‘ObamaCare’ arrives this New Year’s Day


Posted by AzBlueMeanie:

Unless there was a late order entered by Judge Kathleen Cooper in Biggs, et al. vs. Brewer, et al. (CV2013-011699) that did not get recorded on the docket, Arizona's expanded Medicaid (AHCCCS) program under "ObamaCare" is effective today.

If you have been approved for Medicaid (AHCCCS) health care coverage, you are among the millions of Americans who now have health care coverage that you did not have before thanks to "ObamaCare." With new year, Medicaid takes on broader role:

Medicaid embarks on a massive transformation Wednesday — from a safety-net program for the most vulnerable to a broad-based one that finds itself at the front lines of the continuing political and ideological battle over the Affordable Care Act.

Already the nation’s largest health-care program, Medicaid is being expanded and reshaped by the law to cover a wider array of people.

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On Wednesday, people who have signed up for coverage under the new law will become eligible to receive it, in what supporters have hailed as a historic moment for health care in the United States.

So far, more than 2 million Americans, many previously uninsured, have enrolled in private health plans, thanks in large part to new federal subsidies for low- and middle-income people to buy coverage.

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A far greater number — about 3.9 million — took steps in October and November to sign up for Medicaid, according to federal figures. That includes people who became eligible for the state-federal program under the expansion as well as those who could have enrolled previously, but for one reason or another did not sign up until now.

Twenty-five states and the District expanded Medicaid under the Affordable Care Act. In many of those places, the program will be open for the first time to anyone whose income is below 138 percent of the poverty level — individuals making less than $15,856 a year or a family of four earning under $32,499 in 2013 dollars. That includes childless adults, who were excluded in most states despite a widely held misperception that all poor people automatically qualified for Medicaid.

“The big change is that it really is going to operate the way most people thought it did,” said Judy Solomon, a Medicaid expert at the Center on Budget and Policy Priorities, a think tank focused on policies affecting low- and moderate-income people.

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In the states that rejected the expansion, Medicaid will largely remain limited to groups of people who traditionally have been covered by the program: children, pregnant women, very-low-income parents and the poor elderly and disabled.

Even in states that aren’t expanding Medicaid, there are some significant changes, including new Medicaid eligibility standards. For people who are not in long-term care, the program will no longer take into consideration how much participants have in assets, such as savings or retirement accounts.

Medicaid already covers about 16 percent of the U.S. population — more people than Medicare, the federal health program for people 65 and over. That includes 31 million children, nearly 9 million disabled adults under age 65 and more than 4.6 million low-income seniors. It finances 40 percent of all the births in the United States and is the largest source of coverage for Americans with HIV and AIDS. More than 60 percent of those living in nursing homes are covered by Medicaid.

Supporters of the health-care law say that expanding Medicaid is a critical part of the effort to reduce the ranks of the uninsured and will build acceptance for a program that has been stigmatized since its inception in 1965 as essentially a fringe benefit for those on public assistance.

Rep. Henry A. Waxman (D-Calif.), one of Medicaid’s leading champions in Congress, said that as a result of the expansion, “we’ll see a whole lot of grateful Americans, and a whole lot more support for Medicaid, in areas where it has traditionally been scorned as a poor people’s program.”

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President Obama and many Democratic lawmakers initially resisted the dramatic Medicaid expansion that became part of the Affordable Care Act. But it turned out to be significantly less expensive than providing federal subsidies to lower-income people to buy private health insurance through the state and federal exchanges.

The law, as enacted in 2010, required all 50 states to expand Medicaid to reach the goal of extending coverage to 30 million uninsured Americans over the next decade. But the Supreme Court ruled in June 2012 that states could not be compelled to expand their programs. Because so many states rejected the expansion, the Congressional Budget Office estimated in 2012 that 6 million fewer would enroll in Medicaid over the next decade than initially expected.

Today, the Medicaid expansion, more than any other aspect of Obamacare, demonstrates the nation’s red-blue divide. States that are led by Democrats have rushed to embrace the Medicaid expansion, as have a small number of states governed by Republicans.

The decision by many states to reject the Medicaid expansion has thwarted a basic goal of the law, which is to make health-care coverage universal and affordable. And it has produced a perverse result: In the non-expansion states, people just above the poverty line are eligible for subsidies to buy private insurance, while those below it are not, and thus get no benefit from the Affordable Care Act.

Ed Kigore and Ryan Cooper have correctly labeled this the The “wingnut hole” measured: 5 million without insurance thanks to GOP refusal:

Because of the decision on Obamacare by the Supreme Court, which left the decision to expand Medicaid (a key part of Obamacare) up to the individual states, most Republican-controlled states refused said expansion, leaving substantial portions of the citizenry in the lurch.

Ed Kilgore has been calling this the “wingnut hole,” and many have been speculating about its size. How many Americans will go without health insurance simply because the GOP dislikes the president? Well, happy 2014, dear readers: initial estimates are in, and we have 5 million lucky winners!


About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America. . . . The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children. . . .

Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.

That’s approximately the combined population of Delaware, Vermont, the District of Columbia, North Dakota, South Dakota, Wyoming and Alaska. Or alternatively, either Alabama, South Carolina, Colorado or the whole of Norway alone.

The Supreme Court decision was doubly unfortunate, because Republican states tend to be poorer than average and contain a disproportionate number of potential beneficiaries who are losing out. Obamacare, by virtue of distributing benefits downward, was aimed at those very people; it never occurred to the law’s architects that the vagaries of politics and law might give states a way out, and so they didn’t design a backup coverage mechanism.

"It’s worth remembering that the federal government will pay 100 percent of the cost of the Medicaid expansion through 2016 and 90 percent of the cost afterward. It could very well work out that refusenik states will not even save money because of additional spending on the uninsured in emergency rooms and elsewhere." In fact, those Red States that did not take the carrot of federal funding will be hit by the stick of having to pick up more of the costs of caring for Medicaid patients. They will, of course, take it out on the poor as the GOP always does.

But eventually voters in these Red States will see the benefits their friends and relatives living in Blue States are receiving under "ObamaCare" and will aks "WTF? Why don't we have the same benefits in this state?" They will turn on the ideological reactionary extremists who are the obstructionists denying them access to health care, and costing their states money. The wingnut position is fiscally irresponsible and morally depraved, and cannot be sustained.

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AZ BlueMeanie
The Blue Meanie is an Arizona citizen who wishes, for professional reasons, to remain anonymous when blogging about politics. Armed with a deep knowledge of the law, politics and public policy, as well as pen filled with all the colors stolen from Pepperland, the Blue Meanie’s mission is to pursue and prosecute the hypocrites, liars, and fools of politics and the media – which, in practical terms, is nearly all of them. Don’t even try to unmask him or he’ll seal you in a music-proof bubble and rendition you to Pepperland for a good face-stomping. Read blog posts by the infamous and prolific AZ Blue Meanie here.