I’m just happy that the people in Red States will be paying tax dollars to support expanded Medicaid in Blue States.
Actually many providers do not want, and do not currently accept, Medicaid patients. It’s unlikely larger numbers of them are going to be much of a boon. Medicaid’s reimbursement rules are pretty bad compared to Medicare, which is why very few hospitals/doctors decline Medicare but very many decline Medicaid.
Medicaid is generally accepted to be the worst of the government-provided health insurance/coverage offered in the United States, for patients and providers.
No, that’s not actually true at all. The Federal government doesn’t tax the States.
Most of what you’re saying is accurate, but your broader point is incorrect. Hospitals generally (or possibly always) accept Medicaid. I don’t recall if they’re required to accept it by law but in any event, the alternative for them to is to treat patients for free (they get DSH payments to help offset this, but it’s not much), so it’s better than nothing.
The expanded Medicaid is a boon for hospitals, at least in the short run, and they lobbied hard for expanded Medicaid in all states which were contemplating the issue.
Physicians are something else. I would expect that physicians which accept Medicaid will be overloaded, and there might be some retrenchment there. (Truth is that if there’s a reduction in uninsured people then there might be longer lines for everyone. But it seems at the outset that the plans on the exchanges are going to have very narrow networks for the most part, which would tend to mitigate this.)
But it taxes people who live in states. Not sure what your point is.
It does tax the people of the states, which I think was what he/she was saying.
I don’t see why the feds would need to cut reimbursement in such a case. When they thought all 50 states were going to essentially be forced to participate, and then even after the Supreme Court ruling when they thought red states would do the sensible thing and take the money, they were still planning to pay for those people’s medical care.
Why, in the unlikely event that all of them move to blue states, would the feds rethink this? They would still be covering the same number of people they had intended to originally, but all the economic ripple effects from the medical sector would occur within blue states. Yet taxpayers from all 50 states would pay the tab. Sounds fine and dandy to me!
Saying “the red states are going to subsidize states that expand Medicaid” is not accurate. States are not taxpayers, they are States, they do not fund Medicaid in other States.
The point goes deeper, but it’s worth mentioning how incorrect it is to confuse all the taxpayers in a State that voted for Mitt Romney as being somehow the State itself.
Further, the taxpayers in those States are not subsidizing anything. They pay Federal taxes that are appropriated by Federal laws, once the taxes are collected it is no longer their money. Federal taxes can build bridges in Alaska, ships in Virginia, statues in D.C. or congressional junkets that fly over Antarctica.
Federal tax dollars do not belong to the States, so it is an absolute impossibility that Federal tax revenue that just happens to be collected in Mississippi could “subsidize” stuff anywhere. Those are Federal tax dollars, not Mississippi tax dollars.
Under the Articles of Confederation Congress had the power to request, based on assessments, an amount of taxes from each of the States. The States had the power to decline or approve the request. That’s not a good system, and in large part we did away with that by giving the Federal government from the outset some direct taxation powers, expanded by a Constitutional Amendment which gave direct income taxing powers. The income tax represents a tax relationship between the United States of America and citizens of the United States of America, the dollars collected are for purposes of American government. You do not pay taxes as a Floridian, you pay them as an American, and thus you as a Floridian are not subsidizing anyone, you’re paying your taxes.
Further, I don’t believe any classical use of the word subsidy would actually include a situation where “in a Federal system, taxpayers in one State pay for something that is not directly beneficial to them, but is instead beneficial to people in taxpayers and citizens who live in one of the other States.” I’ve heard people make this argument before in terms of States that receive more Federal dollars than they pay, and I’ve rejected it then as well. It’s a nonsense argument, Federal dollars are Federal dollars, they never belonged to the States.
The fact that the feds were planning to do something is not a reliable indicator that they won’t change it later. Things have already changed WRT the ACA specifically, and more could be coming. In particular, there is likely to be downward pressure on the federal budget. The enhanced Medicaid subsidy was put in as a sweetener for the states, but once they’ve expanded past a few years it will be politically very difficult for them to cut people off and the sweetener won’t be needed. I’m not predicting that this will happen any time soon, but I wouldn’t be so sanguine.
