General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsStates can opt out of Medicaid expansion, citizens must buy x, and that's a progressive victory?
Sorry, I'm short on glee right about now. I'd rather they kept the teeth on the Medicaid expansion and did away with the individual mandate.
FarLeftFist
(6,161 posts)conditions, etc. I'm sure we all know the good parts.
Luminous Animal
(27,310 posts)FarLeftFist
(6,161 posts)Luminous Animal
(27,310 posts)And I have no idea what you mean by ability to pay only premiums. What? Where in the bill does it protect against bankruptcy? Massachusetts system, which is very similar to ACA, still has the same rate of medical bankruptcy as the rest of the nation.
Oh, and by the way, my family would not qualify for any exchange or subsidy. We currently pay $19,956 a year for a family of three for insurance coverage. We were actually turned down for a home loan because our insurance costs are so high. It's killing us.
So, where is this affordable insurance of which you speak?
FarLeftFist
(6,161 posts)Last edited Thu Jun 28, 2012, 10:16 PM - Edit history (1)
Also, with health exchanges & cost-sharing you may want to eventually switch providers. Not to mention that with more people buying insurance premiums should go down.
SickOfTheOnePct
(7,290 posts)Most people that file medical bankruptcy have insurance, and it isn't just the lifetime cap that gets them, it's the co-pays and payments for treatments not covered by insurance.
Nothing in this bill change any of that. There will most likely be fewer bankruptcies due to medical bills, but it's still going to happen.
This is the beginning, not the end.
Schema Thing
(10,283 posts)SickOfTheOnePct
(7,290 posts)Or is it just an opinion?
Schema Thing
(10,283 posts)Most families will be able to "afford" the out-of-pocket. Won't be easy in a bad year, and not all will be able to make it, but most will manage.
jeff47
(26,549 posts)A state can fail to set up an exchange. If they do so, the feds set up their exchange for them.
That's only true if you're covered by employer-based insurance, and that premium sounds like you may not be covered by your employer. If you are not covered by a plan from your employer, you "qualify" for the exchanges.
Well, the exchanges won't exist until 2014, since Congress wanted to reduce the short-term cost of the bill. So it's a tad premature to expect the exchanges to lower cost.
Schema Thing
(10,283 posts)Hoyt
(54,770 posts)Unless you are just in some high cost area, I think there's something in the ACA that will help you. Hope so.
girl gone mad
(20,634 posts)A lot of wishful thinking going on today.
FarLeftFist
(6,161 posts)girl gone mad
(20,634 posts)will still very much exist.
Many people here, yourself included, seem to believe that insurers can no longer deny claims or kick people off of their plans, both of which are completely false.
FarLeftFist
(6,161 posts)girl gone mad
(20,634 posts)because we decided not to help millions so that corporations can continue to reap massive profits. We could have gotten a lot of the good things in this bill without the huge downside.
dionysus
(26,467 posts)nothing is ever going to magically wipe out the medical insurance companies in one fell swoop.
wishful thinking is believeingthat if the scotus overturned the ACA that somehow single payer will whoosh in and save the day...
msongs
(67,509 posts)HopeHoops
(47,675 posts)Zalatix
(8,994 posts)Trekologer
(1,002 posts)Citizen: So you're saying that you could have expanded Medicaid coverage to me and my family and it wouldn't have cost the state anything for the first 3 years because the Federal government would have paid for all of it and even after that the Federal government still pays at least 90%?
Zalatix
(8,994 posts)Knowing those troglodytes, the Koch Brothers and their gang will re-indoctrinate them and they'll fight with renewed vigor for their right to be ripped off.
It's been that way in some of those GOP-controlled states forever.
liberalmuse
(18,672 posts)It's a victory for all the people with pre-existing conditions, and it's a step forward to ensuring all Americans have access to affordable healthcare. As a long time progressive, I have learned to appreciate any step forward, especially since Reagan.
HopeHoops
(47,675 posts)Luminous Animal
(27,310 posts)She was covered under Healthy San Francisco at $49 a month. Once ACA passed, Healthy San Francisco kicked her out of the program because they said that since she could now be covered under my insurance, she was not eligible any more. Now I pay $235 for her insurance. That brings the total for this family of three to $1663 a month. It's killing us.
