# Halbig v. Burwell ruling against Obamacare subsides **URL:** \ **Category:** Great Debates\ **Created:** [July 22, 2014, 2:42pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740 "2014-07-22T14:42:40Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [July 23, 2014, 10:33pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/101 "2014-07-23T22:33:49Z")
> [@slash2k](#): > > In many (most?) states, Medicaid covers only select categories of poor people: pregnant/nursing women, children, people with disabilities, and the elderly poor are the usual targets. > > Being poor, in and of itself, doesn’t qualify you for Medicaid. In particular, working-age adults who are not disabled, not pregnant, and not the parents of small children are only eligible in a handful of states. I don’t agree. The only other baseline requirement is federal or state rules regarding residency, immigration status, and documentation of U.S. citizenship. So let’s ante up. Name the state in which being poor (i.e., making less than 133% of the federal poverty level) is not sufficient on its own to qualify for Medicaid (assuming the applicant is a legal resident or citizen). Since you say this is true for many or most states, this should be easy. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 23, 2014, 10:37pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/102 "2014-07-23T22:37:59Z")
> [@doorhinge](#): > > (post shortened) > > As per your request - > > \*For most of his career, Barney Frank was the principal advocate in Congress for using the government’s authority to force lower underwriting standards in the business of housing finance. Although he claims to have tried to reverse course as early as 2003, that was the year he made the oft-quoted remark, “I want to roll the dice a little bit more in this situation toward subsidized housing.” Rather than reversing course, he was pressing on when others were beginning to have doubts. > > His most successful effort was to impose what were called “affordable housing” requirements on Fannie Mae and Freddie Mac in 1992. Before that time, these two government sponsored enterprises (GSEs) had been required to buy only mortgages that institutional investors would buy–in other words, prime mortgages–but Frank and others thought these standards made it too difficult for low income borrowers to buy homes. The affordable housing law required Fannie and Freddie to meet government quotas when they bought loans from banks and other mortgage originators.\* > > [Hey, Barney Frank: The Government Did Cause the Housing Crisis - The Atlantic](http://www.theatlantic.com/business/archive/2011/12/hey-barney-frank-the-government-did-cause-the-housing-crisis/249903/) That doesn’t say what you claimed nor does it support the notion that Barney Frank did anything to cause the crisis. This stuff is still fresh enough in our memories that we haven’t forgotten how the right tried to deflect blame with this bullshit. Blaming Barney Frank’s actions in 2003 and the CRA from 1992 for the crisis in 2008 is a pretty dramatic distortion of history and entirely ignores the effects of deregulation on the credit default swap industry. We can start a new thread on this if you want but we’ve done this before and you are wrong, the crisis was largely the fault of Republican driven deregulation and free market failures. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 23, 2014, 10:39pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/103 "2014-07-23T22:39:37Z")
> [@John\_Mace](#): > > If anyone is interested, there’s a much better discussion going on in the Pit thread. cite? ---
**Author:** ![Ambrosio\_Spinola](https://avatars.discourse-cdn.com/v4/letter/a/9de0a6/32.png) [@Ambrosio\_Spinola](https://boards.straightdope.com/u/Ambrosio_Spinola)\ **Post date:** [July 23, 2014, 10:59pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/104 "2014-07-23T22:59:29Z")
> [@Bricker](#): > > So let’s ante up. Name the state in which being poor (i.e., making less than 133% of the federal poverty level) is not sufficient on its own to qualify for Medicaid (assuming the applicant is a legal resident or citizen). Since you say this is true for many or most states, this should be easy. Here’s a handy [chart](http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf) (requires PDF) about Medicaid eligibility requirements. In Texas, just for one, an adult who is a parent is not eligible for Medicaid if they earn more than 15% of the federal poverty level, and I’m not sure a childless adult is eligible at all. Many Southern states have similar income requirements. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [July 23, 2014, 11:12pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/105 "2014-07-23T23:12:53Z")
> [@Bricker](#): > > I don’t agree. The only other baseline requirement is federal or state rules regarding residency, immigration status, and documentation of U.S. citizenship. > > So let’s ante up. Name the state in which being poor (i.e., making less than 133% of the federal poverty level) is not sufficient on its own to qualify for Medicaid (assuming the applicant is a legal resident or citizen). Since you say this is true for many or most states, this should be easy. > [@Ambrosio\_Spinola](#): > > Here’s a handy [chart](http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf) (requires PDF) about Medicaid eligibility requirements. In Texas, just for one, an adult who is a parent is not eligible for Medicaid if they earn more than 15% of the federal poverty level, and I’m not sure a childless adult is eligible at all. Many Southern states have similar income requirements. **Bricker** : The ACA would have made things as you say, starting this year, but the SCOTUS ruling that states were not obligated to accept the federal funding and expand medicare allowed states to opt out. Some did. I don’t know how many, but Texas was one of them. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [July 23, 2014, 11:15pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/106 "2014-07-23T23:15:53Z")
