News Health Systems

Pennsylvania Gradually Easing off Job Requirement in Medicaid Non-Expansion Plan

Tara Murtha

Pennsylvania Gov. Tom Corbett had hoped to make the state the first to tether job-search requirements to Medicaid eligibility.

After insisting that Medicaid enrollees will have to prove they are looking for full-time work in order to qualify for Medicaid coverage, Pennsylvania Gov. Tom Corbett is finally easing up on the requirement, which experts say was unlikely to be approved.

Pennsylvania is one of 26 states rejecting Medicaid expansion offered under the Affordable Care Act, despite the fact that the state has an increasing number of uninsured residents, bucking the national trend. The decision, blasted by health advocates, leaves 500,000 residents in the coverage gap—earning too much to quality for Medicaid but not enough to qualify for tax credits that would allow them to purchase plans under the state exchange.

In lieu of expansion, Gov. Corbett proposed a plan called Healthy PA. Call it an anti-expansion: It is the only state plan to slash benefits for current enrollees.

To reach residents stuck in the coverage gap, Healthy PA proposes to use federal subsidies to help uninsured low-income residents purchase privatized Medicaid insurance plans.

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From the initial proposal, Corbett and secretary of the Pennsylvania Department of Public Welfare Beverly D. Mackereth have insisted that enrollees will have to prove they are looking for full-time work to obtain benefits. The original draft of Healthy PA, published back in December, proposed that most enrollees between the ages of 21 and 65 working less than 20 hours a week demonstrate that they were fulfilling 12 job-searching activities a month in order to keep coverage.

No state has ever tethered Medicaid eligibility to searching for employment.

“Historically, work search and work promotion has not been among the statutory purposes of the Medicaid program,” MaryBeth Musumeci, associate director at the Kaiser Commission on Medicaid and the Uninsured, told Rewire. “Unlike the TANF [Targeted Assistance for Needy Families] program, Congress set out the purpose to be promoting work, whereas the purposes of Medicaid is promoting health care.”

After holding public hearings for feedback on the draft, the administration formally submitted the waiver to the federal government for approval in February. The submitted waiver was “gentler” and “softer” on some cuts and conditions proposed in the original draft, but Corbett remained steadfast about the job-search requirement; most enrollees working under 20 hours per week would have to prove they were seeking employment.

He called it the “Encouraging Employment” program.

Corbett’s notion is that the Encouraging Employment program would promote “personal responsibility,” a phrase that appears 30 times in the 202-page document.

From the waiver:

The goal of the Encouraging Employment program is to better enable low-income, able-bodied Pennsylvanians to move out of poverty while also gaining access to health care coverage.

The program will create an opportunity for unemployed and under-employed individuals to connect with potential employers.

The premise of the Encouraging Employment program ignores some basic facts about full-time employment and health insurance coverage. For one thing, the majority of people on Medicaid in Pennsylvania already work full-time, or live with someone who works full-time. Nationally, most uninsured workers are self-employed or work for small firms.

Secondly, the requirement assumes there are jobs to be found. Last week, FactCheck.org called Corbett out when he claimed that he has done a “remarkable” job creating new jobs in Pennsylvania in a series of statewide radio ads.

During his time in office, the number of government jobs has declined by a net 42,000 (most from local government jobs). When looking at all jobs, including government jobs, Pennsylvania has gained 96,300 total jobs under Corbett – a 1.7 percent job growth over three years, ranking the state 46th in total job growth among the states.

Then there’s the fact that less than 60 percent of Pennsylvania employers offer health insurance. Meanwhile, full-time employment fails to enable citizens to “move out of poverty” anyway.

Despite the data, and the unlikelihood of the federal approval, the administration doubled down on the job-search requirement after submitting the waiver.

From Kaiser Health News and the Philadelphia Inquirer:

[T]he administration is sticking to its most controversial proposal: a requirement for work-search or job training.

“We believe it’s important,” said Mackereth. “Encouraging employment ties in strongly to good health outcomes.”

She said the goal is to remove people from public assistance. “We don’t want people to remain on government-funded health insurance. We’re providing tools for people to use.”

Last week, the administration signaled they are backing off. In a letter sent to Health and Human Services Secretary Kathleen Sebelius, Corbett proposed a “potential modification” to the waiver. From the letter, dated March 5:

This proposal will be a voluntary, one-year pilot program to positively encourage those who are able to work, to participate in job training and work opportunities … This pilot program will not be a condition of eligibility, but rather those individuals who participate will lower their premiums and cost sharing as incentives.