SickOfTheOnePct
(7,290 posts)I also expect to see businesses begin to drop dependent coverage.
I'm not against expanding coverage, I just wish that people would be realistic about the costs.
progress2k12nbynd
(221 posts)But I wouldn't expect much response from DUers. Too busy cheerleading to actually check the real score of the game.
Lasher
(27,686 posts)Deductibles and copays are killing me as well. And I've got a better setup than most. My health insurance isn't too bad if I never need health care.
Scootaloo
(25,699 posts)treestar
(82,383 posts)It would be in their fine print, written in before the ACA.
HopeHoops
(47,675 posts)Something's screwy here. Other than catastrophic coverage (which would definitely be cheaper than $1663), the standard is a choice between individual (the one working) and individual plus family, regardless of how many kids you have. They shouldn't be charging you extra to add your daughter to a family plan you already have. What insurance company do you have?
tblue
(16,350 posts)You really don't hear a lot of griping out of them. And they're not exactly the shy, silent type.
I think they're delighted with this bill and they gave Roberts the directive to let it stand with the mandate.
The part about Medicaid is not good and kind of makes a mess of things.
Medicare for All would be so much better. Sigh.
EFerrari
(163,986 posts)So Roberts found a way for the insurance industry to hold off serving a high risk pool for a while until Congress can get it together.
NYC Liberal
(20,140 posts)Honeycombe8
(37,648 posts)You have to buy some minimum coverage, and there are a lot of options.
If you qualify for Medicaid, the mandate doesn't apply to you. If you get ins. thru your employer, like most people, the mandate doesn't apply to you. If you are a senior, the mandate doesn't apply to you.
If you are one of the working poor, the mandate applies...and you will get govt assistance to buy some minimum of coverage.
If you are a decently paid middle class person/family, the mandate is for YOU. Since you can afford it but refuse to buy it, that can officially be called a deadbeat position, since you expect OTHER PEOPLE to pay for what you can afford possibly even more than the people who will have to pay your bills.
That is reasonable. And it's a step in the right direction, toward universal coverage.
EFerrari
(163,986 posts)jeff47
(26,549 posts)The decision was that the Feds can only take away the new money for Medicaid expansion. The feds can't take away the old money they were already providing for current level of Medicaid.
EFerrari
(163,986 posts)jeff47
(26,549 posts)So, could you give me 0 dollars then? I'll take it as 250,000 $20 bills.
Honeycombe8
(37,648 posts)Can that be true?
Autumn
(45,120 posts)If they did lose funding for opting out, that would be incentive but they do not lose any funding.
Honeycombe8
(37,648 posts)Autumn
(45,120 posts)Feds can withhold the funds for the medicaid expansion. They can not withhold funds for the current level of medicaid.
SickOfTheOnePct
(7,290 posts)In fact, it saves them billions in the long run.
This isn't a win for people that make too much for Medicaid but not enough for premium subsidies.
ProSense
(116,464 posts)"It doesn't cost states anything if they opt out of the Medicaid expansion
In fact, it saves them billions in the long run. "
It doesn't cost them any existing Medicaid funding, but don't get the additional funding unless they abide by the law.
http://www.scotusblog.com/2012/06/court-holds-that-states-have-choice-whether-to-join-medicaid-expansion/
Also, the government is funding nearly the entire cost of the expansion so states aren't liable for "billions."
Federal Government Will Pick Up Nearly All Costs of Health Reforms Medicaid Expansion
http://www.democraticunderground.com/1002496395
SickOfTheOnePct
(7,290 posts)But getting $900,000 in funding to cover $1 million in costs is a losing proposition, fiscally speaking.
And, you're wrong, states that opt out will save billions in the future. That's just simple math.
Luminous Animal
(27,310 posts)ProSense
(116,464 posts)And, you're wrong, states that opt out will save billions in the future. That's just simple math.
For example: $1 million minus $900,000 would result in an exposure of $1 million over 10 years.