This [link](http://www.advisory.com/daily-briefing/resources/primers/medicaidmap) shows the states that took the Medicaid expansion (26, plus DC). ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 23, 2014, 11:17pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/107 "2014-07-23T23:17:09Z")
> [@Really\_Not\_All\_That\_Bright](#): > > These calculations appear to present a decent argument if you consider Medicaid spending in a vacuum. But pretending Texas’ Medicaid budget operates in a vacuum is silly. > … No. It does not operate in a vacuum. Studies have shown that newly insured Medicaid patients are using health care at a higher rate and [going to the Emergency Room at an increasing rate](http://www.npr.org/blogs/health/2014/01/02/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon) for care. Health care costs could be even higher based upon that. The cost of providing care at Emergency Rooms due to [EMTALA](http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act)is an unfunded mandate. State government does not pick up the cost directly. Medicaid programs can set rates that providers must accept, typically as a percentage of what Medicare pays. [Medicaid reimbursements are notoriously low.](http://books.google.com/books?id=cXY0UKSLnkMC&pg=PA3&lpg=PA3&dq=Medicaid+reimbursements+are+notoriously+low.&source=bl&ots=VPzxQQZHQ9&sig=eiacxgbsTC5ucVI4EAPh4N1stKw&hl=en&sa=X&ei=pzvQU4ysDsrzoATWs4LgBA&ved=0CCwQ6AEwAg#v=onepage&q=Medicaid%20reimbursements%20are%20notoriously%20low.&f=false) So while use of Emergency Rooms for uncompensated care does raise the cost for insured and uninsured persons, it’s effects on Medicaid rates are minimal. There are apt to be many other effects. Such is the case with a complex system that touches so much of a state’s budget. Perhaps improved medical care for those newly eligible for an expanded Medicaid would lower state expenditures on disability payments? Possibly my eligible population growth rate, which I estimated at one half the rate of general population growth is too low and the actual population would be much higher resulting in 10% higher costs? My goal was to give a very generalized view… that if federal funding comes through as promised at 90% then budget impact would be much less than what states fear. My 58% scenario is actually not what some states fear. Some fear they will get stuck with vanishing federal funding and the full cost of the Medicaid expansion ending up on the state’s bottom line. After all [the federal government has recently threatened to cut payments to states](http://lancasteronline.com/opinion/federal-government-s-medicaid-promises-to-states-are-too-good/article_811a7bee-0ded-11e4-9f95-0017a43b2370.html) for their administrative costs in running the Medicaid program. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [July 23, 2014, 11:25pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/108 "2014-07-23T23:25:45Z")
> [@Ambrosio\_Spinola](#): > > Here’s a handy [chart](http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf) (requires PDF) about Medicaid eligibility requirements. In Texas, just for one, an adult who is a parent is not eligible for Medicaid if they earn more than 15% of the federal poverty level, and I’m not sure a childless adult is eligible at all. Many Southern states have similar income requirements. But those are all overridden by the ACA. As of January 1, 2014, the federal minimum was 133% of poverty. [Per this PDF](http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10005.PDF). States could have (but did not have to) expand their coverage before that date. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [July 23, 2014, 11:27pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/109 "2014-07-23T23:27:07Z")
> [@John\_Mace](#): > > **Bricker** : The ACA would have made things as you say, starting this year, but the SCOTUS ruling that states were not obligated to accept the federal funding and expand medicare allowed states to opt out. Some did. I don’t know how many, but Texas was one of them. Oh. Then my mistake. And a pretty stupid one. I misread the expansion details completely, it seems. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 24, 2014, 4:00am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/110 "2014-07-24T04:00:13Z")
> [@Damuri\_Ajashi](#): > > cite? never mind, I think I found it. It was cleverly disguised. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 24, 2014, 4:08am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/111 "2014-07-24T04:08:30Z")
> [@Ambrosio\_Spinola](#): > > Here’s a handy [chart](http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf) (requires PDF) about Medicaid eligibility requirements. In Texas, just for one, an adult who is a parent is not eligible for Medicaid if they earn more than 15% of the federal poverty level, and I’m not sure a childless adult is eligible at all. Many Southern states have similar income requirements. Holy shit. I didn’t know that. What do the destitute elderly do in those states? ---
**Author:** ![Ambrosio\_Spinola](https://avatars.discourse-cdn.com/v4/letter/a/9de0a6/32.png) [@Ambrosio\_Spinola](https://boards.straightdope.com/u/Ambrosio_Spinola)\ **Post date:** [July 24, 2014, 3:34pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/112 "2014-07-24T15:34:38Z")
> [@Damuri\_Ajashi](#): > > Holy shit. I didn’t know that. What do the destitute elderly do in those states? The _elderly_, as in those 65 and older, are generally eligible for Medicare (some restrictions apply). Otherwise they do the same things that uninsured people everywhere in the United States do, which is try not to get sick and go to an emergency room for acute problems. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 24, 2014, 5:38pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/113 "2014-07-24T17:38:05Z")
