Republicans hate people who use Medicaid, and they really hate the expansion of Medicaid that allows the near-poor to get health insurance. If you talk about some of ObamaCare’s successes, e.g., in Kentucky, Republicans will respond contemptuously that most of the people who signed up are getting Medicaid. The funny thing is that they think we see that as a bad thing.
The entire point of the health care reform push is to make medical care available to people who cannot afford it. I really don’t give a crap if people who can afford health insurance have slightly lower premiums or modestly better coverage. I care that people can see a doctor who could not see a doctor before.
Arkansas is lucky to have a Democratic governor. As a result, they accepted the Medicaid expansion and set up their own exchange. As Arkansas Online (subscription) reports, the near-poor in Arkansas are enjoying a massive benefit:
Notices went out Tuesday to more than 40,000 food-stamp recipients informing them that they have been automatically assigned to a private health-insurance plan under the state’s expanded Medicaid program, the state Department of Human Services announced.
The automatic enrollments take the number of newly eligible people who have been added to the Medicaid program for coverage that will start Jan. 1 to 53,462.
That includes 49,151 who chose or were assigned to a private plan and 4,311 who were assigned to the traditional program because of they were deemed to have exceptional health needs…
…The expansion of the Medicaid program, authorized by the federal Patient Protection and Affordable Care Act and approved by the Legislature this year, extended eligibility for coverage to about 250,000 adults with incomes of up to 138 percent of the poverty level – $15,860 for an individual or $32,500 for a family of four.
Most of those who enroll are expected to be able to sign up for a private plan on the state’s health-insurance exchange and have their premium paid by Medicaid. About 10 percent – those identified as “medically frail” because of their health-care needs – will be assigned to the traditional Medicaid program.The 40,405 who were assigned to a plan Tuesday are among 145,000 recipients of the Supplemental Nutrition Assistance Program who received letters from the department in September informing them that they are eligible for coverage under the expanded program.
Those who responded and said they wanted coverage were sent a notice giving them 12 days to visit a state website, insureark.org, where they would be asked to complete a questionnaire designed to identify the medically frail. Applicants who are not found to be medically frail can then use the website to sign up for a plan.
The automatic assignments affect 38,376 people who indicated that they wanted coverage but did not visit the website, as well as 2,029 who completed the questionnaire but failed to select a plan after it was determined they were not medically frail.
How many of those 53,000 people who will now be receiving free health insurance are typical white Obama-hating southerners who listen to Glenn Beck and Mark Levin on their way to work?
What are they going to think about all this clamor about the malfunctioning federal website that they don’t have to use? What are they going to think about the people who are supposedly losing insurance plans that they like and are not allowed to go to the doctors that they prefer?
It’s going to seem like bullshit to them because their experience is that they got free health care without any problems.
ObamaCare was built to help them, and it is helping them in a massive way.
But the same people are not being helped here in Pennsylvania or throughout the rest of the Deep South. That’s because Republican governors and legislatures are standing in the way.
Maybe will have to wait until we have a new president, but the Bubba vote is ours. It’s just a matter of time.
What most people, who haven’t experienced it themselves, don’t know about Medicaid is that it is the primary funder of middle-class long term care in nursing homes. Yes, the people who go into nursing homes have to spend down all of their hard-earned assets first before they receive Medicaid. Yes, there are certain loopholes if you do “retirement planning” that allows even upper middle-class people to take advantage of Medicaid and still preserve an estate.
Middle-class families who have elderly relatives on Medicaid in nursing homes are not going to take kindly to politicians treating their relatives like grifters.
That is the underlying sentiment even before Obamacare shows how far Medicare reaches into the self-identified middle class. In fact, most of the whiners are the ones who just miss the Medicare extension cut for subsidies, live in red states where governors have done everything possible to sabotage Obamacare, and have either a conservative or more-liberal-than-thou axe to grind.
But…there is enough pain still in the system for Democratic politicians to start pivoting to a position of Medicare-for-all. The insurers and providers just constitutionally (in the sentiment, not the legal sense) cannot keep from continuing their bad behavior.
