Cruz, Lee Push Amendment to GOP Bill to Give Insurers More Options

Two conservative senators are proposing an amendment to the GOP’s health care bill that would give consumers more leeway to purchase the health insurance of their choice.

Sen. Ted Cruz, R-Texas, and Sen. Mike Lee, R-Utah, recently announced an amendment called the Consumer Freedom Option that would allow insurance companies to sell any health coverage plan that they care to as long as the insurers provide one plan that satisfies  the mandates of Obamacare, Townhall reported.

“A key piece I think to getting [the GOP health care bill] passed is an amendment I’ve introduced that I hope will be in the final bill,” Cruz said Wednesday during a radio interview with Texas radio host Mark Davis.

“The Consumer Freedom Option simply says that if an insurance company sells in a given state a plan that is consistent with the Title I mandates, that company can also sell any other insurance plan consumers desire.”

Title 1 of the Affordable Care Act “requires persons to buy ‘qualified health plans,’ those [that] meet all of the benefit mandates and insurance rules, as required under Title I of the ACA, or pay a fine of $695 or an amount up to 2.5 percent of income, whichever amount is greater,” Bob Moffit, a senior fellow and health care expert at The Heritage Foundation, told The Daily Signal in an email.

Cruz’s amendment comes after multiple conservative senators said they oppose the Senate leadership health care plan, called the ‘Better Care Reconciliation Act of 2017,” because it does not fully repeal and replace Obamacare.

Cruz said if his amendment is passed, consumers will be at an advantage.

What this will allow is OK, fine you want to keep your mandates? Knock yourself out with your mandates, but in addition to mandates, let’s let Texans buy the plans they want, let’s let Texans buy the benefits they want and let’s let them get lower prices so that more families who are struggling can actually afford health insurance.

Senate Minority Leader Chuck Schumer, D-N.Y., publically decried Cruz’s amendment.

Mike Needham, the CEO for Heritage Action for America, the lobbying affiliate of The Heritage Foundation, told The Daily Signal in an email that the Senate should welcome Cruz’s amendment.

“What Sen. Cruz is fighting for–a plan that lets states and individuals that want to keep Obamacare do just that while freeing everyone else from the law’s burdensome regulations–shouldn’t be a heavy lift for the party that promised repeal for years,” Needham said.

Needham said senators should consider Cruz’s amendment to bring consensus:

The last several months have taught us a lot. It turns out many Republicans didn’t want to repeal Obamacare at all. Conservatives have made compromise after compromise in these negotiations. It’s time for Sen. Cruz’s colleagues to give his proposal a fair hearing.


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School-Based Health Services and Medicaid in Context: A Better Way to Pay

Congressional efforts to reform health care include capping federal funding and streamlining Medicaid to refocus it on its original, neediest recipients and slow the rate of growth for what has become an expensive, unrestricted entitlement threatening the future of the safety net for those in greatest need.

Yet critics argue that such efforts would adversely impact low-income schools, which in some cases tap into Medicaid for reimbursements for certain health-care related costs, such as school nurses and other health care professionals, and equipment for children with special needs.

Critics charge that limits on Medicaid would “put schools in competition with hospitals and doctors’ offices for coveted funds – a shift they say that’s sure to leave them short-changed.”

But the health care reform proposal making its way through Congress does not actually prescribe any reductions in Medicaid-reimbursed school services.

In fact, states are free to spend their current Medicaid funds—or to appropriate new funds—to school-based health services. Even if a state were to choose to move away from school-based strategies to meet the health-care needs of the poor children they are required to serve under Medicaid, schools would still have numerous other sources of funding for school-based health services.

Mechanics of School-Based Medicaid Reimbursements

Congress’s proposed reforms to Medicaid would only cap federal Medicaid contributions to states.

While the current funding formula varies by state, on a national basis the federal government has historically funded about 57 percent of total Medicaid spending. Although the reform would cap the per enrollee amounts that the federal government contributes to states, nothing in the proposal mandates that any fewer people be covered or any less money be spent in the aggregate.

Medicaid requires that poor children’s health care be covered, but does not prescribe that such coverage be delivered by school districts.