"Billions"?
What's the cost to a state for denying access to health care coverage for a segment of its population?
My guess is that these states are engaged in political posturing.
SickOfTheOnePct
(7,290 posts)I didn't think that I actually had to state that the $1 million figure was used as an example due to the nice, round numbers involved.
Mississippi is one of the first states to come out and say they most likely won't opt in. Savings over 10 years estimated at $1.7 billion. And that's a pretty small state.
So yes, I stand by my claim that opt-out states will save billions in the long run.
ProSense
(116,464 posts)...you believed that?
<...>
House Speaker Philip Gunn, R-Clinton, said in a statement that the federal health care law could be "a budget-buster for our state." Republican Lt. Gov. Tate Reeves said adding 400,000 people to Medicaid would cost about $1.7 billion over 10 years.
http://www.sfgate.com/news/article/Miss-Medicaid-expansion-unlikely-GOP-leaders-say-3671131.php
Texas Medicaid Director: 91 Percent Of Texans Will Have Insurance If State Implements Obamacare (February)
http://www.democraticunderground.com/1002360864
SickOfTheOnePct
(7,290 posts)Or did you forget to post a link?
FarLeftFist
(6,161 posts)procedures. There is also preventative care measures. Savings also come from having less people get sick costing billions over decades.
SickOfTheOnePct
(7,290 posts)The hospitals and doctors do, through higher prices for the insured.
jeff47
(26,549 posts)Declining the expansion is a losing proposition because the same people will get broke enough to qualify for current Medicaid, and their care will cost more.
Lionessa
(3,894 posts)jeff47
(26,549 posts)'Cause they have to offer Medicaid to poor children, pregnant women and the elderly to get any federal funds.
JimDandy
(7,318 posts)Last edited Fri Jun 29, 2012, 01:24 AM - Edit history (1)
Because the ER mandate is still in place, with today's ruling, those who don't/can't buy health insurance will, in effect, be paying annual insurance premiums for ER care - via the IRS. Perhaps the government could even earmark for ER care all refunds the IRS seizes from individuals who don't pay the 'no health insurance penalty'. In fact, to get away from both the "this is a new tax" meme and the negative connotation of "penalty payment" the administration could instead label these payments as "Emergency Room Insurance Premiums".
dsc
(52,175 posts)Brown has said it would cost CA close to $3billion dollars over 6 years and Rendell says it would cost PA about $1.5billion over the same amount of time. While there would be some offsetting savings that aren't being counted the cost would still be billions.
Trekologer
(1,002 posts)Governor Brown signed California's $142.6B budget on Wednesday. The estimated cost for California would be an additional 0.35% of that budget.
Pennsylvania's budget (signed today) is $27.7B. The estimated cost would be an additional 0.9% of the budget.
dsc
(52,175 posts)in California that is about 16 billion and in pa it is about 300 million. Since both figures are for 6 years in California it is 500 b a year and in PA it is 250 million a year. In PA's case that is doubling their deficit.
Iggy
(1,418 posts)that's my understanding.
it's called providing an incentive. and it's called state's rights.
I assume the crafters of the ACA did this to deal with the crybaby GOP governors out there who want to
play politics with the money-- just like they did with the grant money for "high speed" rail.
go ahead. any governor dumb enough to do this will pay the price come election time.
SickOfTheOnePct
(7,290 posts)Then 90% after that. And yes, it is states' rights, as in states have the right now to opt out.
And I wouldn't be so sure that voters will vote out conservative governors and legislators that decide to opt out. They elected conservatives for a reason.
Iggy
(1,418 posts)yes, and part of that is due to the fact not enough democratic voters bothered to show up to vote
in 2010.
in fact, in 2009-2010 the Repuglican Governors Assoc. put together a plan and funding to defeat
ten democratic governors in key swing states. they succeeded in NINE of the states- including the
nightmare walker in WI, Snyder in Michigan, and Kasich in Ohio.
WTF?! Helloooo? now these governors have a say over any redistricting going on.
did the Democratic Governors Assoc. do anything to try to stop this?