Also, there is a coming reorientation of self-care that shows promise from reducing the demand side. So far it is those who can most afford to pay for health care who have latched on to this. Which is why Bernie Sanders’s community health clinics need to be fully funded and not succumb to the austerian budget axe. They will reduce the deficit by cutting Medicare and Medicaid costs.
In principle the Bubba vote is ours. But there is the abortion/contraception….icky sex issue that goes along with health care that has been the wedge issue that Republicans keep using to tilt the vote of the good Christian Bubbas and their persuadable relatives.
preach it and tell it.
I’ve been saying for awhile that I’m tired of folks scapegoating Lequesha and Rosa Maria as the face of Medicaid, when, in actuality, in terms of THE LARGEST PERCENTAGE OF DOLLARS..
it’s Sally and Bob’s Grandma and Grandpa.
Democrats get into trouble by failing to be progressive enough. When we take a middle tack, it can seem to middle class people like the party only represents the poor. Clearly the Republicans only represent the rich. To the middle class, it can seem like no one represents them.
Obamacare’s biggest weakness, in my view, is that it’s hurting healthy upper-middle class families and individuals, too rich for subsidies, who find they have to pay higher rates to account for the non-healthy folks who can sign up for their plans.
And though it’s perfectly true that they benefit too from these changes because of 1) poor family members, 2) the possibility they may eventually have medical conditions of their own, 3) other Obamacare provisions that remove lifetime caps, allow kids to stay on insurance, etc. — they still feel themselves getting squeezed in an effort to make things better for poor folks.
This is why a public option or Medicare for all was so important. Obama was wrong to call it “belt and suspenders.” He should have been truthful that he couldn’t get it past the most conservative Democrats. When Obamacare is criticized now, the response should be that we still need a public option (to complete the law). By failing to be adequately progressive, middle class people come to believe Democrats aren’t looking out for them.
In many ways Medicaid is nursing care insurance for the working and middle classes. That’s certainly where most of its money goes. I wish they’d call that out more.
This is one of the reasons that I continue to think that the White House communications staff is incompetent.
I can personally confirm all of this. My mother, a widow who raised 4 children,retired from a Yankee owned drapery manufacturing plant which provided no retirement plan. Because she stood on her feet for almost 30 years, my very conservative brother convinced her to retire at 62 and live off her social security, supplemented by monthly checks from 3 of those 4 kids. She lived until age 94 and spent the last almost 6 years of her live in a nursing home with dementia. That same conservative brother (who doesn’t think that people have a right to healthcare) had done the necessary to clear her for Medicaid a couple years before the nursing home. Her only asset was a home valued at $25,000 by the county and which he had had transferred out of her name to ours at that same time.
Without that medicaid for the nursing home we would all be broke!! There was also the owner of a locally owned brokerage firm at which I worked for the last couple of years of my life who circulated instructions to his wealthier clientele about how to sell down one’s assets in order to qualify. When I tell that to other conservative relatives, they mostly hush up.
We do need a solution for very expensive end of life care.
I don’t know if this is true nationally, but I called the Covered California customer service line a while back because I thought I would be eligible for MediCal (our Medicaid), except that I had assets.
They told me that as of Jan 1st there would be no further assets test for Medicaid.
My income increased and I wound up being eligible for an enhanced silver plan and have signed up with Kaiser–my first medical insurance in 12 years, after spending a decade as an unpaid family caregiver for my Dad.
But if it’s true that there will be no assets test for Medicaid, that’s going to help a boatload of seniors who need long-term care.
Wow. My mom was a medical eligibility worker for years, and the asset testing was the most frustrating part of her job. People would go to elaborate lengths to hide relatively modest assets just so their kids could in some way benefit.
This is one reason low income minorities can’t climb out of poverty, by the way – they don’t inherit any assets. So it compounds income inequality.
Highly progressive income taxes and heavy duty estate taxes would be a superior solution to income and wealth inequality.
Doubt that a majority of voters are cool with Medicaid paying for Dad’s long term care so that his kids can inherit a bundle when he dies. (How soon before this becomes “Obamacare” gold for GOP candidates? “Medicaid paid $1 million so kids could inherit $1 million.) The whole point of accumulating assets during our working years are to see us through our retirement years. Some (for a multitude of reasons) will always come up short and collectively we take care of them. Some will always end up with a surplus and most of it rightly belongs to the collective we that made that surplus possible.
