What makes the Republican position on Medicaid expansion truly sick
In their ideological vendetta against Obamacare, red states seem more willing to let low-income people die than get healthcare
Republican-controlled states argued before the supreme court that the ACA law’s expansion of Medicaid is unconstitutionally coercive. Photograph: Justin Sullivan/Getty Images
If you want to get a sense of the enfeebled and wanton state of the modern Republican party, there really is no better place to start than on the issue of Medicaid, the federal program that provides healthcare coverage for the poor.
In a desperate effort to undermine the law they hate, Obamacare, Republican governors and state legislatures in half the states have either rejected or intend to reject a key part of the president’s signature domestic initiative – namely, billions in federal dollars to extend Medicaid coverage to their poorest citizens. While Republicans argue they are acting out of highminded fiscal rectitude, the reality speaks to something else altogether – petulance and hyper-partisanship.
Accepting billions in federal dollars and expanding care to the uninsured would mean tacitly accepting the reality of Obamacare. And that is tantamount to treason in the Republican party. So, as a result, when the law goes into full effect next year, millions of Americans will be left on the outside looking in, denied coverage for no other reason than the misfortune of residing in a red state.
If we lived in a country where both major political parties shared a sense of social empathy, the Medicaid expansion piece of Obamacare would be among its least controversial provisions. Under the law, Medicaid coverage would become available for those living below 138% of the poverty line. The federal government would fully pick up the bill for the first few years of the law, and then eventually cover 90% of the costs.
But when the US supreme court upheld Obamacare last year, it overturned the provision of the bill that gave the federal government authority to penalize states that did not agree to expand Medicaid coverage. Though this decision gave states the right potentially to reject the expansion, few at the time thought this would be an issue. Ron Pollack, director of the consumer group Families USA, expressed the views of many:
“I think the states are going to pick this up. It would be an act of fiscal malpractice for states to turn this down.”
Considering the billions of Medicaid dollars that would be pumped into state coffers, it was hard to disagree. But what liberals had not fully countenanced was the continued refusal of Republicans to come to grips with Obamacare.
Indeed, a year after the supreme court ruled on the legality of the law, congressional Republicans are continuing their futile struggle to scrap it. Earlier this month, House Republicans voted for the 37th time to repeal Obamacare. Beyond such peevish symbolic gestures congressional Republicans are trying to put as many roadblocks as possible in front of the healthcare law’s rollout. They refuse to consider any technical corrections to the bill in order to assist with its implementation.
Prominent Republicans, such as Senate minority leader Mitch McConnell, claim the bill is simply too broken to be fixed and repeal is the only option. But the unlikely possibility of repeal is a figleaf for the GOP’s real interest: sabotaging the bill in order to gain a political advantage in the 2014 midterm elections. The more Obamacare is seen as a disaster, the better chance of voters punishing Democrats at the polls, or so the political argument goes.
The problem is that this obstructionism is having real and enduing consequences. According to a survey maintained by the Kaiser Foundation (pdf), fewer than half the states have agreed to fully partake in the Medicaid expansion, with 20 not moving forward at this time.
What do all these states have in common? Either a Republican governor or a legislature controlled by Republicans. In some states, even the support of a GOP governor has not been enough to bring along recalcitrant legislators. In Arizona, Governor Jan Brewer – no friend of the Obama administration – is locked in a heated battle with her state legislature over the issue and has threatened to veto every bill that comes to her desk until the Medicaid issue is resolved.
Read Full article Here
Reverse LePage: Conservative Arizona governor threatens to veto all bills if lawmakers don’t OK Medicaid expansion
Brian Cassella | MCT
Arizona Gov. Jan Brewer, shown here greeting delegates Aug. 28, 2012, at the Tampa Bay Times Forum in Tampa, Fla., is one of several Republican governors pushing state legislators to approve Medicaid expansion allowed under the federal Affordable Care Act.
Posted June 02, 2013, at 9:52 p.m.
Republican fissures over the expansion of Medicaid, a critical piece of the 2010 health-care law designed to provide coverage to millions of uninsured Americans, continue to deepen, with battles in Arizona and elsewhere showing just how bitter the divisions have become.
