Thursday, October 17, 2013

Prediction for states opting out of Medicaid


"About 5.2 million poor, [non-illegal immigrant status] uninsured adults will fall into the “coverage gap,” created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
These people are projected to have incomes too high to qualify for their state’s existing Medicaid programs, but below the federal poverty level (nearly $11,500 for an individual) required to be eligible for federal subsidies to buy private coverage on the new online insurance marketplaces set up by the Affordable Care Act. Medicaid is the state-federal health insurance program for the poor."

"The law provides full federal funding for three years to states that expand Medicaid to cover residents under 138 percent of the poverty level (or just under $15,900 for an individual). But the Supreme Court made that requirement effectively optional for states, and most Republican led-states have opted against expanding the program."

"Nearly half of the uninsured in the coverage gap live in Texas (1 million), Florida (763,980) and Georgia (409,350) — largely because those states have the most uninsured and limited Medicaid eligibility today."


I imagine there will be an attempt at national shaming of these states as incidents of lack of care are brought to attention, Will theses states cave, or will they establish some sort of in-state insurance coverage? 


33 comments:

Icepick said...

Florida is on its way to being a blue state. The only reason Republicans dominate the state government is because the state-wide elections are held out of sync with Presidential elections, and lots of Democratic voters don't seem to know or care an election is on unless a Presidential election heads the ticket.

So for now, Republicans dominate at the state level. But they're eventually going to start caving on this issue as electoral pressures mount. Give it until 2017 at the latest, perhaps as early as 2015 if the President gets the amnesty he wants. We got a lot of Mexican peasants in Florida.

test said...

No they aren't going to cave. They're going to pray all the uninsured move to California, or at least that future unskilled immigrants will choose Cal over TX because of this.

bagoh20 said...

That's one side of the decision, Marshal, but the jobs are mostly in Texas, so they will get the ones that want to work, and California will get the ones who want the benefits, which we supply in bounty.


Give me your lazy, your poor,
your welfare cases yearning to live for free,
The wretched refuse of your broken values.
Send these, the shameless, regulation-tost to me,
I lift my windmill beside the golden calf!

test said...

bagoh20 said...
That's one side of the decision, Marshal, but the jobs are mostly in Texas, so they will get the ones that want to work, and California will get the ones who want the benefits, which we supply in bounty.


It's win-win.

edutcher said...

If you want to encourage a behavior, subsidize it.

Aridog said...

These people are projected to have incomes too high to qualify for their state’s existing Medicaid programs, but below the federal poverty level (nearly $11,500 for an individual) required to be eligible for federal subsidies to buy private coverage on the new online insurance marketplaces set up by the Affordable Care Act.

Not much of a subsidy in that shit. So where is all the new tax money going to go?

test said...

Aridog said...
Not much of a subsidy in that shit. So where is all the new tax money going to go?


I think this is misleading. I think subsidies are offered up to 400% of the PL, or
roughly $45k.

Joe Biden, America's Putin said...

I see the media will slip past the fact that ObamaCare website doesn't
work and jump right into all the satellite distractions.

Joe Biden, America's Putin said...

It's too bad the opportunity to fix health care using the free market has been by-passed. Now we have tax payer subsidized care, and a multi-billion dollar government system that doesn't work.

At least Obama's donors and cronies continue to stuff their pockets.

Aridog said...

Marshal said...

I think this is misleading. I think subsidies are offered up to 400% of the PL, or
roughly $45k.


That's what I thought, too, from other resources, however that is not what the NBC piece said.

Now I am curious. I would like to see a scale of subsidy amounts available at various steps between the PL and the 400% mark. Here's my homework to find out. Table 1 therein is a start.

Paddy O said...

Don't underestimate California's ability to muck things up. The coverage system here is good on paper but it's a mess in practice. We were wading into this as our brokered insurance was mandated to end, but there wasn't clear steps yet to replace it.

What we saw was very daunting. In a way, not unlike tax brackets, people at certain levels would be better served by making less money, not taking jobs, so as to get health care. So, less tax base to provide health care to more people, with everyone paying much more if they do work.

Fortunately, God answered our prayers, and I got a job with benefits starting on the 1st. It's only a 1 year contract, but that might be enough to get past the initial mess.

