November 13, 2024
Since the conclusion of the presidential election we have received several questions from NYS Council members about Medicaid Work Requirements – what they are, how they have been used in the past, etc. I found a few good articles to help us level set as we contemplate what may lie ahead and how we can organize to push back against any threats to the individuals we serve. Here’s a good article from the Commonwealth Fund: https://www.commonwealthfund.org/publications/explainer/2024/apr/work-requirements-medicaid-enrollees
Also, from HHS (published by the current Biden-Harris Administration) there’s this: https://www.hhs.gov/sites/default/files/national-work-requirements-fact-sheet.pdf
And finally here’s one from from Axios (published at the beginning of 2024): https://www.axios.com/2024/01/24/medicaid-employment-requirements-republican-states-laws
We will talk more about the implications of the recent elections at all levels of government in the days to come.
———————-
In case you hadn’t heard… Governor Hochul will make an announcement tomorrow announcing the re-launch of the midtown and lower Manhattan congestion pricing initiative with a $9 price tag for cars entering lower and midtown Manhattan at peak hours. The MTA board is apparently going to meet to pass the amended proposal on November 20. The media is reporting that the Governor’s goal is to get the program up and running before President-elect Trump takes office in January – a time frame that (according to the NY Times) aims to preempt Trump’s vows to kill the program. The state had previously projected that it could raise close to $1B a year and it is not clear whether (with the reduced fees) it will hit this annual target. This has budget implications for the 25-26 budget as well as the outyears. Governor Hochul is expected to propose a 40% reduction across the board from the previously approved tolling structure.
————————
Politico, 11/13/24
A LAME LAME DUCK? The likely GOP sweep of the House, Senate and White House has dampened expectations for health care policy riding in a lame-duck package.
Since Democrats control the Senate until early January, Republicans could be incentivized to push significant legislation until the next Congress, when they would likely have full control of both chambers. Democrats could also attempt to force Republicans to deal with a health care package in the next Congress with a slim majority.
Lawmakers face a Dec. 20 deadline to avert a government shutdown, but what else could ride on that package remains an open question, as well as whether they’ll punt on a fiscal 2025 spending deal again.
House Appropriations Chair Tom Cole (R-Okla.) told Pulse before the election that while he’d prefer to wrap up Congress’ remaining business this calendar year, that call will be left up to the president-elect. House Speaker Mike Johnson made similar comments Tuesday.
“It’s massively up in the air right now,” one of five health care industry lobbyists granted anonymity to discuss the situation told Pulse. “Policy could get lost in the political jockeying. … There is less incentive than normal for both sides to play nice because both popular and unpopular policy choices land on Republicans in 2025.”
A second health care industry lobbyist told Pulse they expect a short-term extension so the GOP gets the credit, even if the package is similar to what would have happened in other electoral outcomes.
“It has been eerily quiet post-election,” a third industry lobbyist told Pulse. “They must be waiting for smoke signals from Mar-a-Lago. My bet is on a lamer-than-usual lame duck.”
Congress typically acts on deadline, and several health care policies expire at the end of the year.
“There is a very good chance that this Congress will do at least a few health care extenders as part of a government spending bill,” a fourth lobbyist told Pulse.
Telehealth: Lawmakers are widely expected to extend pandemic-era rules that run out at the end of the year allowing broader telehealth access in the Medicare program.
Doctor pay: CMS finalized a nearly 3 percent Medicare payment cut in 2025 for doctors, who are pushing hard for relief.
Hospital at home: A five-year extension for about-to-expire pandemic-era rules allowing patients to receive hospital care in their homes has had broad bipartisan support.
Community health centers: A major form of funding for community health centers expires at the end of the year. Health center advocates are pushing for another payment bump after receiving one earlier this year.
How to pay for all the time-sensitive policies also is an open question. They could include PBM reforms or Senate-passed drug patent changes from Senate majority leader candidate John Cornyn (R-Texas).
“Does the incoming Trump administration want this Congress to pay for these provisions now or punt into next year when they are also likely needing to close out FY 25 and prepare for a budget reconciliation process?” a fifth industry lobbyist told Pulse.