Wait – ObamaCare effectively is a way out of a “death tax”? That’s actually going to make a lot of haters’ heads spin.
Their heads are too compartmentalized to ever spin. Medicare as a government entitlement program doesn’t even compute for them.
Something similar helped to limit Carol Moseley Braun to a single term in the US Senate.. Although she did refund Medicaid for the money that should gone for her mother’s care.
KFF report on nursing homes In 2011 there were 1.4 million certified residents in nursing care. 63% of the cost was covered by Medicaid, 14% by Medicare, and 22% other.
KFF report – Distribution of Medicaid Spending by Service. (More than you ever wanted to know about Medicaid in this report.) Nationally, Long-term care consumes 30.2% of Medicaid dollars.
Medicaid Payments by enrollment group 2010. Nationally: Aged 22%, Disabled 42%, Adult 15%, Children 21%. (As close to half of births in the US are covered by Medicaid that is a small portion of Medicaid spending.)
Thanks for the stats.
Not getting how “self-care” for those most able to pay for health care is related to CHCs. Can you explain?
In the near term on the supply side, it probably won’t matter if CHCs are directly funded with federal dollars or they end up under within the network of providers paid for by PPO insurers.
Expect results similar to that seen for charter schools. Lower pay for medical professionals and higher pay for senior employees at PPOs and better returns for stockholders. But Medicaid beneficiaries will feel more secure with an insurance company managing their health care than the government because having “health insurance” means one is middle class. (Some beneficiaries may not be all that bright, but when they receive most of their communications about their health insurance from a private insurance company it’s easy to appreciate how they are misled.)
The is a coming change in primary health care as more clinical trial show the beneficial results of what is called “functional medecine”. That focuses on prevention, exercise, and recent studies in nutrition in order to reduce the occurrence of chronic diseases like diabetes, heart disease, and certain cancers. There is also current study that might lead to reductions in cases of MS, Alheimers, and certain other degenerative diseases. Among the well-to-do “foodies” and denizens of new farmers markets, there is a huge self-care clinical trial going on. The results are beginning to show the value of this approach and recommendations about carbs, fats, salt, and other established dietary “facts” are about to put the public into informational whiplash.
But this information is not getting out into rural communities and urban neighborhoods because there are not the primary care facilities in those areas to begin with and where they still exist the practitioners are not in the information loop on these new findings.
The well-to-do can afford the fee-for-service for the growing number of functional medicine practitioners. But the fee schedule operates much differently from the current micromanaged fee-for-service system based on Medicare costs that creates the infamous $100 aspirin in hospitals. There is a higher lump-sum cost-of-entry into this kind of medical service.
I don’t see evidence of PPO insurers going into the rural areas and urban neighborhoods that are the areas of concern in Bernie Sanders’s provision in the ACA. It requires substantial subsidies to get practitioners to live there or go there on a regular basis.
You’re mixing social trends with economic and public policy trends. We’ve only known for practically a century that primary health care is the best bang for the buck. It’s why public health clinics were built and funded (too often underfunded) by communities.
Yes, the well-to-do are shifting their health care dollars to concierge type primary care providers (a flat fee annual cost) and purchasing health insurance for possible big ticket medical costs. They pay a lot for all that individual attention from their primary care doctor — but that’s more a status and privilege than improving their health care outcomes from what they had in the traditional fee for service model. Before doctors were forced into PPOs that have required the doctors to limit their time with patients to a few minutes. As with all very high end new goods and services, it’s likely to become what the middle class will desire as soon as they know about it. It’s also what health insurance companies don’t want them to know about as it means fewer dollars flow through their books and on which they can take their cut.
CHCs are private clinics that are mid-way between traditional public health clinics and private practice primary care doctors. They don’t suffer the social stigma of “public clinics,” but they also get more dollars through direct public grants, patient co-pays and coinsurance, and reimbursements from various health insurance operators. CHCs are stand alone providers and not integrated with the larger and total health care system. PPOs have moved into that space and will expand their power and reach with the expansion of Medicaid. Once again in AR:
Also note from this chart the states where PPOs already control the bulk of Medicaid funds for acute care. 80.4% in AZ (Vermont not so much so far.)
