Virginia Legislature Expands Medicaid

In what one TV reporter referred to as a “knock-down, drag-out battle in the General Assembly”, the Virginia State Senate has just passed a budget that includes Medicaid expansion. This will make Medicaid accessible to about 400,000 more low-income Virginian adults. According to the Washington Post, the expansion is likely to cost about two billion dollars, 90% of which will be covered by federal funding for the state under the 90:10 cost split available to states undertaking Medicaid expansion.

Virginia is now the 34rd state (including the District of Columbia) to expand its Medicaid eligibility. Unfortunately, according to The Hill, it is likely that work requirements for “able-bodied” recipients will be inserted into the package sometime later in the year.

Medicaid now covers one in every five Americans, according to Kaiser Family Foundation data, and virtually all Medicaid recipients have no access to other insurance options.

Utah may become the 35th state to expand if its ballot initiative for Medicaid Expansion passes next November. Politico reports that, determined to make Medicaid more widely available in their state, volunteers in Utah have gathered the 147,000 valid signatures required to compel a statewide vote on the issue. Maine achieved Medicaid Expansion by a popular vote last November. Most recently, Idaho residents have undertaken a petition drive to get the question on the ballot in their state.

Fewer Uninsured Than Expected After Individual Mandate Repeal

With the repeal last December of the “Individual Mandate” in the Affordable Care Act requiring all citizens to have health insurance, the number of uninsured Americans was expected to rise sharply. The Congressional Budget Office projected last year that 13 million people would become uninsured between 2017 and 2027 as a result of the repeal.

Last week, however, the CBO reduced that estimation. According to Inside Health Policy, it now “expects one-third fewer people to be uninsured due to the individual mandate repeal than it had predicted in November.” The CBO is producing detailed new coverage estimates that will come out later this year.

While any reduction on the number of people with insurance coverage is disappointing, it seems clear that retaining coverage is still a high priority for most people, ever in the absence of the Individual Mandate.

New Jersey Becomes Second State To Adopt Individual Health Insurance Mandate

According to Politico, Gov. Phil Murphy on Wednesday signed into law a bill that will require all New Jersey residents to have health coverage or pay a penalty, making the state the second in the country to adopt an individual health insurance mandate. Democratic lawmakers drafted the bill in response to Congress’ decision to repeal the federal mandate established under the Affordable Care Act. The repeal, the New Jersey lawmakers feared, would drive healthier people out of the state’s Obamacare market and cause premiums to spike.

Still Having Trouble Explaining How Co-Pay Estimator Adjustment Systems Work?

A few weeks ago, we sent around a fact sheet on Co-Pay Estimator Adjustment Programs, how they work and why they may be making it very difficult for some patients to afford the medicines they need.

You can now also look at an animated cartoon version prepared by the Alliance for Patient Access to explain this issue.

If you work with case managers, patient navigators or other staff who provide patient assistance and support, you may also want to make these materials available to those staff. This is a complicated issue – and not one likely to affect a lot of patients. But, for those who have to get their medications through insurance companies and PBMs that are using Co-Pay Estimator Adjustment Systems, these tools may make it easier to help patients understand why their billing is changing.

View the latest HIV Policy Update here.