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Today's Poll!States saying no to 'Obamacare' could see downside
Wednesday, July 18, 2012
WASHINGTON (AP) — For Gov. Rick Perry, saying "no" to the federal health care law could also mean turning away up to 1.3 million Texans, nearly half the uninsured people who could be newly eligible for coverage in his state.
Gov. Chris Christie not only would be saying "no" to President Barack Obama, but to as many as 245,000 uninsured New Jersey residents as well.
The Supreme Court's recent ruling gave governors new flexibility to reject what some Republicans deride as "Obamacare." But there's a downside, too.
States that reject the law's Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new "doughnut hole" — a reference to a Medicare gap faced by seniors.
Medicaid is a giant federal-state health insurance program for the poor, now mostly covering children, mothers and disabled people. The expansion in Obama's health care overhaul was originally expected to add roughly 15 million uninsured low-income people, mainly adults without children, who currently are not eligible in most states. Washington would pick up the entire cost for the first three years, with the federal share then dropping to 90 percent. The Medicaid expansion accounts for about half the total number of uninsured people projected to get coverage under the law.
If every state were to reject that Medicaid expansion — as the Supreme Court ruling now allows — some low-income people would still be picked up by other coverage provisions meant to help the middle class.
But nearly 11.5 million uninsured people below the federal poverty line would be left behind in a new coverage gap, according to recent estimates from the Urban Institute. That brings to mind the infamous "doughnut hole" in the Medicare prescription drug benefit, in which seniors with high drug costs find themselves paying out of pocket much of the year.
Those who fall into the new gap would neither qualify for Medicaid in their states under current rules nor be eligible for subsidized private insurance in new state marketplaces that Obama's law calls exchanges.
Low-income children and mothers would continue to have insurance through Medicaid. Then, starting in 2014, millions of people over the poverty line would have subsidized private coverage through the new exchanges. "And then this group in the middle has nothing," said Matt Salo, executive director of the National Association of Medicaid Directors. His organization takes no position on what states should do.
Things only get trickier from there.
Many states might actually go along with the Medicaid expansion.
"This is a lot of federal dollars that will lead to a lot of people having health care," said Salo. That means federal taxes from states opting out would be helping to subsidize coverage elsewhere.
And hospitals in opt-out states would still get hit with cuts programmed in the law under the assumption that every state would take the Medicaid expansion and fewer uninsured people would be needing charity care.
"You are still paying for that coverage expansion but not getting the benefit of it," said Herb Kuhn, president of the Missouri Hospital Association. "So you as a state are exporting your dollars to another state. If you have some adjoining state that accepts (the Medicaid expansion) then you are basically sending your dollars to your neighbor."
Kuhn's state is leaning against the expansion. Since the Supreme Court ruling last month, Republican leaders in at least 10 states have indicated they will reject or lean toward rejecting the Medicaid expansion. They cite a combination of reasons, including strained budgets, lack of confidence that Washington will honor its financial commitments in the long run and years of frustration with Medicaid mandates that limit state choices and shift costs from the federal government.
But other state officials are saying they will study their options and wait until after the November elections to decide. If Republican Mitt Romney wins the White House and starts dismantling Obama's law, opt-out states might not have to face the Medicaid doughnut hole. But the whole calculation changes if Obama is re-elected and his overhaul starts looking more and more like a done deal.
If that happens, some experts expect that states now refusing will try to cut deals with the federal government, angling for concessions on the expansion itself or the rest of their Medicaid programs.
"One of the things that happens in cases like these is negotiated settlements with specific states," said Dan Mendelson, president of Avalere Health, an analytical firm serving health care industry and government clients. "What I expect to happen here is that the federal government is going to be more flexible and allow states to do the expansion in ways that suit them."
It's hard to see that happening now. Opponents of the health care law are as adamant as ever, even after the Supreme Court upheld most of it, including the mandate that most Americans carry health insurance or pay a fine.
"I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government," Texas Gov. Perry said last week. About one-fourth of Texas residents are uninsured, the highest percentage of any state.
But John Hawkins, top lobbyist for the Texas Hospital Association, says his group isn't dropping the subject.
"We have told the governor we are willing to continue the discussion," said Hawkins. "It's hard to imagine how you get from here to there without accessing federal funds at some level."
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Comments
Graceful 11 months ago
Nothing like AP campaigning for Obama. Is there any doubt left that the AP is biased? It is worthless.
dokeus6 11 months ago
Nothing out of the Ordinary. Republicans are willing to leave the poor out on an island by themselves. The Almighty Christian Right who are blind to their fellow human beings. WWJD.
Sequoia 11 months ago
What about the "objective analysis" that shows that what you call "socialized medicine" is working well in Canada and northern European countries? If your theories were true, Canada and the Scandavian countries would all be doing poorly. How come they're not?
