Missourians faced a health care gap, so they took matters into their own hands

Missourians faced a health care gap, so they took matters into their own hands

Missourians faced a health care gap, so they took matters into their own hands

Organizing for Medicaid expansion

Missourians mobilized by the thousands to get Medicaid expansion on the ballot this year, a move that will impact 230,000 low-income residents in the “coverage gap.”

For almost a decade, advocates in Missouri have been lobbying their legislators to expand Medicaid coverage in the red state. 

Since the Supreme Court ruled in 2012 that the Medicaid expansion under the Affordable Care Act was optional, 36 states plus Washington, D.C., have adopted and implemented the expansion. In those states where coverage has not been expanded, the decision has come at a devastating cost to Americans who fall into the “coverage gap,” advocates said.

“When the Affordable Care Act was originally passed, folks who were making up to 138% of the federal poverty level were supposed to be on Medicaid. And folks making more than 138% of the federal poverty level would be given subsidies to buy coverage through the exchange or healthcare.gov,” Kelly Hall, director of health policy for the Fairness Project, told ABC News.

“Because some states haven’t expanded their Medicaid program, they are creating a problem for people who don’t make enough money to get the subsidies on the exchange, but they make too much money to be on their state’s Medicaid program.”

In the states that chose not to expand Medicaid coverage, the maximum income for Medicaid eligibility varies. In Missouri– which for now has one of the lowest Medicaid income eligibility limits in the U.S.– this meant that a family of three had to earn at most 21% of the federal poverty level, or $4,479 in 2019, annually to be eligible for Medicaid. Subsidies for the Affordable Care Act marketplace aren’t accessible until earning 100% to 400% of the federal poverty level.

After their conservative state legislature did not address the issue for years, Missourians mobilized by the thousands to get Medicaid expansion on the ballot. This year, Missouri became one of two states–along with Oklahoma– that voted to implement that expansion next year.

ABC News is examining the coverage gap and expansion of Medicaid as part of its “My America” video series, which highlights issues that are key to the electorate in the run-up to the 2020 election and spoke to voters and experts about the issue. 

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The personal cost

Fair Grove, Missouri resident Amber Ledbetter, a single mother of two, is one of thousands of Americans without healthcare because their income falls into the “coverage gap.”

“It’s stressful, especially with the kids,” Ledbetter told ABC News. “I don’t want to end up in a position where I’m having to bankrupt my family just to get the health care that I need immediately.”

Ledbetter has Crohn’s disease, a chronic illness that causes her fatigue and pain and impacts her ability to work as a house cleaner. Last year, she was so sick she had to go to the emergency department. 

“I kept putting it off and putting it off and was working through the pain and probably causing myself more harm,” she said. “I was more concerned about what the bill would be than the treatment I was going to get.”

Ledbetter said she makes too much money to qualify for Medicaid in Missouri, but not enough to qualify for Affordable Care Act subsidies. 

“I was just caught in this gap that I didn’t know existed,” said Ledbetter, who has to take into consideration what she could get covered through charity when she discusses treatment options with her gastroenterologist. 

Single mom Victoria Altic fell into the coverage gap last year. The Missouri resident racked up thousands of dollars in medical debt, she told ABC News, after several episodes of seizures a couple of years ago. She delayed seeking medical care for an ear infection, and the resulting visits caused her to go further into debt, she said. 

“One of the worst parts about all of that, besides the actual health effects of not having health insurance, is the financial aspect, where you’re falling into debt,” said Altic, who was laid off from her restaurant job at the start of the coronavirus pandemic.

Erich Arvidson’s parents were in the coverage gap– both retired but not yet eligible for Medicare– when his father fell ill last year, he told ABC News.

“My sister and I were forced to make decisions for him based on what he could afford and not necessarily what was the best course of action for him,” the Boonville, Missouri resident said.

His father died last February. Then, a few months later, his mother fell ill. “We had to make those same decisions just right away,” Arvidson said.

On the ballot

In Missouri, citizens can petition to put constitutional amendments on the ballot. Arvidson was one of thousands of volunteers who worked to get the Medicaid expansion on the ballot as on amendment in August.

“Ballot measures are a team sport,” said Hall, of the Fairness Project, which focuses on ballot initiative efforts to promote economic and social justice. “It takes a lot of different folks putting money into the effort, putting sweat equity in the effort, standing on street corners with clipboards and talking to their neighbors.”

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In Missouri, volunteers collected over 350,000 signatures from all over the state to get Medicaid expansion on the ballot, Hall said.

