General Discussion

Nuclear Unicorn

(19,497 posts) Thu Jun 28, 2012, 11:47 AM Jun 2012

Concerning the exchanges (or rather, lack thereof)

USSC says the feds cannot withdraw medicaid funding if the state declines to establish an exchange --

The court did find one part of the law unconstitutional, saying its expansion of the federal-state Medicaid program threatened states' existing funding. The court ruled that the federal government can't put sanctions on states' existing Medicaid funding if the states decline to go along with the Medicaid expansion.

http://online.wsj.com/article/SB10001424052702304898704577480371370927862.html?mod=WSJ_hpp_LEFTTopStories

OK, but suppose you work for a company and that company decides that a $1,600 tax is cheaper than a $5,000 insurance policy? So companies start unloading policies. Where do the people go?

You aren't going to get the non-coverage tax raised in this congress. The insurance companies are going to lose revenue. The consumers aren't going to have an alternative.

Please feel free to tell me how I'm wrong.

10 replies

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Concerning the exchanges (or rather, lack thereof) (Original Post) Nuclear Unicorn Jun 2012 OP

I was also wondering about that scenario phantom power Jun 2012 #1

er... your comment says one thing Schema Thing Jun 2012 #2

The idea appears to be Nuclear Unicorn Jun 2012 #3

maybe I'm wrong, but I don't think the exchanges are tied to Medicaid at all. Schema Thing Jun 2012 #4

The Medicaid expansion and the exchanges are separate Nuclear Unicorn Jun 2012 #5

I don't think it's tied to the state failing to establish an exchange Schema Thing Jun 2012 #10

The feds will establish the exchanges if the states don't. Nothing to do with Medicaid. rgbecker Jun 2012 #6

Fed Exchange = Medicare for All Rosco T. Jun 2012 #8

This opens the door for Medicare for all... Rosco T. Jun 2012 #7

Or maybe the insurance companies will be deemed Nuclear Unicorn Jun 2012 #9

phantom power

(25,966 posts)

1. I was also wondering about that scenario

Reply to Nuclear Unicorn (Original post)

Thu Jun 28, 2012, 11:50 AM

Jun 2012

Schema Thing

(10,283 posts)

2. er... your comment says one thing

Reply to Nuclear Unicorn (Original post)

Thu Jun 28, 2012, 11:50 AM

Jun 2012

and the paragraph you quote says something entirely different.

The exchanges have nothing to do with Medicaid expansion (or lack thereof), except that both things are part of the 2700 page umbrella of the ACA.

Nuclear Unicorn

(19,497 posts)

3. The idea appears to be

Reply to Schema Thing (Reply #2)

Thu Jun 28, 2012, 12:01 PM

Jun 2012

that if a state declined to establish an exchange they would forfeit Medicaid funding. But now that has been ruled unconstitutional. So if a state declines to establish an exchange there is -- currently -- no way to enforce their compliance. But the rest remains intact. So employers can dump people into exchanges that don't exist at a cost savings to them and the feds can't force the exchanges into existence by threatening to withhold Medicaid funding.

So where will exchanges come from if some states choose to be -- shall we say -- recalcitrant? (Or perhaps I judge red states too harshly.)

Schema Thing

(10,283 posts)

4. maybe I'm wrong, but I don't think the exchanges are tied to Medicaid at all.

Reply to Nuclear Unicorn (Reply #3)

Thu Jun 28, 2012, 01:37 PM

Jun 2012

I think you've conflated two separate things, Medicaid expansion and the exchanges.

Nuclear Unicorn

(19,497 posts)

5. The Medicaid expansion and the exchanges are separate

Reply to Schema Thing (Reply #4)

Thu Jun 28, 2012, 01:58 PM

Jun 2012

You're absolutely correct in this but there was a loss of ALL Medicaid funding if a state failed to establish an exchange. That was the "enforcement clause," if such a clunky expression can be forgiven.

So, back to my ponderings --

-- IF an employer has a net savings by dumping coverage and

-- IF a state has no exchange and

-- IF an employee doesn't qualify for Medicaid (because -- you know -- they're employed)

Then where do they go for coverage?

Schema Thing

(10,283 posts)

10. I don't think it's tied to the state failing to establish an exchange

Reply to Nuclear Unicorn (Reply #5)

Thu Jun 28, 2012, 07:06 PM

Jun 2012

The medicaid funding was to be lost if the state refused to expand Medicaid as the law request.

rgbecker

(4,836 posts)

6. The feds will establish the exchanges if the states don't. Nothing to do with Medicaid.

Reply to Nuclear Unicorn (Reply #3)

Thu Jun 28, 2012, 02:06 PM

Jun 2012

The problem of employers dumping people into the market place on their own is a question of whether the employers see an advantage to offering to pay for insurance to get good employees or not. If they don't, of course, the employees have the right to find their own insurance or another employer. Will the insurance be too expensive? There will be no reason to expect the employers will get insurance any cheaper than the employee on their own thanks to the new standard being that all insurance companies have to provide the same minimum coverage and to everybody. The employers will have to decide whether to pay the penalty/tax for not providing coverage and losing employees or paying for insurance and being competitive for employees. Each industry will no doubt develope a standard, as now. Some businesses never offer insurance, some always do.