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Southern governors secede from Medicaid

Because individuals choosing to buy coverage is quite different than the state covering people, at virtually 0 cost (to the individual).
I'm disputing that the long term effects of medicaid expansion will provide a net benefit.
Rather than leave the program to focus on those who need it most, we're going to dilute it for everyone under X income.

Some states don't cover those who need it the most. In Texas, if you're a single person earning $3,000 per year, you are too wealthy to qualify for Medicaid. PPACA expands Medicaid to those earning less than 133% of the poverty line. That's $14,856 for a single person, or $30,656 for a family of four. Not exactly people rolling in cash, and not exactly what I would call "diluting it."

As it is, Medicaid pays less than 60%, of what private insures pay, adding more people (most of which are not in dire need) will not better things.

See above re: "dire need."
And comparing Medicaid to private insurance companies is a flawed comparison, because that isn't the choice that most Medicaid recipients face. Medicaid's 60% rate is considerably higher than the approximately 0% rate of what the uninsured poor pay.

Not only this, but it adds an unintended side effect.
When recessions hit, more people will qualify for the program and at the same time, states will have lower taxes to fund said program.
That would require the program to cut services to a greater degree, which hurts those who need it most, worse.

States will have a higher tax base in the first place, due to a healthier population that misses fewer days of work/school, and due to higher salaries resulting from fewer employers providing health benefits. Furthermore, the federal government is picking up 90% of the cost of the expansion, meaning that state Medicaid budgets will be mostly insulated from the effects of recession since the federal government is not constrained by budgets in the same ways that states are.

Something you missed, is that Medicaid already comes with federal subsidization, from 50% to up to 85%.
States are still cutting these services, regardless of current federal subsidy.

There is a huge difference between cutting Medicaid when you're getting a 50% subsidy versus when you're getting a 90% subsidy. In the latter case, states are getting NINE TIMES more federal assistance for every dollar they contribute.

Medicaid represents the 2nd largest budget item in most/all states, behind education spending, that's with federal subsidy.

States are already paying the health care costs of their uninsured residents, the costs are just more hidden and usually don't appear on any government balance sheet. The economic costs include hospitals or state governments directly picking up the tab for treating the uninsured, a lower tax base and less educated population due to absenteeism, increased risk aversion which discourages entrepreneurship and higher education, reduced job mobility which promotes economic stasis, etc.

Putting these residents on Medicaid doesn't create a new cost to the states...it just makes it clearer what the state was ALREADY paying and allows them to shift 90% of the cost to the federal government.

And if in the aggregate, most people use it irresponsibly, then it may not work out well.

Why would Medicaid recipients be more likely to use health care irresponsibly than anyone else who has health insurance? I think there are some rather nasty moral assumptions about people in poverty here.

I already know all this.
Describing "red states" as stingy, needs some backing.

Eligibility requirements are generally much stricter in conservative states. These states therefore will have the most federal subsidies coming their way starting in 2014, should they choose to participate.
http://www.kff.org/medicaid/upload/7993-02.pdf
 
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Some states don't cover those who need it the most. In Texas, if you're a single person earning $3,000 per year, you are too wealthy to qualify for Medicaid. PPACA expands Medicaid to those earning less than 133% of the poverty line. That's $14,856 for a single person, or $30,656 for a family of four. Not exactly people rolling in cash, and not exactly what I would call "diluting it."

Sure it's diluting it.
Adding more people to an underpaying system, increases the underpayments.

See above re: "dire need."
And comparing Medicaid to private insurance companies is a flawed comparison, because that isn't the choice that most Medicaid recipients face. Medicaid's 60% rate is considerably higher than the approximately 0% rate of what the uninsured poor pay.

That's assuming people will behave the same, when insured and uninsured.
These programs cause changes in behavior.

States will have a higher tax base in the first place, due to a healthier population that misses fewer days of work/school, and due to higher salaries resulting from fewer employers providing health benefits. Furthermore, the federal government is picking up 90% of the cost of the expansion, meaning that state Medicaid budgets will be mostly insulated from the effects of recession since the federal government is not constrained by budgets in the same ways that states are.

Another gross assumption.
You won't have that much higher of a tax base, if the people you're serving aren't taxed.
The income levels you're citing don't get taxed at all, in many states and get thousands in refunds from the feds.

There is a huge difference between cutting Medicaid when you're getting a 50% subsidy versus when you're getting a 90% subsidy. In the latter case, states are getting NINE TIMES more federal assistance for every dollar they contribute.

You're just low balling it.
The effective matching rate is some where around 65%, for most states.
Regardless of subsidy, these increased costs will require cuts during economic recession, when you have the added load of people on the programs, who've lost income.


