Entire ACA upheld by Supreme Court

[Danzig]

got home from work and spanish class. figured i'd start looking in my usual spots for more being said on obamacare, and here's something interesting already. and it goes more into what i said earlier-that if states can't be forced (and today's ruling takes away the one big stick to force them) into participating by expanding medicaid, what would that do to ppuca:

http://www.slate.com/articles/health...the_poor_.html

Don’t Celebrate Yet
The Supreme Court’s decision will make it much harder to extend health insurance to America’s poor.
By Darshak Sanghavi|Posted Thursday, June 28, 2012, at 7:45 PM ET

and here's the teeth of it:

"When one understands that the ACA’s real impact will derive from its expansion of Medicaid, the Supreme Court’s decision seems more worrisome. By limiting the federal government’s power to expand Medicaid in many states, the Supreme Court has seriously damaged the liberal dream of universal health coverage. As I wrote last fall, almost half of all people who qualify for free health insurance never sign up, especially in the Southern states where the highest number of uninsured people live. That’s not because inhabitants are lazy; it’s because those states create all kinds of barriers to Medicaid enrollment, since they have to assume some of the costs. The Supreme Court’s decision leaves the federal government without a big stick to beat ornery states like Texas, Florida, and Mississippi into expanding Medicaid, which means it has been left powerless to make sure that poor people get their coverage.

State reluctance to expand Medicaid gets at the core problem in health care today—it’s just too damn expensive and the ACA does very little about that. Currently, the average person consumes $5,000 per year in health care. By simple math, newly insuring 60 million people will cost taxpayers $300 billion annually, a far higher number than many policymakers admit. (For example, health care costs now consume 54 percent of Massachusetts’s budget, with the lion’s share going to the expanded Medicaid, despite massive federal subsidies.) And the dream that newly insured people will take advantage of more preventive services, often touted as a means to cut costs, hasn’t panned out, according to a meticulous new study from Oregon."

...i know the focus was on the IM, because that was felt to be the constitutional bugaboo. but there's far more to the whole thing. by ruling that they can't cut current state medicaid funding, there is NO earthly reason for a state to decide to expand their program, especially with many already suffering budget-wise with their current medicaid outlays vs funding.
then there's the fact, since i've read more on the ruling, that they've slashed the fine amounts-you've just removed a real reason for people to go after coverage. it should cost MORE, not less, to not buy it, if the intent is to get young, healthy, non-insurance buying people to decide to buy it.

so, they didn't remove the heart, but it's still possible it's a mortal blow.

[pointman]

Originally Posted by Danzig

got home from work and spanish class. figured i'd start looking in my usual spots for more being said on obamacare, and here's something interesting already. and it goes more into what i said earlier-that if states can't be forced (and today's ruling takes away the one big stick to force them) into participating by expanding medicaid, what would that do to ppuca:

http://www.slate.com/articles/health...the_poor_.html

Don’t Celebrate Yet
The Supreme Court’s decision will make it much harder to extend health insurance to America’s poor.
By Darshak Sanghavi|Posted Thursday, June 28, 2012, at 7:45 PM ET

and here's the teeth of it:

"When one understands that the ACA’s real impact will derive from its expansion of Medicaid, the Supreme Court’s decision seems more worrisome. By limiting the federal government’s power to expand Medicaid in many states, the Supreme Court has seriously damaged the liberal dream of universal health coverage. As I wrote last fall, almost half of all people who qualify for free health insurance never sign up, especially in the Southern states where the highest number of uninsured people live. That’s not because inhabitants are lazy; it’s because those states create all kinds of barriers to Medicaid enrollment, since they have to assume some of the costs. The Supreme Court’s decision leaves the federal government without a big stick to beat ornery states like Texas, Florida, and Mississippi into expanding Medicaid, which means it has been left powerless to make sure that poor people get their coverage.

State reluctance to expand Medicaid gets at the core problem in health care today—it’s just too damn expensive and the ACA does very little about that. Currently, the average person consumes $5,000 per year in health care. By simple math, newly insuring 60 million people will cost taxpayers $300 billion annually, a far higher number than many policymakers admit. (For example, health care costs now consume 54 percent of Massachusetts’s budget, with the lion’s share going to the expanded Medicaid, despite massive federal subsidies.) And the dream that newly insured people will take advantage of more preventive services, often touted as a means to cut costs, hasn’t panned out, according to a meticulous new study from Oregon."

...i know the focus was on the IM, because that was felt to be the constitutional bugaboo. but there's far more to the whole thing. by ruling that they can't cut current state medicaid funding, there is NO earthly reason for a state to decide to expand their program, especially with many already suffering budget-wise with their current medicaid outlays vs funding.
then there's the fact, since i've read more on the ruling, that they've slashed the fine amounts-you've just removed a real reason for people to go after coverage. it should cost MORE, not less, to not buy it, if the intent is to get young, healthy, non-insurance buying people to decide to buy it.

so, they didn't remove the heart, but it's still possible it's a mortal blow.