> [@Ambrosio\_Spinola](#): > > The _elderly_, as in those 65 and older, are generally eligible for Medicare (some restrictions apply). Otherwise they do the same things that uninsured people everywhere in the United States do, which is try not to get sick and go to an emergency room for acute problems. Well the thing about medicare is that it costs money. You have to pay a premium and there is a deductible and copay and all sorts of other shit. IIRC more than half the people on medicaid are also on medicare. ---
**Author:** ![Drum\_God](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drum_god/32/44_2.png) [@Drum\_God](https://boards.straightdope.com/u/Drum_God)\ **Post date:** [July 24, 2014, 6:18pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/114 "2014-07-24T18:18:53Z")
Regarding this notion that the Federal government is some uncontrollable beast that is answerable to no one, I encourage people to vote. If a state’s voters are concerned that the Fed is going to renege on its commitment to continue funding of Medicaid (and whatever else), then they should vote for candidates who will ensure that the desired funding continues. “What if the Federal government runs out of money?!” Well, vote for people who will construct a tax policy that will ensure continued funding and a continued equitable share in providing that funding. It’s not like we don’t have a voice. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [July 24, 2014, 7:44pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/115 "2014-07-24T19:44:53Z")
> [@Damuri\_Ajashi](#): > > Well the thing about medicare is that it costs money. You have to pay a premium and there is a deductible and copay and all sorts of other shit. IIRC more than half the people on medicaid are also on medicare. The destitute elderly are usually eligible for Supplemental Security Income (SSI), and in many states (including both Texas and Kansas), SSI automatically qualifies you for Medicaid. Where lack of Medicaid expansion really hurts is among the working-age poor. Here in Kansas, working-age non-disabled adults who are not pregnant and do not have children under the age of 19 at home are not eligible for Medicaid, period. A parent with children at home is eligible if the family’s countable income does not exceed $471/month (family of four). ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 25, 2014, 1:26am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/116 "2014-07-25T01:26:40Z")
> [@Drum\_God](#): > > Regarding this notion that the Federal government is some uncontrollable beast that is answerable to no one, I encourage people to vote. > > If a state’s voters are concerned that the Fed is going to renege on its commitment to continue funding of Medicaid (and whatever else), then they should vote for candidates who will ensure that the desired funding continues. “What if the Federal government runs out of money?!” Well, vote for people who will construct a tax policy that will ensure continued funding and a continued equitable share in providing that funding. > > It’s not like we don’t have a voice. Its like you haven’t even heard of the Koch brothers. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [July 25, 2014, 1:27am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/117 "2014-07-25T01:27:44Z")
> [@slash2k](#): > > The destitute elderly are usually eligible for Supplemental Security Income (SSI), and in many states (including both Texas and Kansas), SSI automatically qualifies you for Medicaid. > > Where lack of Medicaid expansion really hurts is among the working-age poor. Here in Kansas, working-age non-disabled adults who are not pregnant and do not have children under the age of 19 at home are not eligible for Medicaid, period. A parent with children at home is eligible if the family’s countable income does not exceed $471/month (family of four). Oh, OK. I thought maybe Texas had a Soylent Green industry I didn’t know about. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 25, 2014, 11:02am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/118 "2014-07-25T11:02:39Z")
Hmmm… [del]Right-winger[/del] Technical consultant to Obama campaign, [Jonathan Gruber](http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29) who worked “with both the administration and Congress to help craft” the PPACA claims [subsidies only flow through state exchanges](http://www.forbes.com/sites/theapothecary/2014/07/25/obamacare-architect-agreed-with-gop-exchange-subsidies-can-only-flow-through-state-exchanges/?partner=yahootix) by design in a 2012 video. He changed his tune since. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [July 25, 2014, 11:51am UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/119 "2014-07-25T11:51:34Z")
That’s a bombshell. It’s the first evidence that subsidies were only intended for state exchanges. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [July 25, 2014, 12:00pm UTC](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740/120 "2014-07-25T12:00:17Z")
The article also outs him as pretty dishonest. He’ll say anything to defend the law, even if it contradicts what he said about it previously. [Previous page](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740.md?page=5) [Next page](https://boards.straightdope.com/t/halbig-v-burwell-ruling-against-obamacare-subsides/693740.md?page=7)