To be clear, there’s no way “all of them” - or anything close to it - will move to Blue States. Medicaid eligibility already varies a lot by state and there are people of all incomes in every state. I was suggesting something a lot more limited than that.
So, “welfare queens”, the “47%”, the “entitled”, etc., these are also nonsense, right? After all, federal dollars are federal dollars, they never belonged to the people.
FWIW, believe it or not, this NOT intended as a personal gotcha. I happen to agree with your post for the most part.
I’m not going to disagree with this sentiment, just suggest that this is a special case. This is a subsidy because the Feds are subsidizing the expansion of Medicaid. This subsidy does not benefit people in red states because their Republican leadership specifically chose to reject the subsidy.
This isn’t a matter of Iowa getting more corn subsidies than Maine, because Maine doesn’t grow much corn. It’s Iowa getting more corn subsidies then Nebraska, because Nebraskas governor chose to reject corn subsidies over a political dispute.
Folks in red states pay taxes that support this subsidy, but do not benefit from it because their governor hates Obama. This amuses me. I’m also amused that the Obamacare Website Debacle generally affects residents of states that rejected the opportunity to setup their own exchange. My understanding is that the state exchanges generally work ok.
It’s like the state governments are really sticking it to Obama by crapping all over their own residents.
All of those things are some level of nonsense, but not necessarily for the reason I have argued.
Welfare queens are mostly nonsense because as a matter of fact it was mostly an overblown phenomenon. There were indeed some people who lived up to the stereotypical concept of a welfare queen but it wasn’t such a problem in and of itself that it justified change (I agreed with the Clinton era welfare reforms regardless.)
I never said Federal tax dollars never belonged to the people, I said they never belonged to the States. All government money in some sense belongs to the people collectively, but is held in trust for us and managed by the stewardship of the government. For that reason the government has a compelling interest to use that money in an appropriate way for the public good. Some would (and could) argue that situations like that of a “welfare queen” are not ideal for the public good, for example. That’s got nothing to do with whether or not Federal tax dollars “belong to the States.”
Again, I don’t really view this as a subsidy at all. This is a government program we’re talking about. I wouldn’t say that the Federal government “subsidizes” State education systems just because it gives money to them, I’d say it “helps fund.” That’s a different concept to me than “subsidy”, which implies some artificial tweaking of supply/demand through various mechanisms (price controls, price floors, production credits et al.)
Most people that are net payers of the Federal income tax (which is what funds Medicaid, it isn’t funded by payroll taxes) do not receive Medicaid benefits at all. So almost all taxpayers are “subsidizing” [what we’re actually doing is paying for it, not subsidizing it] Medicaid regardless. If I’m making $85,000 a year and my State refuses to participate in the Medicaid expansion, why do I care? How is anything different for me in that situation?
I’d imagine the number of people who are actually net taxpayers (and thus could be capable of “subsidizing” anything) who are eligible for Medicaid is quite low.
The exchange point also forgets the 7 states that chose to operate partnership exchanges. These are states that I believe all support Obamacare and the Medicaid expansion, but they chose the partnership model because they felt their population density, IT infrastructure and etc were not up to snuff to operate their own exchanges. They decided to go the partnership model, trusting that the Federal government with its superior IT resources would be able to deliver a much better product than they could have themselves. So those 7 States are actually being fucked because they trusted the Federal government, and certainly didn’t oppose Obamacare.
So insurance pays for everything? Like trimming my son’s ingrown toenail and an HPV innoculation that cost me $140 despite having decent insurance? With deductables and only paying a percentage of costs, insurance merely makes you not as bankrupt with major medical costs.
Well put; and I too am mightily amused.
Because the medical sector is such a huge part of a state’s economy, and even if your salary does not come directly from that sector, it is impacted by the indirect effects of a giant hole in funding for that sector. Additionally, your state’s refusal to participate may result in higher levels of infectious disease that may impact you directly, more absenteeism, and other effects that diffuse through the population.
