Why Opting out of the Public Option will NOT be an Option for States

[FrenchieCat]

.....
Because of the cost to states of Medicaid
From Wikipedia, the free encyclopedia


Not to be confused with Medicare.

Centers for Medicare and Medicaid Services (Medicaid administrator) logoMedicaid is the United States health program for eligible individuals and families with low incomes and resources. It is a means-tested program that is jointly funded by the states and federal government, and is managed by the states. Among the groups of people served by Medicaid are certain eligible U.S. citizens and resident aliens, including low-income adults and their children, and people with certain disabilities. Poverty alone does not necessarily qualify an individual for Medicaid.<2> It is estimated that approximately 6 percent of poor Americans are not covered by Medicaid.<3> Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States. Because of the aging Baby Boomer population, the fastest growing aspect of Medicaid is nursing home coverage.

Each state may have its own name for the program. Examples include "Medi-Cal" in California, "MassHealth" in Massachusetts, "Oregon Health Plan" in Oregon, and "TennCare" in Tennessee. States may bundle together the administration of Medicaid with other separate programs such as the State Children's Health Insurance Program (SCHIP), so the same organization that handles Medicaid in a state may also manage those additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors.

State participation in Medicaid is voluntary; however, all states have participated since 1982 when Arizona formed its Arizona Health Care Cost Containment System (AHCCCS) program. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly.

Some states have incorporated the use of private companies to administer portions of their Medicaid benefits. These programs, typically referred to as Medicaid managed care, allow private insurance companies or health maintenance organizations to contract directly with a state Medicaid department at a fixed price per enrollee. The health plans then enroll eligible individuals into their programs and become responsible for assuring Medicaid benefits are delivered to eligible beneficiaries.

Comparisons with Medicare
Medicare is an entitlement program funded entirely at the federal level.<7> It is a social insurance focusing primarily on the older population. As stated in the CMS website,<8> Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end stage renal disease. The Medicare Program provides a Medicare part A which covers hospital bills, Medicare Part B which covers medical insurance coverage, and Medicare Part D which covers prescription drugs.

Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. Unlike the Medicare entitlement program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program.

http://en.wikipedia.org/wiki/Medicaid#cite_note-autogen...


In otherwords, the Public Option becomes a boon to governors in cash strapped states (and most are), who have high medicaid administrative and joint cost. They opt out, and they are stuck with continuing footing a bill that they didn't have to. They stay in, and the cost of Medicaid would decline (as the whole point of the public option is to achieve bargaining power for more, and thereby reduce cost of all health insurance, including that which is paid by both the feds and States).


Offering an Opt-out aka the Put-up or Shut-up Option may be a win/win for Democrats.

(edited based on information provided lower down in the thread).

[Ed76638]

1. You assume that these governors are logical people

And will act logically.

[FrenchieCat]

2. If they aren't, then their state deficits will continue to climb......

and their choice becomes fodder for their opposition....

A Democrat can easily run, explaining how he can bring savings to a state by participating in the Public Option.

[Ed76638]

3. You also assume that people will vote logically.

[sandnsea]

4. They're expanding Medicaid

To 133% of poverty. I don't follow why you think Medicaid clients will suddenly have the money to pay health premiums, even with subsidies. They're poor.

[FrenchieCat]

6. I believe that the Subsidies offered with the Public Option is exactly

for those who can't afford insurance. I would assume this means that the Feds will be picking up the bill via the public option. Don't know why Medicaid would continue, considering that it is a very large portion of many state budgets.


EXAMPLE:
An Overview of the Indiana State Budget

Updated October 2009

Contents
Introduction
Revenues, Expenditures and Balances
Where Does It Come From, Where Does It Go?






The budget pie points out the difficulty the legislature faces when revenues fall short. Education and Medicaid are 75% of the budget. Medicaid is an entitlement program. Its spending is determined by the rules of eligibility for its services. Medicaid spending has been growing rapidly for many years, as the costs of medical services have risen. Restraining Medicaid spending growth is difficult, though the state has succeeded in restraining growth during recent biennia.

