February 20

Trump officials face decision on lifetime limits for Medicaid

By Nathaniel Weixel – via TheHill.com

The Trump administration is facing a crucial test of how much flexibility they are willing to give states to remake their Medicaid programs.

Federal officials have already given the green light to two states to impose work requirements on Medicaid recipients, and at least eight other states are hoping to follow.

But a handful of other states want to go even further by putting a lifetime cap on how long people can be enrolled in the Medicaid program.

No state has ever put a limit on how long a person can receive Medicaid benefits. But given that the Trump administration has already shown a willingness to approve conservative policies like work requirements, premiums and lockout periods for Medicaid, many experts and advocates think lifetime limits could also win approval.

Critics of lifetime limits say they would fundamentally shift Medicaid from a health care safety net program for the poor and sick to a welfare program.

“It’s clear that [the administration] view[s] Medicaid not as a health insurance program. They are hopeful to get as many people off the program and off public assistance as possible,” said Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities.

The Trump administration has made state innovation a priority and has promised to fast-track Medicaid waivers, especially those that will impose work requirements on beneficiaries.

To date, five states — Maine, Arizona, Utah, Wisconsin and Kansas — have applied for waivers from the Department of Health and Human Services to put a cap on how long Medicaid beneficiaries can receive health benefits.

The waivers vary, but the proposals are generally tied to work requirements. Utah and Arizona both seek a maximum of five years eligibility. In Arizona, the five-year window would only apply when a beneficiary doesn’t meet the work requirement.

Utah’s request makes a deliberate link between benefit limits and welfare.

“This limit frames public healthcare coverage for adults as temporary assistance (similar to Temporary Assistance for Needy Families (TANF)), with the expectation that they do everything they can to help themselves before they lose coverage,” the application says.

The lifetime cap proposals reflect the administration’s view that only the “able-bodied” will be impacted. In all the requests, children, pregnant women and people with disabilities would be exempt from coverage limits.

The Department of Health and Human Services doesn’t comment on outstanding waiver requests, but Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has made clear her view that Medicaid should only be for the most vulnerable citizens.

“True compassion is lifting Americans most in need out of difficult circumstances,” Verma said in a recent Washington Post column.

“This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens,” she wrote.

Conservatives have long argued that spending on entitlement programs like Medicare, Medicaid and Social Security needs to be curtailed before the costs overwhelm the federal budget.

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Trump officials face decision on lifetime limits for Medicaid
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The Trump administration is facing a crucial test of how much flexibility they are willing to give states to remake their Medicaid programs.

Federal officials have already given the green light to two states to impose work requirements on Medicaid recipients, and at least eight other states are hoping to follow.

But a handful of other states want to go even further by putting a lifetime cap on how long people can be enrolled in the Medicaid program.

No state has ever put a limit on how long a person can receive Medicaid benefits. But given that the Trump administration has already shown a willingness to approve conservative policies like work requirements, premiums and lockout periods for Medicaid, many experts and advocates think lifetime limits could also win approval.

Critics of lifetime limits say they would fundamentally shift Medicaid from a health care safety net program for the poor and sick to a welfare program.

“It’s clear that [the administration] view[s] Medicaid not as a health insurance program. They are hopeful to get as many people off the program and off public assistance as possible,” said Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities.

The Trump administration has made state innovation a priority and has promised to fast-track Medicaid waivers, especially those that will impose work requirements on beneficiaries.

To date, five states — Maine, Arizona, Utah, Wisconsin and Kansas — have applied for waivers from the Department of Health and Human Services to put a cap on how long Medicaid beneficiaries can receive health benefits.

The waivers vary, but the proposals are generally tied to work requirements. Utah and Arizona both seek a maximum of five years eligibility. In Arizona, the five-year window would only apply when a beneficiary doesn’t meet the work requirement.

Utah’s request makes a deliberate link between benefit limits and welfare.

“This limit frames public healthcare coverage for adults as temporary assistance (similar to Temporary Assistance for Needy Families (TANF)), with the expectation that they do everything they can to help themselves before they lose coverage,” the application says.

The lifetime cap proposals reflect the administration’s view that only the “able-bodied” will be impacted. In all the requests, children, pregnant women and people with disabilities would be exempt from coverage limits.

The Department of Health and Human Services doesn’t comment on outstanding waiver requests, but Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has made clear her view that Medicaid should only be for the most vulnerable citizens.

