Reluctance in Some States Over Medicaid Expansion

[dkf]

While upholding the most hotly debated part of the health care overhaul law — a requirement that most Americans have health insurance or pay a penalty — the Supreme Court said in its ruling on Thursday that states did not have to expand Medicaid as Congress had intended — leaving a huge question mark over the law’s mechanism for providing coverage to 17 million of the poorest people.

In writing the law, Congress assumed that the poorest uninsured people would gain coverage through Medicaid, while many people with higher incomes would receive federal subsidies to buy private insurance. Now, poor people who live in a state that refuses to expand its Medicaid program will find themselves in a predicament, unable to obtain either Medicaid or subsidies.

That potential gap will probably lead to ferocious statehouse battles in the coming year, as states weigh whether to accept billions of dollars in federal aid to pay for expanded coverage. The health care industry, sensing the skepticism in some states, is preparing a campaign to persuade state officials to accept the money for coverage of the uninsured.

But already, governors in Kansas, Nebraska and South Carolina, among other states, have said they would have difficulty affording even the comparatively small share of costs that states would eventually have to pay.

http://www.nytimes.com/2012/06/30/us/politics/some-states-reluctant-over-medicaid-expansion.html?_r=1&pagewanted=all&pagewanted=print

[NightWatcher]

1. Reluctance? pRick Scott in Florida said, screw you we aint doin it

he then stroked his hairless chin and laughed about the election he was going to help steal in November

[banned from Kos]

2. No state will raise taxes to support expanded Medicaid.

Even California.

The governor and assembly will have to shift costs around.

[Ruby the Liberal]

3. I know that I have a very dim view on most Americans

when it comes to making informed choices at the polls, but this one is a no brainer.

Medicaid is a federal program. The Feds are funding this 100% the first 2 years and 90% the year after that. ALL Americans are paying for it.

So what are these numb-nuts Governors going to tell their citizens - you are paying for it, but there will be no benefits, that goes to other states?

Sadly, yes - that IS what they are going to say, and half of the citizens of this country will vote them right back in anyway.



Edit - that should have read "Medicaid expansion is a federal program".

[pinto]

5. Good points.

[dkf]

6. They should have kept it at 100%.

Of course they thought they had the threat of withholding Medicaid funds to states so they thought the cost benefit would be even more obvious.

If the Federal Government couldn't afford the extra 10% then why can the states? Offering what is basically a teaser rate isn't good either.

[EFerrari]

14. This was Roberts' poison pill. n/t

[SickOfTheOnePct]

21. Yep, and it potentially reaches far beyond Medicaid

The federal government has long imposed its will on states regarding any number of issues by threatening to cut off all funding for related items, i.e., raising the drinking age to 21, and I believe lowering the level that constitutes drunk driving.

SCOTUS has now ruled that such a choice is no choice at all, and I anticipate that states will use this argument to push back against any such issues in the future.

[pinto]

4. Gov. Dave Heineman of Nebraska (R) calls it "unfunded". Doesn't expansion include Fed block grants

to help cover costs of insuring low income residents via Medicaid?

[elleng]

8. This is where Dems, POTUS, Sebelius must step in, NOW,

and explain, in no uncertain terms, how this works.

Is the Times correct?

'Now, poor people who live in a state that refuses to expand its Medicaid program will find themselves in a predicament, unable to obtain either Medicaid or subsidies.'

[PoliticAverse]

16. The bill is written assuming the expansion of Medicaid will cover most up to 133% of poverty level,

but it does include subsidies for those below 133% of the federal poverty level who aren't eligible for
Medicaid. Here is the approximate maximum premium table:

[elleng]

18. Thought so.

Thanks.

Should Times 'correct' its statement? Or emphasize that its up to the refusednik states to explain to their constituents???

[dkf]

9. In the end 10% is left to the states to cover.

[pinto]

10. I'd like to see estimates of what that 10% is expected to cover. Children already get Medicaid,

the disabled and those over 65 are covered under Medicare. It would be more upfront to the debate, imo, if Governors offered some fairly specific estimates. The CBO may have some data, I'd guess.

[PoliticAverse]

23. Medicaid expansion map by state...

http://www.propublica.org/special/state-by-state-how-health-reform-could-expand-medicaid
http://news.yahoo.com/blogs/ticket/map-where-obamacare-expand-medicaid-most-175400889.html

[pinto]

32. Thanks.

[Wounded Bear]

36. Nice map....note on my state, Washington...

Our AG, Rob McKenna, joined the Repub band wagon in the law suit, over the objection of the governor and most of the assembly. He's now running for governor. The Seattle Times endorsed him, but I won't.

We are a traditionally blue state in Pres elections, but not as progressive locally as I'd like in some ways.

Hopefully, the Dem opponent hammers him on this. Our State Basic Health system was pretty good for a while, and was even at one time touted as a model for other states. Predictably, it's been under attack the last few years. An infusion of Federal funds would help immeasurably. Raising the eligibility would help people like me, struggling along in low end jobs, with marginal access. If not for the VA, I'd be totally screwed.

[msongs]

7. let the red state voters demand health care from the people they elected....

you get what you vote for

[Fawke Em]

34. Judging from the map above, there were quite a few

blue states who sued, as well.

My red state didn't even join the fray.

