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Wed Jan 9, 2013, 09:19 AM

The health care law is still the biggest expansion of the safety net since Medicare [View all]

Before the health care law, the President signed the expansion of CHIP.

Obama Signs Children’s Health Insurance Bill


WASHINGTON — The House gave final approval on Wednesday to a bill extending health insurance to millions of low-income children, and President Obama signed it this afternoon, in the first of what he hopes will be many steps to guarantee coverage for all Americans.


The roll call ended a two-year odyssey for the child health legislation, which President George W. Bush adamantly opposed on the ground it would lead to “government-run health care for every American.”


In a major change, the bill allows states to cover certain legal immigrants — namely, children under 21 and pregnant women — as well as citizens.

Until now, legal immigrants have generally been barred from Medicaid and the State Children’s Health Insurance Program for five years after they enter the United States. States will now be able to cover those immigrants without the five-year delay.

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Who Benefits from the ACA Medicaid Expansion?

A key element of the Affordable Care Act (ACA) is the expansion of Medicaid to nearly all individuals with incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual; $26,344 for a family of three in 2012) in 2014. Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured. The ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups. By 2016, Medicaid, along with the Children’s Health Insurance Program (CHIP), will cover an additional 17 million individuals, mostly low-income adults, leading to a significant reduction in the number of uninsured people.

Medicaid does not cover many low-income adults today. To qualify for Medicaid prior to health reform, individuals had to meet financial eligibility criteria and belong to one of the following specific groups: children, parents, pregnant women, people with severe disability, and seniors. Non-disabled adults without dependent children were generally excluded from Medicaid unless the state obtained a waiver to cover them. The federal government sets minimum eligibility levels for each category, which are up to 133% FPL for pregnant women and children but are much lower for parents (under 50% FPL in most states). States have the option to expand coverage to higher incomes, but Medicaid eligibility levels for adults remain very limited (Figure 1). Seventeen states limit Medicaid coverage to parents earning less than 50 percent of poverty ($9,545 for a family of 3), and only eight states provide full Medicaid coverage to other low-income adults. State-by state Medicaid eligibility levels for parents and other adults are available here.

The ACA expands Medicaid to a national floor of 138% of poverty ($15,415 for an individual; $26,344 for a family of three). The threshold is 133% FPL, but 5% of an individual’s income is disregarded, effectively raising the limit to 138% FPL. The expansion of coverage will make many low-income adults newly eligible for Medicaid and reduce the current variation in eligibility levels across states. To preserve the current base of coverage, states must also maintain minimum eligibility levels in place as of March 2010, when the law was signed. This requirement remains in effect until 2014 for adults and 2019 for children. Under the ACA, states also have the option to expand coverage early to low-income adults prior to 2014. To date, eight states (CA, CT, CO, DC, MN, MO, NJ and WA) have taken up this option to extend Medicaid to adults. Nearly all of these states previously provided solely state- or county-funded coverage to some low-income adults. By moving these adults to Medicaid and obtaining federal financing, these states were able to maintain and, in some cases, expand coverage. Together these early expansions covered over half a million adults as of April 2012.

Eligibility requirements for the elderly and persons with disabilities do not change under reform although some individuals with disabilities may become newly eligible under the adult expansion. Lawfully residing immigrants will be eligible for the Medicaid expansion, although many will continue to be subject to a five-year waiting period before they may enroll in coverage. States have the option to eliminate this five-year waiting period for children and pregnant women but not for other adults. Undocumented immigrants will remain ineligible for Medicaid.

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16 million: number of Americans who become eligible for Medicaid under the health care law

Having failed to repeal Obamacare, Republicans refuse to implement it

Posted by Greg Sargent

Republicans failed to block Obamacare in Congress. Their argument to overturn Obamacare as unconstitutional failed before the Supreme Court. They failed to elect a president to repeal the law. The drive to block or kill Obamacare failed in Congress, failed in the courts, and failed at the ballot box. Obamacare is here to stay.

Which leaves Republicans only one remaining way to scuttle the law — do everything they can to ensure that it fails. And so, many Republicans on the state level are refusing to implement it by refusing to set up exchanges — thus ensuring that the federal government sets them up instead.

Today we’ve hit a critical moment in that effort:

The vast majority of Republican-led states, faced with a Friday deadline to submit plans for running the insurance exchanges at the heart of the law, have opted instead to relinquish much or all of their control to the federal government.

Just 18 states and the District say they plan to operate their own exchanges, which are slated to begin enrollment in October. In an additional 32 states, the exchanges will be run either entirely by the federal government or a federal-state partnership.

It’s now official: In well over half of the states, local governments will relinquish all or some control over implementation of a law that will impact untold numbers of their own constituents. In so doing, they are reducing, rather than increasing, control over what happens in their own states — all in the name of states’ rights.

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And there is room for improvement.

White House might use Medicare reform momentum to push further health care reform

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