If California doesn't address this, and people are confronted with broken systems that hit home finally, it's a great place to pull back from our Blue destiny. Though, the state republicans are like the entrenched Republicans in the US Congress. Happy to be in the minority as long as they hold onto their little pieces of power.

bagoh20 said...

The sad thing about that, April, is that almost anything else we did would have been better in every way. We ended up with probably the worst system possible. Even though I'm totally against it, I think single payer would be better than this.

I do partly fault the Republicans that were around for not fixing some of the things that were wrong with the old system when they could have. Those problems seem so minor now compared to the ones ahead with this monstrosity or government stupidity.

It's gonna be a slow motion burn of painful realizations for our citizens that dominates the news for years, at least on Fox anyway. The other media will be spending time on the inner conflicts of the Republican Party, and racism, racism, racism.

bagoh20 said...

I expect Obamacare to be the worst thing that ever happened to the Democratic Party, but I still wish it would get repealed. As attractive as it is that the Democrats will implode over it, it's just not worth the cost to our people.

AllenS said...

While I agree that it's just not worth the cost to our people. There's should be a lesson there for the people to be more careful whom they elect.

Unfortunately, that isn't going to happen. This country appears to be on a slow but steady decline, and I see no way to stop it.

William said...

A serious illness is inherently dramatic. If the sick person has no insurance and goes broke paying for his care, then that adds more strings to the adagio. Try dramatizing the plight of a twenty seven year old who can't afford a car because his insurance premiums are too high.

William said...

A serious illness is inherently dramatic. If the sick person has no insurance and goes broke paying for his care, then that adds more strings to the adagio. Try dramatizing the plight of a twenty seven year old who can't afford a car because his insurance premiums are too high.

edutcher said...

This is the same cycle we saw with 20 years of FDR and Harry Truman and yet the Democrat rule did end and they had the same sort of low info (ie low intellect) voters we have today. Things just have to get bad enough - and I think we're seeing the beginning of that.

As for repealing ChoomCare, Prohibition was an amendment and that was repealed.

Aridog said...

bagoh20 said ...

Even though I'm totally against it, I think single payer would be better than this.

In my opinion, that is precisely the design intent of the ACA. It is designed to suck so bad that even sane people will favor single payer.

There's that and the simple phenomena discussed on Chip Ahoy's prior thread about how animals react to "subsidy" so to speak...once begun, it is nearly impossible to stop it. Thus, this mess leads us inexorably to single payer.

The was a simpler method, with government as overseer, but not provider, similar to workman's compensation insurance, but mandated and collected where absent similar to unemployment insurance.

AllenS said...

Yeah, who wouldn't want a single payer health care system from a government that can't live within it's own means? A government who cannot balance it's own checkbook.

Joe Biden, America's Putin said...

I fear single payer more than anything. We will all have to ask permission from the government and then wait in line and possibly die before life-saving treatments will be allowed. And it will be 100% tax payer subsidized, which means the economy will drag on like a wounded animal.

Like the horrid and cruel NHS system in Britain.

Other than that, I totally agree, Bagoh, the republicans missed many an opportunity to change health insurance and health care for the better. They could have worked on a plan to buttress the system we have now with more free-market competition thus lowering costs and expanding access in a real way.
Like removing the employer-health insurance link and allowing individuals to carry insurance with them from job to job, and allowing insurance to be purchased across state lines.
These ideas were bandied about but let us remember that the Democrat's live and breathe to push us down the road to a socialized system. Any real reforms would have been met with fierce resistance from the left.
Like, for example, all attempts to fix and sure-up social security. All ideas were/are met with harsh mindless vilification by the radical left. As if the radical left know anything about actual economics outside of their 2+2=5 Orwellian weirdness.
Another example is when the left insisted Fannie and Freddie. were stable. Riiight.
It's a shame the R's don't fight like the D's do when they hold the cards of power.

deborah said...

Marshal:
"No they aren't going to cave. They're going to pray all the uninsured move to California, or at least that future unskilled immigrants will choose Cal over TX because of this."

Interesting.

Aridog said...

AprilApple said...

I fear single payer more than anything.

Those of us in the USA over 65 have no choice, but we are allowed to buy private health care supplemental insurance. In some cases the supplemental coverage is partially subsidized by a former employer. Never-the-less, once past 65 and on Medicare your coverage will be constrained to the degree that medical facilities are unsure of federal ruling on payments...and that is an everyday occurrence.

