Why would States opt out of the Medicaid expansion?

[JEDI]

http://money.cnn.com/2012/06/29/news/economy/health-care-medicaid/index.htm?source=cnn_bin

the supreme court ruling allows states to opt out of the new Medicaid expansion.

but the Fed govt picks up 100% of the new enrollees for the 1st 3 years, and drops down just 10% (to 90% of the tab) afterwards.

a 90% substidy to cover more poor in their state.
Why would States reject that?!

 

[Newbian]

Because it's different / a bill by the opposite political side.

 

[Perknose]

SOCIALISM! Jack-booed Federal thugs! Fear of the 21st century! Because that Muslim Kenyan proposed it! The deep-seated Pro-Life position, which unfortunately is completely abandoned once you are actually born.

 

[MovingTarget]

Either to spite Obama or because, like in my state, we barely tax enough to keep the lights on. Medicaid expansion under this new program would be a boon for our state, but funds do have to be raised on the state level to cover it. "No new taxes" for the lose.

We must be some sort of GOP-utopia if our level of taxes/services were the only metric. Don't be like us.

 

[DCal430]

http://money.cnn.com/2012/06/29/news/economy/health-care-medicaid/index.htm?source=cnn_bin

the supreme court ruling allows states to opt out of the new Medicaid expansion.

but the Fed govt picks up 100% of the new enrollees for the 1st 3 years, and drops down just 10% (to 90% of the tab) afterwards.

a 90% substidy to cover more poor in their state.
Why would States reject that?!

Actually States like California will have significant cost increase right a way due to the fact that they cover undocumented immigrants and there is zero reimbursement for this. California will still do the expansion, but it will cost the state money. Under the expansion more undocumented immigrants will qualify, so more cost for the state.

 

[nehalem256]

http://money.cnn.com/2012/06/29/news/economy/health-care-medicaid/index.htm?source=cnn_bin

the supreme court ruling allows states to opt out of the new Medicaid expansion.

but the Fed govt picks up 100% of the new enrollees for the 1st 3 years, and drops down just 10% (to 90% of the tab) afterwards.

a 90% substidy to cover more poor in their state.
Why would States reject that?!

Because that 10% is probably 100s of Millions of dollars per state.

And you have to trust that federal government will not reduce the 90% reimbursement later on.

 

[Jhhnn]

Either to spite Obama or because, like in my state, we barely tax enough to keep the lights on. Medicaid expansion under this new program would be a boon for our state, but funds do have to be raised on the state level to cover it. "No new taxes" for the lose.

We must be some sort of GOP-utopia if our level of taxes/services were the only metric. Don't be like us.

Yeppers. So cheap as to be stupid, kinda like people won't invest their own money to get a free money 401K match from their employer...

The Red State ownership class doesn't need medicare expansion, anyway, while keeping their constituencies faithfully barefoot & pregnant covers the rest of it.

 

[Infohawk]

Isn't it like the train funding? Some states are making principled stands against federal spending, even if they benefit from it. (And of course they'd be criticized for being hypocrites if they accepted the funding, so it's a lose-lose as usual with partisanship.)

 

[Jhhnn]

And you have to trust that federal government will not reduce the 90% reimbursement later on.

So what? Just cut services, blame Obama. In the meanwhile, state residents have been made better off.

 

[nehalem256]

So what? Just cut services, blame Obama. In the meanwhile, state residents have been made better off.

Cutting services is harder than not starting them in the first place. Oh, and you still have too come up with 100s of millions of dollars too.

Given the Trillion dollar deficits I would not exactly have a lot of faith in the Federal government keeping its funding promises.

 

[Jhhnn]

Isn't it like the train funding? Some states are making principled stands against federal spending, even if they benefit from it. (And of course they'd be criticized for being hypocrites if they accepted the funding, so it's a lose-lose as usual with partisanship.)

It's like every other right-wing attitude. There's nothing in it for the people who can say "Screw you- I got mine!"

 

[wirednuts]

medicaid should have been expanded to everyone in the united states.

 

[boomerang]

Either to spite Obama or because, like in my state, we barely tax enough to keep the lights on. Medicaid expansion under this new program would be a boon for our state, but funds do have to be raised on the state level to cover it.

Not to spite Obama. No state is run by people that ignorant.

The feds reduced the cost of health care to a great degree by shifting the burden onto the states. It's all out there to read and has been since the bill was passed. It's very important to look at things like Obamacare from a practical perspective. Wishing things are going to work out is just setting the whole thing up for failure. The feds can't bankroll the program so they dump the burden on the states wishing and hoping that they can come up with the funds to cover the expense. The costs are just being shifted.

Off the topic, but illegals by law will not be paying for their health care. The law states that only citizens are mandated to have coverage. Low income people will not pay and/or will be subsidized on a sliding scale. Thirty million illegals will bear no costs as well as the poor and the working poor. The cost of health care has been shifted to the states and ultimately the middle class. It's a recipe for disaster. Wishing and hoping it's going to work out is no guarantee of a positive outcome.

All this with no jobs, rampant outsourcing of labor and ever increasing costs of living due to federal policies. It's time to face the facts. We're in deep, deep trouble and Obamacare is only going to make it worse.