Despite expressing distaste for the new law, some GOP governors have endorsed an expansion of Medicaid, and three — Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — are trying to persuade their Republican-controlled legislatures to go along. The governors are unwilling to turn down Washington’s offer to spend millions, if not billions, in their states to add people to the state-federal program for the poor. But they face staunch opposition from many GOP legislators who oppose the health-care law and worry that their states will be stuck with the cost of adding Medicaid recipients.
In one of the most explosive of the internal Republican battles, Brewer, a firebrand tea party favorite who once famously wagged her finger at President Barack Obama, has declared a “moratorium” on all other legislation until her Medicaid plan, which would add 300,000 Arizonans to the program, is approved. She has backed up her threat by vetoing five unrelated bills.
In Ohio and Michigan, the governors are pressing for last-minute compromises before their legislatures adjourn this summer. In Florida, the legislature, which has adjourned, rejected Republican Gov. Rick Scott’s plan to expand Medicaid.
These conflicts over the health-care law illustrate a larger divide within the Republican Party over an array of issues, including immigration and automatic budget cuts.
The Medicaid expansion is one of the two main ways the health-care law would provide coverage to the uninsured. The other is through health insurance exchanges, which will sell policies to individuals whose incomes are too high for Medicaid; many of those people will receive subsidies to buy the health plans.
Medicaid eligibility varies from state and to state and depends on income and other factors. The health-care law, in an effort to make eligibility uniform, mandated that anyone earning up to 138 percent of the poverty level, or $15,856 in 2013 dollars, be eligible for the program. But last June, the Supreme Court, while upholding most of the health-care law, ruled that states could refuse to expand their Medicaid programs. That set the stage for bitter debates — ones ruled as much by ideology and politics as by financial realities — that have been occurring in state capitals nationwide.
Under the law, the federal government will pay 100 percent of the cost of newly eligible Medicaid recipients for the first three years, beginning in January. After that, the federal contribution will taper, leveling off at 90 percent for 2020 and beyond.
Twenty-three states and the District have agreed to the Medicaid expansion. Nineteen states have decided against the expansion and eight are debating it, according to Avalere Health, a consulting firm. States that decline to expand Medicaid now could still sign up in later years.
The debate over Medicaid has been emotional and vitriolic in many states. In Texas, Gov. Rick Perry, R, was heckled during a recent speech for opposing an expansion. In Montana, chaos erupted after a lawmaker accidentally voted against expanding the program, causing the measure to fail. Pro-Medicaid advocates in some states, frustrated by inaction from their elected leaders, are working to put the matter to voters in the form of ballot initiatives.
The hostility is evident in Arizona, where authorities are investigating a threatening phone call and emails directed at lawmakers who support expanding the program. Opponents of the expansion have condemned the alleged threats.
Read Full Article Here
Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums
Irvine, California, where health insurance premiums for the average 25-year-old who purchases insurance for himself will nearly double under Obamacare. (Photo credit: Wikipedia)
Well, it’s been an interesting week in health care land. For a while now, independent analysts—and conservative critics—have raised concerns that Obamacare will dramatically increase the cost of individually-purchased health insurance for healthier people. This would, of course, contradict President Obama’s promises that “if you like your plan, you can keep it” and that the cost of insurance would go down “by $2,500 per family per year.” What’s new is that liberal columnists, facing reality, are conceding that premiums will go up for most people in the individual market. But they’re justifying it by saying that “rate shock” will help a tiny minority of people who can’t get insurance today. If they had said that in 2009, would Obamacare have passed?
Last month, progressive pundits were trumpeting news out of California that the cost of health insurance under Obamacare in that state was surprisingly low. “Well, the California bids are in,” wrote Paul Krugman on May 27. “And the prices, it turns out, are surprisingly low…So yes, it does look as if there’s an Obamacare shock coming,” the shock that Obamacare will work just fine.
