• I guess they did want Obamacare to be more expensive

    Others are covering the latest ins and outs of the Medicaid expansion deals with much more timeliness than I. The Florida state Senate has rejected Gov. Scott’s deal with HHS. Word is they want a deal more like Arkansas got.I’m reading that Texas and other states might want in on this deal, too.

    I feel compelled to repeat myself again. This will cost more money, likely a lot more money. Private insurance, even that on the exchanges, is much more expensive than Medicaid. I get why these states want their deals. Those in the health care industry will make more, those in the insurance industry will make more, and various other interest groups will make more.

    But it will cost us – taxpayers – much more money. For what? The coverage is likely skimpier, they’re trying to get cost-sharing in, and there are tons of hoops and inefficiencies. And it costs more!

    I’m still fascinated by this. It really does appear that all of the talk of Obamacare being “too expensive” was just talk. It turns out that increased government spending in the “right” areas for the “right” reasons is no problem at all.


    • By right, you mean moneyed interest. And remains a cruel irony that privatization for all its hoopla cost more for less in every respect – from charter schools to prisons and embassy security. And in those private companies, where does the money flow ?— It doesn’t go to the salaried employees but to the CEOs and corporate leadership —plutocracy at its finest.

    • Of course the talk of Obamacare being too expensive was just talk.

      Try this as a means of predicting legislative action, especially by Republicans (notice which states are rejecting Medicaid expansion): if there’s a conflict between the 1% (or the 0.001%) and everyone else, predict the result will favor the 1%.

    • It’s important for readers to note that commercial plans already deliver Medicaid benefits in most states. The Medicaid benefit has a poorer network because it pays a lot less than commercial for each service. However, Medicaid charges little cost sharing (for non-disabled adults and kids), and in some ways, the package of services it covers is broader (e.g. early prevention, screening, detection and treatment, or EPSDT services for kids). For people with mental illness or substance abuse, the Medicaid may actually work out to be a better benefit than commercial insurance, where you’d pay $15 or $30 for an office visit with a psychologist or social worker, for example.

      What these red states are talking about is paying to provide a commercial benefit for the population that would have been under Medicaid. I suppose they could be assuming that commercial plans are so efficient that they will be able to deliver the more costly commercial benefits at what they would otherwise have been paid under Medicaid. If so, this is a nonsense assumption. It’s been tried. And it’s failed (e.g. in TennCare). But it would fit with how these folks think imo.

    • See “The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy” Kimberly J. Morgan and Andrea Louise Campbell

      “Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the Part D drug benefit. Although delegated governance has been politically expedient—enabling the passage and growth of government programs in an anti-government political climate—such expediency has frequently come at the cost of good governance. Outsourcing program responsibilities to non-state actors does not appear to produce more efficient or effectively-run government. Moreover, when the delegation occurs in a way that brings commercial actors into a program, this creates potential hazards (e.g. marketing abuses, fraud) that require oversight by a muscular political agency. Yet, the same hostility towards government that drives the decision to delegate governance in the first place also impedes the growth of an effective oversight body. As a result, various program failures arise that are frequently blamed on government officials who have never been sufficiently empowered to deal with these problems..”

    • AC – Methinks you are not quite cynical enough –

      “Conservatives” do not want Obamacare, period – so how to kill it, Plan A – defeat it by claiming it is “too expensive” – didn’t work, Plan B – challenge it as unconstitutional – didn’t work, Plan C – (where we are now) sabotage, wherein they make sure it IS, in fact, “too expensive and we can’t afford it”, so to “balance the budget”, it must be cut …. (That is the approach already being taken with Medicare – the “deficit demands” it must be cut.) Like so much else, the fact that it didn’t have to be “too expensive” will be beside the point – it will be made so …

      That is my take – too cynical? Methinks not … wait and see how it pans out …