“We went everywhere,” Arvidson said. “We went to county fairs. We went to cotton carnivals and apple festivals and stood on town squares and just talked to people about it and gathered the signatures that we needed.”

On August 4, Missourians voted 53% to 47% to pass the amendment to expand Medicaid coverage. The move came two months after Oklahoma also passed its expansion through a ballot measure.

That signaled to Hall and other experts that Medicaid expansion is “not a partisan issue anymore.”

“The same voters in Missouri and Oklahoma who are going to the polls to vote for President [Donald] Trump are also saying we want Medicaid expansion,” she said.

“Nobody really asked, well, is this a Democratic thing or is this a Republican thing?” Richard Von Glahn, policy director of the coalition Missouri Jobs with Justice, told ABC News. “Voters don’t actually think that way. They think, well, what is this actually going to mean for the state?”

Beyond Oklahoma and Missouri, other states, including Idaho, Maine, Nebraska and Utah, have voted to expand Medicaid through a ballot measure, as opposed to a bill.

“What we learned is that if we’re going to be successful in moving and shifting power in a state like Missouri, which is so adverse to providing equity for the poor and people of color, what we must do if organize and mobilize,” Dr. Rev. Vernon Howard, president of the Southern Christian Leadership Conference of Greater Kansas City and a community organizer for Missouri’s Medicaid expansion, told ABC News. 

Step in the right direction

Medicaid expansion coverage is set to begin in Missouri on July 1, 2021. The constitutional amendment, protected from changes by the state legislature, will impact about 230,000 low-income Missourians, according to Von Glahn– Missourians like Ledbetter and Altic.

“I know it’s still gonna take some time before I can take advantage of those health care options for Medicaid,” Ledbetter said. “But it’s a step in the right direction.”

The move will make a “huge difference” for Altic.

“I wouldn’t have to worry about whether I can go to the doctor if I have a small earache and wonder if it’s going to become something way worse,” she said.

For Howard, the passage was a sign of “hope to bring equal access to voting to the ballot.”

“There is hope to bring living wages for the working poor,” he said. “There is hope to bring healthcare as a right and not a privilege. And when we mobilize and organize together around these issues, we can see good things happen.”

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Medicare finalizing coverage policy for coronavirus vaccine

Medicare finalizing coverage policy for coronavirus vaccine

Medicare finalizing coverage policy for coronavirus vaccine

A senior Trump administration official says Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced soon

Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday.

The coming announcement from the Centers for Medicare and Medicaid Services aims to align the time-consuming process for securing Medicare coverage of a new vaccine, drug or treatment with the rapid campaign to have a coronavirus vaccine ready for initial distribution once it is ready, possibly as early as the end of the year.

It’s questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. Emergency use designation is a step short of full approval.

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The administration official said Medicare’s announcement will try to resolve several legal technicalities that could conceivably get in the way of delivering free vaccines to millions of seniors, a high-risk group for COVID-19, the disease caused by the coronavirus. The officials spoke to The Associated Press on the condition of anonymity to discuss a pending regulation.

President Donald Trump and lawmakers of both parties in Congress have spelled out their intention that all Americans will be able to get the vaccine for free. But the official said a series of potential legal obstacles that could get in the way of Medicare payment never got unscrambled. 

Earlier this month, Medicare administrator Seema Verma said her agency was close to resolving the issue.

“I think we’ve figured out a path forward,” Verma said at the HLTH conference, a forum for innovators. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”

“Stay tuned,” she added.

The $1.8 trillion CARES Act passed by Congress in March called for free vaccination for all Americans, from seniors covered by Medicare to families with employer-sponsored health insurance.

A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have committed that the program will not interfere with their own science-based decisions. Vaccines that don’t meet the test for approval would be discarded.

States have already begun submitting their plans for vaccine distribution to the federal government. 

Initially, it’s expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff. Older people are also high on the priority list because their risks of serious illness and death from the coronavirus– which has killed more than 225,000 people in the United States– are much higher. It could be well into next year before a vaccine is widely available.

Medicare’s impending announcement was first reported by Politico.

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Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

The Trump administration is set to announce as early as this week that Medicare and Medicaid will cover out-of-pocket costs for a potential coronavirus vaccine that is granted emergency use authorization, according to a person familiar with the matter.

Coming days before the election, the move could help President Donald Trump among seniors and lower-income Americans even though top medical experts don’t expect a vaccine to be approved until well after Election Day. In the run-up to the election, Trump had applied intense pressure on agencies to deliver policy wins that might help his reelection, aides said.