Luminous Animal
(27,310 posts)currently receive for un-expanded Medicaid. In fact, states that opt out will save money by not offering expanded care because, even though the bulk of the funding for expanded Medicaid will be born by the Feds, the states are required to kick in a portion.
SickOfTheOnePct
(7,290 posts)loyalsister
(13,390 posts)West Virginia, Alabama, South Carolina..... Missouri was getting 70% + before the GOP took over the legislature. Now with the medicaid drawdown so much more money will be free to spend on other programs that are terribly underfunded
http://aspe.hhs.gov/health/fmapearly.htm
edited for afterthoughts.
jeff47
(26,549 posts)Leading to much more expensive care.
Declining the expansion saves money the same way that not paying your electric bill this month saves money.
loyalsister
(13,390 posts)Unless they go for those federal funds, the Dems can argue that they are driving up their state budgets.
SickOfTheOnePct
(7,290 posts)Paying 10% of something still costs more than paying 100% of nothing.
loyalsister
(13,390 posts)Especially with veterans needing services not provided by the VA, aging baby boomers, reduced incomes, etc. Making sure there are matching funds for the already natural expansion will provide some relief in state spending.
Notice how much the poorer states draw down from the federal government.
http://aspe.hhs.gov/health/fmapearly.htm
SickOfTheOnePct
(7,290 posts)It's funding for the expansion of the income limits that won't be funded, and since some states won't expand the income limits, they're still better off, in the long run.
I'm not saying it's right, it just is what it is.
sabrina 1
(62,325 posts)I know the far right has always maintained these people exist, but I've never been able to find them nor have they ever been able to introduce me to any of them. Why are we seeing this right wing meme here?
I KNOW people who have no insurance, and I can assure you that they would have it if they could afford it. I do not know a single person who can afford it who does not have it.
This is the third time today I asked for some statistics on this claim being thrown around. Not once have I received a response with back up for it.
44, 000 people die each year in the US because they have no insurance, I've asked this before, to no avail, so I"m trying again. Are you saying these people are 'dead beats' willing to die rather than pay for a policy? And if not, which age group are we talking about, men, women, working people, small businesses. Please clarify this statement you made because over the course of then years of hearing it from Rush Limbaugh et al, I have never seen one iota of evidence that these people exist.
rustydog
(9,186 posts)majority of premium payments on healthcare instead of ceo benefits...your college kids can remain on your insurance...small businesses can deduct insurance premiums on workers...there is so much more that is good with the law.
Why are so many people ready to throw the baby out with the bath water?
SickOfTheOnePct
(7,290 posts)If you make too much to qualify for Medicaid under current standards, but not enough to get premium subsidies, you're left out in the cold.
And don't be surprised to see employers drop dependent coverage.
ProSense
(116,464 posts)If you make too much to qualify for Medicaid under current standards, but not enough to get premium subsidies, you're left out in the cold.
...has nothing to do with the ruling. A "loss of for many poor people" implies that the law does something negative. That's not the case. It's a positive for many low-income Americans because it raises the income limits.
SCOTUS ruling on health care law a huge win for Medicaid
http://www.democraticunderground.com/1002868894
SickOfTheOnePct
(7,290 posts)If they can't get Medicaid, and they can't get premium subsidies, how is that not a loss?
FarLeftFist
(6,161 posts)Like saying feeding a million homeless people is a loss because you can't feed 1.3 million people.
SickOfTheOnePct
(7,290 posts)But it's certainly a loss for poor people that, prior to this ruling, would have been covered under Medicaid and now won't be.
Of course it's an overall win, but it's certainly a loss for people that still won't have coverage due to the ruling today.
There is also the potential that a state could, if they choose, contract their current Medicaid coverage in order to save even more money.
For example, (and for ProSense, these numbers are just examples, not real numbers), if a state is currently required to offer Medicaid to anyone that is at 100% of the poverty level, with a 57/43 federal/state split, then that state could, in theory, decide to only cover people at 75% of the poverty level. Doing so would obviously reduce their Medicaid rolls, thus saving the state $43,000 for every $100, 000 they were paying out in fees/costs.