MaryBeth Musumeci told Rewire it’s not clear that making the requirement voluntary will be approved, either.

“It still remains to be seen. These waivers enter into a period of negotiation,” she said. “This is still subject to the federal-level comment period through the end of this month, and no decision by CMS would be made before then.”

Pennsylvanians can submit public comment here until March 28.

Culture & Conversation Politics

Latino Votes Count or ‘Why Would They Be Trying to Suppress Them?’: Dolores Huerta on What’s at Stake in 2016

Ally Boguhn

“We know that we’ve had this problem that Latinos sometimes don’t vote—they feel intimidated, they feel like maybe their vote doesn’t matter,” Huerta told Rewire. Huerta encouraged people to consider both what is at stake and why their vote might be suppressed in the first place.

Republican nominee Donald Trump launched his campaign for president in June 2015 with a speech notoriously claiming Mexican immigrants to the United States “are bringing drugs, and bringing crime, and their rapists.”

Since then, both Trump’s campaign and the Republican Party at large have continued to rely upon anti-immigrant and anti-Latino rhetoric to drum up support. Take for example, this year’s Republican National Convention in Cleveland, where Sheriff Joe Arpaio—whose department came under fire earlier this year for racially profiling Latinos—was invited to take the stage to push Trump’s proposed 2,000-mile border wall. Arpaio told the Arizona Republic that Trump’s campaign had worked with the sheriff to finalize his speech.

This June, just a day shy of the anniversary of Trump’s entrance into the presidential race, People for the American Way and CASA in Action hosted an event highlighting what they deemed to be the presumptive Republican nominee’s “Year of Hate.”

Among the advocates speaking at the event was legendary civil rights leader Dolores Huerta, who worked alongside César Chávez in the farm workers’ movement. Speaking by phone the next day with Rewire, Huerta—who has endorsed Democratic nominee Hillary Clinton—detailed the importance of Latinos getting involved in the 2016 election, and what she sees as being at stake for the community.

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The Trump campaign is “promoting a culture of violence,” Huerta told Rewire, adding that it “is not just limited to the rallies,” which have sometimes ended in violent incidents, “but when he is attacking Mexicans, and gays, and women, and making fun of disabled people.”

Huerta didn’t just see this kind of rhetoric as harmful to Latinos. When asked about its effect on the country at large, she suggested it affected not only those who already held racist beliefs, but also people living in the communities of color those people may then target. “For those people who are already racist, it sort of reinforces their racism,” she said. “I think people have their own frustrations in their lives and they take it out on immigrants, they take it out on women. And I think that it really endangers so many people of color.”

The inflammatory rhetoric toward people of color by presidential candidates has led to “an alarming level of fear and anxiety among children of color and inflaming racial and ethnic tensions in the classroom,” according to an April report by the Southern Poverty Law Center (SPLC). The organization’s analysis of the impact of the 2016 presidential election on classrooms across the country found “an increase in bullying, harassment and intimidation of students whose races, religions or nationalities have been the verbal targets of candidates on the campaign trail.” Though the SPLC did not name Trump in its questions, its survey of about 2,000 K-12 educators elicited up more than 1,000 comments about the Republican nominee, compared to less than 200 comments mentioning other presidential candidates still in the race at that time.

But the 2016 election presents an opportunity for those affected by that violent rhetoric to make their voices heard, said Huerta. “The Latino vote is going to be the decisive vote in terms of who is going to be elected the president of the United States,” she continued, later noting that “we’ve actually seen a resurgence right now of Latinos registering to vote and Latinos becoming citizens.”

However, a desire to vote may not always be enough. Latinos, along with other marginalized groups, face many barriers when it comes to voting due to the onslaught of voter restrictions pushed by conservative lawmakers across the country—a problem only exacerbated by the Supreme Court’s 2013 ruling gutting portions of the Voting Rights Act (VRA) meant to safeguard against voter suppression efforts. The 2016 election season will be the first presidential election without those protections.

As many as 875,000 eligible Latino voters could face difficulty voting thanks to new restrictions—such as voter ID laws, proof of citizenship requirements, and shortened early voting periods—put into place since the 2012 elections, a May analysis from the National Association of Elected and Appointed Officials found.

