In Expanded Medicaid States, they’re not “uninsured” anymore. Someone is paying for them to be covered under Medicaid, and their bills are getting paid.
That “someone” is all federal taxpayers, even the ones in Unexpanded Medicaid States. Their insurance rates don’t benefit from a reduction in uninsured people. They pay for the service, but don’t get the benefit.
The Medicaid expansion covers people at 133% of the poverty level (138% of the current poverty level), for an individual we’re talking about people who make less than $16,000/year. Would they not be eligible for substantial subsidies on the Federal exchange plans? Medicaid might be a better option for them, but they should still be eligible for almost or entirely subsidized insurance on the Federal exchange.
In fact I’ve read many “case stories” of individuals in the $19k-22k salary range who will pay nearly or actually zero out of pocket due to Federal subsidies. So I’d be surprised if an individual earning less than $16,000 a year (133% of the Federal poverty level is $15k and change) would not qualify for an almost full subsidy–so assuming people are willing to sign up for subsidized healthcare I suspect this doom and gloom scenario of hospitals going under in States that have not expanded Medicaid will not play out.
Since you’ve conceded that Medicaid expansion won’t actually so much increase Medical sector receipts but just fill in for projected losses, and I’ve explained why (if Obamacare works as advertised) that isn’t likely to happen, that undermines the entire point you were making.
Which would explain why hospitals don’t care much about medicaid expansion. Except for those few who are, apparently, misinformed. Understandable, since they don’t know much about the cost of medical care, certainly not as much as you do.
(A google-vomit page for “Hospitals urge medicaid expansion”. Quite a lot of them, it appears.)
No different than my taxes going to subsidize corn producers, oil exploration/production and various other things that by and large don’t happen here in Virginia. Except I view those as “real” subsidies, because they are altering natural supply/demand.
But my taxes are also funding things like Federal works in Western states, which due to the much higher amount of Federal land managed by BLM have a disproportionate amount of Federal funding relative to Virginia. Am I subsidizing States like Montana and North Dakota or am I just paying the government to manage American land that happens to be out west, but which we should all be paying to manage since it’s part of our country?
Again, if Obamacare will work as advertised, people who are 133% of the new poverty level or 138% of the current poverty level will earn less than $16k/year as individuals and will almost certainly qualify for a fully subsidized plan on the exchange. Meaning they will still be able to get healthcare with zero monthly premium cost to themselves.
So there are basically only two routes here, you can argue that:
or
Simple either or, there. I’m not saying which it will be, I’m just saying if Obamacare works as expected I don’t see a problem. Maybe the Hospitals, who you are happy to use as an authority, know more about healthcare than the President and Sebelius, and they know Obamacare won’t work as advertised? Is that the argument you’re making?
If you have the option, why on earth would you go to the exchange? Medicaid is almost fully paid and if you get an exchange-with-subsidy, even if the premium is fully covered, you are still paying the deductible out of pocket.
As I mentioned, it’s different because plenty of it happens in Virginia, the question is whether your State Leaders are willing to accept the subsidy for it, or simply allow your Federal tax dollars to subsidize markets in other states, while leaving yours untouched.
Anyway, if Virginia’s Governor decides that the residents of his state should not get any of those federal dollars, I’m cool with that, I don’t live there.
You probably wouldn’t, unless you wanted to pay a little more for a better choice of physicians and such.
So in Texas if you earn $15,500 a year, which is right at 133% of the Federal poverty level, you could buy a Silver plan for $305 per year after the tax subsidy. The maximum out of pocket costs would be $2,250 per year. What that indicates then is such an individual, even if they have no savings, and no means to pay their out of pocket costs and thus their medical bills go to collections–could at most cost $2,250 per year to society/insurers as a whole.
So I’ll say the impact will be small if these people sign up for Obamacare as we are told they all will. Note that statistically some 25% of people who have health insurance do not use it in an average year, so we’re talking about:
75% of people who would have received Medicaid but instead take a low cost exchange plan who for whatever reason do not pay their out of pocket costs and send it to collections, would cost at maximum $2,250/year. That’s if they hit their full out of pocket costs, which is also going to be a much smaller population and then only a subset of that population will actually straight up fail to pay their bill. Some people with low income do have savings to draw from.
Yes, but many people who live there are Americans. I am concerned for their well-being, because I am one as well.
They do? What wonderful news! Do share more of this wonderful news, like, citations and stuff! Gosh, I thought poor people spent just about all their money on food, rent, chidren, clothing, stuff like that. I really had no idea that they had extra income to squirrel away against a day that ends with a “Y” !
Do tell us more!