It turns out, however, that Krugman was uncritically regurgitating California’s misleading press release. In fact, the average 25 and 40-year-old will pay double under Obamacare what they would need to pay today, based on rates posted at eHealthInsurance.com (NASDAQ:EHTH). More specifically, for the typical 25-year-old male non-smoker, the average Obamacare “bronze” exchange plan in California will cost between 64 and 117 percent more than the cheapest five plans on eHealth. For 40-year-old male non-smokers, it’s between 73 and 146 percent more.
Democrats now: It’s ok if premiums double for average people
Ezra Klein of the Washington Post, in response to my article on this topic, checked out the eHealth rates for plans in his hometown of Irvine, California, and compared them to a similar website sponsored by the government at healthcare.gov. He found that the third-cheapest plan there cost only $109 a month, “if they’ll sell it to you for that price.” According to the government, Ezra notes, 14 percent of people who tried to buy that plan—Health Net’s IPF PPO Value 4500—were turned away. Another 12 percent were asked to pay more than $109.
To Ezra, it’s galling that three-fourths of his compatriots can pay $109 for health insurance, because 12 percent were not eligible for the plan, and another 14 percent had to pay somewhat more. This is why Obamacare is a great achievement, he says, because Health Net will have to serve all comers, regardless of prior health status.
And I appreciate Ezra’s perspective. I, too, am a supporter of universal coverage, so I understand Ezra’s passion for providing health insurance to the sick. But what we didn’t know last week—and we do now—is how much more the healthy will have to pay for that insurance, under Obamacare. In Orange County, where Irvine is located, the three-fourths of the 25-year-old population that is in good health will have their premiums jacked by 95 percent.
And that’s for Obamacare’s “catastrophic” coverage; the more comprehensive “bronze” plan increases premiums by 130 percent. For the fraction—one-eighth of the total—who, under the old system, would have been charged more, the premium increase due to Obamacare will be somewhat less.
And the vast majority of those who were turned away are able to find insurance—albeit at a higher price—elsewhere. Based on enrollment in Obamacare’s high-risk pool program, the number of people in America who are truly uninsurable is closer to 150,000. That’s a pretty small number in a nation of 300 million. Previous estimates of the uninsurable population came in around 2 to 4 million people, but it’s likely that for many of these individuals, the principal problem is not that they’re denied coverage, but that the premiums are high.
Experts in the economics of health insurance understand that this has been Obamacare’s central flaw from the beginning. The law’s heavy-handed approach to the health insurance market massively drives up premiums for the average person.
Ezra makes another accurate point that is important to emphasize: these increased premiums affect people who shop for insurance on their own. If you get insurance through your employer, especially if your employer is large, you should be significantly less affected. But an increasing number of people shop for insurance on their own, because fewer and fewer employers are sponsoring health coverage. According to the Congressional Budget Office, in 2022, around 25 million people will be purchasing coverage for themselves, and another 25 million will be enrolled on the exchanges. That’s a lot of people. And it doesn’t include the 30 million that will remain uninsured.
Universal coverage, done right, can address these problems in a way that makes insurance affordable for everyone. But Obamacare’s sops to special interests—from the various services all plans are required to cover, to the fact that the law forces young people to pay more to subsidize well-established older people—is not the right way, because it makes insurance too costly.
Democrats then: Rate shock is a right-wing myth
The key thing to remember is that back when Obamacare was being debated in Congress, Democrats claimed that it was right-wing nonsense that premiums would go up under Obamacare. “What we know for sure,” Obamacare architect Jonathan Gruber told Ezra Klein in 2009, “is that [the bill] will lower the cost of buying non-group health insurance.” For sure.
In 2009, was Ezra saying that it’s ok that premiums will double for the average person, because a minority of people will pre-existing conditions will benefit? No.
Earlier that year, AHIP, the private insurer trade group, commissioned a report from PriceWaterhouseCoopers to analyze the impact of Obamacare on health insurance premiums in the individual market. That report, which I reviewed here and elsewhere, found that the version of Obamacare then being considered by the Senate Finance Committee would increase premiums by 14 to 32 percent, depending on the year you looked at. In retrospect, the PwC report was a bit optimistic.