“True compassion is lifting Americans most in need out of difficult circumstances,” Verma said in a recent Washington Post column.

“This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens,” she wrote.

Conservatives have long argued that spending on entitlement programs like Medicare, Medicaid and Social Security needs to be curtailed before the costs overwhelm the federal budget.
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“The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working age, able-bodied adults … does not make sense,” Verma said in a speech late last year.

Advocates promise a legal fight, and say lifetime limits go against the entire purpose of Medicaid.

“This strikes me as lawsuit bait. I suspect this could be a bridge too far,” said Jocelyn Guyer, a consultant with Manatt Health. “Work requirements are also a sweeping change, and this is a step beyond. This seems like it would be asking for more litigation and controversy and trouble.”

Advocates for Medicaid also argue that coverage limits would be a huge administrative burden, and that there’s no evidence they even work.

Lifetime limits “won’t take away the need for care,” said Jerry Vitti, CEO of Healthcare Financial, a health care advocacy company. “You’re not lifting someone up by lowering their health status.”

Advocates also argue that the administration is encouraging states to break the law. ObamaCare allowed states to expand Medicaid to anyone making up to 138 percent of the federal poverty level — about $16,600 this year.

Republicans believe the expansion discourages “able bodied” people from working because it provides free health care. Legislation that congressional Republicans pursued unsuccessfully last year would have repealed ObamaCare and rolled back the Medicaid expansion.

“This is clearly an attack on the [Medicaid expansion] population. What could not be done legislatively is being done administratively,” Vitti said.

February 15

Will Trump’s budget lower Medicare drug costs? Not for some

Some Medicare beneficiaries would pay more for their prescription drugs under President Donald Trump’s budget even as the sickest patients save thousands of dollars, a complex trade-off that may make it harder to sell Congress on the plan in an election year.

In budget documents, the administration said its proposals strike a balance between improving the popular “Part D” prescription benefit for the 42 million seniors enrolled, while correcting design flaws that increase program costs for taxpayers. Health and Human Services Secretary Alex Azar is expected to testify on the proposal later this week in Congress.

Trump has made bringing down drug costs a top priority, but his administration’s plan would create winners and losers. The high cost of medicines is the leading health care concern among consumers.

Independent experts said the administration’s plan will help beneficiaries with the highest prescription drug costs, an estimated 1 million of the sickest patients, those whose individual bills reach a total of more than $8,418 apiece.

But about 4.5 million seniors in the group just behind them could end up spending more of their own money. That’s because the budget proposes a change in how Medicare accounts for manufacturer discounts received by patients whose total bills range between $3,750 and $8,418. They could wind up paying about $1,000 more.

A senior Senate Democrat said the Trump plan missed the mark.

“Instead of picking winners and losers and leaving big pharma unscathed, the president should follow through on his promise to lower high drug prices by getting Republicans in Congress to work with Democrats on behalf of Americans who are getting clobbered at the pharmacy counter,” Sen. Ron Wyden, D-Ore., said in a statement. Wyden is the ranking Democrat on the Finance Committee, which oversees Medicare.

“The package reduces costs for some but increases costs for others, and the effect on premiums is not clear,” said Tricia Neuman, a Medicare expert with the nonpartisan Kaiser Family Foundation. Also unclear is how the Trump plan interacts with changes to the Medicare prescription plan enacted by Congress just last week.

Medicare’s prescription drug benefit is delivered through private insurance plans. Here’s more detail on the trade-off for beneficiaries:

— The budget eliminates cost sharing for Medicare beneficiaries who reach the program’s “catastrophic” coverage threshold, currently $8,418 in total costs. Instead of paying 5 percent of the cost of their medications, the sickest patients would pay nothing. They’d be the winners.

— A second group just behind the sickest patients would lose ground financially. Currently Medicare counts manufacturer discounts received by patients in this group to calculate total spending that determines when they qualify for catastrophic coverage. That practice would stop, meaning beneficiaries would have to spend more of their own money to reach the threshold for the richer catastrophic coverage.

“It’s complicated,” said Joe Baker of the Medicare Rights Center. “The winners in this proposal are people with very high drug spending. The people who are the losers here are the people who are stuck in the middle.”

In other Medicare drug changes, the budget calls for requiring insurers to share manufacturer rebates with patients, and it expands coverage for medications to treat substance abuse.

