Map of life expectancy at birth from Global Education Project.

Tuesday, August 12, 2014

Political Malpractice

No, you probably didn't read it here first, but the RW Johnson Foundation has a new analysis of the fate of people in those states that refused to accept the Medicaid expansion. Since I never know for sure how much readers may already know, I feel compelled to maybe bore and talk down to you about exactly what the Medicaid expansion is.

Prior to the Affordable Care Act, in order to be eligible for Medicaid you had to be a minor child, an adult caring for minor children or a pregnant woman, and you had to be disabled. That's called "categorical eligibility." Also, generally speaking, you had to be below the official poverty level. States set varying income eligibility limits and other requirements, but every state provided Medicaid to people with no income --which means that it was the working poor who were left out in the less generous states, even if they were categorically eligible. States are reimbursed anywhere from 50% to 80% of the cost of providing Medicaid for those people, depending on the economic circumstances of the state. That is still true, it hasn't changed. That was a good enough deal that every state took it, and kept taking, no matter how conservative their government.

The Medicaid expansion eliminates categorical eligibility, which means that non-disabled adults without kids can get it. It also raises the income eligibility threshold to 138% of poverty. And it reimburses the states 100% for these newly eligible people initially, falling to 90% by 2020.

In the ACA as passed by congress and signed by the president -- AKA tyranically imposed by the socialist usurper -- states had to accept the Medicaid expansion in order to continue participating in classic Medicaid. But John Roberts, a jurist who only calls balls and strikes and would never legislate from the bench, rewrote the statute such that states can keep classic Medicaid without accepting the expansion.

As a result, 24 governors decided not to allow the federal government to provide health care to their poor and low-income citizens. Also, those people are not eligible for subsidies to buy insurance on their own because the ACA assumed they would have Medicaid. Not that they could afford it even with the subsidies. So they're out of luck. Also out of luck are the hospitals and health care workers who would get paid to take care of them.

As the RWJ Foundation tell us, by the time the dust settles in 2016, 6.7 million people in those states who would otherwise have been insured will not be. The states will forego $43 billion in reimbursement by that year, for which they would have had to spend $291 million in their own money. The main argument the Republican governors make against accepting the expansion is that cost, but accepting the money would obviously boost their economies and tax revenues, while those same states will happily spend $45 billion in incentives to private business during that time. So they are, in other words, total hypocrites. (Hospitals and physician practices are private businesses, by the way. But evidently they don't count.)

There are only two reasons why the Republican state governments have rejected the Medicaid expansion. 1) The president is Barack Obama, and there's just something about him, what could it be? and 2) They want low income working people in their states not to be able to get health care, because they're just takers and the part where they make stuff by having jobs doesn't count. And note that it is mostly working people who are deprived because disabled people and parents without jobs are already covered.

Another way to put this is that they are psychopaths. Nevertheless that seems to be popular with their citizenry and they expect to do well at the polls this November. Explain it to me.


MissFifi said...

I would love to explain it, but I fear my language would get a touch colorful.

Reality is many people vote against their best interests. They live under the belief that they too, can one day be part of the 1% because the politicians tell them it is fact and they still push the American Dream. Suffice to say, the dream has died. Working hard does not mean comfy lifestyle anymore. It means struggle, credit card debt and health care issues no matter how much you try. God forbid anyone suggests you be happy with what you have, you are an enemy to Capitalism and should be shipped off to Socialism Land.
Yeah, welcome to 'Merica.

Daniel said...

In our case the Democrat governor was a strong advocate for expansion but could not get it passed by the Republican legislature.

The debate would go down like this:

Republican legislator: We are talking about giving health care to able bodied adults who are free loaders.

Democrat legislator: That is an outrageous statement we are talking about providing health care to the working poor.

Medical community: We strongly support Medicaid expansion

Me: I seriously question our collective IQ.