Officials have been working for several weeks on changing regulations to allow for Medicare and Medicaid recipients to receive free vaccines.

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It’s not clear whether Trump himself will make the announcement of the rule change, though he is working to appeal seniors during stops in Florida later this week.

Politico first reported the coming changes.

There are currently four US Phase 3 trials of coronavirus vaccines as part of the federal government’s Covid-19 vaccine program, Operation Warp Speed.

Dr. Anthony Fauci, the nation’s top infectious disease expert, said Sunday that experts will know by early December whether a potential coronavirus vaccine is safe and effective, but widespread availability will likely not occur until several months into 2021.

Operation Warp Speed aims to have Covid-19 vaccines moved to administration sites within 24 hours of emergency use authorization or Food and Drug Administration license– with the goal of providing the vaccine free of charge.

“In terms of a principle and an aspiration, it’ll be that no American has to pay for a single dime out of pocket to get a vaccine,” Paul Mango, deputy chief of staff for policy at the US Department of Health Human Services, said back in September.

The federal government already struck a deal earlier this month with retail pharmacies CVS and Walgreens to help distribute the coronavirus vaccine– once one or more gets authorized– to long-term care facilities like nursing homes, with no out-of-pocket costs.

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Inaccurate Census count could affect $1.5 trillion in federal funding

Inaccurate Census count could affect $1.5 trillion in federal funding

A census taker knocks on the door of a residence in August in Winter Park, Fla. Census workers visited households that hadn’t yet responded to the 2020 census.

The consequences of an inaccurate census

Highway construction. Food stamps. Rural education. Medicare.

The federal government relies on data derived from the decennial census to distribute roughly $1.5 trillion in funds for these programs, along with more than 300 others. The money goes to state and local governments, non-profits, businesses and households across the nation.

That’s why experts are so concerned that the US Census Bureau could end its 2020 count early, which they say will increase the chances of missing many Americans, particularly immigrants, people of color, low-income folks and rural residents. And that, in turn, could reduce federal funding for programs that support them and entire communities.

“The Census data are used to determine who gets what slice of each pie,” said Andrew Reamer, a research professor at George Washington University who specializes in Census-guided federal spending. “If you miss 10,000 people, they are gone for the decade.”

The Supreme Court on Tuesday granted a request for from the Trump administration to halt the process while an appeal plays out. A lower court order would have required the count to continue until October 31, but the administration argues that the shortened deadline is needed to give the agency time to deliver the results to the President by December 31, as required by law.

The decennial census serves as the foundation for three other sets of data the Census Bureau creates that are used in apportioning federal funding. An accurate population count is key and any undercount can translate into significant losses.

For instance, had Texas’ population been undercounted by 1% in 2010, the state would have lost nearly $292 million in federal reimbursements for Medicaid and the Children’s Health Insurance Program in fiscal 2015, Reamer’s research found. Pennsylvania would have received about $222 million less, while Florida would have been sent nearly $178 million less.

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Medicare uses geographic data based on the Census to determine how many pharmacies must be in Part D enrollees’ networks and how much to reimburse physicians.

And states utilize Census-based population data to allocate federal highway funding, while federal agencies determine support of disadvantaged youth employment efforts and nutrition programs for women, infants and children based on the share of kids in poverty in a specific area.

Some states and local communities incorporated the importance of the Census count into their outreach, reminding their residents that federal funding for their roads, schools and other programs depends on their filling out the survey.

“It’s a very critical piece of policy and planning and funding,” said Mallory Bateman, state data center coordinator at the University of Utah. “This is our way to show who lives in the state… and get them the funding that they need.”

The census has never been perfect. It typically overcounts White Americans and misses people of color and those living in rural areas, among others. But this year, the problem could be even more extensive, largely because of the shorter deadlines for following up with those who don’t respond and for processing the results, said John Thompson, a former Census Bureau director under the Obama administration.

Also, immigrants– both legal and undocumented– may be less likely to fill out the survey because of increased fears that the data will be used against the, after President Donald Trump issued a memorandum to exclude undocumented immigrants from the counts used to apportion the House of Representatives, Thompson said. The Supreme Court will hear a case this term seeking to block Trump’s move.

“Many communities will certainly receive less than their fair share of federal funds,” said Alex Tausanovitch, director, campaign finance and electoral reform at the left-leaning Center for American Progress.

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