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It makes no sense that the poorest among us, if stuck in a heartless Red State that won't opt in for the Expanded Medicaid program, will be penalized with no Medicaid coverage.

So, if the FED is willing to pay 100% of Expanded Medicaid to states that opt in, then provide an online option for those trapped in the heartless states to sign up.

How hard is that to fix?

Then in 3 years when the FED drops its contribution to 90%, ask the health care providers to reduce the costs for these people by 10%.  It would be cheaper over time than the cost of them showing up in emergency rooms unable to pay.

Where is the logic?

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Comment Preferences

  •  Tip Jar (14+ / 0-)

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Thu Sep 26, 2013 at 07:54:19 AM PDT

  •  Doesn't that have to do with how medicare is... (4+ / 0-)
    Recommended by:
    jfromga, hnichols, Deep Texan, Sylv

    delivered?

    I'm not sure of the system in the US but I understood it to be that the Fed pays for certain coverages.  If the State refuses to provide those coverages, the Fed cuts the funding, but can't deliver that coverage in place of the State.

    Tax and Spend I can understand. I can even understand Borrow and Spend. But Borrow and give Billionaires tax cuts? That I have a problem with.

    by LiberalCanuck on Thu Sep 26, 2013 at 08:09:12 AM PDT

  •  Unfortunately (10+ / 0-)

    Medicaid is provided through the states; the feds just pay part of the cost (54% for regular Medicaid, 100% for the expansion).

    Covering people outside of the states would be a new program. Good luck getting that through the House.

  •  Law was not written that way (14+ / 0-)

    unfortunately.

    In the Obama Administration;s defense, no one in their right mind could have anticipated what the SCOTUS did.

  •  We can thank SCOTUS for this mess (12+ / 0-)

    For some reason the Supremes decided that the Fed could not take away all Medicaid funding (as was originally stated in the law) if the state refused to implement the ACA portion. That let the wingnuts play God with peoples' lives and their health without any down side for them. For some reason Medicaid is administered by the individual states with funding from the Feds and as far as I know there is no mechanism to get around this. Social Security and Medicare are completely independent of the states so I don't know why Medicaid is different.

    I wish it were not so but with the Tea Nuts firmly entrenched there is no way in hell this is going to change any time soon.

  •  My understanding of the STATED reason (5+ / 0-)

    is that, while the feds pick up all of the tab in 2014, the states would begin to pay some of the costs after that. And in the years after 2014, the feds could even further reduce the amount of the tab they were responsible for, shifting more costs to the states.  

    Thus, the STATED reason was that they did not want to commit to a program that (even though it would cost them nothing in the first year) long term could be very costly for that state.

    I'm sure that, for Republican governors, the fact that their actions would hurt the prospects for a smooth rollout of the ACA was an added plus.  

    •  That is why non-participating states opted out (1+ / 0-)
      Recommended by:
      Tonedevil

      It doesn't answer WoE's question, which restated is - why can't Fed simply have affected folks in non-participating states sign up for 100% Medicaid, with the Feds running the whole show?

      The answer to which as VcLib and others opine is simple.

      Medicaid is structured as a program administered at the state level.

      All the Fed does is help defray costs.

      So the planned work-around is unworkable in states who chose not to participate - for the stated reasons you correctly recall - in ACA legislated Medicaid expansion.

  •  Answer: hatred & fear (1+ / 0-)
    Recommended by:
    Deep Texan

    Hatred of the poor, of minorities, of President Obama.

    The other part is fear of federal power and centralization and becoming dependent on the federal government.  This shouldn't be discounted, for this fear of encroaching government has been a powerful strain in American political culture since the nation's inception.

    But it's also true that at least from about the late 1880s through the 1930s politicians from red states led the way in calling for and enacting legislation that broadened the scope of federal power to help the poor and ordinary Americans, and in offsetting the power of business and the wealthy.

    That all began to change in the 1940s, and this sentiment grew steadily over the following decades, accelerating in the mid-1960s with the passage of civil rights and anti-poverty legislation, and reaching its crescendo with the election and re-election of Ronald Reagan.

    The trigger in the South was clearly race - Southerners were fine with New Deal liberalism so long as its benefits were not extended to minorities in any significant way.  But it's not totally clear that race is what caused the anti-governmental shift in western and Midwestern red states.  I think race surely played some role, but it might also be related to genuine resentment and alarm over the rapid growth of federal power in the postwar period.  The Sagebrush Rebellion of the 1970s and 1980s, which was a resistance by western states to environmental regulations, was one such manifestation.  The 1978 taxpayer revolt in California (way back when the state was quite red) was another.

    So that's the long and short of why red states would be so seemingly irrational in their rejection of essentially free money to insure their poor.  

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Thu Sep 26, 2013 at 08:43:45 AM PDT

  •  WoE - the basic reason is that the states (4+ / 0-)

    actually administer the plan, enroll the participants and process the claims. Unlike Medicare, the federal government doesn't have the infrastructure in place to manage the Medicaid program.

