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Sat Jan 13, 2018, 02:11 PM

Smoking penalties, ER fees, premiums on the poor: How states want to shrink Medicaid

Retweeted by David Fahrenthold: https://twitter.com/Fahrenthold

People are dramatically underestimating the scope and significance of the Trump administration's order on work requirements for Medicaid. GOP-led states are gearing up to dismantle Medicaid in ways that go far beyond work requirements. Story coming soon



I spent last +24hrs combing thru GOP plans on Medicaid. Here are some policies theyre aiming for: - Impose new premiums on poor (like earning $5K/yr) - Kick poor off who dont make payments - Fines for "improper" ER use - New fees 4 smokers Story:



Wonkblog

Smoking penalties, ER fees, premiums on the poor: How states want to shrink Medicaid

By Jeff Stein January 12 at 2:00 PM

Indiana hopes to make Medicaid enrollees pay a fee if they smoke cigarettes. Arizona wants to put a five-year limit on how long its poor residents can be enrolled in the program. And Kentucky wants families earning as little as $5,100 to pay Medicaid premiums and to kick patients out of the program if their payments get 60 days behind. ... These proposals are part of a host of changes that mostly conservative states have unsuccessfully sought for years to overhaul Medicaid, a federal insurance program for the poor and disabled.

Now, the Trump administration is giving at least some of these initiatives the green light. On Thursday, health officials issued new guidance to state Medicaid directors, saying the administration would allow states to impose work requirements on certain Medicaid recipients a first in the program's 53-year history. Doing so will help Medicaid recipients who are not disabled find employment, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, argued in announcing the changes.

{Trump administration opens door to states imposing Medicaid work requirements}

Ten states have already filed requests for waivers to add work requirements to their Medicaid policies, and the Trump administration approved a proposal Friday from Kentucky to overhaul its Medicaid program, including by imposing new work requirement and premiums.

The states' proposals vary widely, from small tweaks to changes that would dramatically reduce their program's size and scope. And many plans go far beyond the new work requirements, pitching provisions that include raising premium payments for Medicaid enrollees, new fees for emergency room visits and requirements for drug testing and treatment.
....

Jeff Stein covers policy for Wonkblog
Follow @jstein_wonkblog

Seema Verma's Twitter feed: CMS Administrator

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Reply Smoking penalties, ER fees, premiums on the poor: How states want to shrink Medicaid (Original post)
mahatmakanejeeves Jan 13 OP
marble falls Jan 13 #1
greymattermom Jan 13 #2
Aristus Jan 13 #3
Skittles Jan 17 #4
mahatmakanejeeves Jan 17 #6
Aristus Jan 17 #7
Skittles Jan 17 #8
Aristus Jan 17 #9
dalton99a Jan 17 #5

Response to mahatmakanejeeves (Original post)

Sat Jan 13, 2018, 03:09 PM

1. As the proud possesor of a second hand smoke cancer I'mm all for the cutting off of tobacco.

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Response to mahatmakanejeeves (Original post)

Sat Jan 13, 2018, 03:24 PM

2. Smoker penalties in Kentucky?

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Response to mahatmakanejeeves (Original post)

Sat Jan 13, 2018, 04:43 PM

3. I'm not opposed to smoking penalties.

Day after day after day in clinic I see my patients ruin their health and the health of the people they live with by smoking.

I beg my patients who smoke to quit.

I tell my patients with asthma, COPD, congestive heart failure, and coronary artery disease that nothing I do for them is going to make a difference in the long run if they don't quit.

Since I started in clinical practice seven years ago, I've diagnosed four patients with lung cancer. Two survived (one with a pulmonectomy) and two died, one of them sixteen days after diagnosis.

No one is born smoking. One doesn't slip and fall and take up the habit. One doesn't develop the habit after exposure to a rare bacterium, virus or allergen. Smoking is a choice.

As a life-long non-smoker hailing from a non-smoking family, I'm subject to perfectly valid accusations that I don't know how hard it is to quit. This is true, from a practical stand-point. I've never had to try. But I read the medical literature, all of which mention the difficulty of quitting a habit so addictive, and deliberately designed to be that way by the tobacco companies.

But these same studies also mention that people quit every day, and stay quit. It's possible.

How much does it mean to you to avoid an agonizing death, gasping for air, while the people who love you watch helplessly?

Are Medicaid penalties a price worth paying?

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Response to Aristus (Reply #3)

Wed Jan 17, 2018, 02:36 AM

4. the main motivation for me to quit smoking was being hassled by non-smokers

they made it TOO MUCH WORK...took me seven tries but I learned something each time, and I finally beat that nicodemon...you are correct, it CAN be done - there are now more ex-smokers than there are smokers

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Response to Skittles (Reply #4)

Wed Jan 17, 2018, 10:08 AM

6. Not only that: I was in the grocery store yesterday. I saw that a pack of Newports costs $7.21. NT

Marlboros are about a buck cheaper. Sheesh. How much is that costing per month, just out of pocket?

This was in northern Virginia. New York City, I couldn't say what cigarettes cost.

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Response to Skittles (Reply #4)

Wed Jan 17, 2018, 10:09 AM

7. I'm glad you quit, Skittles.



You need your wind when you're kicking ass, even mine from time to time...

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Response to Aristus (Reply #7)

Wed Jan 17, 2018, 04:28 PM

8. heh

I thought the hardest part was realizing (on the 6th try) that just having any kind of alcoholic drink was an overwhelming trigger......so for some time I had to give that up too. I have since been able to return to having an occasional drink. I don't worry much about it now - the times have changed to where I am just not around cigarette smoke the way I used to be (yes, I remember smoking at work!).

Aristus, I am curious what you think of your patients smoking pot (I don't do that myself; it always made me feel paranoid). Are there effects on the lungs from that? The reason I ask is while smoking cig rates have declined, I'm sure pot smoking is becoming more popular as it becomes legalized.

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Response to Skittles (Reply #8)

Wed Jan 17, 2018, 04:38 PM

9. A study was published about four years ago that states that marijuana smoke is not as bad for you

as tobacco smoke. But most people don't smoke a pack's-worth of joints a day. But I remind my patients that they're still inhaling the by-products of combustion: carbon monoxide, carbon dioxide, and so on.

I tell them I have no medical objection to cannabis use (and that for some conditions, such as insomnia, chronic pain, etc. it's much less bad for you than a corresponding pharmaceutical), but I ask them not to smoke it, and recommend edibles, tinctures, oils, etc.

The sooner cannabis is fully legalized, the better for everyone.

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Response to mahatmakanejeeves (Original post)

Wed Jan 17, 2018, 08:52 AM

5. Kick

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