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Ezra Klein at Bloomberg runs through some of the political risks to GOP-controlled states conducting rearguard actions against the ACA, including an issue which hasn't received all that much coverage so far:
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Moreover, because Medicaid’s expansion was conceived in part as a new source of revenue for hospitals, Obamacare ratchets back payments -- called disproportionate share payments or DSH payments in health wonk parlance -- that the federal government makes to providers who treat the uninsured. Texas, for instance, received almost $1 billion in DSH payments in 2011. Under Obamacare, it will receive far less.
Warnings from the Right that Obamacare would be a disaster have been legion. Given the importance of DSH payments to the financial well-being of hospitals catering disproportionately to under- or uninsured populations, they might very well be right - but mostly or entirely in red states which prefer to die in the last ditch than accept the law.
The risk for the GOP, as Klein points out, is that the ACA may end up working just fine in blue states, leaving GOP politicians to explain to their own people why hospitals are closing, the uninsured still at the mercy of debt collectors for basic healthcare, and the state budget going begging for millions while other places "move forward into broad, sunlit uplands" of the new ACA health insurance regime.
The result might well satisfy ideological purists wedded to the 10th Amendment and genuine federalism: a two-track nation of dog-eat-dog, laissez-faire red states where the answer to getting health insurance is "enrichissez-vous". It might be harder for political animals, concerned less with ideological purity than re-election, to tolerate.
Of course, liberals might very well be happy that red states leave the money on the table. In a two-track nation, that federal money will probably end up being spent in blue states, helping to improve access to healthcare there and counter-balance the disproportionate federal spending in red states, mostly on military-industrial complex expenditures.
But that's not really the point of Klein's column. The question is whether GOP politicians will be able to explain the deal to their constituents: "you're going hungry because we're not taking the free lunch because we don't believe in taking free lunches so you're going hungry".
the problem is the fascist liberals dont understand costs
things cost money...and money we (as a federal governmnet) dont have
obama care will not save any money, will not make things cost less, will not get anybody covered that is not covered already because they cant afford insurance
and we cant afford singlepayer...at least not the """free 100% care""" that americans think tey are entitled to
the problem is the fascist liberals dont understand costs things cost money...and money we (as a federal governmnet) dont have
It isn't very likely that "liberal fascists" don't understand costs: there are some rather eminent economists among those "liberal fascists".
But suppose they really are liberal fascists, or rather, revolutionary Marxists. America as a whole clearly does have the money to pay for the federal expenditures provided for in the ACA - it would simply have to come from higher rates of taxation, probably on the top 5% of Americans whose incomes and fortunes have increased so remarkably in the last few decades.
I'd expect you to object to such an idea very strenuously, of course. But let's at least be clear that the money exists. Your side may be right when they say that higher taxes will ruin us - maybe so. But the money is there. So what we're really arguing isn't that "we don't have it" but that "we don't want to spend it".
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obama care will not save any money, will not make things cost less, will not get anybody covered that is not covered already because they cant afford insurance
That's an unproven hypothesis. But whether you're right or wrong, it is going to be tested.
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and we cant afford singlepayer
Another unproven hypothesis. And if you're right on both, then what? The old non-system, the pre-ACA status quo? Good luck.
Of course, liberals might very well be happy that red states leave the money on the table. In a two-track nation, that federal money will probably end up being spent in blue states, helping to improve access to healthcare there and counter-balance the disproportionate federal spending in red states, mostly on military-industrial complex expenditures.
But that's not really the point of Klein's column. The question is whether GOP politicians will be able to explain the deal to their constituents: "you're going hungry because we're not taking the free lunch because we don't believe in taking free lunches so you're going hungry".
Texas is on its second year of no Fed dollars. We've accepted it.
We've also accepted that Texas will not expand medicaid. The Fed is only subsidizing it for 2 years and then states have to fund it themselves.
You seem to think everyone wants everything Uncle Sam offers and that is not the case.
And if people don't like it they are free to move to states like CA who say yes to everything the Fed offers.
You seem to think everyone wants everything Uncle Sam offers and that is not the case.
I don't think that. It's quite clear the opposite is true. My interest here is the political implications for the party which rejects Uncle Sam's largesse.
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And if people don't like it they are free to move to states like CA who say yes to everything the Fed offers.
This is also plainly true. But again, there are implications for red-state economies, particular if it's not only labor-force mobility we're talking about, but also business investment. There will be incentives for companies to move their operations to blue states with functioning ACA-based health systems, if the ACA works as intended, notwithstanding other countervailing considerations such as low labor costs, tax rates, etc.
Texas said no to expanded medicaid. Texas also defunded PP and lost $39 million in Fed dollars.
You should be happy that Texas isn't taking Fed dollars.
Texas does take federal dollars - but instead of allocating them for what they are supposed to be used for, it uses them to "balance the budget" and give tax cuts to corporations.
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