• This is a political forum that is non-biased/non-partisan and treats every person's position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

Southern governors secede from Medicaid

Harry Guerrilla said:
It could require another billion or more in state taxes for this program expansion.
Click to expand...

And at a time when not only states are running out of money, but city after city is falling flat broke.
 
Harry Guerrilla said:
Further reading on this subject has brought some more things to light.
The feds are only going to cover, new eligible Medicaid at 100% costs, for the first 3 years and after that they'll pay 90%.

Seeing that Medicaid, tends to be one of the largest budget items for states to begin with and even paying for these people at 90%, it still represents a greater burden on the states finances, to cover these people.
If I were a state governor/legislature I'd reject it to, based on future financial obligation.
Click to expand...

It's the feds that will be paying the 90%, not the states. The states are getting a 9-to-1 match on their money from the federal government...AND they get a lot of uninsured people covered...AND their health care providers will actually get paid for treating those people. States really can't afford NOT to take this deal. This is especially true of red states with stingy Medicaid programs, because they are eligible for more federal money to bring them into compliance with the Medicaid expansion.
 
Last edited:
Kandahar said:
It's the feds that will be paying the 90%, not the states. The states are getting a 9-to-1 match on their money from the federal government...AND they get a lot of uninsured people covered...AND their health care providers will actually get paid for treating those people. States really can't afford NOT to take this deal. This is especially true of red states with stingy Medicaid programs, because they are eligible for more federal money to bring them into compliance with the Medicaid expansion.
Click to expand...

And in x amount of time, that 90% goes away. Leaving the states to carry the burden the feds threw on them.

One must look at the big picture, not the 'quick fix'...
 
This isn't complicated. What the GOP governors are threatening to do is popular. The Democrats have to face the fact that the public has figured out the lies being used to promote the scheme.
 
wbcoleman said:
This isn't complicated. What the GOP governors are threatening to do is popular. The Democrats have to face the fact that the public has figured out the lies being used to promote the scheme.
Click to expand...

Secession has been popular in the South before.
 
wbcoleman said:
Right. I'm imagining that the voters threw out 63 Democratic members of the House, the biggest loss since 1938. Just me being consumed by hatred. :doh
Click to expand...

You got an influx of right wing weirdos in an off year election with a much smaller turnout than a Presidential election. Enjoy it while you can.
 
I've also read Christy in NJ, Walker in WI and ? in Iowa are resisting this likewise...

Not exactly 'Southern states'...secession indeed...:lamo
 
Kandahar said:
It's the feds that will be paying the 90%, not the states. The states are getting a 9-to-1 match on their money from the federal government...AND they get a lot of uninsured people covered...AND their health care providers will actually get paid for treating those people. States really can't afford NOT to take this deal. This is especially true of red states with stingy Medicaid programs, because they are eligible for more federal money to bring them into compliance with the Medicaid expansion.
Click to expand...

In three years time, it represents an increase in what states will have to pay for medicaid.
This is when states are already cutting back on medicaid, as it is.

The feds are only covering 100% of the cost for new people, not the people previously covered.
 
Harry Guerrilla said:
Further reading on this subject has brought some more things to light.
The feds are only going to cover, new eligible Medicaid at 100% costs, for the first 3 years and after that they'll pay 90%.

Seeing that Medicaid, tends to be one of the largest budget items for states to begin with and even paying for these people at 90%, it still represents a greater burden on the states finances, to cover these people.
If I were a state governor/legislature I'd reject it to, based on future financial obligation.
Click to expand...

You are absolutely right in that is an issue.

But states could easily cover that by implementing an internet sales tax nationwide and having that revenue, or partial revenue, go to fund it.

This would be a great way to deal with it since one reason why state budgets have been falling is because they are losing tax revenue because storefront vendors must pay state sales taxes but online vendors don't.

It would also take away an unfair advantage from online vendors and allow storefront vendors to compete again.
 
wbcoleman said:
This isn't complicated. What the GOP governors are threatening to do is popular. The Democrats have to face the fact that the public has figured out the lies being used to promote the scheme.
Click to expand...

Yeah, it's especially popular to people who don't live in those states and won't have to deal with the consequences of what the governors are doing.
 
samsmart said:
You are absolutely right in that is an issue.