Another feature, for those who live in "No-fault" automobile insurance states, look for 22 to 25% increases in your premiums, due to the medical liability portion of said n-f insurance.

My auto insurance just increased by roughly 24% and the carrier insists it is medical coverage related. Period...but can't/won't provide details. I shopped 6 major carriers to see if it was common...every one of them had the same impact. This for a driver with no tickets, no accidents, no nothing for over 20 years ...the issue is all about future medical cost escalation. Period.

Don't bother with a carrier who comes in at $400 or so under everyone else...that is a bait and switch outfit and your policy will leap upwards in 6 months or at your renewal time.

Rabel said...

I'm surprised that I did not know about the "coverage gap" and the fact that if you make less than 100% of the poverty level but make too much to qualify for your states' Medicaid program - you do not qualify for the tax credit subsidies.

According to Kaiser 5 million people will fall into this gap. I guess it is something that neither side wanted to publicize.

Pelosi was right.

Methadras said...

I've already highlighted easy solutions that didn't require ACA and I think there may have been a republican plan or two were similar in what I proposed that were summarily ignored by Reid and Pelosi at the time, so there you go. It's there way or no way.

Methadras said...

A nice treatise on the basic illegality of private health insurance in Canada from 2001. Which is exactly what is going to happen with single payer when it rears its ugly head. People are fucked with ACA.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/

Methadras said...

Also an opposing point of view from 2011. Very interesting stuff to read.

http://blogs.theprovince.com/2011/12/15/marvin-storrow-banning-private-health-care-is-likely-illegal/

Leland said...

Texas maligned by the national media?

Texans expect it like the sun rising in the east.

I Have Misplaced My Pants said...

No they aren't going to cave. They're going to pray all the uninsured move to California, or at least that future unskilled immigrants will choose Cal over TX because of this.

From your lips to God's ears.

Rick Perry won't cave. Greg Abbott (who is smiling at me from his wheelchair, cradling a rifle, on the cover of Texas Monthly in my reading basket) won't cave. Good thing Abortion Barbie doesn't have a chance in hell at the big office in Austin.

I Have Misplaced My Pants said...

No they aren't going to cave. They're going to pray all the uninsured move to California, or at least that future unskilled immigrants will choose Cal over TX because of this.

From your lips to God's ears.

Rick Perry won't cave. Greg Abbott (who is smiling at me from his wheelchair, cradling a rifle, on the cover of Texas Monthly in my reading basket) won't cave. Good thing Abortion Barbie doesn't have a chance in hell at the big office in Austin.

deborah said...

I think it's interesting that states' rights are protected.

deborah said...

Meth, thanks for the links, I'll check them out soon.

Chip Ahoy said...

Why must it be federal?

My own situation worked out well but not because I made wise healthcare choices. No. I'm a dummkopf, I would not have purchased it. I was young and impervious, indestructible, and I'd use the money for a 100 more interesting urgencies. Yet having it saved my life. Repeatedly. I would not be here without it.

I know people who are not here without it. Actually, I don't know their situation, I know people who died with great healthcare so it's all very confusing to me.

I know people without healthcare who have lived a very long time with very serious self-destructive tendencies and with state medicade, but that is Colorado. [One guy showed me his x-ray. Scattered pick-up sticks inside there, patched all over the place. Horrifying. Jumped from a 4 stories. A psychological mess.]

So for the first time ever my group premium went down 7% after steadily rising for years without interruption. Why?

I am one who drags the group down. Yet my rates went down significantly.

It means they planned wisely, there were not so many claims, that more people joined our group. Perhaps more families signed up, more spouses, more part-time employees signed up due to the chaos outside.

Eh?

So why must it be federal? There would be pre-existing conditions among the newbies to the group. FRB hires handicapped. I knew deaf people there. Others too. There were hiring quotas that would affect group insurance. Yet for the very first time premiums went down. And that's nothing to blow mucus out of your nose about, I meant nothing to sneeze about. So. Local. Regional. That is the way to go. Federal is too easily manipulated by *moves in to whisper* PARTY !111!1

deborah said...

I don't think it does need to be federal. I think I read here or there that the central govt will pay 100% of any state's medicaid expansion to cover more poor, for three years only. Then what?

I think it's good the states get to experiment with the care of their own poor, to see if it will work better than Medicaid. A state like Texas will probably turn out better in the long run because businesses will go there due to more lax regulation.