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Updated: 18 hours 54 min ago

KHN’s ‘What the Health?’: Hot Covid Summer

July 29, 2021

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Predictions of a “hot vax summer” that would let Americans who had their covid immunizations celebrate the waning of the pandemic are turning out to have been premature. Covid-19’s delta variant is driving up cases in all 50 states, prompting new recommendations for masks and a growing number of vaccine requirements, including one for most federal workers.

Meanwhile, official Washington celebrated the anniversary of the 1990 Americans with Disabilities Act, which sought to guarantee an array of protections, as concerns grow that people with covid aftereffects could dramatically expand the population needing those protections.

This week’s panelists are Julie Rovner of KHN, Mary Ellen McIntire of CQ Roll Call, Anna Edney of Bloomberg News and Rachana Pradhan of KHN.

Among the takeaways from this week’s episode:

  • The new CDC recommendation for vaccinated people in areas with high covid transmission rates to wear face masks inside has brought complaints from conservative groups about mixed messaging and overzealous regulators. Public health officials counter that the change in advice is understandable because the virus is evolving.
  • The covid surge is most pronounced in areas where vaccination rates were low and may suggest a failure of the public health message that the vaccines are protective only if enough people get vaccinated.
  • The federal effort to vaccinate the public is slowly gaining important support from conservatives. Senate Minority Leader Mitch McConnell is financing public service ads in his home state of Kentucky, and Sarah Huckabee Sanders, who served as one of former President Donald Trump’s press secretaries and is now running for governor of Arkansas, wrote an op-ed about the value of the vaccine.
  • President Joe Biden has appeared reluctant to endorse vaccine mandates, partly because Republicans have been so adamant about opposing them. Even his expected announcement calling for federal workers to get a shot will have an option to undergo regular testing instead.
  • Employers, however, are growing impatient and many are mandating that workers be inoculated for covid. It had been assumed that they would wait for the Food and Drug Administration to give final approval to the vaccines, but that is taking longer than many businesses want.
  • The Missouri Supreme Court ruled unanimously that the state must expand Medicaid, something a majority of voters endorsed last year. The Republican-led legislature refused to fund the expansion and the governor had said he would not expand the program until the legislature funds it.
  • Mississippi officials have filed their brief with the Supreme Court seeking support of a state-passed abortion ban, while House Democrats passed spending bills that get rid of long-standing rules prohibiting the use of federal funds for the procedure. Both sides of the debate seem poised to energize voters.

Also this week, Rovner interviews Samantha Young, who reported the latest KHN-NPR “Bill of the Month” feature about an Olympic cycling hopeful with an Olympic-size medical bill following a bike accident. If you have an outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: HBO’s “The Weight of Gold,” by Brett Rapkin, Michael Phelps, Peter Carlisle and Michael O’Hara Lynch

Mary Ellen McIntire: The AP’s “‘OK Not to Be OK’: Mental Health Takes Top Role at Olympics,” by Jenna Fryer

Anna Edney: The New York Times’ “Erin Gilmer, Disability Rights Activist, Dies at 38,” by Clay Risen

Rachana Pradhan: The Tennessean’s “Tennessee to Restart Nearly All Vaccine Outreach Paused Amid GOP Pressure, Says Health Commissioner,” by Brett Kelman

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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California facilita que residentes de bajos ingresos obtengan y mantengan una cobertura de salud gratuita

July 20, 2021

SACRAMENTO, California – Conseguir agua potable le costó a Ignacio Padilla su seguro médico.

Este veterano de la Segunda Guerra Mundial necesitaba pagar el préstamo de la bomba de agua instalada en su propiedad de un acre, en el condado rural de Tulare. Ahorró cuidadosamente unos cuantos miles de dólares para poder pagar la deuda, pero se dio cuenta de que esos ahorros lo situaban por encima del umbral de activos para seguir en Medi-Cal, el programa de Medicaid de California para personas con bajos ingresos.