Those Federal tax dollars are collected for Federal purposes. It should not be expected they will be used to fund specifically things in my State just because they were collected here. Do you not understand the point of Federal taxation versus having the States collect and manage all the tax revenue?
You seem to be focusing on the cause versus the effect. The cause is different for any number of tax and spending issues, but the effect is the same. So I see no real difference in this Medicaid expansion versus basically all other Federal spending.
Virginia will most likely participate in Medicaid expansion after Terry McAuliffe wins the gubernatorial election.
Let me stop you right there. No advocate for Obamacare has ever to my knowledge claimed that people at that income level would sign up for the exchanges. In fact, this assertion makes no sense: why would they expand Medicaid if they expected people of this income level to sign up for the exchanges?
I have spent years at that level of income and I know that I would not have signed up for a plan with such high out-of-pocket costs even if it was a lot cheaper with the subsidy than it might otherwise be.
Besides, correct me if I’m wrong but I don’t believe the exchanges (or at least the subsidies) are even available to people who fall within that income range where they would be eligible for Medicaid expansion. My understanding of the law was that it was supposed to have different remedies for people at different strata. And it was formulated with the expectation of all 50 states expanding Medicaid, so there would be no need for this kind of overlap.
I remain convinced that red states refusing to join the Medicaid expansion is a classic case of cutting off one’s nose to spite one’s face.
They’ll come around. Their behavior offends one of the deepest principles of conservative governance, it “leaves money on the table”. They dug in their heels in the expectation that they just might win, ObamaCare would be crushed by the Supremes, or some other miracle. Didn’t happen, and there are no more rabbits in the hat.
Anyone can buy plans on the exchange pretty much. Some people if they are offered workplace plans will receive no tax subsidy, unless they can demonstrate the workplace plan covers a % of costs below some level at which point they are then eligible for the subsidies (if their income also makes them eligible for subsidies.) There is nothing to prevent people from signing up for an exchange plan at $15,000 a year. They would normally be notified they could receive Medicaid, but it checks to see if they are in a State that has expanded Medicaid, if they aren’t then they would be able to buy the exchange plans.
People with income that low are exempted from the individual mandate though, because it has exemptions if you can show that health insurance would cost more than some % of your income or various other things that basically mean very low income people who aren’t eligible for Medicaid would not be required to buy it or pay the penalty. But they can certainly still get a subsidized exchange plan. I was using a calculator from Kaiser for Texas to come up with my numbers, and they made it clear that “Your State has chosen not to expand Medicaid, but you are eligible for a Silver plan at $305 a year after subsidy” and etc etc.
Also, $2,250 out of pocket costs is not a deductible it’s the total out of pocket costs for the year. You would have significant coinsurance to get that high, your medical costs for a year would have to be something like $37,500. Silver plans are supposed to provide 94% of the cost of all covered services and 100% after you’ve hit your out of pocket maximum.
Not to mention for $305 it’s also getting you 100% covered out of pocket expenses, immunizations etc.
It leaves money on the table for some taxpayers, but not really for the States themselves. The genuine fear with Medicaid expansion is the 2020s when States might end up being on the hook for unsustainable amounts of the program.
Still, 300 bucks is a lot of money for someone at that income level. Whereas Medicaid is free.
Sumbitch, you make a good point. Medicaid 1.0 was originally strongly resisted by conservative states, and was (and still is) optional for states to participate in. But the 50th and last state to come around was Barry Goldwater’s Arizona, 30 years ago or so. This despite the federal contribution being much stingier for 1.0. If these balking red states want to do something that makes a shred of fiscal sense, they should cancel their original flavour Medicaid along with refusing to join the expansion. That would actually free up some tax money they could refund to rich people.
And stimulate job growth, as gated communities hire more security.
Silver Plans provide for a maximum of 30% coinsurance, not 6%.
As for your example, please cite it as $305 a year is very, very cheap ($26 a MONTH) and give the market it’s in.
For Houston, TX, i’m showing that Kaiser tries to shunt you directly to signing up for Medicaid through Kaiser’s website at the $15,000 level. And the e-health (where Kaiser seems to be driving you to to shop for plans.) site is starting plans at $110 a month after subsidy for bronze ($6000 deductible, 0% coinsurance after it’s met) with Silver starting at $217 with a $3000 deductible and 20% coinsurance upto $6350.
Ehealth reference plans: Blue Advantage Bronze HMO 006 and Blue Advantage Silver HMO 004 (both offered by BCBS of Texas)
This is my cite, using income of $15,250, and a San Antonio zip code/county.
I don’t know if that link will work since I’m linking to the result based on data I entered (it looks like the query string contains the data, so it may work.) But what the website says is: