By Christine Vestal
Stateline.org

Less than a year after low-income Arkansans started receiving health coverage under the Affordable Care Act’s controversial Medicaid expansion, the state is declaring its so-called “private option” experiment a success.

In Indiana…
Indiana Gov. Mike Pence has asked federal officials for permission to extend the Healthy Indiana Plan in place of a traditional Medicaid expansion.

The Indiana proposal could cover as many as 350,000 non-disabled adults ages 19-64 who earn between 23 percent and 138 percent of the federal poverty level. In 2014, that means a maximum income of $16,105 annually for an individual and $32,913 for a family of four.

The plan would require some participants to pay a deductible or fee to participate, which has raised questions among federal officials who are reviewing the proposal.

Hospitals saw fewer uninsured patients, state coffers were spared millions in health care costs and private insurers reported record-low premium hikes. Most important, Arkansas’ uninsured rate fell from 23 percent to 12 percent, the sharpest drop in the country.
But lawmakers in Arkansas, where Gov. Mike Beebe is a Democrat and the legislature is controlled by Republicans, have already asked the federal government for adjustments to their groundbreaking plan, under which Arkansans used Medicaid dollars to purchase private health insurance on the insurance exchange created under the ACA. Meanwhile, other states are customizing their own alternative approaches to expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty level ($16,105 for an individual).

“It’s an iterative process,” said Matt Salo, director of the National Association of Medicaid Directors. “States are probing the defenses of the HHS (U.S. Department of Health and Human Services) fortress to see what they can get approved,” he said.

Ever since the U.S. Supreme Court made the federal health law’s Medicaid expansion optional for states, the debate over expansion has become a proxy for supporting or opposing Obamacare.

After the November elections, more states are expected to reconsider their largely political decisions to pass up millions in federal dollars that can be used to improve the health of their residents.

“This is a fight within the Republican party,” said Joan Alker, director of Georgetown University’s Center for Children and Families. “After the election, when governors and lawmakers feel less threatened, we should see more movement,” she said. Alker and others cite Idaho, Montana, Nebraska and Florida as possible converts.

So far, 28 states and the District of Columbia have decided to expand Medicaid and 22 have not. Of the 28 states that have expanded the federal-state program, 19 have Democratic governors and nine – Indiana, Iowa, Michigan, Nevada, New Jersey, New Mexico, North Dakota, Ohio and Pennsylvania – are led by Republicans.

Jennifer Nelson for www.theindianalawyer.com

The Indiana Court of Appeals, after skirting around the issue in 2012, decided that Indiana should use the case-by-case approach to address subrogation claims of landlords’ insurers against negligent tenants.

Tennant Hillary Mannia caused nearly $750,000 in damages to Summer Place Apartments when a fire started resulting from her disposal of cigarettes on a balcony. After the fire, the apartment’s insurance company, Greater New York Mutual Insurance Co., filed an insurance subrogation action in the name of LBM Realty LLC, which owned the apartments. Mannia filed for summary judgment, asking the trial court to adopt a no-subrogation rule, citing Sutton v. Jondahl, 532 P.2d 478 (Okla. Ct. App. 1975), which would preclude the complaint against her.

Sutton stands for the proposition that absent an express agreement in the lease to the contrary, landlord and tenant are considered co-insureds under a landlord’s fire-insurance policy; the insurer, therefore, has no right of subrogation against the tenant to recover payments made under the insurance policy due to fire loss, even if the fire is caused by the tenant’s negligence.

The trial court adopted the rule and applied it, which led to the grant of her motion to dismiss. LBM appealed, and the COA reversed and remanded without adopting any approach.

Now, two years later, the appeals court has decided that the case-by-case approach should be adopted.

“Having considered the range of possible approaches, we conclude that Indiana should hereby adopt the largely case-by-case approach, finding that a tenant’s liability to the landlord’s insurer for damage-causing negligence depends on the reasonable expectations of the parties to the lease as ascertained from the lease as a whole and any other admissible evidence,” Chief Judge Nancy Vaidik wrote. “Although the case-by-case approach is said to provide less predictability than either the pro- or no-subrogation approaches, we find that this approach best effectuates the intent of the parties by simply enforcing the terms of their lease. In determining the expectations of the parties as articulated in the lease, courts should look for evidence indicating which party agreed to bear the risk of loss for a particular type of damage.”