If revenues fall short and Medicaid entitlements can't be cut, the budget must be balanced by cutting other spending categories. To keep education from being cut, the health and social services, public safety and all other slices must be reduced. But these spending categories make up only 25% of the budget. If that's not possible, then education must be cut. The fact that education is such a large part of the budget means that in hard times it is vulnerable to budget cuts.
http://www.agecon.purdue.edu/crd/localgov/Topics/Essays...

[sandnsea]

8. Medicaid will absolutely continue

It will be expanded to include adults up to 133% of poverty, Kennedy wanted it to be 150%. How to pay for that is one of the problems.

The public option will not be govt funded in the long run. It has to be supported from premiums, just like private insurance. That's been another of the debates. People will get subsidies to pay for the premiums, just like they would with private insurance. The cost savings would have to come from removing profit and reducing reimbursements. One CBO report said it would be about 10% less.

[FrenchieCat]

9. The cost of such would still be reduced to the state......

just based on sheer bargaining power that the Public Option would add to other government funded programs.....

So indeed the cost of Medicaid would be reduced, and therefore so would the cost of such by states.

After all, that's the point of a public option to begin with; reducing cost of all premiums, including those paid by the Feds and the state....

[sandnsea]

10. Maybe

I just don't see one having anything to do with the other. And if there's a public option in, say, 30 states; that will push the costs down all over the country or the states with expensive premiums will lose businesses.

I think states are more likely to implement the public option because of pressure from citizens. It's funny how many Democratic ideas sound good to the red states when they come from a Democrat in the state instead of at the national level. I don't think it's the Party of No, I think it's just the Party of Nuts.

[saracat]

5. You just don't get it. Access is bankrupt. Arizona is considering defunding it completely

it may be gone as we speak considering our budget defeicit just tripled and is one of the highest if not the highest in the nation. Our legislature "would" vote against the PO and we would be stuck with mandates that gave us nothing.There would be NO competition and our rates would be the same. I know some don't give a damn but many of us can't just move. And we have no jobs. Arizona has no business to cater to except tourism, and that doesn't care if we have medical insurance or not. Our realty marketcouldn't get any worse so you can't "punish" us further.To many folks, this will become a states rights issue and lose us any of the ground we may have gained. With this on the table, we will lose the congressional seats we picked up. Like morons , our state party, one of the weathiest in the nation, chose to fund federal races, and many in blue states other than local races.that is why we are red. Many of us can't last long enough for real "change" for all. This was supposed to be the shot.But I guess to some, as long as most are happy,those that die or lose everything are just "collateral damage." We are the price that is paid. Sorry I can't be thrilled. I believe ALL folks, even Republicans, deserve health care.NOW.Not when it is too late.

[phleshdef]

18. Elect better people to run your state.

If a state opt out public option is the only way the Senate will get it through, then thats what we have to do. We have to deal with political realities and not dwell on utopian fantasy. Thats life. It sucks, its tough, but it is what it is.

[Oregone]

20. "We have to deal with political realities and not dwell on utopian fantasy"

If the "political realities" suggest that policy should mandate purchases without guaranteeing affordable choices for everyone, then fuck political realities. That is simply not a yoke worth putting upon the backs of Americans to prove a point or gain political capital.

Asking for sane social policy is not "utopian fantasy". The Democrats have single-handedly destroyed the possibility of some type of real progressive reform like single-payer, and most people have accepted that. But that doesn't mean everyone is ready to grin and eat a shit sandwich that may create a regressive system for some people and cause more issues upon social mobility. To sit there and write people's concerns off as "utopian fantasy" is pure bullshit. Its absolutely absurd to force people to be burdened by the corrupt private market because of some political game. The reality is, the minute you play that game, you already lose by showing your utter disregard for the welfare of people

[phleshdef]

22. Blah, blah blah. If it doesn't have the votes, its fantasy, if it has the votes it isn't. Period.

Either suck it up or get out of the way. I'm sick of this BS.