State government administration of the program determines who is an eligible provider, (which could include a school), and payment rates. But there is neither a requirement nor a prohibition on funding health services in schools via Medicaid dollars. Thus, if a state determines that school health reimbursements are a good use of Medicaid dollars, the state legislature can appropriate funding.

Putting Medicaid Spending for School-Based Health Services in Context

Payments to school districts made via Medicaid for health services equate to approximately 1 percent of total Medicaid reimbursements, with schools billing the program for an estimated $4 billion in 2015, of which approximately $2 billion is federally funded.

Further, Medicaid reimbursements to schools are dwarfed in comparison to K-12 school spending generally, which include other funding sources for health care.

More than half of the U.S. Department of Education’s annual budget goes to K-12 spending, with the largest tranches comprising spending on programs authorized under the Elementary and Secondary Education Act (ESEA) – now known as the Every Student Succeeds Act (ESSA) – and the Individuals with Disabilities Education Act (IDEA).

Yet The New York Times claims that, because of the health reform bill, “the ability of school systems to provide services mandated under the federal Individuals with Disabilities Education Act would be strained. The law is supposed to ensure that students with disabilities receive high-quality educational services, but it has historically been underfunded.”

Such a claim distorts the reality of current federal education spending on children with special needs, conflating IDEA – a totally separate program – with the limited amount of services reimbursed through Medicaid.

Although some IDEA health services may be reimbursed through Medicaid, at the discretion of a state’s Medicaid plan, funding for IDEA, which is at historically high levels, is a separate federal funding stream authorized and appropriated as an autonomous program, and IDEA far outstrips annual Medicaid payments at nearly $13 billion per year.

Schools Access Myriad Federal Health Care Funding Streams

Federal, inflation-adjust per pupil spending nearly tripled since the 1970s, with overall federal K-12 education spending at approximately $40 billion. Total federal, state, and local K-12 education spending totals $634 billion annually. Taxpayers finance numerous federal programs and grant streams that support health-related services in schools.

The Department of Health and Human Services funds a number of school health programs:

  • The Health Resources and Services Administration’s (HRSA) Special Programs of Regional and National Significance (SPRNS) grants, a portion of which pays for training for school nurses, was funded at $77 million in 2016.
  • The Community Integrated Service Systems (CISS), designed to support children’s healthcare in early education settings, was funded at approximately $10 million in 2016.
  • The Maternal, Infant, and Early Childhood Home Visiting Program, which provides home visiting programs for at-risk populations to promote school readiness and child health and to improve academic achievement, was funded at $400 million in 2016.
  • Telehealth Network Grants, which focus on providing telehealth services to rural communities through school-based health centers, were funded at $17 million in 2016.

The Department of Education also provides some health care-related funding for schools. Title IV of the $24 billion ESSA includes $1.65 billion in funding that can be used for school-based health services, such as mental health programs, programs that support a healthy lifestyle, and drug and violence prevention.

A Better Way – Give Schools and Parents Options

Whether it is the recent hand-wringing over Medicaid reimbursements, or any number of other niche programs, public school special interest groups have long complained about the prospect of any diminution in the ever-increasing rate of spending for myriad federal programs—and the bureaucracy that supports them.

While federal education spending has ballooned over the past five decades, such inflation has not led to academic excellence, instead saddling districts with an ever-growing bureaucratic compliance burden and non-teaching personnel to match.

Congress should free schools from the labyrinth of federal education programs and allow them to prioritize existing federal education dollars in a way that meets local needs.

The Academic Partnerships Lead Us to Success (APLUS) proposal would do just that, allowing states to put federal education dollars toward locally determined priorities, such as special education services.

It’s also worth noting that new innovations in the education choice space make it possible to more flexibly and directly meet students’ special needs, bypassing bureaucratic public school arrangements altogether by allowing parents to arrange the services tailored to their individual child’s needs.

Private providers deliver services for children with special needs through a direct-to-provider system through education savings account (ESA) models.

For example, in Arizona’s education savings account program, which provides parents with 90 percent of what the state would have spent on their child in the district system directly into a parent-controlled account, families can use funds to pay for private school tuition, as well as a range of special education services if their child needs them.

