No Obamacare, No Medicaid, No Nothing

The way Obamacare was supposed to work (for those without employer-based or government health care) was that some would get Medicaid under an expanded program, some would get insurance with government subsidies, and some would get insurance without government subsidies.

But when the Supreme Court found Obamacare constitutional, they also held that states didn’t have to expand Medicaid, and right now 25 states (all with GOP govs and/or legislatures) have refused to do so.  These red states are also among the poorest and unhealthiest states, places like Alabama and Mississippi.

So about 5 million people can’t get health insurance because they are too poor to qualify for subsidies.  Yes, you read that right.

Obamacare has left them in the same sad, sorry place they were before — with health care navigators encouraging them to try free clinics.  They should also encourage them to vote.

 

 

 

If You Like Your Plan…

You really can keep it (for another year, if your insurance company agrees).

The Prez just announced that insurance companies can (but don’t have to) extend plans in the individual and small-group markets even if they don’t meet the criteria for Obamacare.

Insurers must tell their customers what benefits these plans lack and that they have more alternatives in the Obamacare exchanges, including subsidies for many.  Some people are about to discover their plans don’t cover things like, oh, hospitalization.

So the WH is basically shoveling some of the poop it is thigh-high in and dumping it on insurance companies and state insurance commissioners to deal with.  After all, many of these policies no longer exist and it’s no small task to re-create them.

The legal authority for this?  The Prez is using his “enforcement discretion.”  Yes, they just made that up.

 

Stay Well, People in Red States

Obamacare authorizes subsidies for health insurance bought on an exchange “established by a state.”  So far, 34 states have refused to establish such exchanges, and people in those states are signing up — or trying to, God bless them — for insurance and subsidies on the federal exchange.

Can people using the federal exchange get subsidies?  A federal judge has refused to dismiss a case, Halbig v. Sebelius, arguing they can’t.  Eventually, this will go to the Supreme Court.

If people in more than half the states can’t get subsidies, it’s going to be a disaster for them and for Obamacare.

The other disaster — and it’s already here, it’s not just a possibility — is that the statute doesn’t provide subsidies for people who qualify for Medicaid.  You either get Medicaid or you pay full freight.  But half the states have refused to expand Medicaid under the ACA, even though the federal government pays 100% of that expansion for three years and 90% thereafter.  We’re talking about 8 million people who would qualify for expanded Medicaid not getting it.  By upholding Obamacare as constitutional, but finding that states can refuse to expand Medicaid, the Supreme Court created the absurd situation where people making too much for Medicaid get subsidies, but their poorer brethren don’t.  The most desperate are being denied.

When the ACA was drafted, it was just assumed that every state would expand Medicaid (since it would save states billions of dollars in paying for the uninsured) and would establish an exchange.  The Dems believed that GOP governors and legislators wouldn’t cut off their noses to spite their faces.  There’s a lot of red states with unattached noses.

The GOP’s Phony Outrage on Subsidies

If Obamacare were going to be as apocalyptic as the GOP claims (The whole country will be working part-time!), they’d just sit back and wait for that disaster and savor their sweep of both Houses of Congress in 2014 and the White House in 2016.

But, really, they are afraid that people are going to like Obamacare, especially with the subsidies for lower and middle-income families.  They are outraged about these “government subsidies.”

But what do they think the government is already doing with health care?  Health care subsidies are the biggest tax expenditure in the tax code, costing the government hundreds of billions of dollars each year.

If you get health insurance from your employer, you don’t pay taxes on the value of that benefit, it’s not counted as part of your income.  Your employer, in turn, gets to deduct all those health insurance premiums as a business expense.

So our current employer-based health system is already heavily subsidized by the federal government.  And by the way, one of the reasons wages have stagnated is the growing cost of health insurance.  Your employer is paying you more, he’s just doing it by paying those increased premiums for you.

So for the GOP to decry that the government is suddenly subsidizing health insurance is specious.  It’s been going on for decades. Big time.

The GOP claims they want consumer-based health care.  Well, this is it.  Every time someone buys insurance on the new exchanges from a private insurance company, that’s consumer-based health care.

 

Thank You, SCOTUS

When the Supreme Court voted that Obamacare was constitutional, they also held that states didn’t have to expand Medicaid as the law intended.  About 25 states, with GOP governors or legislatures or both, have so far refused to expand Medicaid.

This leaves us with the bizarre anomaly that more prosperous people will be eligible for health insurance subsidies, while poorer people still won’t be able to get health insurance.

The NYT* points out that the head of a family of four making $14 an hour will qualify for subsidies, but someone making $10 an hour won’t be able to get any help at all.

This is what happens when the law is an ass, and one of our two major political parties hates poor people.

*  “States’ Policies on Health Care Exclude Poorest,” Robert Pear