[Oregone]

25. If this is the Democrats attitude, they really have no business touching Health Care Reform

A party that is too worried about passing anything to score political points, even if it could possible mandate irresponsible private insurance at the detriment of its citizens, has no business even trying

That doesn't sum up everyone's views, but most certainly sounds like what I am hearing here

[Bluenorthwest]

24. By your standard Canada is Utopia

[phleshdef]

38. No, by my standards the political climate of the US today ISN'T.

Work with what you got to achieve progress, not cry about what you want when it doesn't exist.

Thats just life.

[Aramchek]

7. it's genius

It forces our opponents to stand up in Public and take affordable Healthcare away from their constituents.
If they go through with it it will end many of their careers.

[Oregone]

11. or moronic

Because while people play political games that may not pan out in the crazy world of politics, real people on the ground suffer from lack of a decent public option and a mandate to satisfy

[FrenchieCat]

12. Those folks you are concerned about will suffer much more

if the Health Bill is not a good one....

I think political calculation is good,
especially coming from someone who thus far,
has taken risks only to come out a winner.

[Oregone]

13. And thats still to be seen

Who knows if itll even be a good one for states that remain in. The coming days will tell

[FrenchieCat]

14. That's right.....

and when it comes to Obama, I have a tendency to give him the benefit of the doubt
(cause there is absolutely no reason not to....considering all that he has already done,
in his first 9 months in office).

And I tend to speculate positively instead of cynically.
This works for me....
cause then, I don't feel like a fool at the end of it all...
cause then it would seem that one would have to then go out
and find something else to be unhappy about in order to save face.
That cycle has to be exhausting,
I would imagine.

[Oregone]

15. Obama isn't making the legislation

So your benefit is misplaced.

[FrenchieCat]

16. No. He's leading.......

Just not in the way that we have seen in a long time.....

He giving us a voice in the debates;
which is how it should be.

Like you said, just wait.

[saracat]

28. And if he is "leading " us to opt out or trigger, many of us won't have the time to wait

but the collateral damage doesn't matter to some as long as long as he gets to pass"something" it doesn't matter. Just as a previous Admin did under other circumstances, the WH is willing to shepard in any kind of a HCR Bill, no matter how bad it is, and hang a "mission accomplished" banner over it.
If we can't get a good bill that covers everyone NOW, with control of both houses and the WH, there isn't much leadership being displayed. We will see but all this talk of compromise is just chilling.

[saracat]

32. The WH is making bad policy and it sucks..If it is true as Schumer said that the

President can have "any HCR Bill he wants, because the senate Democrats are working as a team to back the WH" that means he doesn't want something that will cover all Americans but wants a policy that will be poltically viable in the coming elections. Throwing citizens under the bus for political consequences is not something I respect.If somehow, with the majorities in both houses, as well as controlling the WH, the Prez manages to get a Public Option that covers everyone, without an opt out throwing bipartisan cover at the expense of lives, I will be thrilled. But I suspect we will NOT see that. People are already acting as hcr apologists and we don't know anything yet.It seems many don't care what is in this bill.

[phleshdef]

17. Oh well, if thats what it takes to make it happen, break the eggs, make the omelet...

I'm not trying to be cold or heartless or anything like that. But I want to see something actually get passed and this seems to be passable in the Senate, whereas the holy grail type ideas that most liberals want are not passable in the Senate. Thats reality. If some states have to deal with being denied the public option, those people are free to vote out whoever the moron is denying them that and elect someone better. And once they get the public option, you can guarantee that no one with even a hint of the thought that they might take it away will get elected there ever again.

[Oregone]

19. So this creates a possible mandate for private insurance only

And you are ok with that?

My point has nothing to do with "holy grail" ideas. The "public option" model is the feces of the "holy grail" to start with, so don't even think I am talking in that context. But to legislate mandated private insurance with no affordable and responsible public alternative as a possibility for some percent of the population is simply bad policy.

Seriously, if a mandate wasn't involved, than who cares. But could you imagine doing this with education?!? Creating a system where you may not provide public education but force all parents to satisfy a mandate (aka, purchase private school for their kids).

This is fuckn crazy talk from a party that is supposed to be the sane one.

[ipaint]

21. Democrats are now center right conservatives

They abandoned the working class, working poor and poor decades ago and now they are jettisoning large swathes of the middle and lower middle classes in order to keep a criminal corporate stranglehold in place, fat with taxpayer subsidies.