You mean that insuring another 60 million people won't pay for itself? I thought that Obamacare won't add to the deficit and Riot assured us it wouldn't, how could this be? She even gave us a pie chart.

[Riot]

Originally Posted by pointman

You mean that insuring another 60 million people won't pay for itself? I thought that Obamacare won't add to the deficit and Riot assured us it wouldn't, how could this be? She even gave us a pie chart.

^^^ often confuses on-line persona with bitchy 14-year-old mean girl

The Supremes did remove the ability to withhold all Medicaid funds from states that just want to take the money, not actually spend it on their poor people via Medicaid, and run. Feds can still withhold some Medicaid money.

So if states want to step up, take Medicare money, then announce they are not going to spend it on the poor who are on Medicaid ... well, good luck the next election, Gov.

[Danzig]

Originally Posted by pointman

You mean that insuring another 60 million people won't pay for itself? I thought that Obamacare won't add to the deficit and Riot assured us it wouldn't, how could this be? She even gave us a pie chart.

yeah, a pie in the sky chart, viewed thru rose colored glasses.

[Danzig]

Originally Posted by pointman

You mean that insuring another 60 million people won't pay for itself? I thought that Obamacare won't add to the deficit and Riot assured us it wouldn't, how could this be? She even gave us a pie chart.

perry came out today and said (no surprise) no expansion of medicaid, no exchanges. he joins fla, south car, louisiana....
26 states sued fighting obamacare. what will happen with that legislation if over half the country doesn't opt in?

[Riot]

Originally Posted by Danzig

perry came out today and said (no surprise) no expansion of medicaid, no exchanges. he joins fla, south car, louisiana....
26 states sued fighting obamacare. what will happen with that legislation if over half the country doesn't opt in?

Notice that it is the poorest, most uninsured, least healthy red states doing this: they choose to simply be killing their poor and lower middle-class citizens by denying them the health care access afforded them legally by the #ACA Medicaid expansion.

Those losers need to be kicked out of office.

What happens? Those states still get to take the money, but don't have to use it for it's intended purpose. Their citizens suffer by remaining out of the health care system.

As far as refusing to set up the exchanges, the federal government comes in and does it for the state, if the state refuses. So the state loses any "states rights" to tailor the exchanges specifically to the needs of that state. They get the generic federal plan.

That will affect you, Danzig, as your governor is refusing to follow the benefits the law gives you. Too bad for you.

Ezra Klein's WonkBlog explains it easily and well

If governors opt their states out of the health law’s Medicaid expansion — as many are now threatening to do — it’s the poorest Americans who would find themselves getting the rawest deal.

This set of charts from our graphics department helps explain why: People who earn less than 100 percent of the Federal Poverty Line (about $11,170 for an individual) are ineligible for tax credits to purchase health insurance. In a state like Arkansas, for example, that could be a big deal:

[Riot]

The states whose Republican governors so far say they will refuse to expand Medicaid, or have state-specific health insurance changes for their citizens under the ACA are:

Mississippi
Arkansas
New Jersey
Florida
South Carolina
Louisiana
Texas

That is to say, the less you’ve been doing on Medicaid so far, the more the federal government will pay on your behalf going forward. And that gets to an irony of the health-care law: Red states have, in general, done less than blue states to cover their residents, so they’re going to get a sweeter deal under the terms of the Affordable Care Act.

[slotdirt]

Lots of states have said they won't accept the Medicaid expansion; too bad Riot's list doesn't include many of them.

[Riot]

Originally Posted by slotdirt

Lots of states have said they won't accept the Medicaid expansion; too bad Riot's list doesn't include many of them.

Can you list the other ones? I've just listed the ones where I've seen the govs come out publicly and said they will not.

Kentucky, thank goodness, has a Democratic governor who has already instructed the state to start creating our exchanges - much to the displeasure of our KY Republican senators Rand Paul and Mitch McConnell, who would prefer to have our poorest people continue to be uninsured and not receive health care.

Found two more:

Republican Gov. Scott Walker of Wisconsin
Republican Gov. Terry Brandstadt of Iowa.

Too bad, poor people of those states - your governor denies you health care. And too bad, insured citizens of those states - you will continue to personally pay for these uninsured (freeloaders) in your ER costs and insurance premium costs.

[Danzig]

Originally Posted by slotdirt

Lots of states have said they won't accept the Medicaid expansion; too bad Riot's list doesn't include many of them.

yeah, too bad i can't see the list.