Katherine and Christo Visser in Arizona, parents to Jordan – a student with cerebral palsy – use their ESA to pay for equine therapy to build Jordan’s muscle strength, while also paying for a private reading tutor who specializes in serving children with visual impairments. These health-related education services are paid out of the Visser’s ESA, enabling them to contract directly with providers that work with Jordan.

Empowering parents with education choice while freeing states and school districts from federal red tape will offer children greater access to the services they need, while the proposed reform of federal Medicaid financing will give states stronger incentives to make sound choices about how best to deliver Medicaid services to children in need.

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Democrats’ Fearmongering Over Medicaid Ignores Just How Bad the Program Is

Die-hard Obamacare defenders are out in force to protest Republican repeal efforts.

The protesters are falsely claiming the repeal will gut Medicaid, causing frail, indigent seniors to be evicted from nursing homes. It’s sheer demagoguery.

But even these phony claims could have redeeming value if they get the public to take a closer look at nursing homes and see the filth, rampant infections, and neglect—conditions routinely tolerated by our indifferent public officials.

Indifference is the real culprit, not inadequate Medicaid money.

For example, New York state pays among the highest Medicaid rates in the nation—yet also tolerates some of the worst conditions. A shocking 40 percent of nursing homes in New York provide inferior care, according to federal ratings.

That’s worse than 39 other states.

Nationwide, one-third of nursing home residents suffer serious, often permanent, injuries due to neglect, according to a federal inspector general report.

Incontinent residents languish in soiled diapers that lead to sores and infections. Residents unable to eat and drink on their own develop severe dehydration. Others suffer falls and internal injuries because of medical errors or overmedication.

The deadliest problem is infection. A staggering 380,000 nursing home residents a year die from infections, according to federal estimates. Not all are preventable. But nursing homes are infection cauldrons.

The routine precautions taken in hospitals to limit infections—such as testing patients for superbugs on admission, disinfecting rooms and equipment, and keeping infected patients apart from others—are ignored in nursing homes.

Residents with staph infections are rolled into communal dining rooms and seated next to other residents. Superbugs contaminate bedrails, curtains, and rehab equipment.

Caregivers tasked with bathing and grooming residents go from one bed to the next, without using disposable gowns and gloves, spreading bacteria from resident to resident.

Because even rudimentary infection prevention is lacking, one-quarter of residents pick up dangerous, drug-resistant bacteria, according to new research by Columbia University School of Nursing. Columbia’s Carolyn Herzig warns infection rates are increasing across the board and action is urgently needed.

Medicaid recently adopted new standards calling for more infection precautions, but delayed the start date to November 2019. Why delay when hundreds of thousands of elderly residents will die from infection in the meantime?

Don’t count on the media to cover these deaths. The Washington Post is busy claiming repeal “takes a sledgehammer to Medicaid.” The New York Times reports that “steep cuts to Medicaid” will force some seniors out of their nursing homes.

Here’s the truth: There are no “cuts.” Medicaid spending will continue to increase every year, though at a slower rate.

The real threat to seniors isn’t Medicaid funding levels. It’s that Medicaid officials tolerate substandard nursing home care, when they could use the program’s market clout to demand safer care. About 66 percent of long-term residents are paid for by Medicaid.

The federal government rates nursing homes from one to five stars, based on periodic inspections, staffing levels, infection rates, and other quality measures.

But even nursing homes that get the lowest one-star rating year after year—indicating substandard care—are allowed to stay open. They should be shut down.

From Baton Rouge to Chicago, and in smaller towns across the country, protesters and Democratic politicians are fear-mongering that seniors will die on the streets if repeal passes.

Gov. Andrew Cuomo is holding health care events across New York this week, parroting the Democratic Party’s false claims.

In truth, Cuomo’s one of the culprits. On his watch, low-rated nursing homes are getting Medicaid money. New York has begun rewarding top-rated homes with slightly higher payments—an idea worth duplicating in other states.

But Cuomo and other politicians need to do more to stand up to the powerful nursing home industry.

Frail, elderly nursing home residents shouldn’t be made to suffer. That’s the goal protesters and politicians should focus on. Enough with the partisan scare tactics.

Note: This piece is a substitute for Michelle Malkin’s weekly column. Mrs. Malkin is off this week.

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