Lo sacaron del programa de seguro médico en 2019.

No fue un gran problema en ese momento. Padilla aún tenía cobertura de Medicare y del Departamento de Asuntos de Veteranos (VA), y podía llevar una vida independiente, aunque aislada.

Pero ahora Padilla tiene 95 años y sufre una insuficiencia cardíaca congestiva. Sus hijos están tratando de que vuelva a recibir el Medi-Cal para que pueda cubrir los gastos de una residencia de adultos mayores.

A su hija mayor, Emily Ysais, le preocupa que las finanzas de Padilla —por limitadas que sean— vuelvan a descalificarlo. Recibe $1,100 al mes de su pensión y de la Seguridad Social. Si el VA aprueba el pago mensual por cuidados que ella le ayudó a solicitar, su padre podría superar el límite de la “prueba de activos” de Medi-Cal.

“Tenemos las manos atadas”, dijo Ysais, de 67 años. “Es difícil encontrar la manera de cuidarlo”.

Pero las cosas están cambiando, aunque quizás no lo suficientemente pronto para Padilla. Una disposición del recién aprobado presupuesto estatal de California eliminará la prueba de activos para los 2 millones de californianos inscritos tanto en Medi-Cal como en Medicare, el programa federal de seguro de salud para personas de 65 años o más y personas menores de 65 años con ciertas discapacidades. En su lugar, su elegibilidad financiera se basará únicamente en los ingresos, como lo es para millones de personas en Medi-Cal.

La eliminación de la prueba cambiará las cosas para los californianos mayores o discapacitados que necesiten cuidados de larga duración, pero que viven un dilema: no ganan lo suficiente para cubrir los altos costos de los cuidados en hogares y no pueden confiar en Medicare, que no cubre las estadías prolongadas en centros para mayores. Pueden conseguir ese cuidado a través de Medi-Cal, pero primero tendrían que acabar con sus ahorros.

El acuerdo sobre el presupuesto estatal para 2021-22 incluye varias disposiciones que facilitarán el acceso y la permanencia en Medi-Cal, incluida la eliminación de la prueba de activos. Todas las personas mayores de 50 años serán elegibles, independientemente de su estatus migratorio.

Y a las nuevas madres se les permitirá permanecer en Medi-Cal durante un año después de dar a luz, en lugar de 60 días.

El presupuesto también incluye $15 millones en los próximos tres años, a partir de este año, para desarrollar formularios de inscripción en línea y traducirlos a varios idiomas, y $8 millones para que los condados ayuden a algunas personas que reciben atención en el hogar a permanecer inscritos.

California tiene un alto índice de aceptación de Medi-Cal, con un 95% de personas inscritas que cumplen los requisitos, señaló Laurel Lucia, directora del programa de atención sanitaria del Centro para la Investigación Laboral y la Educación de la Universidad de California-Berkeley. Pero del resto de personas sin seguro, unas 610,000 cumplen los requisitos para recibir el Medi-Cal, añadió.

“Lo estamos haciendo bien, pero hay muchas personas que reúnen los requisitos y no están inscritas”, afirmó Lucia. “Las barreras a la inscripción y retención de Medi-Cal son realmente multifacéticas, por lo que las soluciones tienen que serlo también”.

Este es un momento especialmente volátil para el programa, que cubre 13,6 millones de californianos. El estado trata de mejorar la calidad de la atención mediante la renegociación de sus contratos con las compañías de seguros de atención gestionada. Al mismo tiempo, el gobernador Gavin Newsom y el Departamento de Servicios de Salud del estado están proponiendo una revisión masiva que proporcionaría más servicios a las personas sin hogar y a las personas encarceladas, e impulsaría la atención a la salud mental.

Mientras tanto, la inscripción de Medi-Cal sigue creciendo: Los funcionarios estatales estiman que la inscripción se disparará a 14,5 millones este año fiscal, que comenzó el 1 de julio.