States are already paying the health care costs of their uninsured residents, the costs are just more hidden and usually don't appear on any government balance sheet. The economic costs include hospitals or state governments directly picking up the tab for treating the uninsured, a lower tax base and less educated population due to absenteeism, increased risk aversion which discourages entrepreneurship and higher education, reduced job mobility which promotes economic stasis, etc.

Putting these residents on Medicaid doesn't create a new cost to the states...it just makes it clearer what the state was ALREADY paying and allows them to shift 90% of the cost to the federal government.

You're making these assumptions based on static behavior.

Why would Medicaid recipients be more likely to use health care irresponsibly than anyone else who has health insurance? I think there are some rather nasty moral assumptions about people in poverty here.

Over utilization is nearly guaranteed when co pays are nominal and there are virtually no out of pocket expenses for the individual.
It costs practically nothing to use their Medicaid benefits for anything.

Eligibility requirements are generally much stricter in conservative states. These states therefore will have the most federal subsidies coming their way starting in 2014, should they choose to participate.
http://www.kff.org/medicaid/upload/7993-02.pdf

So that amounts to "stingy" a negative value judgement?
 
Sure it's diluting it.
Adding more people to an underpaying system, increases the underpayments.

You keep saying it's an "underpaying system," but your only basis of comparison is another system that is generally not available to the people on Medicaid. If it was, then they wouldn't *be* on Medicaid.

That's assuming people will behave the same, when insured and uninsured.
These programs cause changes in behavior.

What does that have to do with the payment rate? If Medicaid pays 60% the rate of private insurance (using your numbers), and the uninsured poor pay almost nothing, what possible behavior modifications do you think would tip the balance to Medicaid being a raw deal? Especially since the behavior in question isn't the behavior of the patient, but rather the behavior of the entity paying the bills?

Another gross assumption.
You won't have that much higher of a tax base, if the people you're serving aren't taxed.
The income levels you're citing don't get taxed at all, in many states and get thousands in refunds from the feds.

I'm not just talking about the current income of the Medicaid recipients themselves. Their employers pay taxes based on the profits they get from the person's added value...which is reduced due to absenteeism. Additionally, the recipient himself will earn more in the future if he/she is able to work and/or go to school...which is less likely without health insurance.

You're just low balling it.
The effective matching rate is some where around 65%, for most states.

You're still comparing a 2-to-1 matching grant to a 9-to-1 matching grant. Those are quite different.

Regardless of subsidy, these increased costs will require cuts during economic recession, when you have the added load of people on the programs, who've lost income.

This is simply not true. The higher the matching grant, the LESS the states will be willing to cut. A 9-to-1 match is practically free money, and under those circumstances the calculus is such that states will cut less important things before they cut Medicaid.

You're making these assumptions based on static behavior.

And you're going to need more than this vague assertion to show that their behavior will change. Specific examples of HOW their behavior will change and why...and its relevance to acknowledging the economic costs that already exist and shifting 90% of them to the federal government.

Over utilization is nearly guaranteed when co pays are nominal and there are virtually no out of pocket expenses for the individual.
It costs practically nothing to use their Medicaid benefits for anything.

This problem is no worse for Medicaid patients than it is for anyone else who has private insurance. Free health care is fundamentally different than free widgets; very few people enjoy being at the doctor's office and getting extra tests, so no one intentionally takes more health care than they need. And although it's true that overutilization is a problem, we'd be far better off by enacting policies that encouraging higher deductibles for those who CAN afford it, rather than excluding people from Medicaid who CAN'T afford it.

So that amounts to "stingy" a negative value judgement?

Conservative states generally have extremely strict eligibility requirements for Medicaid, thus I call it "stingy." You can call it whatever you like; the point is the same no matter what you call it.
 
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You keep saying it's an "underpaying system," but your only basis of comparison is another system that is generally not available to the people on Medicaid. If it was, then they wouldn't *be* on Medicaid.

It under pays based on insurance compensation.
If doctors can't make as much with Medicaid, they will start to reduce or eliminate the amount of Medicaid patients they see.
(This has already been happening, btw.)

The people who need it most (disabled, children, pregnant women) will find themselves with further reduced options, because of the increase in patients seeking care, with a system that under pays regular service rates.
So you're taking away from some, to give to others.

What does that have to do with the payment rate? If Medicaid pays 60% the rate of private insurance (using your numbers), and the uninsured poor pay almost nothing, what possible behavior modifications do you think would tip the balance to Medicaid being a raw deal? Especially since the behavior in question isn't the behavior of the patient, but rather the behavior of the entity paying the bills?