I just went on healthcare.gov to help a family member who has, as I do, the misfortune to live in a state not cooperating with the Affordable Care Act.
The healthcare.gov home page came up instantly. Since we aren’t masochists, she clicked on the paper application link, and that also came up right away.
So she’ll mail in the form. According to the Washington Post, one of 1,500 employees will process the application and mail back the eligibility determination in about a week an a half.
Then she has to talk to someone at a call center to complete the process. Maybe that will be a nightmare, but it doesn’t sound that way.
First, it affects your health care costs. Those uncovered folks still get some measure of care, even if only through the ER. If they can’t pay, you pay, in the form of higher insurance rates needed to cover more destitute uninsured. If they can pay, they pay out of pocket, that is less money available for other spending, a net drain on the local economy. People going bankrupt over medical bills increases uncertainty and drags down the local economy as well.
The other conflation is:
[ul]
[li]The massive traffic to the site that it couldn’t handle, with[/li][li]The complexity – perhaps overcomplexity – of the process, with[/li][li]Other (pace Mr. Klein) glitches, with[/li][li]The horrible mess people expect to find, and to which they’re attributing anything that’s at all different from what they want.[/li][/ul]
The talking point for this is “yes, but you’re not required by law to use The Sims.” Of course, you’re not required by law to use healthcare.gov either.
True, but if some nations with certain characteristics have had success with their systems, it follows even less that a similar system can’t work somewhere else.
My understanding is that it was said most people would be able to pay less for as-good-or-better coverage. I’m not convinced that isn’t the case.
Those people are already uninsured and having the same impact on our hypothetical person’s insurance rates before ACA was ever dreamed up.
I don’t think you’ve made any convincing argument whatsoever that Medicaid expansion is going to cause any increase at all, let alone a boom, in the “Medical sector.” Many people that are uninsured currently, and would eligible for expanded Medicaid (if their State approved it, and they applied for it) are already generating significant medical sector revenue. In fact, many of them are generating more revenue (through tax revenue used to pay for emergency care, for example) than they might generate if instead they occasionally go in to a GP or something for minor ailments and such instead of using an ER.
It’s obviously a good thing that more people on Medicaid might actually reduce healthcare spending, but it undermines your point that obviously a Medicaid expansion is going to represent some huge boon to the medical sector in States that participate.
Further, I’m stipulating a person who makes $85,000 here. So this isn’t the guy working retail/fast food/low level service industry who might care more if more doctors and nurses work in the area. This is probably an engineer at the local chemical plant or mid level manager at some local Fortune 500 office–not someone whose job or salary are significantly impacted by 20 doctors vs 15 doctors living in the vicinity of his office.
Actually, it’s not that expanding Medicaid will cause a huge increase in funding in the medical sector but will prevent a huge decrease. Before Obamacare was passed, hospitals got funding from the federal government to help cover the cost of emergency care for the uninsured. But these payments have been drastically reduced in conjunction with the law since there are supposed to be far fewer uninsured now. In states that accept the expansion, this should even out. But in those that don’t, it may create a huge fiscal hole and cause some hospitals to even go under.
Why would you think only people working retail/fast food etc. would be impacted by sucking billions of dollars of federal medical funding out of red states? There are hospital administrators in that zone; but further, what about people who own businesses and who have more customers with more money if that money is being infused into the state’s economy? What about landlords that rent to hospital orderlies? What about car salesmen?
Sure, you can cherry-pick examples of people at the $85K level who are basically immune to the vicissitudes of their local economy because they are working for big manufacturing or Fortune 500 outfits. But that is hardly true for all or even the vast majority of people in that range.
And even the ones who are immune in terms of whether they keep their jobs do benefit or suffer based on the local economy. If the economy is worse, that means more crime, less infrastructure, worse schools for their kids, more wear and tear on their car, greater costs to provide themselves with security, loss of value to their home, fewer choices in restaurants and entertainment venues. And it may result in the nearest hospital being farther away in an emergency.