 
But Medicaid reforms would likely not be part of new ACA legislation, since as Condeluci says, “I would think Republicans would have learned their lesson from last year’s ACA ‘repeal and replace’ exercise.”  But, he says Republicans won’t be able to resist an attempt to at least make some Medicaid reforms like codifying “work” requirements and “playing around with Medicaid eligibility for able-bodied individuals with no children.” 
If in control of the House, Republicans would also try to repeal the employer mandate, the medical device tax, and the annual excise tax on insurance carriers, Condeluci says.
Separate from the congressional election results and predictions of what may happen is a new report from Avalere looking at how a change to governors in key states may swell the number of individuals in the Medicaid program. The analysis said that some 2.7 million people from states that have not expanded Medicaid could gain program coverage should their newly elected governors choose to take the expansion path.
“Fourteen of the 36 states that are holding gubernatorial electionsin November 2018 have not expanded Medicaid. Of those, six—Florida, Georgia, Kansas, Maine, South Dakota, and Wisconsin— are considered ‘toss-ups’ and could seek to expand if the Democratic candidate is elected governor, subject to approval from their legislatures,” Avalere said.
If these half-dozen states were to expand, approximately 2.4 million individuals could gain access to Medicaid coverage. Similarly, Medicaidexpansion ballot referenda in three states—Idaho, Nebraska, and Utah—could lead to expansion, regardless of governors’ elections results. 
“If voters in these three states decide to expand coverage, an additional 325,000 people could be enrolled in 2019. In combination with the people who could gain coverage in the ‘toss-up’ states, approximately 2.7 million people could be newly covered by Medicaid in those nine states combined,” the report said.
Fred Bentley, a vice president at Avalere, tells Provider if the Medicaid expansion scenario were to play out, there would not be a direct impact on LT/PAC providers, since the funding for the first few years of ACA-related Medicaid eligibility expansion comes from the federal government. 
But, down the road, as states take on more responsibility for subsidizing the expansion population, there “could be reason to raise concerns” to the extent costs grow and eat up more of the budget. “States would look at all things then to reign in Medicaid spending,” Bentley says.
Read the Avalere report at 
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