Los cambios en el Medi-Cal que se aprobaron en el presupuesto incluyen una expansión que los legisladores demócratas han estado buscando durante años: California ya permite que los inmigrantes indocumentados de hasta 26 años reciban todas las prestaciones de Medi-Cal. A partir de la próxima primavera, esto se ampliará a los mayores de 50 años.

Las autoridades estatales estiman que unas 175,000 personas se inscribirán en el primer año, y que otras 3,600 lo harán cada año a partir de entonces, lo que acabará costando al estado $1,300 millones anuales.

Y a partir del próximo mes de julio, las nuevas madres podrán permanecer en Medi-Cal hasta un año después de dar a luz. Para 2027, la cobertura adicional se espera que le cueste al estado unos $200 millones al año.

La líder republicana de la Asamblea, Marie Waldron, de Escondido, quien dijo que apoya la ampliación de la elegibilidad para el programa en circunstancias limitadas, fue la autora de un proyecto de ley que permitiría a las personas encarceladas inscribirse antes de su excarcelación, que finalmente se incluyó en el presupuesto que entrará en vigor en 2023.

Pero dijo que los cambios en el presupuesto de este año van demasiado lejos.

“La costosa atención médica administrada por el gobierno no funciona, y la mayoría de los votantes no quieren pagar por ella”, señaló Waldron. “Pero los demócratas de California parecen pensar que a todo el mundo le va a encantar una vez que esté en ella, lo cual no es cierto. Es un socialismo rastrero”.

La eliminación de la prueba de activos de Medi-Cal para los californianos mayores y aquellos con ciertas discapacidades, que entra en vigor el 1 de julio de 2022, marca un cambio dramático en el programa. Los funcionarios estiman que le costará al estado unos $200 millones al año una vez que se implemente, debido al aumento de las inscripciones.

Ahora mismo, estas personas no pueden acceder a Medi-Cal si tienen ahorros superiores a los $2,000. Para las parejas, son $3,000. Las complicadas reglas dictan lo que cuenta como “activo” y lo que no: una casa no cuenta y un auto tampoco, pero un segundo auto sí. Los anillos de compromiso y las joyas de familia están bien, pero otras joyas cuentan para el límite.

En última instancia, la prueba favorece a las personas y familias que pueden sortear las normas y encontrar formas de ocultar el dinero en cuentas exentas, apuntó Claire Ramsey, abogada de Justice in Aging.

“Se crean obstáculos administrativos, lo que mantiene a la gente artificialmente fuera del programa”, dijo Ramsey. “Si es difícil para los abogados entender todas las reglas, ¿qué significa eso para la persona promedio que sólo está tratando de conseguir un seguro de salud?”

La Ley de Cuidado de Salud a Bajo Precio (ACA) eliminó la prueba de activos para la mayoría de los inscritos en Medicaid, basando la elegibilidad financiera exclusivamente en los ingresos, pero dejó fuera a las personas que califican tanto para Medicaid como para Medicare.

Esto es especialmente importante cuando se trata de costosos cuidados a largo plazo, como las residencias de mayores, que pueden costar $10.000 al mes, explicó Patricia McGinnis, directora ejecutiva de California Advocates for Nursing Home Reform.

Medicare sólo cubre los cuidados en residencias en circunstancias limitadas y durante un máximo de 100 días. Después de eso, los pacientes deben encontrar otra manera de pagar, ya sea de su propio bolsillo o a través de Medi-Cal. Dado que muchas personas no pueden acceder a Medi-Cal si tienen demasiado dinero u otros bienes, tienen que gastar sus ahorros y deshacerse de sus pertenencias antes de poder entrar en el programa.

“Miles y miles de personas se han empobrecido para poder permitirse la atención en residencias”, afirmó McGinnis. “¿Quieres atención médica gratuita? Vas a tener que gastar hasta el último céntimo que tengas para conseguirla”.