February 14

Investing for retirement: a long-term game many workers aren’t even playing

By Angela Antonelli via Marketwatch.com

As a bullish 2017 stock market continued its steady rise to record breaking levels, President Trump and others took the opportunity to highlight these gains for retirement savers and their 401(k)s. But that record-breaking streak came to end in early February as the stock market finally tumbled, reminding us that what goes up usually comes down.

The lesson from this: highlighting short-term gains to retirement portfolios can do more harm than good to long-term retirement savings and can weaken the financial well-being of today’s workers.

Behavioral economists tell us that people don’t often act in their best interests because we often suffer from inertia and a short-term vision when it comes to making important financial decisions. We are seeing this now as a rising stock market increased the size of retirement portfolios. A recent Washington Post article reported that some investment managers are seeing clients cash in on that euphoria by pulling dollars out of retirement funds for vacations, college and home improvement. This can be a costly mistake in the long run by jeopardizing retirement readiness.

If a 40-year-old couple decides to withdraw $20,000 from their retirement fund to pay for a luxury dream cruise, they would pay a 10% penalty, or additional $2,000, on the withdrawal. If they kept that same $20,000 invested in their 401(k) for 25 more years until they reach age 65 and, assuming a 4% annual return, they would have an additional $53,000 in their retirement portfolio. Is that luxury cruise worth the extra $33,000 or more over your lifetime if you take that money out of your retirement fund now to pay for it?

John Wasik, in a Forbes column published just after the market tumble, offers sage advice regarding how to view the stock market when it comes to retirement savings. “No matter which mix you choose, stay the course and hew to your savings goals. By knowing how much to save for retirement and keeping on the road to get there, you’ll surprise yourself at how much money compounds over time. Compounding is the one thing you don’t have to work for, and it’s effective for everyone.”

Now more than ever, employers and plan providers can make a difference by improving and investing in workplace-based retirement savings plans and offering financial literacy education to help workers make informed and better decisions about saving. Even the simple step of making available free online calculators so workers can see how much they need to save to achieve their goals or how much that dream vacation will cost them now versus 25 years from now can lead to better outcomes.

But the greater tragedy of only focusing on the gains in 401(k) or other retirement plans is that it creates a false sense of progress in the overall retirement readiness of American workers. A 2016 U.S. Government Accountability Office report found that the median defined contribution savings among working households aged 25-64 was $41,900 in 2013 and an estimated one-third of working households had no defined benefit or defined contribution retirement savings from a current or former job. And a rising tide can’t lift all boats if one-half of those boats aren’t even in the water. More than half today’s private sector workers – an estimated 55 million Americans – do not have access to an employer-sponsored retirement savings program.

Wall Street might be getting the message. During the recent World Economic Forum in Davos, Switzerland, BlackRock Chief Executive Larry Fink spoke about access and inclusion. “I think the question isn’t the financial system but the inclusiveness of the financial system, and we don’t talk about that at all,” he said during a panel about Remaking the Future of Global Finance.

Fink highlights that the equity market has nearly tripled in the last 10 years, which only benefits those who own stocks. “We are not addressing the issue of inclusion, of more participation in the marketplace,” Fink said on CNBC. And that “has to come from working with the majority of the population on financial literacy, and improving that financial literacy so they don’t feel frightened of moving their money into long term instruments.”

Providing greater access to retirement savings programs is important to improving financial well-being. Even families with modest incomes can find a way to save if they have good information, access to payroll deduction and advice about how to balance competing financial concerns, and budget and save for a range of different needs, such as short-term emergencies. Planning and discipline can help families avoid short-term decisions that could cost them dearly in retirement.

Policy makers understand the importance of developing innovative ways to expand access to the millions of workers who currently do not have an employer-sponsored retirement plan at work. Workers are 15 times more likely to save if they are offered a plan through their employer. In states like California, Connecticut, Illinois, Maryland, Oregon, Vermont and Washington, policy makers are partnering with the private sector to expand access to retirement savings options. They are offering simple, low-cost, easy ways for employers – especially small businesses who most often do not provide such plans – to provide their employees with access to individual retirement accounts (IRAs) or 401(k)s. These policy leaders are at the forefront of including so-called behavioral nudges, such as auto-enrollment, in program design to help millions of Americans begin to save for their retirement.

The best time to save is when things are looking good. The recent volatility of the stock market represents an important teachable moment about investing and saving for retirement. Saving for retirement is a long-term game. When times are good, and more people have more to save, policy makers, educators, employers and Wall Street should be doing even more to provide workers and families with the best information, financial literacy and savings options possible to help them make well-informed financial decisions to weather the economic storms and generate benefits to last a lifetime.