Sequoia 11 months ago
Is there a country you would call "capitalist" with a health care system that performs better than a country that you would call "socialist"?
Isn't it true that most all developed countries are a mixture of "socialism" and "capitalism," so that using either one of these words is about emotion than an accurate description of economic systems?
dokeus6 11 months ago
How can you consider the United States health care system the best?
Look at the stats(if you need help trying to figure them out grace I will walk you through them. I know how Republicans hate numbers except the ones that are in their bank accounts).
We pay almost double what other countries are paying for healthcare. Our mortality rates are lower than other countries .
Our nation is not about empowering everyone our nation has become all about empowering the sons and daughters of the wealthy so they can continue to put the rest of the country down. It's the Caste System all over again. You talk of sedition and hatred towards the government. WHO is running the government Grace. It's not the middle class I can guarantee that. It's the rich who are running this country into the ground and it hasn't happened in the last three and a half years like you think .
dokeus6 11 months ago
Well grace where i'm from the saying goes "In God we Trust, everyone else better bring numbers". So when you don't pay attention to stats, you lose my support for any argument you have. Stats are derived from real world situations.
dokeus6 11 months ago
Grace this situation is all about class warfare. The United States is all about class warfare. Or haven't you lived here the last 30 years?
JCLifer 11 months ago
Easy. Last two years of W. Bush's term, when Frank, Pelosi, and even Obama were in the legislature.
Sequoia 11 months ago
After reading Grace for a while, I'd bet Grace would say the dive started well before that. Probably the War of Northern Aggression.
Sequoia 11 months ago
Well, you know, back then if Republicans had tried to solve the problem with a real idea, instead of just calling everyone else's idea "socialism" and just saying no, no, no, then we might have gone that way. Their response to Medicare and Medicaid was exactly the same as their response to the ACA. Ignore the problem, then obstruct and demonize when the other side stepped up and made a decision.
The Republicans had plenty of chances to work on health care during the Bush years. Instead we got unfunded wars (and an unfunded Medicare program, BTW!), and none of them worried about the costs of those things. Now, Obama is trying to work on a problem that the Republicans avoided, and suddenly Republicans say the sky is falling. Funny, that.
If you don't solve the problem, someone else will. And you may not like what they do.
JCLifer 11 months ago
What is wrong with health care? We are talking about government (we taxpayers) paying for everyone else's costs. ObamaCare is all about income redistribution and is not about health care quality.
JCLifer 11 months ago
Oh my! Another Internet cop!
John 11 months ago
What OBJECTIVE analysis shows socialized medecine is working well in Canada and Northern Europe? You and you fellow supporters of ObamaCare keep writing that stuff but it simply is not true. I have lived in several different countries in Europe, in Norther New York (within a mile or so of the Canadian border), and in Canada. In every place I have lived I have heard horror story after horror story of the socialized medical programs. Canadians who have enough income and are close enough to the U.S. nearly always choose to travel to the U.S. if they are facing severe medical issues and Europeans in general, especially those in England, Denmark, and Norway constantly are vocal about long lead times to see doctors, long (exceeding 20 and 30 hours) waiting times in hospitals, etc. . .Now those are real cases, not imaginary to win an arguements. I have never visited a country with socialized medecine where the people were even close to being satisifed and in EVERY CASE they say things akin to, "I wish I had the money to travel to the states." The ONLY time I hear of folks wanting to travel outside of the U.S. for medical care is when someon wants to partake of a "radical" or unapproved procedure that is only available outside of the country.
Sequoia 11 months ago
The "horror stories" you "heard" are not an objective analysis, either. My good friend (a Marine from Oklahoma... no "liberal") lives in Canada and loves the health care system there. His wife has a lot of illness and a low-paying service job, so it works well for her too. Freedom from a health care plan attached to a corporate workplace has allowed him to work for himself, and it has allowed her to get the care she needs without going bankdrupt. These stories are just as valid as your stories.
The reason people don't travel to Canada from the U.S. is because they can't participate in the health care plan there, so why would they?
Don't confuse the issue: I'm not saying we don't have some of the best doctors. I'm saying our system of delivering decent care to the greatest number of people doesn't work as well as other countries.
If the health plans in those other countries are so unpopular, why do surveys from those countries indicate people support them?
theglobeandmail.com/life/health-and-fitness/canadians-happy-with-primary-health-care-study-says/article4216139/
A little research suggests that the self-serving stories you "heard" don't reflect the vast majority of the people.
Objective analysis is based on facts and data, such as the survey I cited, not on anecdotes which happen to re-inforce a belief you already hold.
Maybe you can cite some data. Otherwise, your stories are not persuasive.
Sequoia 11 months ago
Chill, Grace. John was the one with the anecdote.
