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1. Not everybody under the FPL is Medicaid-eligible. In fact, most people aren't.
2. It's a misunderstanding that states bear all of the costs of the expansion. It is still a fund-matching program, with contributions by both the state and federal governments. The plan was that the federal government would cover 100% of the expansion costs for the first three years, then 90% until 2020. After that, the regular matching formula applies. It is not just being "dumped" on the states to fund.
In my opinion, states that rejected the expansion are shooting themselves, and the country, in the foot. The taxpayers will continue to pay for write-off of healthcare costs incurred by the poorest (and often sickest) citizens. It looks good on the surface, politically, to reject the expansion in red states...but it's a stupid and costly move.
Well, it depends.
If a state was covering everyone it could before, almost the entire increase the feds will cover, so not taking it would be shooting themselves in the foot. However, if a state had stricter requirements before, the gap between those and the old max isn't almost all covered so there's some loss and need to make choices there. The red states are much more likely to fall into the latter camp than the blue, so it's somewhat less of a no-brainer for them -- not to mention the concern that it could be hard to roll back after 2020. I'm not saying they are right to not expand, just that it isn't so black and white.
For the country on the other hand, people with coverage incur substantially more medical care than similar people who are uninsured so to claim it will be payed for regardless and be "costly" for the nation more broadly is the opposite of what what occurs in practice. See: http://www.columbia.edu/~tg2370/ande..._uninsured.pdf
1. Not everybody under the FPL is Medicaid-eligible. In fact, most people aren't.
2. It's a misunderstanding that states bear all of the costs of the expansion. It is still a fund-matching program, with contributions by both the state and federal governments. The plan was that the federal government would cover 100% of the expansion costs for the first three years, then 90% until 2020. After that, the regular matching formula applies. It is not just being dumped on the states to fund.
In my opinion, states that rejected the expansion are shooting themselves, and the country, in the foot. The taxpayers will continue to pay for write-off of healthcare costs incurred by the poorest (and often sickest) citizens, but with no control or oversight that Medicaid expansion would provide. It looks good on the surface, politically, to reject the expansion in red states...but it's a stupid and costly move.
And what exactly do you think will happen in 2020 when the regular matching formula for state contributions kick in.
You see, this is like the equivalent of a interest only home loan. It's an good deal for states for 3 years. Than states will be required to chip in a bit for 3 years. But what happens in 2020 when they gotta support all those new people on medicaid?
What's California going to do in 2020? What's New York going to do in 2020. To pay for all these new medicaid enrollees with the regular federal/state formula. Raise taxes again? Isn't California already at 13% state income taxes for the wealthy already thanks to prop 30?
We have got to think long term. State governors don't want their states to be on be hook for billions of unfunded medicaid enrollees.
The states' do not have to take over the Medicaid expansion. Once the feds stop or reduce funding the states can drop coverage.
A significant fraction of them will not be eligible for the subsidies in the ACA. Their Republican "representatives" have dealt them a cruel blow by not taking part in the medicaid expansion that was built in for the poorest in the ACA.
And what exactly do you think will happen in 2020 when the regular matching formula for state contributions kick in.
You see, this is like the equivalent of a interest only home loan. It's an good deal for states for 3 years. Than states will be required to chip in a bit for 3 years. But what happens in 2020 when they gotta support all those new people on medicaid?
What's California going to do in 2020? What's New York going to do in 2020. To pay for all these new medicaid enrollees with the regular federal/state formula. Raise taxes again? Isn't California already at 13% state income taxes for the wealthy already thanks to prop 30?
We have got to think long term. State governors don't want their states to be on be hook for billions of unfunded medicaid enrollees.
Hillary will be president and at the rate Pubs are doing themselves in, the Dems will have a large majority in both Houses of Congress and a liberal Court. Can you say single-payer?
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Quote:
Originally Posted by Goodnight
The cost of Medicaid is an issue but how will the people living above the threshold for Medicaid but below the income threshold for ACA get health care not presently available. Meanwhile almost all republican controlled states refused Medicaid Expansion to cover this segment of the uninsured poor.
As far as I know, in my state anyway - which didn't expand medicaid, if a person falls in that gap then they aren't required to get insurance under the ACA, and they won't be fined for not having insurance.