When it comes to restrictions like this, Huerta “absolutely” saw how they could create barriers for those hoping to cast their ballot this year. “They’ve made all of these restrictions that keep especially the Latino population from voting. So it’s very scary,” said Huerta, pointing to laws in states like Texas, which previously had one of the strictest voter ID laws in the country. (The state has since agreed to weaken its law following a judge’s order).

“We know that we’ve had this problem that Latinos sometimes don’t vote—they feel intimidated, they feel like maybe their vote doesn’t matter,” Huerta went on.

Huerta encouraged people to consider both what is at stake and why their voting rights might be targeted in the first place. “What we have to think about is, if they’re doing so much to suppress the vote of the Latino and the African-American community, that means that that vote really counts. It really matters or else why would they be trying to suppress them?”

Appealing to those voters means tapping into the issues Latinos care about. “I think the issues [Latinos care about] are very, very clear,” said Huerta when asked how a presidential candidate could best appeal to the demographic. “I mean, immigration of course is one of the issues that we have, but then education is another one, and health care.”

A February survey conducted jointly by the Washington Post and Univision found that the top five issues Latino voters cared about in the 2016 election cycle were jobs and the economy (33 percent), immigration (17 percent), education (16 percent), health care (11 percent), and terrorism (9 percent).

Another election-year issue that could affect voters is the nomination of a U.S. Supreme Court justice, Huerta added. She pointed out the effect justices have on our society by using the now-decided Whole Woman’s Health v. Hellerstedt case as an example. “You know, again, when we think of the presidents, and we think of the Supreme Court and we know that [was] one of the issues that [was] pending in the Supreme Court … whether what they did in Texas … was constitutional or not with all of the restrictions they put on the health clinics,” she said.

Latinas disproportionately face large barriers to reproductive health care. According to Planned Parenthood, they “experience higher rates of reproductive cancers, unintended pregnancy, and sexually transmitted infections than most other groups of people.” Those barriers are only exacerbated by laws like Texas’ HB 2, as the National Latina Institute for Reproductive Health explained in its amicus brief in the Whole Woman’s Health case prior to the decision: “Texas Latinas already face significant geographic, transportation, infrastructure, and cost challenges in accessing health services.”

“H.B. 2’s impact is acute because of the day-to-day struggles many Latinas encounter when seeking to exercise their reproductive rights,” wrote the organization in its brief. “In Texas, there is a dire shortage of healthcare facilities and providers in predominantly Latino communities. Texas has the highest percentage of uninsured adults in the country, and Texas Latinos are more than twice as likely as whites to be uninsured …. Additionally, the lack of public and private transportation creates a major barrier to accessing health services, especially in rural areas.”

As Rewire’s Tina Vasquez has reported, for undocumented women, the struggle to access care can be even greater.

Given the threats cases like Whole Woman’s Health have posed to reproductive rights, Huerta noted that “Trump’s constant attacks and misogynist statements” should be taken with caution. Trump has repeatedly vowed to appoint anti-choice justices to the Supreme Court if elected.

“The things he says without even thinking about it … it shows what a dangerous individual he can be when it comes to women’s rights and women’s reproductive rights,” said Huerta.

Though the race for the White House was a top concern of Huerta’s, she concluded by noting that it is hardly the only election that matters this year. “I think the other thing is we have to really talk about is, the presidency is really important, but so is the Senate and the Congress,” said Huerta.

“We’ve got to make sure we get good people elected at every level, starting at school board level, city council, supervisors, commissioners, etc. state legislatures …. We’ve got to make sure reasonable people will be elected, and reasonable people are voted into office.”

Analysis Politics

Koch Brothers Move to Influence Congressional and State Races

Ally Boguhn

The Kochs are poised to play a momentous role in financing hundreds of candidates across the country and launching attacks on those who oppose their goals. Given their network’s penchant for funding anti-choice politicians and causes, that's something that should deeply concern reproductive rights advocates.

Over the weekend, Charles and David Koch’s network of ultra-wealthy donors and the politicians they fund convened in Colorado Springs, Colorado, to strategize about how to push their message across the countrya meeting that should signal cause for alarm for those concerned with big money in politics.

At the event, Charles Koch, joined by at least 300 donors who had each committed at least $100,000 annually to the network, reportedly outlined plans to get those with similar political ideologies elected to office and to “cultivat[e] conservative leaders at the state level,” according to the Washington Post.

During the 2012 election cycle, the Kochs’ network raised an estimated $407 million to influence races. As the Post‘s Matea Gold noted in a 2014 report, that level of funding gave the Kochs and their supporters expansive and almost unparalleled room to try to exert political influence.

As Adele Stan reported for Rewire in 2013, such influence extended in part to anti-choice groups, who received millions from Koch-connected organizations during the 2010 midterm and 2012 presidential election cycles. In addition, Koch-linked organizations gave tens of millions of dollars to candidates who were almost entirely opposed to abortion rights.

“The resources and the breadth of the organization make it singular in American politics: an operation conducted outside the campaign finance system, employing an array of groups aimed at stopping what its financiers view as government overreach,” explained Gold in another article. “Members of the coalition target different constituencies but together have mounted attacks on the new health-care law, federal spending and environmental regulations.”

In 2015 the Kochs revealed during their annual winter donor retreat that their network planned to spend up to $900 million on the 2016 election cycle, according to the New York Times—a number so high that it “would put [the network] on track to spend nearly as much as the campaigns of each party’s presidential nominee.” Conservative news outlet National Review, however, reported in May that the billionaires had intended to scale back the scope of their electoral funding, instead “steering their money and focus away from elections and toward a slew of the more intellectual, policy-oriented projects on which they have historically lavished their fortune.”

Still, the Kochs are poised to play a momentous role in financing hundreds of candidates across the country and launching attacks on those who oppose their goals. The extent of their contributions is carefully concealed by the web through which they funnel money—consisting of political action committees, issue-advocacy groups, nonprofit organizations, and the like—but what has been reported thus far offers a small glimpse into their political influence.

Though the allocated total spending was downgraded, the Koch network is nevertheless on track to spend almost $750 million this election cycle, with about $250 million going to politics and the Koch groups that work on policy issues, including Americans for Prosperity and the Freedom Partners Action Fund.

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“The [Koch] network is and will continue to be fully engaged in 2016’s political and policy battles. We want to maximize the number of freedom-oriented Senators,” James Davis, a spokesman for the Koch network, told the Hill in June amid news that the network was moving to spend $30 million on ad buys. “We see that on a number of issues, particularly free speech, the current majority is far preferable to the alternative.”

According to the Center for Responsive Politics’ OpenSecrets.org, which provides a comprehensive record of federal campaign contributions, the dark money group Americans for Prosperity—a 501(c)(4) that focuses on “citizen advocacy”—has spent at least $2,422,436 thus far on federal elections this cycle, investing in key Senate races in Nevada, Ohio, Pennsylvania, and Wisconsin.

Most of that money, more than $1.9 million, has been spent in Ohio to oppose the state’s former Democratic governor, Ted Strickland, in his race against incumbent Sen. Rob Portman (R). The two politicians have been locked in a tight battle for a critical seat that could help determine which party takes control of the Senate. The Koch-backed group launched a seven-figure ad buy last August focusing on Strickland’s tax policies as governor of Ohio.

Freedom Partners Action Fund, a super PAC founded by the Kochs in 2014 to which they have directly given $6 million so far this cycle, has invested even more into opposing Strickland, spending more than $9.4 million in independent expenditures, according to the Sunlight Foundation’s Influence Explorer. As was the case with Americans for Prosperity’s spending, much of that funding went directly to gigantic television and digital ad buys, again hitting Strickland’s tax policies.

In Wisconsin, Americans for Prosperity has spent $66,560 in opposition to Democratic Senate candidate Russ Feingold in his race against incumbent Republican Sen. Ron Johnson. Freedom Partners Action Fund’s spending in that same race, meanwhile, totals $2,102,645 in independent expenditures to oppose Feingold. The latter group also spent another $5,500 in support of Johnson.

However, just after Johnson spoke at the Republican National Convention in late July, Freedom Partners Action Fund pulled the $2.2 million worth of airtime they had reserved for the candidate. The ads were slated to begin airing on August 3.

James Davis, speaking on behalf of the organization, claimed the decision did not mean the group was no longer backing Johnson. “We are realigning our television advertising strategy to ensure maximum impact across key Senate races,” Davis told the Huffington Post. “We will continue direct citizen outreach through our grassroots activists, volunteer phone calls, digital media and direct mail. Last weekend alone Network grassroots organizations made almost half a million contact attempts to targeted audiences.”