If you're honest with yourself you know why it's going to be repealed.

 

[Jhhnn]

Cutting services is harder than not starting them in the first place. Oh, and you still have too come up with 100s of millions of dollars too.

Given the Trillion dollar deficits I would not exactly have a lot of faith in the Federal government keeping its funding promises.

You silly man. The only reason that the govt might cut funding is right wing fol-de-rol- you know, expansionary austerity, laying people off to create jobs, and never, ever raising taxes, no matter what.

You're probably one of those people who won't put their own money into investment to get the 401K match... buying a new gun instead is obviously the better choice, huh?

 

[Jhhnn]

Not to spite Obama. No state is run by people that ignorant.

The feds reduced the cost of health care to a great degree by shifting the burden onto the states. It's all out there to read and has been since the bill was passed. It's very important to look at things like Obamacare from a practical perspective. Wishing things are going to work out is just setting the whole thing up for failure. The feds can't bankroll the program so they dump the burden on the states wishing and hoping that they can come up with the funds to cover the expense. The costs are just being shifted.

Off the topic, but illegals by law will not be paying for their health care. The law states that only citizens are mandated to have coverage. Low income people will not pay and/or will be subsidized on a sliding scale. Thirty million illegals will bear no costs as well as the poor and the working poor. The cost of health care has been shifted to the states and ultimately the middle class. It's a recipe for disaster. Wishing and hoping it's going to work out is no guarantee of a positive outcome.

All this with no jobs, rampant outsourcing of labor and ever increasing costs of living due to federal policies. It's time to face the facts. We're in deep, deep trouble and Obamacare is only going to make it worse.

If you're honest with yourself you know why it's going to be repealed.

Amazing exaggeration & distortion. 30M illegals? Really? The rest? Right wing delusion.

 

[woolfe9999]

To give an idea of how much this will cost a state, the Medicaid expansion was projected to cost the federal government $100 billion a year with every state assumed to be opting in. That is supposed to be 90% of the cost. That means the states' portion of it is about $11 billion yearly. A single state would incur about $200 million/year average (assuming the state is 1/50 or 2% of the national population), in practice probably between ~$40 million (Alaska) and ~$2 billion (California.) It isn't free, but relatively speaking, it's cheap. It's probably a %1-2 increase in a state's budget.

That said, they can reject it for any reason they want, and I suspect some will.

Incidentally, has anyone considered the fiscal impact that this new opt out will have? If half the states opt out, that will save $50 billion/year in federal spending, $500 billion over 10 years, but it has no effect on the tax increases or spending cuts used to fund the bill. The CBO has estimated ~125 billion in net deficit reduction over those 10 years. Even assuming that conservatives were correct that this number is off because it rested on certain flawed assumptions, it's going to be pretty difficult to escape the conclusion that it will be a deficit reducer should half the states opt out of the Medicaid expansion. That expansion was a huge portion of the total projected spending for the bill. We'll see.

- wolf

 

[cubby1223]

but the Fed govt picks up 100% of the new enrollees for the 1st 3 years, and drops down just 10% (to 90% of the tab) afterwards.

a 90% substidy to cover more poor in their state.
Why would States reject that?!

But it is people who live in states who pay the taxes so the fed gov't can hand it back out.

Or, are you claiming that because it is coming from the feds, the money is actually coming from selling our debt to China, instead of raising taxes?


Do you support this program because you believe it is free money? What is your own personal reasoning?

 

[cubby1223]

You silly man. The only reason that the govt might cut funding is right wing fol-de-rol- you know, expansionary austerity, laying people off to create jobs, and never, ever raising taxes, no matter what.

You're probably one of those people who won't put their own money into investment to get the 401K match... buying a new gun instead is obviously the better choice, huh?

Whatever

His line of reasoning is better than the "liberals" around here who seem to believe federal programs are good because they are free.

Think I'm exaggerating? Look at the first post in this thread. And, have you seen any of the tv commercials the government has put out since the supreme court ruling the other day? Personal stories about how amazing the government's free services have kept families together and happy?

You evaluate a service based on the whole situation, and not based primarily on how well you can "hide" the costs.

 

[a777pilot]

Control and who has it.

 

[MovingTarget]

Not to spite Obama. No state is run by people that ignorant.

The feds reduced the cost of health care to a great degree by shifting the burden onto the states. It's all out there to read and has been since the bill was passed. It's very important to look at things like Obamacare from a practical perspective. Wishing things are going to work out is just setting the whole thing up for failure. The feds can't bankroll the program so they dump the burden on the states wishing and hoping that they can come up with the funds to cover the expense. The costs are just being shifted.

Off the topic, but illegals by law will not be paying for their health care. The law states that only citizens are mandated to have coverage. Low income people will not pay and/or will be subsidized on a sliding scale. Thirty million illegals will bear no costs as well as the poor and the working poor. The cost of health care has been shifted to the states and ultimately the middle class. It's a recipe for disaster. Wishing and hoping it's going to work out is no guarantee of a positive outcome.