If this piss poor, center right, republican controlled legal mandate/faux opt out option is an example of the leadership role Obama has claimed to have taken... same old, same old. Heard the same tired, endlessly regurgitated arguments regarding the passage of nafta, welfare reform and constant deregulation.

I hope this crap passes. It will be a disaster but it seems we need to hit an even lower, much nastier bottom before we get real reform. If there really is no appetite among the upper middle class and above for reform for all citizens the sooner we hit the bottom the better.

Too bad so many will suffer and die waiting for the haves to reach the have not stage.

[Oregone]

27. "I hope this crap passes"

LOL. I don't know why I care anymore, besides my friends and family that gotta deal with this crap (fortunately I don't)

[phleshdef]

23. It would be nice if you would get off your soap box and pay attention to what was suggested.

There will be a public option for all states. If a state opts out and subjects itself to private mandates, then the people of that state have to either:

A. Sit around with their thumbs up their asses and deal with the consequences of their own inaction

OR

B. Get off their lazy asses and realize they need to elect better leaders that don't put them in such messes by opting out of public options

I've had it with everyone bitching and moaning and whining because they can't have their fucking binky right now. It is what it is and the votes are what they are. Of course I personally would rather have some grandiose single payer universal healthcare system. But guess what? We can't have it right now. The Senate is NOT progressive enough to pass it. Thats reality. TOUGH! Grow up, get over it, take what we can get and move on to fight to make it better.

[Oregone]

26. Nice false binary choice there

"grandiose single payer universal healthcare system" vs a system that could create private mandates.

Wow. Its come to this. I had no idea asking for sane policy is like asking for a binky.

[phleshdef]

37. I never said I approved of private mandates, I believe there will be a public option.

And I believe any state government that tries to take it away will be committing political suicide.

But yea, you are crying for a binky because you want something that isn't legislatively possible right now. The only difference between you and I is I accept that is the reality and am willing to take less in hopes of getting more later. You want it all and you want it all right now.

[Oregone]

40. "You want it all and you want it all right now"

We are so far from "all" that its ridiculous you can even mention it. I don't so much as have a personal stake in this debate (I have real, sane health care). Im merely pointing out what is good and bad policy.

[SpartanDem]

29. Do you think it's likely that this will even happen?

especially if reports are true that they won't able to until after the program is running. So given the odds of this actually happening I'm ok with it.

[Oregone]

31. If it isn't likely, it wouldn't effect the vote

It would be a moot concesssion. Therefore, either the Democrats are giving something away that will make no impact, or it will motivate some on the right to vote for it because they see it as likely.

You can't have it both ways here. How can you claim this will motivate those to the center-right to vote on the bill (if they know itll never be used) and that it will never be used? Thats like suggesting these people, and their lobbyist army, are stupid

Regardless, its all devolving into a little game of chicken, and playing chicken in a non-casual world of politics can have unexpected results. We don't know for certain that this will not create mandated private insurance, but we know it creates the possibility. Isn't that enough of a problem? Creating a loophole that can fuck over an entire state?

[saracat]

30. If this is thevoiceof the "New" Democratic party, I am deeply ashamed.

[Aramchek]

33. I guess you would rather there not be a Public Option?

you confuse me with your moving goalposts...

[Oregone]

34. If it comes at the cost of some states just getting mandated private insurance, yes

The Democrats can do better than this crap.

If they are going to mandate 100% of people purchase health insurance, but do not offer a public affordable alternative for 100% of them, their plan is beyond lacking and potentially regressive in totality.

The existence of ANY public option, in itself, is not a litmus test for adequate reform, and therefore, worth any and every concession. This notion is silly, beyond belief.

[Aramchek]

35. you do realize that that All States will have to participate in the PO

for a few years before they can Opt Out, right?

By that time, the Repukes running these States will be powerless to complete the Opt Out, because if they do they will enrage the masses.

Look a little deeper.

Opt Out is Kryptonite.
The Repukes can't get anywhere near it.

