• Millions of poor Americans will not benefit from health reform

    A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

    Follow the link (my addition) for more.

    This is not a massive failure of the design of the Affordable Care Act. It’s due to the Supreme Court ruling that the Medicaid expansion was optional. Nobody thought that such a ruling was likely.

    However, one could argue that it was possible to have anticipated that potential outcome and, therefore, the ACA’s designers should have sought a more robust design. Medicare for all — or at least for Medicaid eligible individuals — would have been more robust. Allowing the would-be Medicaid eligible access to subsidies for exchange coverage would have been more robust.

    But wait. That’s possible! Arkansas has received approval to do just that. So the design is quite robust. Flexible even.

    Yes, there are some federally imposed limits to that flexibility. But the expansion is almost entirely federally funded. So, is that reasonable or not? Are the limits so onerous to warrant denying so many poor Americans benefits almost all other, wealthier Americans enjoy?*

    * Anyone in any public program (Medicare, the VA, Medicaid) or receiving a tax subsidy for employer-sponsored health insurance or on an exchange is getting more than millions of poor Americans denied Medicaid will get.


    • Giles Ward, Republican State Senator of Mississippi, says, “you can argue pretty much any way you want.”

      As a New Yorker transplanted in Louisiana, this one of the many things that puzzle and worry me about living in the deep South. Ward says that nothing anyone says makes any difference. No facts, no reasoning. As an outsider, the message I hear loud and clear is, “Be quiet.” As a teacher, I worry every day whether I am crossing an unmarked line.

      The Louisiana legislative debate over Medicaid expansion paid little attention to anyone’s medical needs. Debate was almost exclusively focused on the possibility that Medicaid expansion might cost something, despite the federal government taking the vast majority of the costs.

      Conservatives here, who are completely in control, deny race has anything to do with their position. They say clearly that there is a right way to live – church, “family values,” owning a business – and anything else is a evil invasion. From that perspective, conservatives have so many enemies that they do not need to pick them by race.

    • “Poor Americans”

      You just answered your own questions on whether or not they will be considered deserving by many.

      If they were deserving, they wouldn’t be poor. And round and round we go.

    • Due to its strong bargaining position, Medicaid gets a steep discount on medical services compared to private insurers. How will this be budget neutral if they’re going to be paying a premium by going through a private insurer?

      • It won’t be budget neutral, unless it restricts pent-up demand to balance additional rent (admin,profit,cost of capital).

        It is an experiment in charging copays to Medicaid recipients for the primary benefit of insurers and secondary benefit of providers.

        Another experiment will be Medicaid medical tourism to India, Costa Rica, or just about anywhere that controls costs. The slogan : “Because Medicaid recipients need vacations too.”

    • OK, the states won the right to refuse to expand Medicaid. I tend to see Justice John Roberts as a relatively honorable person, so I accept his and the court’s decision from 2012.

      Now we have a group of 8-10 million persons who are too “rich” for Medicare in the stingy and largely southern states.

      But they were left out of the ACA in terms of getting subsidies.

      What prevented Pres Obama from expanding federal ACA subsidies to this group back In 2012?

      Did he need the approval of Congress to do this? I am not sure.

      Would the hick congressmen from the stingy states have resisted if he tried to expand subsidies? We will never know.