Until today, doing so would risk the federal government cutting off all Medicaid funding. But today's ruling is clear that the threat of taking away all funding is no longer an option. So, what is to stop cash-strapped states from reducing the number of Medicaid recipients in order to save money?
Yes, today is an overall win, but there are many people that won't have the coverage that they would have had prior to the ruling.
SickOfTheOnePct
(7,290 posts)Now they don't. You don't consider that a loss for the people that yesterday could look forward to coverage and now can't?
Your definition of win v. loss is quite different than mine. In states that opt out (and why wouldn't they, there is no penalty or doing so, in fact, there is a financial incentive to opt out), there are many poor people that will now have no medical coverage. How is that not a loss?
ProSense
(116,464 posts)You're comparing apples to oranges.
The increased poverty limits are effective under the health care law. Nothing about Medicaid in its existing form changes. The rules for existing Medicaid still apply to that program.
The expanded program (increased poverty limits) is what cannot be used to determine a penalty.
SickOfTheOnePct
(7,290 posts)States do not have to accept the expanded poverty limits for Medicaid. Prior to today, refusing to expand Medicaid would result in loss of all Medicaid funding. The decision today overturned that part of the law.
States will still cover the people that are covered under current standards, but they are no longer required to either accept the expansion or lose all funding. As such, all of the people that would have been covered under the expansion will not be covered in states that opt out. And those same people won't qualify for premium subsidies, so they won't be able to afford insurance in the exchanges either.
It's a new donut hole fo the poor in states that opt out of the expansion.
How will those people get coverage?
ProSense
(116,464 posts)"States do not have to accept the expanded poverty limits for Medicaid. Prior to today, refusing to expand Medicaid would result in loss of all Medicaid funding. The decision today overturned that part of the law. "
...you do. As I said, you are talking about the law as it relates to the expansion and the penalty. For those states that opt out, they cannot be penalized for not implementing the expanded program. Still, that has nothing to do with the current criteria for non-expanded Medicaid, the traditional program.
SickOfTheOnePct
(7,290 posts)Why don't you tell me what effect you think this will have on people that looked forward to coverage prior to this ruling that will now not receive that coverage? You don't think it's a loss for them?
A win for most, yes, but we shouldn't deny the fact that it was a loss for many.
Riftaxe
(2,693 posts)Luminous Animal
(27,310 posts)GarroHorus
(1,055 posts)MADem
(135,425 posts)Autumn
(45,120 posts)MADem
(135,425 posts)shit on We The People quite decisively?
It's a victory, even if it isn't a complete one.
One step at a time.
No pleasing some people. Don't be sorry, though--go on and stew if it makes you happy.
usregimechange
(18,373 posts)MADem
(135,425 posts)AnotherMcIntosh
(11,064 posts)MADem
(135,425 posts)revision--and not a moment sooner.
AnotherMcIntosh
(11,064 posts)MADem
(135,425 posts)How very petulant.
You do realize we've been working to get this kind of health care coverage for well over HALF A CENTURY, don't you? Ted Kennedy died waiting on this day.
And you're whining that you didn't get your way at one crack?
Forgive me if I find your impatience and "One shot and I'm Out" attitude a bit tiresome.
If you put your shoulder to the wheel, be prepared to keep it there, year in, year out, for a long, long time. BTDT is for dilettantes.
AnotherMcIntosh
(11,064 posts)Not only are you wrong with respect to the rest of your post, there is no factual basis for you to say or imply that "we've been working to get" mandatory purchase of health insurance "for well over HALF A CENTURY." It's simply not true. There is no factual basis for that whatsoever.
There is no whining at all, unless you are doing the whining.
There is also no "One shot and I'm Out" attituted displayed at all. The fact that you seem to be somewhat annoyed by my responses seems to indicate the exact opposite. If you're annoyed, too bad.
MADem
(135,425 posts)Don't play the despair card and then get annoyed when I notice.
I'm not wrong with respect to any of my post, but think what you'd like. Gripe all you want. The only one you can bring down with your misery and carping is yourself.
Today is a good day for America.