[MineralMan]

11. The states that are objecting already have terrible Medicaid programs.

It's intentional, I think. The philosophy seems to be something like, "Well if we don't give those poor folks (wink, wink, nudge, nudge) that kind of free entitlement stuff, maybe they'll pack up and leave our state. We don't want their kind here anyhow."

Substitute your own word for "poor folks."

[kentuck]

12. Run ads in those states.

Point out to the people that their Governor has decided that their children do not deserve medical care if they get sick. For 3 years, it was going to cost them nothing. Let him know what you think.

[Fawke Em]

31. Tennessee here... and I already saw an ad.

It ran during the Martin Bashir program on THE DAY the ruling came down.

[davepdx]

13. On Saturday's "Up with Chris Hayes" I saw a different perspective

There was a Medicare/Medicaid expert on who made the point that in the first couple years the Federal Government would be paying 100% of the bill for the new program and then over X number of years (I don't remember the details) the portion of the cost paid by the Federal Government would reduce from 100% to 90%.

The expert made the point that the same number of people would be requiring health services with or without participating in the program. He said that the hospitals would be demanding that the state take the money and to not leave that large chunk of money on the table. He said the same pattern of bravado and bluster by the nay-sayers occurred when Medicaid was going online and that eventually all the states complied. Let's hope this is the case.

[SickOfTheOnePct]

15. What should the states cut out of their budgets to pay for their portion? n/t

[proud2BlibKansan]

17. In Kansas, corporations pay no taxes

So we could start by taxing them.

[davepdx]

20. Those will be extremely tough choices and will vary from state to state.

I suspect that there will probably need to be a combinations of cuts and new sources of revenue. I have no definitive answer for your question. I was merely trying to make the point that the Medicare/Medicaid expert made that in these states (that refuse the federal funds) when the gravely ill come into the emergency rooms they are going to have to be treated. Emergency Room treatment is, in general, the most expensive type of treatment. The hospitals will have to treat them, absorb the cost and the hospitals would then end up driving the state legislatures into action.

[SickOfTheOnePct]

27. I agree 100%

But I think in the states that have already decided they won't do it, hospitals will do what they've always done - increase rates for the insured to cover their losses on the uninsured.

One of a couple of reasons that premiums will be continue to rise.

[davepdx]

30. I wonder how much they can effectively raise rates though?

I wonder how much they can effectively raise rates though?

They can raise rates but would they really get any more reimbursement fromt he insurance corporations?

The only people who pay full boat are the uninsured. Health insurance plans are contracted and used to pay what would be a fractional percentage of hospital charges. I don't have any recent first hand experience with insurance reimbursements as I haven't worked in a hospital since 1997. At that time the insurance corporations seemed to be dictating what they would pay. The hospitals were put in a take it or leave it situation when it came to contracting with a health plan. I'd think that sticking the insurance corporations with a heavier bill would be even tougher today. I could be wrong though.

[kestrel91316]

19. Reluctance my ass. They are in open defiance, saying they REFUSE.

They ain't gonna join up in any damned commie plots, by gum. They will then go pave some commie roads.

[elleng]

22. Right, has nothing to do with 'reluctance' for financial reasons,

ESPECIALLY because Feds pay 100% up front.

[SickOfTheOnePct]

24. I agree that finances are probably not the primary reason

But 100% up front doesn't mean a thing down the line when they're left to pay the 10%, which will be billions over the years.

[dkf]

26. That's the teaser rate. They should have kept it 100%.

[elleng]

28. Wouldn't matter to the haters,

and 80 or 90% in the future still pretty good, especially assuming economy will improve down the road.

[dkf]

33. The economy isn't going to recover very strongly.

There is pretty anemic growth projected.

[elleng]

37. Yes but I said 'down the road,'

and I mean far enough down that states will be in good enough shape to not be forced to 'eat their young.' As with most legislation, this part is, I think, a decent plan for the future. But as I've said, haters will be haters. Citizens w/in the refusednik states will have to recognise that. (I'm not optimistic.)

[dkf]

38. They are about to change the way states account for pensions.

States will be in worse shape soon.

http://www.moneynews.com/Economy/State-Pension-us-economy/2012/06/25/id/443351

[SickOfTheOnePct]

25. If you're speaking of the Medicaid expansion I wouldn't call it defiance

Since they aren't required to do it.

[elleng]

29. Defying logic, reason, and the best interests of their constuents.

I call it defiance.

[Fawke Em]

35. They're afraid it will start working and work so well

that people will eventually demand the Medicare-for-all option.

It's not financial.

It's not that setting up the exchanges is hard or even an unfunded mandate.

It's that once people become educated and start seeing actual rates vs. subsidies vs. Medicare, they will begin the demand for single payer and the insurance companies lose.

Period.

[Life Long Dem]

39. Howard Dean: It's 'gubernatorial malpractice' not to accept Medicaid funds

"This is just stupidity if governors refuse this," said Dean, who served as governor of Vermont and came close to capturing the Democratic presidential nomination in 2004. "Because not only does it boost their healthcare sector and insure a lot of people, it raises their gross domestic product, because it increases spending by the private sector and the hospital sector in every aspect of the state's economy."

http://leanforward.msnbc.msn.com/_news/2012/07/02/12531684-howard-dean-its-gubernatorial-malpractice-not-to-accept-medicaid-funds?lite