Americans for Prosperity has thus far spent $63,233 in Pennsylvania’s key Senate race opposing Democratic candidate Katie McGinty, who is running against incumbent Sen. Pat Toomey (R), while Freedom Partners has spent $3,518,492 in independent expenditures doing the same.

And in Nevada, Americans for Prosperity has spent $16,074 opposing Democratic candidate Catherine Cortez Masto, who is running against Republican Rep. Joe Heck for the seat being vacated by Senate Minority Leader Harry Reid (D). Freedom Partners Action Fund has thus far spent $3,899,545 there opposing Cortez Masto. The group used much of that money pushing ads which were deemed by fact-checkers to be “mostly false,” alleging that as attorney general of the state, Cortez Masto had killed jobs by “driving” Uber out of Nevada. In truth, said Politifact, Uber only left temporarily and the ad “takes things out of context.”


Though the Kochs have seemingly failed to put much effort into House races thus far through Americans for Prosperity and the Freedom Partners Action Fund, there have been a few notable exceptions.

In early July, Americans for Prosperity geared up to launch a campaign aimed at aiding the re-election of Rep. Mike Coffman (R-CO), according to the Washington Post. The organization is reportedly not investing in paid media for the race, but it will be sending hundreds of staffers out to spread its message door to door. The Post reported that the 501(c)(4)’s goal in Colorado is to “help preserve the Republican majority by targeting districts where [Americans for Prosperity] already has staff and resources and can most efficiently affect voting outcomes, according to the group.” The group expects to spend six figures in the Colorado race.

Americans for Prosperity has already spent $62,384 thus far opposing the Democratic candidate for the House, state Sen. Morgan Carroll, in her race against Coffman.

The nonpartisan Rothenberg & Gonzales Political Report, which analyzes U.S. House, Senate, and gubernatorial campaigns, rates the Colorado 6th Congressional District as a toss-up, though it leans Republican.

Earlier in the year, Americans for Prosperity also spent $190,973 to defeat Rep. Renee Ellmers (R-NC) in her failed bid for re-election. Ellmers lost her primary race for North Carolina’s 2nd Congressional District in early June to her Republican colleague Rep. George Holding after redistricting in the state led the two to run against each other. Her defeat came amid targeting from anti-choice groups looking to unseat the representative despite her opposition to abortion, for reportedly speaking out against language in the House of Representatives’ 2015 20-week abortion ban that would have required rape victims to formally report their assault to police in order to be exempted from the law.

Koch Industries Inc. Political Action Committee (KOCHPAC), the political action committee for Koch companies, has invested almost all of its $1,209,900 in contributions to House Republican candidates. In total, the PAC has given $1,050,900 to 165 Republicans running for House seats and $8,500 to Democrats. The group has also given a total of $181,500 to 23 different Republicans running for the Senate, including Sen. Kelly Ayotte (NH), Sen. Marco Rubio (FL), Sen. Rand Paul (KY), Sen. Roy Blunt (MO), and Sen. Mike Lee (UT).

What was outlined above is probably just the tip of the iceberg. In addition to other Koch-connected groups not listed here, there are likely also other forms of spending by the groups discussed that has gone undisclosed.

Take, for example, some of the Kochs’ state-level work. As the Brennan Center for Justice explained in a recent report on money in politics, “it is at the state and local levels that secret spending is arguably at its most damaging,” and that is where the Kochs are now shifting some of their attention.

Though “dark money” 501(c)(4) groups, including Americans for Prosperity, are not required to disclose all of their spending, media reports indicate that the organization’s affiliates are investing in local races. According to the Brennan Center’s analysis of six states with available spending data, “on average, only 29 percent of outside spending was fully transparent in 2014 in the states we examined, sharply down from 76 percent in 2006.”  Yet, the report notes, “dark money surged in these states by 38 times on average between 2006 and 2014.”

Exact numbers may be elusive, but there is no doubt the Kochs will have major influence on the 2016 election cycle. According to Rewire‘s analysis, spending from just three of the key Koch groupsFreedom Partners Action Fund, Americans for Prosperity, and KOCHPAChas already occurred in congressional races in 43 states across the country. Given the network’s penchant for funding anti-choice politicians and causes, that’s something that should deeply concern reproductive rights advocates.

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