Angela Antonelli is a research professor and the executive director of the Georgetown University Center for Retirement Initiatives (CRI) at the McCourt School of Public Policy.

February 14

Attention Seniors: An Important Medicare Deadline Is Approaching

By Elizabeth O’Brien February 12, 2018

Not loving your Medicare Advantage plan? You have until Feb. 14 to ditch it under the annual Medicare Advantage Disenrollment Period, which ends on Valentine’s Day.

Note that this isn’t a continuation of open enrollment, the annual period from Oct. 15 through Dec. 7 when you can make any number of changes to your Medicare coverage. Only one move is permitted during the winter disenrollment period: switching from Medicare Advantage to original Medicare, which is Parts A and B. You can also buy a Part D drug plan and a Medigap supplement plan. Unless you have special circumstances, you’ll have to wait until October to make any other changes to your coverage for a Jan. 1, 2019 start date.

Medicare Advantage, also known as Part C, is insurance offered by private carriers that are contracted with the government to provide Part A hospital coverage and Part B outpatient coverage. Since 2004, the number of beneficiaries enrolled in these private plans has more than tripled from 5.3 million, or 13% of all beneficiaries, to 19 million, or one-third of beneficiaries, according to the Kaiser Family Foundation. The average monthly premium for enrollees of Medicare Advantage plans with drug coverage is $36 per month in 2017, although some plans have $0 premium.

One reason Medicare Advantage plans are popular is because many pay for services and treatments that original Medicare doesn’t, such as eyeglasses, hearing aids and dental work. What’s more, many Medicare Advantage plans offer prescription drug coverage with no deductible, compared with a deductible of up to $405 under the Part D drug plans that are sold to beneficiaries on original Medicare.

The trade-off is that the majority of Medicare Advantage plans are HMOs with relatively narrow networks, so your doctor and hospital choices are more limited. In 2015, more than one-third of Medicare Advantage enrollees were in plans with narrow doctor networks, according to the Kaiser Family Foundation.

By contrast, under original Medicare, beneficiaries can see any doctors around the country who accept Medicare. That’s a big reason why you might want to go back to original Medicare.

There’s a big caveat, though: if your plan is to have original Medicare and a Medigap supplement plan, keep in mind that these supplemental plans are medically underwritten. That means, you may be charged more for coverage or rejected altogether based on your health status. While it’s too late to complete the underwriting process before the deadline, a consultation with a broker should give you a good idea whether you’re a candidate for the supplemental plans available in your region, says Joe DeLuca, director of sales at eHealthMedicare.com, a broker that helps consumers select private Medicare plans.

“The key is to call before the 14th,” he says. Each carrier has different selection criteria, and an experienced broker should be able to steer you to one that will accept you.

Don’t drop your Medicare Advantage plan until you’ve gotten assurances that you can buy a Medigap supplement plan at a price you can afford, DeLuca cautions.

February 14

The Health 202: Medicaid plans: We’re not ‘hyperventilating’ about work requirements

Guess who’s not fretting over making low-income Americans work or volunteer in return for government health benefits? The Medicaid insurers covering them.

“I think some of the heavy breathing about how terrible work requirements are going to be is over the top,” Jeff Myers, president of Medicaid Health Plans of America, the country’s largest association of Medicaid plans, told me last week.

There has lately been a frenzy of pushback from Democrats and progressives against the Trump administration’s unprecedented move to allow states to enact work requirements as a condition of receiving benefits. Some red states are imposing such requirements for the first time in the program’s five decades, following the failure of the GOP Congress to repeal and replace Obamacare — which expanded Medicaid in many states.

Last month, the Centers for Medicare and Medicaid Services issued guidance saying states may require non-disabled Medicaid recipients to work, volunteer or undergo job training to participate in the program. Out of a dozen states that have applied for work requirements, CMS granted Kentucky’s request last month and on Friday gave the go-ahead to Indiana, my colleague Amy Goldstein reports.

Because this is a pioneering move for CMS — the Obama administration rejected work requirements, saying they were inconsistent with Medicaid’s objectives — it has incited spirited applause from the political right but loud groans from the left. House Minority Leader Nancy Pelosi (D-Calif.) called work requirements a “shameful violation of the letter and spirit of Medicaid” when the guidance was initially issued.