But states could easily cover that by implementing an internet sales tax nationwide and having that revenue, or partial revenue, go to fund it.

This would be a great way to deal with it since one reason why state budgets have been falling is because they are losing tax revenue because storefront vendors must pay state sales taxes but online vendors don't.

It would also take away an unfair advantage from online vendors and allow storefront vendors to compete again.
Click to expand...

States are loosing money because of the unemployment situation and housing prices have stayed sunken.
Lower house values, lower revenue.

I don't believe an internet sales tax will fix this.
 
tessaesque said:
But that investment doesn't matter if they're limited to a 20% "profit" to cover overhead, salaries, and as a carry over for future expenses.

They would essentially have to return that "investment" to the buyers until what they have left is that 20% of total revenue...and then apply that 20% to operations.
Click to expand...

I don't think that's how it works.

Rather, I think how it works is that only a max of 20% of the premiums paid can be used to pay administrative fees.

Let's say that a health insurance company takes in $100 million in premiums from their customers in a single year.

They invest all that money in various ways that year and get a 5% return of their investments that year. So off of investments they will get $5 million in profits that year.

Of the $100 million paid in from premiums, they must pay out at least $80 million to health coverage costs and at most $20 million for administrative costs.

But they have that extra $5 million that they profited from through investments. Which they can then use however they want, such as to pay overhead, to pay salaries or compensation, to pay out more in coverage, pay in administrative costs, or invest it further to get a greater returns from it.

One thing you have to keep in mind is that large institutions rarely keep cash reserves handy. Individuals tend to take their paycheck, deposit it in a bank, and just let it sit until they need it.

Big businesses or individuals with large amounts of wealth don't do that. Every dollar that they sit on "just in case" is one dollar that they aren't investing. Which means it's another dollar that isn't getting a return for them. Which is a greater loss to them.

That's why the credit crunch was so bad for businesses, even large ones. What businesses like to do is instead of have a cash reserve they do payroll via credit and then cash out their investments to pay it back, especially if the percentage of return they get from their investments is at a larger rate than the percentage they have to pay on borrowing the money on credit.

That's also why large banks are resisting regulations requiring reserves on their capital. The more money they need to keep on hand for emergencies is less money they can lend to borrowers, which is less loans they are lending to get rates of return on.

So health insurance companies, who basically profit via investments, will hold on to their money to ensure longer times it's used in investments to get greater returns until they absolutely have to pay out money for health coverage.

Also keep in mind that this will help health insurance companies cut costs such as advertising. Because of the mandate, rather than advertising to convince people to get health insurance at all, companies will now have to advertise on the quality of the insurance they provide. And now that everybody is required to get health insurance, they are going to have a metric ****load of customers to them paying premiums to them. Which means a greater absolute amount of money the individual health insurance companies will take in.

The reason for the cap is to ensure that executives don't keep increasing their salaries to ungodly levels now that every American is required to be a customer of theirs. Trust me - the health insurance companies won't be hurt by this legislation at all.

Not even Halliburton got a deal this cushy.
 
Harry Guerrilla said:
In three years time, it represents an increase in what states will have to pay for medicaid.
Click to expand...

Yes, with a 9-to-1 match of free money from the federal government. I don't know about you, but if I could get someone to give me $9 for every $1 I spent on something that would benefit myself, I'd certainly take advantage of it even if it would cost me slightly more out of pocket. Let's not forget that this isn't simply money disappearing into the abyss; the states are buying something for their money...health coverage for many of their own residents. For every $1 they spend, they buy $10 worth of coverage.

The feds are only covering 100% of the cost for new people, not the people previously covered.
Click to expand...

Right. This is exactly why the states with the stingiest Medicaid programs (i.e. the red states) especially can't afford to turn it down. They'll be eligible to bring on the most new people, since their program was so limited in the first place.
 
Last edited:
Kandahar said:
Yes, with a 9-to-1 match of free money from the federal government. I don't know about you, but if I could get someone to give me $9 for every $1 I spent on something that would benefit myself, I'd certainly take advantage of it even if it would cost me slightly more out of pocket.
Click to expand...

They pay now, but down the road, ALL that money goes away, and it is all on you, and you have no choice to to pay it. Look big picture, look long term.
 
