A coordinated effort between federal and state officials is threatening access to healthcare for hundreds of thousands of Americans, according to a new policy brief from the American Lung Association. In “A Coordinated Attack: Reducing Access to Care in State Medicaid Programs” the American Lung Association highlights the policies in recent Medicaid “1115 waiver” applications, many of which have already been approved for several states, which restrict patients’ access to quality and affordable healthcare. These waivers and their impact on patients could create insurmountable barriers to healthcare for people living with serious and chronic illnesses, such as lung cancer, chronic obstructive pulmonary disease (COPD) and asthma. For many of these individuals, a sudden gap in healthcare coverage could lead to a worsening of their condition or even death.
“The recent waiver proposals and approvals are a systematic attack on the Medicaid program, jeopardizing access to healthcare for hundreds of thousands of low-income patients with serious and chronic health conditions across the country,” said American Lung Association National President and CEO Harold P. Wimmer. “By raising awareness of the negative impact of these waivers on the public’s health, we hope the Administration and state Medicaid programs will stop proposing and approving waivers that arbitrarily reduce access to care. We implore our nation’s leaders to focus on improving the health of and saving the lives of Americans, rather than attacking Medicaid and placing the health of so many Americans at risk.”
These waivers will have real consequences for patients, including those with or at risk of lung disease. For example, in its waiver proposal Kentucky estimated that 95,000 Medicaid enrollees would lose coverage over five years, if their proposal was implemented. However, a group of deans, department chairs and scholars at leading academic institutions estimated that the coverage loss in Kentucky would be much higher, with 175,000 to 300,000 individuals losing coverage. A federal court judge ruled on June 29 that the Kentucky waiver was “arbitrary and capricious” for its failure to consider whether the waiver would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.”
A most recent trend is the failure of states, including Michigan, New Hampshire and South Dakota to include or update required budget neutrality estimates in their waiver applications. These estimates show the cost to the state, but also estimate the number of enrollees who would lose coverage as a result of the waiver. This information is critical to determine if the waiver meets the objectives of the Medicaid program.
“A Coordinated Attack: Reducing Access to Care in State Medicaid Programs” highlights that on the day she was sworn in, Administrator of the Center for Medicare & Medicaid Services (CMS), Seema Verma and then U.S. Secretary of Health and Human Services (HHS) Tom Price issued a letter to every governor in the country inviting them to pursue changes to their states’ Medicaid programs – including proposals that threaten patients’ access to care.
“The American Lung Association calls on CMS to stop approving harmful 1115 waivers and, in light of the federal district court’s recent decision to block implementation of the Kentucky waiver, CMS should also suspend implementation of 1115 waivers containing any provisions that threaten access to healthcare coverage,” added Wimmer.