I don't see that the survey was limited to just healthy people. I still haven't seen any data that there is a problem with people getting surgery.
His story actually points to a reason why Canada's system works, or maybe in your view, why it fails.
Our system actually incentivizes unneccessary, poorly-informed surgery over less expensive prevenative care. I'd argue we do too much surgery and too little prevention in the U.S.
The Canadian system actually favors basic care for many instead of deluxe care for the few. My view, and, I think, the Canadian view, is that people who want deluxe care can pay for it themselves, freeing up the system to provide more care, including preventative care, to everyone else.
If Richie Rich wants to fly to another country for deluxe surgery, great. But our system shouldn't focus on providing deluxe surgeries for Richie Rich paid for by third-party insurance companies that drive up all our costs with no incentive to hold down costs or avoid unneccessary procedures.
I guess that's called "rationing care." But I think that's okay. Rationing doesn't mean that deluxe care isn't available. It is, but you just have to pay for it yourself. Rationing means the system focuses on helping provide the basics in a cost-effective way.
Nobody is "prevented" from getting care. You just have to pay for it yourself.
dokeus6 11 months ago
Irrational? Irrational is speaking for 1.3 million people about denying them health care coverage because a democratic president wants to help the people of this country out. How come we can't achieve it Grace? Massachusetts is. You see failure in everything that is not a republican idea. Well Grace the ACA was a republican idea. You can't escape that fact.
newone 11 months ago
about as worthless as Fox News, if you can even call it news that is.....lol
newone 11 months ago
Unthinking? Really? Coming from someone who eats, drinks and sleeps by Fox New, who if they don't hear it from Fox New's then it most certainly can't be true.... Fox News is the most biase "news" there is.
newone 11 months ago
It is very obvious you are brain washed, I give up. lol
asb 11 months ago
The article seems to be laying out the consequences of medicaid expansion refusal, with no judgement and only fiscal details and analysis. This is how media and academia get on the bad side of the right, or any group that wants to keep a non-real image going. They present facts and explore reality, which violates the preferred view, and so they are attacked. Burn the books, shoot the reporters, hang the witch. The AP is hardly perfect, but remains the largest source of the most objective reporting and analysis in the world. The FRight would prefer the Taliban News Services (TNS).
TNS - "Polio Vaccine a Tool of Western Christian Campaign to Destroy Islam . . . and in other news, doctors and professors claiming vaccines are a godsend are sent to God . . . "
spelchek 11 months ago
You seem to forget that asb and others on here have no problem spending other people's money. No risk to them, so they use demagoguery as their weapon rather than putting the money where their collective mouths are.
dokeus6 11 months ago
So your idea is to keep the system that we have now in place? Where the poor people go to the emergency room and receive health care and the taxpayers pay for it Or we could have some of those that can afford insurance buy insurance and then they go to a medical doctor instead of the emergency room so we the taxpayers don't have to pay for those being treated anymore. Is this a correct ?
dokeus6 11 months ago
Just like Massachusetts?
LuckNLove 11 months ago
"Those that don't have insurance don't have it bec[au]se they can't affo[]rd. It consist mainly of youn[g] people that these don't have jobs."
Seriously? I'm not even sure I understand what you are saying but I'll try to reply as nicely as I can. As I said in my post below, that you so gracefully chimed in on, my sister (like many others) can’t afford health insurance because her current employer doesn’t offer it. She works 40 hours a week and makes too much to get assistance from the government so she is stuck in the middle.
The close minded attitude that seems to be storming the internet and social media is rather disappointing. Not everyone that can't afford health insurance is lazy and young, they are not as fortunate as you! The attitude that everyone is the same is so conservative, it is worthless. Whether you are taxed or charge an extensive premium, it is all the same. Besides with a tax at least you how much you are paying. Until we, as a country, focus to make our people stronger, smarter, healthier we will never be a nation at peace and will all pay for it.
LuckNLove 11 months ago
I can see how that could seem like a socialist idea but what I was going for is that we need to work together to be a stronger nation. I'm suggesting a little less confrontation and more understanding for others. With the diversity in our nation we as a society need to work toward accepting that our own standards are not the sole standard for every person. All I'm trying to say is we need to try to compromise more. I personally struggle with compromises every day. I don't like doing everything I have to do to get through a workday but once I do it, it is done and I move on. It is the only way to keep a job and stay sane... but I digress. I agree that parts of the health care reform have been corrupted but we have start somewhere. All major reforms are a uphill battle that are met with great upheaval but with time slowly balance out. All I'm saying is we need to give it time to show what it can/will do before striking it down. I can see where you are coming from and to be honest I personally, I don't what to pay for someone else’s mistakes, laziness, etc but I don't want to see others hurting either and I certainly don't want someone who has worked hard not get a much needed break that they deserve. Maybe the reform is a much needed break for many?
dokeus6 11 months ago
So, in your opinion Obama is a closet republican?
asb 11 months ago
I don't see bias in the article, I see numeric details and consequences spelled out, with no whining or finger pointing. I see no laughing. I don't even see those conseequences as signs that the present leaders of these states are heartless; rather that they're making a calculated move to show disagreement with ACA. Most of these states will likely find a way to care for their presently un-insured . . . failure to do so when a mechanism is available will get them unelected.