Arbo said:
They pay now, but down the road, ALL that money goes away, and it is all on you, and you have no choice to to pay it. Look big picture, look long term.
Click to expand...

The Affordable Care Act has no such end date. The federal government pays 100% of the cost of expansion for the first few years, then 90% of the cost of expansion thereafter, into the indefinite future.
 
Kandahar said:
Yes, with a 9-to-1 match of free money from the federal government. I don't know about you, but if I could get someone to give me $9 for every $1 I spent on something that would benefit myself, I'd certainly take advantage of it even if it would cost me slightly more out of pocket. Let's not forget that this isn't simply money disappearing into the abyss; the states are buying something for their money...health coverage for many of their own residents. For every $1 they spend, they buy $10 worth of coverage.
Click to expand...

The benefit of this program is hardly going to help that much.
It's already been demonstrated that people on government medical programs already us the ER at much higher rates, than the regularly insured.
Medicaid co pays are nominal, Medicaid payments to medical facilities and doctors is low.
It's not going to help them all that much, when many are limiting or dropping the program.

All it will represent is an increased cost to states, with nothing else.

Kandahar said:
Right. This is exactly why the states with the stingiest Medicaid programs (i.e. the red states) especially can't afford to turn it down. They'll be eligible to bring on the most new people, since their program was so limited in the first place.
Click to expand...

Most states, (both red and blue) are cutting back on Medicaid because the tax money isn't there.
Most states (both red and blue) limit Medicaid to those are disabled, pregnant, under 18 or elderly.

Sorry.
 
wbcoleman said:
The 2010 election was a referendum on Obamacare.
Click to expand...


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.
 
Harry Guerrilla said:
The benefit of this program is hardly going to help that much.
Click to expand...

As long as the benefits are at least 1/10 of the costs, it's to the advantage of every state to sign up for the expansion. It's one thing to argue that the benefits of Medicaid are less than the costs, but would you seriously contend that the benefits of Medicaid are less than 1/10 the costs?

It's already been demonstrated that people on government medical programs already us the ER at much higher rates, than the regularly insured.
Click to expand...

What does this have to do with the effectiveness (or lack thereof) of Medicaid?

Medicaid co pays are nominal, Medicaid payments to medical facilities and doctors is low.
Click to expand...

It's more than the $0 they get if the person doesn't pay their bills because they don't have any money.

It's not going to help them all that much, when many are limiting or dropping the program.
Click to expand...

States are prohibited from cutting back on Medicaid until 2014 (although Maine is currently challenging that provision in court). But to the larger point, it's one thing to cut back if you're only getting a 1-to-1 federal match...it's very different to cut back if you're getting a 9-to-1 federal match.

All it will represent is an increased cost to states, with nothing else.
Click to expand...

Like I said, that money doesn't just disappear into a black hole. The states are actually buying something of value with their money.

Most states, (both red and blue) are cutting back on Medicaid because the tax money isn't there.
Most states (both red and blue) limit Medicaid to those are disabled, pregnant, under 18 or elderly.

Sorry.
Click to expand...

The states with the stingiest Medicaid programs tend to be very conservative states...and these are precisely the states that will benefit the most, since the federal government is offering to foot the bill for most of the cost of the expansion to bring them into compliance with the Affordable Care Act.
 
Kandahar said:
As long as the benefits are at least 1/10 of the costs, it's to the advantage of every state to sign up for the expansion. It's one thing to argue that the benefits of Medicaid are less than the costs, but would you seriously contend that the benefits of Medicaid are less than 1/10 the costs?
Click to expand...

Yes.
I dispute it.
I don't think the benefits of it will outweigh the costs.

Most states seem to be in agreement, as they are cutting services.

Kandahar said:
What does this have to do with the effectiveness (or lack thereof) of Medicaid?
Click to expand...

Medicaid should exist for people who need it most, children and the disabled.
Piling more people into the program, which can cause more medical providers to limit service or drop out completely isn't good for those individuals.

Kandahar said:
It's more than the $0 they get if the person doesn't pay their bills because they don't have any money.
Click to expand...

I'd rather get $0 than -$1.