“This mean-spirited decision will have a particularly damaging impact on women, including women currently taking care of seriously ill family members and those who have chronic health conditions of their own,” Pelosi said.

Last week, Frederick Isasi, executive director of the liberal consumer health lobby, Families USA, called Indiana’s waiver “a profound and deeply saddening departure from our nation’s commitment to the health of our families.”

Yet given the small number of enrollees likely to be affected by the work requirements, the uproar may be premature. Myers says he’s watching states closely to see exactly how they implement work requirements. But he feels that if done the right way, such requirements could give some recipients — but only a small number of them — a needed boost toward employment.

“Most people probably won’t be covered by this work requirement,” Myers said.

Members of MHPA contract with states to cover the 74 million Americans who rely on Medicaid, the federal government’s primary health insurance program for low-income individuals. It’s their plans that stand to lose customers if work requirements prompt a reduction in Medicaid enrollment, as many critics predict. Myers acknowledges that’s a likely effect — after all, enrollment dropped when work requirements were introduced to welfare in the 1990s — but he’s expecting only a minimal effect.

“We’re not hyperventilating that millions of people will get thrown off the rolls,” Meyers told me. “We just want to make sure as states do this, they understand there is a cost involved.”

Why might the effect be limited? For one thing, the majority of Medicaid recipients work or cite some valid reason they don’t, such as a disability or illness, acting as caregivers or attending school. Forty-two percent of Medicaid recipients work full time and 18 percent work part time, according to population survey data analyzed by the Kaiser Family Foundation.

That’s a top argument among critics for why they don’t think work requirements are needed. But it’s also a reason the requirement probably won’t have a massive wave effect on the program — most recipients either work or have some other life circumstance that prevents them, exempting them from the new requirements.

In addition, CMS is giving wider latitude than many were expecting to ensure states provide plenty of exemptions from a work requirement, moving to broadly define what constitutes “work.” For example, the agency in its guidance said those caring for children or undergoing substance abuse treatment could be exempted from working. So could be the 10 million people on Medicaid who have a disability.

And work doesn’t have to mean a paying job, according to the administration. States could also count job training, job searching, volunteer work or education as satisfying the requirement.

It’s still true that imposing more rules on government benefits increase the likelihood that even eligible people won’t be able to sign up because of higher barriers. Kentucky officials have predicted between 90,000 and 95,000 fewer people will be on Medicaid by the end of the state’s five-year waiver period — although that’s only a fraction of the more than 2 million Kentucky residents enrolled in the program.

Tom Miller, a health-care fellow at the conservative American Enterprise Institute, estimates work requirements might affect 20 to 30 percent of the Medicaid population at most.

“The reality is these are marginal things,” Miller said. “You can do this for a smaller fraction of the entire Medicaid population — you’re not going to nudge a large number of folks into full-scale work.”

Critics view diminished Medicaid rolls as a negative, but remember that conservative proponents view it as a victory. The idea, they’ve emphasized, is to make Medicaid a temporary safety-net program with incentives to propel people up the economic ladder.

“True compassion is lifting Americans most in need out of difficult circumstances,” CMS Administrator Seema Verma wrote in an op-ed published in The Post on Sunday.

Myers’s major concerns around these new requirements are logistical in nature. He wants to make sure states don’t impose new burdens of oversight on plans as it’s the states that have traditionally handled enrollment qualification. And he wants safeguards to minimize churn in the program so Medicaid recipients don’t find their care disrupted.

To Myers, the devil is in the details. Back in the 1990s, when work requirements were first added to welfare, enrollment in the Temporary Assistance for Needy Families program declined while job participation increased, especially among low-income single mothers (although the 2001 recession stalled much of that progress), said Ron Haskins, a senior fellow for economic studies at the Brookings Institution.

But Haskins and Myers, too, stress that success varied widely among states, depending on how good they were at helping TANF participants find work. With the new Medicaid rules, states face a lot of decisions about how to implement the requirements, how to enforce them, how broad their scope should be and how to help people fulfill them. The Trump administration is expected to respond to waiver requests from perhaps as many as 10 more states to implement work requirements.

“This is what I think the people talking about work requirements are missing,” Myers said. “There are all kinds of granular decisions to be made at the state level before this can even be implemented.”

