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Sat Apr 7, 2012, 10:47 PM

16 million: number of Americans who become eligible for Medicaid under the health care law

The Temptations of the Court

Why the last hour of the Supreme Court argument over Obamacare matters most.

By Simon Lazarus

By the third day of Supreme Court arguments over the Affordable Care Act, people may be inclined to tune out. They shouldn’t. The final hour may be of far greater consequence than anything else the court hears this week. On Wednesday afternoon, the justices will vet a claim that targets the part of the new law that expands the Medicaid program. The Republican governors and attorneys general bringing the case against the health care law assert that the choice given states by the federal government—either accept coverage of approximately 16 million newly eligible beneficiaries or withdraw from Medicaid and lose all existing federal Medicaid funds—is “coercion.” Hence, they argue that with this provision, the federal government is unconstitutionally undermining state autonomy.

<...>

To back up this scary rhetoric, it’s necessary for opponents of the law to build it up as some unprecedented invasion of states’ independence. At best, these arguments are misleading, if not just plain wrong. For example, the challengers assert that the Medicaid expansion is a uniquely “onerous” imposition on the states. That gets the facts exactly backward. The statute actually provides that the federal government will shoulder 100 percent of the costs of adding newly eligible persons to Medicaid rolls, through 2016, dropping to a permanent level of 90 percent in 2020. That is a vast improvement from the average 57 percent in burden-sharing today. Moreover, several studies show that the new law will lead to a net benefit of $100 billion for state budgets through 2019.

Another dubious complaint is that, unlike past revisions to Medicaid, the health care law is an unprecedented ultimatum: Either accept it or lose all federal Medicaid funds. It would be a good argument, if it were remotely true. In fact, Congress has often amended Medicaid on precisely the same “all-or-nothing” basis. That’s nothing new, and this is no mere debaters’ point. If the latest expansion is invalid because it ties new conditions to the continuation of funding, then all past expansions—in essence the entire existing Medicaid program—is vulnerable.

Republican opponents to the Affordable Care Act have labeled its Medicaid provisions a subterfuge, contrived to “commandeer” state governments to help pay for the law’s implementation by driving Medicaid-eligible uninsured persons to enroll in Medicaid. But that is not how the law reads. In fact, it offers a variety of exemptions that ensure that anyone poor enough to qualify for Medicaid will be excluded from the law’s penalties for noncompliance with the mandate.

- more -

link to Slate article


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Reply 16 million: number of Americans who become eligible for Medicaid under the health care law (Original post)
ProSense Apr 2012 OP
Ikonoklast Apr 2012 #1
enlightenment Apr 2012 #3
Ikonoklast Apr 2012 #4
ProSense Apr 2012 #9
Ikonoklast Apr 2012 #12
jwirr Apr 2012 #17
enlightenment Apr 2012 #15
joshcryer Apr 2012 #6
ProSense Apr 2012 #8
MannyGoldstein Apr 2012 #2
ProSense Apr 2012 #5
banned from Kos Apr 2012 #7
ProSense Apr 2012 #10
NNN0LHI Apr 2012 #11
treestar Apr 2012 #13
Scurrilous Apr 2012 #14
voteearlyvoteoften Apr 2012 #16

Response to ProSense (Original post)

Sat Apr 7, 2012, 10:51 PM

1. The ACA sets up a framework to move this nation to single payer.

And many here either cannot see it, or want to see it fail for reasons unknown.

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Response to Ikonoklast (Reply #1)

Sat Apr 7, 2012, 10:57 PM

3. How?

When?

In what form?

Single-payer cannot - cannot - include for-profit insurance companies. How does the ACA framework deal with those?

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Response to enlightenment (Reply #3)

Sat Apr 7, 2012, 11:02 PM

4. See how Canada did it.

That is the framework.

And even the socialist European health care delivery systems have private insurance companies involved in health care.

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Response to Ikonoklast (Reply #4)

Sun Apr 8, 2012, 01:08 AM

9. It's going

to be either state by state or a Medicare buy in, which would like result in a hybrid system, at least for a time.



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Response to ProSense (Reply #9)

Sun Apr 8, 2012, 11:16 AM

12. It will not happen overnight.

And that is what many here do not understand.

Even if Medicare for all was mandated nationwide by edict today, the private insurance companies would probably be contracted for a while to make it actually work.

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Response to ProSense (Reply #9)

Sun Apr 8, 2012, 10:52 PM

17. And a Medicare buy in will not solve the above problem because what they are talking about above

is nursing home care - Medicare does not pay for nursing home care - only Medicaid does.