    "let's talk about that"

    by VClib on Thu Sep 26, 2013 at 09:00:02 AM PDT

  •  because they want millions of people (1+ / 0-)
    Recommended by:
    OllieGarkey

    to complain about Obamacare.

    that's why.

    they want people through red states, the south, to think it's no good.

    self fulfilling prophecy for those states that refuse the money.

    -You want to change the system, run for office.

    by Deep Texan on Thu Sep 26, 2013 at 09:04:42 AM PDT

  •  Two problems (3+ / 0-)

    ---Medicaid doesn't pay enough as is.  Costs are shifted to the rest of us.  Cuts wouldn't work.

    ---You don't understand the Republican agenda.  The owners of the Republican Party want to return our nation to those thrilling days of yesteryear, about a hundred years ago, where there were two classes of people...oligarchs and serfs.  Maybe a few essential tradesmen.  Social welfare programs MUST be dismantled for the good of The American People, don' cha see?

    •  This is all part and parcel of the "states rights" (2+ / 0-)
      Recommended by:
      OllieGarkey, SingleVoter

      thrust on the right, that got a second wind after the civil rights act, voting rights act, etc.

      The states are in competition with one another to see who can run off its poor , handicapped, elderly, etc. people the fastest.

      You can't make this stuff up.

      by David54 on Thu Sep 26, 2013 at 09:26:52 AM PDT

      [ Parent ]

  •  Red states want to eliminate the poor. (1+ / 0-)
    Recommended by:
    Dr Erich Bloodaxe RN

    Either they die from neglect, they move to a more liberal state, or they don't bother moving there if they're considering such a move.
    It's not quite like putting them in work camps til they die, but it will have the same effect, less noticeably.

    You can't make this stuff up.

    by David54 on Thu Sep 26, 2013 at 09:21:47 AM PDT

    •  Not at all (1+ / 0-)
      Recommended by:
      David54

      They regard Jesus's words

      The poor ye have always with you.
      as a commandment, not a comment. Besides, without the poorest of the poor, whom can you convince the merely abjectly poor, ignorant, and malicious to look down on, and then convince them that you will hurt those others even worse? That is the essence of the Southern Strategy in its origins, the promise that no matter how much damage Republicans do to society and the economy, Blacks will get hurt worse than Whites.

      Ceterem censeo, gerrymandra delenda est

      by Mokurai on Thu Sep 26, 2013 at 09:29:24 AM PDT

      [ Parent ]

  •  55+ pay from their estates... (3+ / 0-)
    Recommended by:
    War on Error, SingleVoter, Orj ozeppi

    Just a Loan.

    [I]f an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market. ...

    Furthermore, to increase enrollment in health coverage without requiring people to complete an application on their own, states are advised to automate enrollment whenever possible by using existing databases for social services programs such as SNAP (food stamps) to enroll people who appear eligible for Medicaid but are not currently enrolled. Therefore, you could find yourself auto-enrolled in Medicaid against your will if your state acts on this advice.

    .... You won’t find the following info in the ACA. It’s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.

    a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.

    b) The HHS site has an overview of the Medicaid estate recovery mandate which also says that at a minimum, states must pursue recoveries from the “probate estate,” which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.

    c) Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it’s a big business.

    This is a huge hit on families!  Even worse it was started by Democrats on a party line vote with VP Gore breaking a tie to pass it.  On the other hand, look how Democrats handled the Medicaid rolls in Tennessee.
    Medicaid:
    Here’s what Krugman’s first commenter says on the Medicaid model:

    Have you noticed all the poor and homeless with missing teeth? (You will now that I’ve mentioned it.) That’s because in order to “control costs” in 2009, Medicaid (Medi-Cal here in CA) simply eliminated dental services for adults. Don’t worry though – they still pay for the teeth to be pulled before these people die of infection (generally).

    (Note that in the United States, bad teeth are a class marker, so it’s harder to get a job with bad teeth, no matter your skills.)

    So why on earth is Krugman advocating the Medicaid model, as opposed to the Medicare model, given that both can “say no”? (Never mind that under Medicaid, after 55, you pay for your care with your assets instead of passing them on to your kids; and never mind that a lot of Medicaid services are contracted out to private entities, which Krugman seems to think that only Republican practice; how droll.) I can’t imagine why; hating on the poors wasn’t my picture of Krugman’s worldview. Still, it has to be said that if you want to look for a Medicaid program that really got gutted, look at how Democratic governor Phil Bredesen (founder of HealthAmerica Corp.) “said no” with TennCare (hat tip Alexa), which I suppose could turn out to be a blueprint for “the future”

    Be sure to watch the video at the link.

    What we really need is Medicare for all-single payer not for profit health care.  O'care is a very expensive detour from that with the goal of preserving the rents for the rich.

  •  I know what you mean. I'm in Ohio, where (4+ / 0-)

    as an 'able bodied adult without children', I'm not eligible for Medicaid, thanks to our lovely Republican legislature, despite having no income.

  •  An Executive Order (1+ / 0-)
    Recommended by:
    War on Error

    may be just the ticket for what you are proposing.  Sounds good to me.  Less likely to get diluted to help balance the state books too!

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