“However, with regard to tenants in a multiunit dwelling, we find that absent clear notice—ideally in the form of an unambiguous, enforceable lease provision—that a negligent tenant will be held liable for damages to areas of the building beyond the tenant’s leased premises, such liability would not be within the tenant’s reasonable expectations and is therefore barred. This approach also avoids the unreasonable expectation and economic waste of requiring every tenant in a multiunit apartment building policy to carry insurance coverage adequate to cover damage to the entire building, particularly when the landlord presumably already maintains such coverage.”

The judges affirmed that summary judgment was properly granted to the extent the $742,402.86 insurance claim is for damages to areas beyond the leased premises because based on the lease, Mannia was not on notice that she would be liable for damage caused by negligence to areas of the multiunit apartment building beyond the lease premises. But summary judgment was inappropriate with respect to damage to the lease premises. They ordered on remand for the trial court to engage in the analysis of the case-by-case approach.

The case is LBM Realty, LLC, d/b/a Summer Place Apartments, an Indiana Corporation v. Hillary Mannia, an Indiana Resident, 71A03-1402-PL-66.

By  Jake Grovum

Without Social Security, the poverty rate among senior citizens in the U.S. would be more than 50 percent; instead, it’s just 14.6 percent.

For people of all ages, food stamps cut the poverty rate by about 10 percent, and they reduce poverty among those under 18 by even more than that. And refundable tax credits, many of which help the working poor, reduce the poverty rate among children by more than a quarter.

That’s the power of the safety net, as shown by new U.S. Census Bureau data measuring poverty in America. The federal poverty rate is based solely on income—for 2013, it was $23,624 for a family of four. But the so-called Supplemental Poverty Measure, released this month, adjusts income to account for the value of housing subsidies, the Earned Income Tax Credit, Temporary Assistance for Needy Families (also known as welfare), Social Security, food stamps (formally known as the Supplemental Nutrition Assistance Program) and other programs.

While it’s difficult to discern how much each program reduced poverty in each state, it is possible to calculate the extent to which people in each state benefit from some of the primary safety net programs. (See Stateline’s data visualization.)

The U.S. supplemental poverty rate in 2013 was 15.5 percent, the census found, equal to 48.7 million Americans. That rate was higher than the official poverty measure — which was 14.6 percent, or 45.8 million.

For individual states, the rates are an average of rates from 2011, 2012 and 2013. Thirteen states and the District of Columbia were poorer under the supplemental measure than under the official one. California had the largest gap between its supplemental and official poverty rates, followed by Hawaii, New Jersey, Florida, Nevada, Maryland, Virginia, the District, Massachusetts, New Hampshire, Connecticut, Alaska, New York and Illinois.

In 26 states, the poverty rate was lower under the supplemental measure than it was under the official measure. The states with the biggest differences were New Mexico, Mississippi, Kentucky, West Virginia, Montana, Idaho, South Dakota and Oklahoma.

The census analysis illuminates the extent to which individual programs cut the poverty rate, by calculating what the poverty rate would have been without the benefit. For example, without Social Security, the poverty rate would have been nine percentage points higher among all Americans.

National school lunch programs reduced the child poverty rate by one percentage point. Even relatively small programs, such as the Low Income Home Energy Assistance Program, which on average pays about $500 per household, left a dent.

Tax credits are a powerful anti-poverty measure. The most well-known is the Earned Income Tax Credit (EITC), a refundable tax credit for low- to moderate-income working individuals and couples and totaled more than more than $65 billion last year. Many states have similar credits that piggyback on the federal one but aren’t included in the federal data.

Mississippi claimed more than $1 billion in EITC dollars. Mississippi taxpayers who received it got an average of $2,817, compared to the national average of $2,300. Vermont recipients had the lowest average payment, at just under $1,900.

The impact that a benefit has on a state’s overall poverty rate largely depends on the number of state residents who receive it. In West Virginia, for example, nearly one in four residents is on Social Security. Last year, West Virginia received a total of $524 million in Social Security payments, or $282 per capita. In Alaska, only one in 10 residents receives Social Security. In that state, Social Security payments totaled $97 million, or $133 per capita.

The benefits of food stamps also vary by state: States with high percentages of their populations enrolled, like Mississippi, saw more than $330 in food stamp payments per capita. In Wyoming, it was less than $100 per capita.

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.