AHH: Enrollment in religious health-care sharing ministries has skyrocketed, especially in states whose Affordable Care Act marketplaces have been plagued by spiraling premiums and reduced competition, Politico’s Paul Demko and Renuka Rayasam report. Only about 150,000 individuals were enrolled in such faith-based plans when the ACA was passed eight years ago, but the nonprofit groups that offer these plans say they now have more than 1.1 million members.

“What was once a fringe idea, limited to devout Evangelicals and small Mennonite churches in more rural parts of the country, has found acceptance with a segment of the population for whom the government safety net is unavailable and the free market options are unaffordable,” Paul and Renuka write. “As more people look for cheaper alternatives to health insurance, they are stumbling on ministry plans to escape Obamacare’s requirements and state oversight, but still satisfy the law’s individual mandate which, despite its repeal in the recent tax overhaul, remains in effect until 2019.”

OOF: There’s no clear evidence that radiation from cellphones causes cancer in humans. That’s after a $25 million National Institutes of Health study that found while exposure to cellphone radio-frequency radiation led to a higher risk of tumors, DNA or tissue damage and lower body weight in some groups of rodents, there are no clear implications for human health, our colleague Ariana Eunjung Cha reports. The study of 3,000 test animals is believed to be the most comprehensive assessment of the health effects of such radiation on rates and mice.

“The strongest finding in the new study involved male rats…that developed tumors in the nerves surrounding their hearts,” Ariana writes. “The experiment involved placing rats and mice into special chambers and exposing them to levels of radiation that mimic 2G and 3G phones, which were standard when the study was launched, for nine hours a day.” Even the lowest levels of radiation used in the study were much higher than the maximum exposure a frequent cellphone user would get.

John Bucher, a senior scientist at the National Toxicology Program, said “at this point we don’t feel that we understand enough about the results to place a huge degree of confidence in the findings.” The Food and Drug Administration issued a statement saying “evidence that whole body radio-frequency energy exposures given to rats or mice in the study actually caused cancer in these animals” is mostly “equivocal or ambiguous.”

Asked if he had changed his cellphone use as a result of the study, Bucher said: “no.”

OUCH: The Department of Health and Human Services appears to have blacklisted a reporter from the trade publication Modern Healthcare for refusing to delete three sentences from a story that Seema Verma, administrator for the Centers for Medicare and Medicaid Services, didn’t like, according to an account from the Association of Health Care Journalists.

Reporter Virgil Dickson got pushback from CMS after publishing a story a few weeks ago about the abrupt resignation of former Medicaid official Brian Neale, reporting that his departure was prompted by a disagreement with Verma. Dickson says he was told by an agency spokesman he’d no longer be allowed on CMS press calls unless he changed the story.

“Dickson believed the agency was making good on its threat on Thursday when, he said, his phone went mute during a CMS press call and a woman’s voice told him he was not allowed to participate,” AHCJ vice president Felice Freyer writes. “An editor later confirmed with CMS officials that he had been banned from press calls, Dickson said….But after AHCJ sent CMS several questions about the incident, an agency spokesman on Saturday evening emailed a one-sentence reply: ‘No reporters have been banned by CMS.'”

The incident underscores rising tension between HHS and some mainstream media outlets, which, as I noted in Friday’s Health 202, have been recently left out of press calls announcing major initiatives, including Medicaid work requirements.

— Sen. Marco Rubio (R-Fla.) is teaming up with Ivanka Trump to marshal Republicans behind an issue Democrats have typically supported: paid family leave. Politico’s Seung Min Kim reports Rubio is floating allowing people to draw Social Security benefits for family leave and then delaying their checks when they hit retirement age. Under this approach, a person who would begin receiving full benefits when he or she turns 67 years old but wants to take six weeks of paid leave would have to wait an extra six weeks after his or her 67th birthday to start getting Social Security checks.

“Capitalizing on President Donald Trump’s endorsement of the idea in his State of the Union address, Rubio is trying to marshal Republicans behind a plan that would neither impose a mandate on employers nor raise taxes to pay for it — two hurdles that have long halted the GOP from embracing paid family leave,” Seung Min writes. Rubio is still in the early stages of crafting a specific plan, but he and Ivanka have recently exchanged emails about it, and Sen. Mike Lee (R-Utah) has also pitched the idea to the president’s daughter, Seung Min reports.

“That’s a new idea for Republicans who still identify it as something that comes out of the left,” Rubio said. “Forcing companies to provide it is perhaps an idea that finds its genesis on the left, but the notion that pregnancy should not be a bankruptcy-eliciting event is one that I think all Americans should be supportive.”

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