[Oregone]

36. "Repukes running these States will be powerless..."

Maybe. Thats a game you seem willing to play.

What people just don't quite get.....if NO ONE will use an "opt out", it would influence NO ONE to vote for the bill, who wouldn't before. You think Senators and the lobbyists in their ears are fucking stupid?

This is absurd. Healthcare is now becoming a game to call people out with, at the risk of having citizens hurt when the bluff is called? I can't believe what Im hearing.

[Aramchek]

39. It's a game that we are winning, yet you would rather lose than play.

"if NO ONE will use an "opt out", it would influence NO ONE to vote for the bill, who wouldn't before"

They think now that they can use it. Just like some people think that the Nuclear Bomb is usable as a weapon.
Their foresight is extremely limited.

We have nothing now.
But We can get something great for everyone.

Once this is clear to the People, they will not allow anyone to strip them of that right.

It's not for calling people out, it's for getting everybody Healthcare.

Quit fighting progress just because you wanted it done your way.

[Oregone]

41. As a Democrat, you already lost by playing games with people's lives

Fuck your mandate and fuck your games

[Aramchek]

42. you can call it whatever you like, a game, a process, democracy...

when all is said and done, there will be a Public Option and for some odd reason,
you just can't stand that.

tell me what this song means:

Crimson flames tied through my ears
Rollin' high and mighty traps
Pounced with fire on flaming roads
Using ideas as my maps
"We'll meet on edges, soon," said I
Proud 'neath heated brow.
Ah, but I was so much older then,
I'm younger than that now.

Half-wracked prejudice leaped forth
"Rip down all hate," I screamed
Lies that life is black and white
Spoke from my skull. I dreamed
Romantic facts of musketeers
Foundationed deep, somehow.
Ah, but I was so much older then,
I'm younger than that now.

Girls' faces formed the forward path
From phony jealousy
To memorizing politics
Of ancient history
Flung down by corpse evangelists
Unthought of, though, somehow.
Ah, but I was so much older then,
I'm younger than that now.

A self-ordained professor's tongue
Too serious to fool
Spouted out that liberty
Is just equality in school
"Equality," I spoke the word
As if a wedding vow.
Ah, but I was so much older then,
I'm younger than that now.

In a soldier's stance, I aimed my hand
At the mongrel dogs who teach
Fearing not that I'd become my enemy
In the instant that I preach
My pathway led by confusion boats
Mutiny from stern to bow.
Ah, but I was so much older then,
I'm younger than that now.

Yes, my guard stood hard when abstract threats
Too noble to neglect
Deceived me into thinking
I had something to protect
Good and bad, I define these terms
Quite clear, no doubt, somehow.
Ah, but I was so much older then,
I'm younger than that now.

[Oregone]

43. "you just can't stand that"

Straw man.

I cannot stand the notion of individual mandates if EVERYONE does not have the option for affordable, comprehensive and responsible insurance.

Of course there will be a public option. The question is if its structure will mitigate the regressive effects of a mandate for all citizens. Thats a debate no one is really engaging in, and instead people are using smoke and mirrors to dance around the problems. Instead of people focusing on the actual structure of the public option, its existence is being used as a litmus test--or rather, perhaps a red herring to distract from the mandates.

You can try and belittle this point of view as much as possible. Eventually the Democrats will, if they do not address it early, face the consequences at election time of bad social policy.

[Aramchek]

46. didn't you already tell me you would rather have nothing than have the public option?

[Oregone]

47. No, thats a lack of reading comprehension

Id rather see nothing than a mandate upon the backs of people who have no public option to turn to (due to firewalls, opt outs, etc).

[Ed76638]

44. My state voted for Barack Hussein Obama.

We deserve... no DEMAND the change we voted, and not to be held hostage to some bitch ass Rethug state government or some corporatist Democrate. Save your goddamn song for someone who gives a fuck.

[Aramchek]

45. The Rethugs who run your State won't be able to pull the plug unntil it's too late

[Life Long Dem]

48. Is this strong enough to prevent states from opting out if they want to?

How do we know if a state opts out that they "will not" receive federal funding by other means to counter the cost of opting out?