AnotherMcIntosh
(11,064 posts)You say, "I am not the one who said "I tried ONCE ... in 2008." But so what? No one else did either.
You say, "Gripe all you want." I say, get a grip. I'm not griping.
You say, "The only one you can bring down with your misery and carping is yourself." I say, I'm not down. If you're engaging in carping and creating misery for yourself, too bad.
MADem
(135,425 posts)Nothing will harsh my mood today....not even Debbie Downers like yourself!!
I'm glad I don't have your "emotional" shitty attitude!
You have a good one, there, Sport.
Strive to be happy, and all that....
AnotherMcIntosh
(11,064 posts)You referred to an "'emotional' shitty attitude." That's your attitude, not mine.
MADem
(135,425 posts)AnotherMcIntosh
(11,064 posts)MADem
(135,425 posts)But you are having a comprehension issue, I fear. See, I don't care what you think and I don't care if you "agree" about something that, like it or not, has already happened. I don't have much regard for your opinions, so they matter not to me. The one who seems terribly annoyed at not being able to compel agreement is you! You'll get over it. It's just the internet.
Rosco T.
(6,496 posts).. the states won't provide, Medicare for all.
you watch.
jeff47
(26,549 posts)Hoyt
(54,770 posts)see that insurance companies are going to have to perform or they will wither and watch plans more popular among consumers flourish.
With the roadblocks faced, this legislation is pretty good. And it will get better.
But, if you still can't cheer anything -- think about the 30 million who don't have any coverage now who will finally have a chance. Think about those who lose their coverage being able to find new coverage because of removing the pre-existing BS. And, if they can't afford the new coverage, there will be subsidies.
bhikkhu
(10,728 posts)In mine, looking at the good beginnings they have, basically my family will get health insurance fully subsidized ( http://www.orhix.org/index.html ). As will most of my neighbors and most of the people I work with - this being a relatively poor area.
My family hasn't had any kind of health insurance since '03 and none of the guys I work with have either - and there is no underestimating the amount of underlying anxiety to that, knowing that a broken leg or a bad infection or anything internal would cost you your house and your job right away, and change the rest of your life (if it didn't simply end it).
Even if it work out that we have a monthly payment or a reasonable copays, its a huge difference.
progressivebydesign
(19,458 posts)EFerrari
(163,986 posts)MADem
(135,425 posts)One I don't think Bernie Sanders would endorse...
Now here's a guy who understands that it is flat out STUPID to make Perfect the enemy of Good.
girl gone mad
(20,634 posts)But at least it's not another bigoted comment about "freeloaders".
bowens43
(16,064 posts)but of course there is much more to it then your silly 'States can opt out of Medicaid expansion, citizens must buy x' nonsense.
loyalsister
(13,390 posts)as of 2004
_ Podiatrists' services
_ Optometrists' services and eyeglasses
_ Chiropractic services
_ Private duty nurses
_ Clinic services
_ Dental services
_ Physical therapy
_ Occupational therapy
_ Speech, hearing and language therapy
_ Prescribed drugs
_ Dentures
_ Prosthetic devices
_ Diagnostic services
_ Screening services
_ Preventive services
_ Rehabilitative services
_ Services for persons age 65 or older in mental institutions
_ Intermediate care facility services
_ Intermediate care facility services for persons with MR/DD and related conditions
_ Inpatient psychiatric services for persons under age 22
_ Christian Science schools
_ Nursing facility services for persons under age 21
_ Emergency hospital services
_ Personal care services
_ Hospice care
_ Case management services
_ Respiratory care services
Why in the world would the states reject funding to pick up what they are not covering when they are bailing out hospitals for indigent ER care, having their jails operating as mental institutions, putting financial pressure on counties and municipalities, etc?
Particularly those who advocate personal responsibility
loyalsister
(13,390 posts)A legislator told my friend she should (illegally) go ahead and drive despite her epilepsy. She said that she would love to see how much money he gets from insurance companies if he sponsors a bill to repeal the law that limits her ability to drive.
Similarly, watch how much insurance campaign contributions state legislators get if they opt out. Who do they want to pay what they won't? The same people we want to pay it "big government"