Kandahar said:
States are prohibited from cutting back on Medicaid until 2014 (although Maine is currently challenging that provision in court). But to the larger point, it's one thing to cut back if you're only getting a 1-to-1 federal match...it's very different to cut back if you're getting a 9-to-1 federal match.
Click to expand...

It still represents an increase in costs.
No matter which way you spin it.

You can argue that there may be some benefit to states, because people are covered medically, but I think that benefit is marginal.

Kandahar said:
Like I said, that money doesn't just disappear into a black hole. The states are actually buying something of value with their money.
Click to expand...

That's disputable.
It depends on how these individuals utilize medicaid.
If they waste it on colds and things that can't be cured and don't require doctors services, it's a waste.

Kandahar said:
The states with the stingiest Medicaid programs tend to be very conservative states...and these are precisely the states that will benefit the most, since the federal government is offering to foot the bill for most of the cost of the expansion to bring them into compliance with the Affordable Care Act.
Click to expand...

I don't believe that to be the case.
I'd like to see some facts on that.
 
Harry Guerrilla said:
Yes.
I dispute it.
I don't think the benefits of it will outweigh the costs.

Most states seem to be in agreement, as they are cutting services.



Medicaid should exist for people who need it most, children and the disabled.
Piling more people into the program, which can cause more medical providers to limit service or drop out completely isn't good for those individuals.



I'd rather get $0 than -$1.



It still represents an increase in costs.
No matter which way you spin it.

You can argue that there may be some benefit to states, because people are covered medically, but I think that benefit is marginal.
Click to expand...

If there is no benefit (or only a marginal benefit) to providing people with medical coverage, then why would people who CAN afford it be willing to shell out thousands of dollars in premiums and/or foregone salary in order to obtain it? The average Medicaid expenditure per capita is about $14,000. Even if we assume that the expansion will cost the same per capita (and it'll probably be less since the Medicaid newbies probably won't be quite as poor as the people who were already on Medicaid), that means that it will only cost the states $1,400 per person. Do you really think that health insurance coverage - especially for someone probably disproportionately more likely than average to get sick - is worth less than $1,400?

That's disputable.
It depends on how these individuals utilize medicaid.
If they waste it on colds and things that can't be cured and don't require doctors services, it's a waste.
Click to expand...

I'm talking about in the aggregate, not individual cases.

I don't believe that to be the case.
I'd like to see some facts on that.
Click to expand...

PPACA calls for participants in the Medicaid expansion to open it up to anyone earning less than 133% of the poverty line. The cost of the expansion (i.e. the difference between wherever the states are now, and the new PPACA level) will be paid 100% by the federal government for the first few years and 90% thereafter. This means that the stingier states currently are, the more federal money they'll be eligible to receive. Here's a couple recent blog posts about it:

A More Points About Medicaid Expansion Super-Happy Fun-Time! - redeyechicago.com

The Affordable Care Act's big giveaway to stingy red states
 
Last edited:
Kandahar said:
If there is no benefit (or only a marginal benefit) to providing people with medical coverage, then why would people who CAN afford it be willing to shell out thousands of dollars in premiums and/or foregone salary in order to obtain it? The average Medicaid expenditure per capita is about $14,000. Even if we assume that the expansion will cost the same per capita (and it'll probably be less since the Medicaid newbies probably won't be quite as poor as the people who were already on Medicaid), that means that it will only cost the states $1,400 per person. Do you really think that health insurance coverage - especially for someone probably disproportionately more likely than average to get sick - is worth less than $1,400?
Click to expand...

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.
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.

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.

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


Kandahar said:
I'm talking about in the aggregate, not individual cases.
Click to expand...

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

Kandahar said:
PPACA calls for participants in the Medicaid expansion to open it up to anyone earning less than 133% of the poverty line. The cost of the expansion (i.e. the difference between wherever the states are now, and the new PPACA level) will be paid 100% by the federal government for the first few years and 90% thereafter. This means that the stingier states currently are, the more federal money they'll be eligible to receive. Here's a couple recent blog posts about it:

A More Points About Medicaid Expansion Super-Happy Fun-Time! - redeyechicago.com

The Affordable Care Act's big giveaway to stingy red states
Click to expand...

I already know all this.
Describing "red states" as stingy, needs some backing.
 
You must log in or register to reply here.
Back
Top Bottom