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Response to Ikonoklast (Reply #4)

Sun Apr 8, 2012, 01:07 PM

15. Canada is not a great framework.

Yes, it is single payer, but the framework itself is problematic for the US. Part of the reason it works in Canada is because the provinces and territories have considerable discretion over what is covered; would this be applied to the states? It doesn't take too much imagination to foresee the consequences of that sort of framework, with some states choosing to cover beyond the 'medically necessary' - things like prescription drugs and dental care - and others choosing not to cover those things. It's one thing to have that sort of disparity of coverage between ten broad areas, but it would be patchwork nightmare if applied to the 52 states.

But assuming that could be worked out - it still begs the question of how the US is going to reach that point from where it stands now. Private, for-profit insurance companies are part and parcel of the ACA - and the regulation over those companies is minimal and far from ironclad. There has to be a recognition that some things are not negotiable - and that just isn't in the fine print of the ACA.

How does the US move from the ACA to anything remotely akin to 'universal care'? The ACA does not provide for a system of health CARE - it provides a system of loose controls over the currently completely out-of-control private, for-profit heath insurance industry. And insurance is not health care - nor does it necessarily provide access to that care, as many, many people in this country can attest.

The ACA is better than nothing - but it really isn't a road to socialized health care. In order to be a road to that, there has to be a point of intersection where one can move from the rocky path of insurance coverage to the tarmac of universal care. Where is that intersection? Where, even, is the will to consider it?

Canada started to move to a system of universal coverage in the 1940s, province by province, starting with hospital care. I admittedly have not done much research into the rationale behind this move, but I suspect that Canada was looking at the changes instituted in the UK in the twenty years before the NHS was formally introduced (1948) and borrowing ideas from what they saw.

In other words, there is a background and history; an early recognition that pay-for-service and for-profit health insurance were not the best option for the nation. The United States has never made much of an attempt beyond Medicare and Medicaid to promote the idea that health care should be a right of citizens, not a hopeful goal to be achieved through the 'Protestant work ethic'.

It took Canada twenty-five years (if you count from 1946, when Saskatchewan began to provide hospital coverage) to reach the point of universal 'Medicare' for all the provinces and territories - and they were not starting from a position of firm belief in free-market capitalism and a desire to 'protect' the for-profit companies that serve as barriers, not facilitators to health care in the US.

We don't even have a consensus among liberals that universal health care is the right answer . . .

As for the 'private insurance companies' in Europe - can you name one country (that uses private health insurance companies to manage primary care) that does not strictly - strictly - regulate those companies?
Yes, there are private insurance companies, but they are strictly regulated to avoid the 'for profit' part of the equation - some with percentages; most with flat fee structures, regardless of age, gender, and state of health. Most of the countries in Europe do allow individuals to purchase supplemental insurance if they want it - that part, I am sure, is where the insurances companies profit - but the key word there is 'supplemental'.

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Response to enlightenment (Reply #3)

Sat Apr 7, 2012, 11:23 PM

6. Well, the failure to get the public option out of comittee...

...did fuck that up big time.

But a public option (ie, a non-profit insurer) would be relatively easy to get passed if we had sane politicians.

At that point I think it's easy to see how this turns into single payer.

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Response to joshcryer (Reply #6)

Sun Apr 8, 2012, 12:13 AM

8. And

"But a public option (ie, a non-profit insurer) would be relatively easy to get passed if we had sane politicians. "

...the bill can still be amended to add one or even a Medicare buy in. I suspect Republicans haven't forgotten that fact.


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Response to ProSense (Original post)

Sat Apr 7, 2012, 10:56 PM

2. How many people will be tossed

off of Medicare if the eligibility age is raised to 67?

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Response to MannyGoldstein (Reply #2)

Sat Apr 7, 2012, 11:16 PM

5. Why don't

"How many people will be tossed off of Medicare if the eligibility age is raised to 67?"

...you look it up and start an OP about it since that has nothing to do with the OP or the President's health care law, which strengthens Medicare and, for the first time ever, provides free preventive care to seniors.

The law has also saved seniors more than $3.2 billion on prescription drugs

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Response to ProSense (Reply #5)

Sat Apr 7, 2012, 11:25 PM

7. Ha Ha! I like that retort

 

plus I am bumping at the same time.

That is how you move things - granular. One million or more per year. Piece by piece.

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Response to ProSense (Original post)

Sun Apr 8, 2012, 09:22 AM

10. Kick! n/t

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Response to ProSense (Original post)

Sun Apr 8, 2012, 09:31 AM

11. Recommended

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Response to ProSense (Original post)

Sun Apr 8, 2012, 12:07 PM

13. What? I thought this law was to help insurance companies!!!



How does all those people going on Medicaid help insurance companies??? This must not be so!!!

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Response to ProSense (Original post)

Sun Apr 8, 2012, 12:55 PM

14. K & R

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