Currently having 0 insurance, of any kind, is a pretty big barrier to treatment, from both necessary care to superfluous care.
Putting people on Medicaid, when it has nominal cost sharing, reverses this in the opposite direction.
The barriers of entry, for both types of care are eliminated.
Which can be good if most often, these people needed necessary care, but that's often not the case.

The amount of care people will seek for colds and the flu, which generally can not be helped, will increase and so will the cost.


I'm not just talking about the current income of the Medicaid recipients themselves. Their employers pay taxes based on the profits they get from the person's added value...which is reduced due to absenteeism. Additionally, the recipient himself will earn more in the future if he/she is able to work and/or go to school...which is less likely without health insurance.

That's assuming that most were somehow sick beforehand and them not receiving care, prevented them from working.
Do you have any numbers to prove that those who will be newly minted Medicaid recipients needed it that much?

You're still comparing a 2-to-1 matching grant to a 9-to-1 matching grant. Those are quite different.

It varies from 2-1, on up.
50% is the base, but can go up to 85%.
West Virginia receives the most subsidy of Medicaid currently, nearing the 85% mark.

This is simply not true. The higher the matching grant, the LESS the states will be willing to cut. A 9-to-1 match is practically free money, and under those circumstances the calculus is such that states will cut less important things before they cut Medicaid.

The 100% to 9-1 match is only for newly minted Medicaid eligible people.
It still represents a cost increase for states, regardless of how much the match is.


And you're going to need more than this vague assertion to show that their behavior will change. Specific examples of HOW their behavior will change and why...and its relevance to acknowledging the economic costs that already exists and shifting 90% of them to the federal government.

You changed the barriers of entry from completely cost prohibitive (in some areas) to completely nominal.
People can seek care, for any reason under Medicaid and only incur nominal costs.


This problem is no worse for Medicaid patients than it is for anyone else who has private insurance. Free health care is fundamentally different than free widgets; very few people enjoy being at the doctor's office and getting extra tests. And although it's true that overutilization is a problem, we'd be far better off by enacting policies that encouraging higher deductibles for those who CAN afford it, rather than excluding people from Medicaid who CAN'T afford it.

It's not enjoyment, it's fear + no barrier to entry.


Conservative states generally have extremely strict eligibility requirements for Medicaid, thus I call it "stingy." You can call it whatever you like; the point is the same no matter what you call it.

The problem is, that using federal poverty guidelines, for 50 states with 50 different costs of living and localized rates of inflation, don't paint a true picture in terms of "stinginess."
 
I realize I am getting older by the day but I distinctly remember voting in 2010 and the Affordable Health care act was not on the ballot.

:) Cute. But also avoidance - the Tea Party wave of 2010 was indeed a reaction to the Bailouts, the Stimulus, and Obamacare.
 
:) Cute. But also avoidance - the Tea Party wave of 2010 was indeed a reaction to the Bailouts, the Stimulus, and Obamacare.

Which was by no means a mandate.
 
:) Cute. But also avoidance - the Tea Party wave of 2010 was indeed a reaction to the Bailouts, the Stimulus, and Obamacare.

As someone who supported the Tea Party movement, I ask why the **** happened in the 2012 GOP primaries?

Mitt is not part of the Tea Party crowd. Mitt is the polar opposite, he created RomneyCare.
 
Kandahar;1060679145 The states have had 200+ years to do so said:
Any why is that? Mitt Romney managed did he not? I'm sure that Massachusetts or one of the many states with huge democratic majorities could have come up with a far better system then this one, which is simply another tax from the poor to the rich.
 
Any why is that? Mitt Romney managed did he not? I'm sure that Massachusetts or one of the many states with huge democratic majorities could have come up with a far better system then this one,

The Affordable Care Act is virtually identical to what Romney did in Massachusetts. And the other 49 states have worse health care systems. If one of the other states could come up with a far better system than this one, then why haven't they? In any case, states are still allowed to opt out of ACA if they have an alternative system which covers at least as many people and offers the same consumer protections...a couple states, Vermont and Oregon, are planning to do exactly that so that they can institute single-payer.

which is simply another tax from the poor to the rich.

That's just absurd. The ACA is very progressive; it provides Medicaid and/or subsidies to the poor and middle-class to enable them to buy insurance, and most of the taxes to pay for it come from the wealthy. You are just factually wrong; I suggest actually reading the provisions of the ACA and their impact on the economy before you make ridiculous claims like "it's a tax from the poor to the rich."
 
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The Affordable Care Act is virtually identical to what Romney did in Massachusetts.

Virtually identical, except, completely different. :roll:
 
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