Quote:
Originally Posted by Slithytoves
1. Not everybody under the FPL is Medicaid-eligible. In fact, most people aren't.
Completely agree.
2. It's a misunderstanding that states bear all of the costs of the expansion. It is still a fund-matching program, with contributions by both the state and federal governments. The plan was that the federal government would cover 100% of the expansion costs for the first three years, then 90% until 2020. After that, the regular matching formula applies. It is not just being dumped on the states to fund.
In my opinion, states that rejected the expansion are shooting themselves, and the country, in the foot. The taxpayers will continue to pay for write-off of healthcare costs incurred by the poorest (and often sickest) citizens, but with no control or oversight that Medicaid expansion would provide. It looks good on the surface, politically, to reject the expansion in red states...but it's a stupid and costly move.
Those that fall in the gap will continue to do what they're doing now - either not seek medical treatment, or, receive medical treatment but default on what they owe, and probably end up filing bankruptcy on it.
They will continue to go to Hospital emergency rooms for their healthcare.
Hey I wonder if there has been academic research done that looked at a group of people who suddenly gained or lost insurance and sees if the same person will have more Hospital emergency room visits if insured or unisured?
Result from the first page when you google "uninsured medical utilization:"
"Abstract
Substantial uncertainty exists regarding the causal effect of health insurance on the utilization
of care. Most studies cannot determine whether the large differences in healthcare utilization
between the insured and the uninsured are due to insurance status or to other unobserved
differences between the two groups. In this paper, we exploit a sharp change in insurance
coverage rates that results from young adults “aging out” of their parents’ insurance plans to
estimate the effect of insurance coverage on the utilization of emergency department (ED)
and inpatient services. Using a census of emergency department records and hospital
discharge records from seven states, we find that aging out results in an abrupt 5 to 8
percentage point reduction in the probability of having health insurance. We find that not
having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in
inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely
to reductions in the care provided by privately owned hospitals, with particularly large
reductions at for profit hospitals. The results indicate that recently enacted health insurance
coverage expansions may result in a substantial increase in ED visits and hospital inpatient
visits for currently uninsured young adults. "
If a state was covering everyone it could before, almost the entire increase the feds will cover, so not taking it would be shooting themselves in the foot. However, if a state had stricter requirements before, the gap between those and the old max isn't almost all covered so there's some loss and need to make choices there. The red states are much more likely to fall into the latter camp than the blue, so it's somewhat less of a no-brainer for them -- not to mention the concern that it could be hard to roll back after 2020. I'm not saying they are right to not expand, just that it isn't so black and white.
For the country on the other hand, people with coverage incur substantially more medical care than similar people who are uninsured so to claim it will be payed for regardless and be "costly" for the nation more broadly is the opposite of what what occurs in practice. See: http://www.columbia.edu/~tg2370/ande..._uninsured.pdf
Thanks for the insights. It seems, though, that most states who rejected expansion have had strict requirements, and the result has been an uninsured populace that doesn't seek care until they are very ill...which ends up costing a great deal. When people don't utilize healthcare, it's no bargain in the long run. Expansion of Medicaid would give the poorest people access to routine care that would help avoid hospitalization costs, and would give them access to places other than emergency rooms when they have an illness or injury that could be treated at a regular clinic/doctor's office. That's where the savings comes in. The write-offs in SC, where I live, are astronomical. But of course, we rejected the expansion.
Re the rollback issue...I wonder if states wouldn't be so keen on a rollback once they saw the benefits of the expansion. Since they do have the rollback option, it seems counterintuitive not to try the plan.
Hillary will be president and at the rate Pubs are doing themselves in, the Dems will have a large majority in both Houses of Congress and a liberal Court. Can you say single-payer?
Single payer will likely happen regardless of hiliary because the ACA is designed to fail.
People will get fed up with the ACA. It not cheap. Millions will still end up without insurance.
The only real issue with single payer and it's a huge issue is how to pay for it. Germany is facing huge pressures trying to control its own health care cost. It recently had to raise individual taxes for health care to I believe 8.5%? And employers still need to kick in 7%. That's a total of 15.5% of taxes from employer and employee to pay for single payer.
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