Un análisis de la Asamblea estatal estimó que 17,802 californianos adicionales habrían sido elegibles en 2018 si la prueba de activos no se hubiera requerido. De ellos, 435 estaban en cuidados a largo plazo, y en el transcurso del año, 263 gastaron su dinero o regalaron sus activos para calificar para Medi-Cal.

La legisladora Wendy Carrillo, demócrata de Los Angeles, autora del proyecto de ley sobre la prueba de activos que se incluyó en el presupuesto, considera que la eliminación del requisito forma parte de un movimiento más amplio hacia la cobertura universal, en línea con los esfuerzos para ampliar el Medi-Cal a los inmigrantes mayores indocumentados o establecer un sistema de pagador único.

“Tenemos que trabajar de forma agresiva y proactiva en una legislación que dé cobertura a más personas”, expresó Carrillo. “Y hasta que tengamos una atención sanitaria universal, estos son los pasos necesarios para garantizarla”.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

California Makes It Easier for Low-Income Residents to Get and Keep Free Health Coverage

July 20, 2021

SACRAMENTO, Calif. — Getting clean drinking water cost Ignacio Padilla his health insurance.

The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He carefully socked away a few thousand dollars so he could make the payoff — only to find that those savings put him over the asset threshold to remain on Medi-Cal, California’s Medicaid program for low-income people. He was booted from the health insurance program in 2019.

It wasn’t an emergency at the time. Padilla still had coverage from Medicare and the Department of Veterans Affairs, and he could live an independent, if remote, life.

But now Padilla is 95 and has congestive heart failure. His children are trying to get him back on Medi-Cal so it can eventually cover the costs for nursing home care.

His older daughter, Emily Ysais, worries that Padilla’s finances — limited though they are — will again disqualify him. He gets $1,100 a month from his pension and Social Security. If Veterans Affairs approves the monthly caregiving stipend she helped her dad apply for, it could tip him over the limit of Medi-Cal’s “asset test.”

“Our hands are tied,” said Ysais, 67. “It’s hard to keep figuring out a way to take care of him.”

Change is coming, though perhaps not soon enough for Padilla. A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people under 65 with certain disabilities. Instead, their financial eligibility will be based solely on income, as it is for the millions of other people in Medi-Cal.

The elimination of the test will be a game changer for aging or impaired Californians who need long-term care but are caught in a common conundrum: They don’t earn enough to cover the high costs of ongoing nursing home care and can’t rely on Medicare, which does not cover extended nursing home stays. They can get that care through Medi-Cal, but they would have to wipe out their savings first.

The 2021-22 state budget deal includes several provisions that will make it easier to get on and stay on Medi-Cal, including the elimination of the asset test. Everyone 50 and over will be eligible, regardless of immigration status. And new mothers will be allowed to remain on Medi-Cal for one year after giving birth, up from 60 days.

The budget also includes $15 million over the next three years, starting this year, to develop online enrollment forms and translate them into multiple languages, and $8 million for counties to help some people who get in-home care stay enrolled.

California has a strong Medi-Cal takeup rate, with 95% of eligible people enrolled, said Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley. But of the remaining uninsured people, about 610,000 qualify for Medi-Cal, she said.

“We are doing well, but so many people are eligible and not enrolled,” Lucia said. “The barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.”

This is an especially volatile moment for the program, which covers 13.6 million Californians. The state is trying to improve the quality of care by renegotiating its contracts with managed-care insurance companies. At the same time, Gov. Gavin Newsom and the state Department of Health Care Services are proposing a massive overhaul that would provide more services to homeless people and incarcerated people and boost mental health care.

Meanwhile, Medi-Cal enrollment continues to grow: State officials estimate enrollment will balloon to 14.5 million this fiscal year, which began July 1.

The changes to Medi-Cal that were approved in the budget include an expansion that Democratic lawmakers have been seeking for years: California already allows eligible unauthorized immigrants up to age 26 to receive full Medi-Cal benefits. Starting next spring, that will expand to people 50 and up.

