Monday, May 20, 2013

Stupid and cruel, both

One of the signs of political sickness in America is the degree to which some Republican governors, apparently out of sheer spite for President Obama, have decided to be both stupid and cruel to citizens in their own states.  I refer to those governors who have chosen not to permit their Medicaid-eligible residents to participate in the federally funded health care insurance subsidies under Obamacare (aka, Affordable Care Act.)

The deal is this:

The Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country.  Beginning in 2014 coverage for the newly eligible adults will be fully funded by the federal government for three years.  It will phase down to 90% by 2020. People newly eligible for Medicaid will receive a benchmark benefit or benchmark­ equivalent package that includes the minimum essential benefits provided in the Affordable Insurance Exchanges. The law includes a number of program and funding improvements to help ensure that people can receive long-term care services and supports in their home or the community.

I think there are about a dozen governors who have turned their back on their citizens.  Here's one example from Pennsylvania:

Pennsylvania Gov. Tom Corbett (R) announced Tuesday that his state will turn down the Medicaid expansion, becoming the first governor of a blue state to officially say no to the coverage provision of the Affordable Care Act that the Supreme Court made optional.

“At this time, without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion,” Corbett wrote in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius.

The decision will please conservative advocates who are urging leaders to stonewall Obamacare implementation. But it’s a blow to the many thousands of uninsured Pennsylvanians who would have received coverage through the program, which extends Medicaid eligibility to Americans up to 133 percent of the poverty line for participating states.

Something is seriously wrong with these people.  They are intentionally creating an uninsured underclass in their states.  I hope that the successors to these governors will see the light.


David Lamb said...

From Facebook:

Let's see...which makes more sense...worst case, the Feds pay 90%, or my citizens pay 100%...let me think about that a minute...

Jonathan Saxton said...

From Facebook:

Cruel, yes. But has nothing to do with stupid. has to do with partisanship, Ideology, and the opportunism resulting from the logic and imperatives of political fundraising and personal political survival.

akhan13 said...

I think (or maybe I just hope) that in the long run reason will prevail and these leaders will change their minds a la Rick Scott in Florida. Whether or not they agree with the Medicaid expansion, every state is going to pay for it through federal taxes, so it is pretty amazing to me that some states would simply give up the federal funding that would not only insure many their uninsured with federal dollars, but would also bring more money into their state's economies. A sad sign of the state of politics in the country today.

Anonymous said...

I believe all OECD countries except ours have universal healthcare. There are 34 of them.

Most of those countries also pay much less than ours for healthcare. Fifty percent to one-hundred percent less.

Said another way, we spent 18% of GDP in 2011 and heading quickly toward 19. Most of the developed world spends between 8% and 12%.

To be a civilized country we need universal healthcare. To be a solvent country we bring healthcare spending under control and REDUCED!

Defenders of high healthcare spending might want to remember that it will take over federal, state and local budgets if not brought under control.

There will be limited "spending room" for federal, state, or local programs to help those most in need.

Controlling and reducing healthcare spending is something every thinking American should support.

Anonymous said...

How about figuring out a way to motivate doctors to accept Medicaid patients before adding millions enrollees?

Naah, that would be putting the horse before the cart I guess.

Anonymous said...

Paul - What is REALLY cruel and stupid is our Federal and State Governments spending out of control and leaving tens of trillions in debt and unfunded liabilities to our children and grandchildren who have no say in any of these decisions. I'd love to give everybody everything they need but there is a fiscal reality that makes this impossible. So we give thirty million more people free Medicaid and just add it on to the tab our kids and grandkids will have to pay back? That is cruel and stupid.

Paul Levy said...

You are paying for their care now, in the form of bad debts at hospitals, who then pass along those costs to other patients and insurance companies.

You are also paying for it because people are not getting preventative care and then show up very sick at ERs or elsewhere.

Better to give people insurance, let them go to their primary care doctors, and get care early so they can avoid more acute illness.

Anonymous said...

We are also making our primary care practioners more efficient. For most routine care, an MD is not needed except to review the care of Nurses and Physician assistants.

So we are seeing more Nurse practioners and physician assistants doing more routine care at the primary care level, with MD oversight.

Khan said...

To anonymous- there are some provisions in ACA to increase access for Medicaid patients through increased reimbursement (parity with Medicare for certain services).

Dianne Parker said...

From Facebook:

Actually Obama Care is the most stupid bill I've ever read, it has more taxes and fines than anything I've ever seen. And frankly I didn't see anything that indicated the Republicans had anything to do with that -

Agnes Doyle Gootee said...

From Facebook:

Good point, Dianne. I fail to see why everyone must pay higher taxes, face high cost fines, and trust their health to a group of maniacal bureaucrats who have run from scandal to scandal and seem to be unable to tell the whole truth.

Anonymous said...

In massachusetts we have seen a variant of Obamacare, originally called Romneycare work effectively at increasing access.

The next step is to contain health costs.

I hope the intellectual and administrative leaders in Mass healthcare and civil servants know how much is riding on their controlling and reducing health costs.

Real healthcare price competition must be engendered -- SOON!

Khan said...

Dianne- I am not going to debate the merits and pitfalls of Obamacare with you, but one thing is pretty straightforward: the taxes and fines you speak of are borne regardless of your state's decision to allow for a (mostly) federally funded Medicaid expansion. So, as Paul is pointing out, anyone rejecting these benefits is punishing their own electorate to spite the President, because they are giving up the benefits of Obamacare even though they still have to 'pay the costs', because the two are not coupled. This is a fact regardless of what anyone thinks the benefit vs burden ratio is, which I fully admit is completely debatable.

e-Patient Dave said...

And I'll bet $1,000 cash, right now, that in the 2014 elections we'll here those exact same governors claiming that the bill hasn't helped people.

Any takers? I'm serious.

chuck said...

I see, so the problem is the Republican governors, not Obamacare which has now MANDATED that come Jan. 1, 2014 there will be MILLIONS uninsured because of being ousted from the coverage they had. Where's the criticism of the people responsible for that?

Paul Levy said...

A very different issue, Chuck. This one is about depriving people of insurance who have never had any.