But Ezra described the PwC analysis as “the insurance industry’s deceptive report,” comparing it to sham research put out by the tobacco industry and Big Oil. Ezra did concede at the time that “buying better insurance will cost somewhat more,” because insurers would no longer be able “to sell a deceptive and insufficient product.”
But high-deductible, catastrophic insurance isn’t cheaper because it’s dishonest. It’s cheaper because it’s more efficiently designed. And it’s precisely that sort of efficiently-designed insurance that Obamacare abolishes.
Businesses in competitive markets can’t survive by cheating
This idea that high-deductible insurance, freely purchased in a voluntary exchange, is a “dishonest” product is an article of faith in some quarters. My good friend and Forbes colleague Rick Ungar recently dedicated an entire blog post to the subject. The numbers that come out of eHealthInsurance.com, Rick says, are lies. What data does Rick cite to prove this? He doesn’t cite any actual numbers. Instead, he cites…anonymous reviews on the internet.
Rick went to epinions.com, and pulled out quotations from people who were unhappy with eHealth’s customer service. And eHealth should certainly do what it can to address customer’s complaints. (The company, however, isn’t directly responsible for the customer service of the insurers whose products it sells.) Remember that, unlike with Obamacare, eHealth is a private business. No one is forced to use their services. Those who do have a bad experience on eHealth can go elsewhere, like healthcare.gov. eHealth, unlike the government, has an economic incentive to make its customers happy. Indeed, the default setting at eHealth is to sort the listed plans by customer popularity.
Read Full Article Here
GOP lawmakers battle GOP governors over Obamacare
WASHINGTON (AP) – It’s Republican vs. Republican in the latest round of political battles over health care.
Conservative Republican legislators in major states are trying to block efforts by more pragmatic governors of their own party to accept health insurance for more low-income residents under President Barack Obama’s health care law.
Unlike their congressional counterparts, who’ve misfired in repeated attempts to torpedo the law, state Republicans may well sink the expansion of Medicaid in populous states such as Florida and Michigan.
That would mean leaving billions of dollars in federal matching funds on the table and hundreds of thousands of the poor uninsured. Expansion opponents say it’s an issue that goes to their core beliefs.
“It’s an ideological principle piece to us on the conservative side,” said state Rep. David Gowan, majority leader in the Arizona House of Representatives. “We don’t believe in the expansion of Medicaid itself – it’s within the process of mandating health care. We don’t believe it’s the government’s duty to do that. It should be open for people to go get their health care.”
Nine Republican governors supported or accepted the Medicaid expansion, a major component of the health care law taking effect Jan. 1. It’s designed to provide coverage to about 20 million uninsured people if all states accept. Washington would pick up the full cost for the first three years and 90 percent over the long haul.
Those helped would mainly be low-income adults with no children at home, people working jobs that pay little and don’t come with health insurance. For uninsured adults below the poverty line, expanded Medicaid is the only way to get coverage under the new law. But middle-class people will be eligible for subsidized private insurance.
Overall, 23 states plus the District of Columbia, are planning to expand their Medicaid programs. About a dozen are undecided.
The nine GOP governors supporting expansion are Jan Brewer in Arizona, Rick Scott in Florida, Terry Branstad in Iowa, Rick Snyder in Michigan, Brian Sandoval in Nevada, Chris Christie in New Jersey, Susana Martinez in New Mexico, Jack Dalrymple in North Dakota and John Kasich in Ohio.
Initially, some observers saw a shift toward pragmatism among Republicans and predicted the governors would get their way. Now experts are not so sure.
Four of the GOP governors have run into real battles. Expansion prospects are flickering in Florida and Michigan. In Ohio, Kasich’s legendary deal-making abilities are being tested. In Arizona, Brewer is trying to stare down Republicans in the state House, and the coming week may determine who prevails.
Read Full Article Here
Bridenstine on Repealing Obamacare
Published on May 14, 2013
Rep. Jim Bridenstine speaks on the House floor concerning the repeal of Obamacare.