State officials estimate about 175,000 people will enroll in the first year, with an additional 3,600 people signing up every year thereafter, eventually costing the state $1.3 billion annually.

And, starting next July, new mothers will be able to stay on Medi-Cal for up to one year after giving birth. By 2027, the additional coverage is expected to cost the state about $200 million a year.

Assembly Republican Leader Marie Waldron (R-Escondido), who said she supports expanding eligibility for the program in limited circumstances, was the author of a bill to allow incarcerated people to enroll before they’re released that was ultimately folded into the budget and will take effect in 2023.

But she said the changes in this year’s budget go too far.

“Expensive government-run health care doesn’t really work, and most voters don’t want to pay for it,” Waldron said. “But California Democrats seem to think everyone will love it once they are on it, which is not true. It’s creeping socialism.”

The elimination of the Medi-Cal asset test for older Californians and those with certain disabilities, which takes effect July 1, 2022, marks a dramatic change to the program. Officials estimate it will cost the state roughly $200 million a year once fully implemented because of the increased enrollment.

Right now, these people can’t qualify for Medi-Cal if they have saved more than $2,000. For couples, it’s $3,000. Complicated rules dictate what counts as an “asset” and what doesn’t: A house doesn’t count and neither does one car, but a second car does. Engagement rings and heirlooms are fine, but other jewelry counts toward the limit.

Ultimately, the test favors individuals and families who can navigate the rules and find ways to hide money in exempt accounts, said Claire Ramsey, a senior attorney with Justice in Aging.

“You create administrative hurdles, which keeps people artificially off the program,” Ramsey said. “If it’s hard for the lawyers to understand all the rules, what does that mean for the average person who’s just trying to have health insurance?”

The federal Affordable Care Act eliminated the asset test for most Medicaid enrollees, basing financial eligibility exclusively on income, but left out people who qualify for both Medicaid and Medicare.

This is especially important when it comes to expensive long-term care, like nursing homes, which can cost $10,000 a month, said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

Medicare covers nursing home care only in limited circumstances and for up to 100 days. After that, patients must find another way to pay, either out-of-pocket or through Medi-Cal. Because many people don’t qualify for Medi-Cal if they have too much money or other assets, they have to spend through their savings and shed their belongings before they can get on the program.

“Thousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. “You want free medical care? You’re going to have to spend every penny you have to get it.”

A state Assembly analysis estimated that 17,802 additional Californians would have become eligible in 2018 if the asset test hadn’t been required. Of those, 435 were in long-term care, and over the course of the year, 263 spent their money or gave away their assets to qualify for Medi-Cal.

Assembly member Wendy Carrillo (D-Los Angeles), the author of the asset test bill that was folded into the budget, sees eliminating the requirement as part of a larger movement toward universal coverage, in line with efforts to expand Medi-Cal to older unauthorized immigrants or establish a single-payer system.

“We need to aggressively and proactively work on legislation that gives more people coverage,” Carrillo said. “And until we have universal health care, these are the steps necessary to ensure that.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices

July 13, 2021

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

The Biden administration stands ready to work with Congress to address drug prices and expand Medicare, Health and Human Services Secretary Xavier Becerra said in a wide-ranging interview with “What the Health?” on Tuesday.

The former California attorney general also said his top priority while in office is to attack health disparities. “There are a whole bunch of Black and brown communities that have never had the kind of access to care that others have,” he said. “And when they come to the doctor, they come with the kind of conditions that show they didn’t have health care before.”

Becerra, who before coming to Washington successfully led a coalition of Democratic attorneys general in defending the Affordable Care Act from efforts to have it declared unconstitutional, said as secretary he’s looking forward to further expanding the 2010 health law.

“Now we’re playing offense,” he said. “We’ve got the ball and we’ve got to march it down the field, and we intend to because there are many Americans who still need good coverage.”

Check back later for a full transcript of the conversation.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).