All this with no jobs, rampant outsourcing of labor and ever increasing costs of living due to federal policies. It's time to face the facts. We're in deep, deep trouble and Obamacare is only going to make it worse.

If you're honest with yourself you know why it's going to be repealed.

Perhaps you are unaware of the political situation in Alabama. You state a lot about shifting costs to the states, but my point had nothing to do with that. Our Republican governor and supermajority legislature have committed so fiercely to not raising taxes or providing new services that we have entire counties going bankrupt. (Counties do not have home rule in our state, so our the governor/state legislature handle local taxation issues) If this weren't the case, we could easily fund our portion of the federal mandate and see a dramatic rise in the overall health of our population. Thats how bad it is. Keeping taxes and services stripped to the bone does not work well on the state level, and it certainly will not on the federal level.

As far as the rest of your post is concerned, the illegal immigration thing is not relevant here. Sure, it is a problem, but it is no different under the ACA than it was before. The free-rider problem posed by illegal immigrants still exists, but will be dramatically reduced overall because of citizens and legal aliens complying with the act.

 

[DCal430]

To give an idea of how much this will cost a state, the Medicaid expansion was projected to cost the federal government $100 billion a year with every state assumed to be opting in. That is supposed to be 90% of the cost. That means the states' portion of it is about $11 billion yearly. A single state would incur about $200 million/year average (assuming the state is 1/50 or 2% of the national population), in practice probably between ~$40 million (Alaska) and ~$2 billion (California.) It isn't free, but relatively speaking, it's cheap. It's probably a %1-2 increase in a state's budget.

That said, they can reject it for any reason they want, and I suspect some will.

Incidentally, has anyone considered the fiscal impact that this new opt out will have? If half the states opt out, that will save $50 billion/year in federal spending, $500 billion over 10 years, but it has no effect on the tax increases or spending cuts used to fund the bill. The CBO has estimated ~125 billion in net deficit reduction over those 10 years. Even assuming that conservatives were correct that this number is off because it rested on certain flawed assumptions, it's going to be pretty difficult to escape the conclusion that it will be a deficit reducer should half the states opt out of the Medicaid expansion. That expansion was a huge portion of the total projected spending for the bill. We'll see.

- wolf

As I pointed out the States cost is actually higher then 10% and not 0 the first three years. there will be millions of people who the expansion covers, but the state will get 0 reimbursement for. this will cost California over a billion dollars in its first year likely.

 

[Zebo]

Because already strapped state budgets will be decimated unless we do much more to reduce inflation in medical services. All sane countries who insure everyone and their sickest control costs such as professional pay, drugs, medical devices and certainly don't have layers of leeches like insurance companies.

 

[woolfe9999]

As I pointed out the States cost is actually higher then 10% and not 0 the first three years. there will be millions of people who the expansion covers, but the state will get 0 reimbursement for. this will cost California over a billion dollars in its first year likely.

Yes I saw that, but not every state covers undocumenteds with its Medicaid, and most states do not have significant populations of undocumenteds. California, Arizona and Texas are the big three. Back east the percentages are extremely low. I don't think that nationally this will make much difference. California IMO should probably re-think its policy. At the very least, it should make the expansion not applicable to undocumenteds, i.e. only allowing them eligibility under the old, narrower thresholds. Nothing in this law requires the state Medicaid systems to cover undocuementeds at all, much less apply the expanded eligibility criteria to them. That is the state's choice.

What do you think of my analysis of the fiscal impact of the opt out? I think it has the potential to greatly improve the fiscal projections for the bill, and I'm not seeing anyone else noticing this rather obvious point.

 

[Jhhnn]

Whatever

His line of reasoning is better than the "liberals" around here who seem to believe federal programs are good because they are free.

Think I'm exaggerating? Look at the first post in this thread. And, have you seen any of the tv commercials the government has put out since the supreme court ruling the other day? Personal stories about how amazing the government's free services have kept families together and happy?

You evaluate a service based on the whole situation, and not based primarily on how well you can "hide" the costs.

As if the current system doesn't hide the costs of lack of preventative care & treatment of those uninsured. As if govt deficits aren't largely the result of serial tax cuts/ borrowing executed over the last 30 years.

I don't think that any of this is "free" at all. I do think it's an extension of Red State welfare, an attempt to extend decent healthcare to "conservative" areas of the country where those at the top keep strangle holds on the economy & their constituencies are too well indoctrinated to do anything about it.

If my taxes need to go up to help support it all, fine- just raise Mitt's first & higher. It's not like he needs a tax break, or that his low rates benefit anybody other than him, no matter how hard we want to believe in the flimflam of trickledown job creator economics. Hell- if he paid 30% federal income tax instead of 15%, it wouldn't affect his lifestyle in the slightest.

 

[Jhhnn]

What do you think of my analysis of the fiscal impact of the opt out? I think it has the potential to greatly improve the fiscal projections for the bill, and I'm not seeing anyone else noticing this rather obvious point.

I think it'll just encourage migration out of low benefit states to high benefit states, rewarding those who create & maintain poverty among their own populations. They get to maintain rock bottom tax revenues & high personal after tax incomes by externalizing the costs of their policy.

Just because people are poor doesn't mean they're stupid.