JCLifer 11 months ago
How is losing Medicaid funding a downside? If we lost a lot of Medicaide funding, it would just mean that more of these poor people would just move to other states and take their problems with them. The per-capita wealth of our state would rise.
Who wants to be king of the ghetto/trailer trash/welfare state? Let other states have that money and let them have the people,
JMO 11 months ago
"States that reject the law's Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new "doughnut hole" — a reference to a Medicare gap faced by seniors."
Sure, low income senior citizens have the ability and funds to pick up and move to another state, right?
JCLifer 11 months ago
So why are we trying to attract Young Professionals? Should we be trying to attract old poor people too? Our government and its priorities are so screwy and counter-productive. Which is it today?
JCLifer 11 months ago
We should not deport them, but if they want to leave on their own, that would be fine.
LuckNLove 11 months ago
I can't say that I completely agree with the Health Care Reform but since it has made it this far and we've been doing health care another way for so long, let’s just see how it plays out. It could be a good thing, it could be a bad thing but we don’t know for sure until we try it! Let’s stop fighting it and work together to make it succeed.
From my view, I work hard to earn money and health care and so does my sister but she isn’t as lucky as me to have a job that provides health care. She is a college graduate looking for the right job and needing severe back surgery… but until she lands that perfect American job she will be without. I CAN say without a doubt that she truly deserves health benefits but I suppose that view wouldn’t make me a Republican and since I don’t claim to be a Liberal, I guess I’m just a human.
LuckNLove 11 months ago
Grace, seriously, a slave to health care?... Maybe you are overreacting just a bit?
LuckNLove 11 months ago
Grace, My initial reaction about the health care was similar to yours. I thought about it, read about, listened to friends with benefits, listened to friends without, listened to my republican friends, liberal friends and decided the only thing I truly care about is the people. Not the politics, not the dog and pony show, not the pieces I dislike, not even the pieces I do like. For our country, health care reform is a revolution that is much needed. In the end, it is only my thoughts; take what you will. Although, I do hope that my beliefs and backing of this reform don’t tread too heavily on your wallet and freedom.
Sequoia 11 months ago
LuckNLove, I would say that a common sense view like yours makes you a true conservative... a dying breed, unfortunately, in the increasingly ideological Republican party, as evidence by Graceful's comment that access to health care for your sister amounts to slavery. Incredible! That's not "conservative." That's insane.
Speaking of fighting, this is what all true conservatives need to fight against. This is what this election will be about. Is affordable health care for working people an idea we need to work on and get right, or is it slavery? (In my view, only actual slavery is "slavery" Crazy, huh?).
I'm a big fan of Andrew Sullivan, one of the most prominent true conservatives who is trying to bring some sanity and common sense back into the Republican party. They don't listen to him, though. They call him a "liberal."
But he's not a "liberal." The vast majority of people who support Obama's effort to work on health care are not "liberals." We're just normal people. We don't care which party works on health care. Unfortunately, only one party is willing to do so right now.
Here's a nice piece he just wrote on why Mr. Sullivan supported both Reagan and Obama. It has everything to do with rejecting the party hype, and embracing the reality that is right in front of us.
andrewsullivan.thedailybeast.com/2012/07/why-obama-is-right.html?tw_p=twt
JCLifer 11 months ago
No one is talking about access to health care. We are talking about the government (taxpayers) paying for everyone's health care costs.
Sequoia 11 months ago
Actually, the ACA is about requiring people to buy insurance, pay some of their own costs, and get care before they have to get E.R. care that drives up costs for everyone. I think you know you're saying the incorrect thing on purpose.
And, come on. The health care you can't afford is the lowest-quality, most inaccessable health care there is.
LuckNLove 11 months ago
From my view, it seems that you are assuming that my sister wouldn’t be able to pay for her health insurance, if offered by her employer, so you (as a country) would have to pay for it. If so, I think you missed my point… What I’m expressing is there is a LOT of people who work every day but don’t have health insurance because the percentage of their income it takes to maintain health is too costly. My sister is just one example that I personally know who maintains a job but can’t afford it, just imagine the countless others.
JCLifer 11 months ago
"If you like your current plan, you can keep it!"
RobHunterJohnson 11 months ago
JC, I have been trying to keep it, now if they would just allow me to figure where it ill be in less than 6 years? Rob
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