There’s one exception to the private health insurance company takeover of public health care dollars and that’s Healthy SF. An excellent model that puts the local public health agency in a proper position. Dedicated public dollars flowing through it instead of insurance companies.
HealthySF didn’t disrupt the existing supply of health care providers; utilizing those that chose to contract with SFDPH. Very importantly it formally protected the flow of public funds to public hospitals. (Boston public hospitals have become even more financially strapped since the implementation of “Romneycare.”) Healthy SF would be healthier if it were the automatic coverage for all SF resident Medicaid beneficiaries. It’s not perfect and with ACA probably won’t be price competitive with lower income, individual health insurance market customers. What it does do that the ACA doesn’t is cover undocumented immigrants. What it doesn’t do is maximize the use of primary health care. Nor do the CHCs. Nor do any health insurance plans both public and private with one exception, Medicaid beneficiaries that fall into certain groups defined as vulnerable.
Why would wealthy people maximize their use of primary health care with a concierge service medical plan? They purchase such a plan because health outcomes are or are perceived to be superior, but they use those services for the same reason that Montana’s State Clinic for state government workers (all with health insurance) is demonstrating success. It’s FREE. Free without the baggage of guilt and shame individuals experience at clinics with sliding scale co-pays and/or co-insurance. Without having to deal with any insurance sign-up, private or public, and without any insurance premiums.
How High Black Turnout Gave Terry McAuliffe His Win in Virginia
African American voters turned out in huge numbers for the Virginia gubernatorial election, giving Terry McAuliffe a win and proving the “Obama model” can work without Obama.
by Jamelle Bouie Nov 6, 2013 10:30 AM EST
One of the big questions of the next few years of politics is whether Democrats can replicate the “Obama model” of minority turnout without the presence of Obama on the ballot. If the Virginia gubernatorial election was a test case, then the early answer is a clear “yes.”
……………..
The explanation for that decline is straightforward. Overall, the electorate is broadly similar to where it was in 2009, when Virginians gave Republican Bob McDonnell a landslide victory of Democrat Creigh Deeds. It has the same proportion of older people to young people (nearly two-thirds of voters were over 45), and the same proportion of women of men. Likewise, the ideological profile of voters is close to where it was in 2009. Then, the electorate was 18 percent liberal, 42 percent moderate, and 40 percent conservative. This year, it was 20 percent of the electorate called itself liberal, 44 percent moderate and 36 percent conservative.
What’s more, Cuccinelli maintained the GOP’s traditional advantage with white and married women, winning the former by sixteen point spread of 54 percent to 38 percent, and the latter by a solid margin of 51 percent to 42 percent. This was a real change from the polls, which had the former Democratic Party leader with a huge lead among all women. McAuliffe’s actual advantage was with unmarried women, who he won 67 percent to Cuccinelli’s 25 percent.
Where the change from 2009 was most significant was among black voters. Then, African Americans were 16 percent were of the electorate, a significant drop from the 2008 election. This year, blacks were 20 percent of all voters, which means their turnout was exactly where it was in 2012. Put another way, for the second year in a row, African Americans turned out at a rate above their percentage of the population, and supported the Democrat by a 9-to-1 margin.
This is huge. For McAuliffe, what it meant is that–for almost every black voter who went to the polls–he could count on a vote, giving him crucial support in a tight race. To wit, more than 37 percent of his vote total came from African Americans. It’s not hard to see what the race would have looked like with 2009 numbers; a four percent drop in black turnout would have slashed roughly 80,000 votes from McAuliffe’s total, turning Ken Cuccinelli’s narrow loss into a slim victory.
http://www.thedailybeast.com/articles/2013/11/06/how-high-african-american-turnout-gave-terry-mcauli
ffe-his-win-in-virginia.html
That certainly explains the geographical voting pattern that I saw on the map. That also argues that white Democratic down-ticket candidates need to stop pandering to policies that hurt black voters and black voter turnout. But upping the turnout to 20% is not sufficient to change legislatures. And there needs to be lots of down-ticket strategic education among all Democratic voters.
Not to mention some organizational reach into the areas of states in which the Bubbas who are benefiting from Obamacare are thickest.
The free dental clinic every year in Wise County VA draws people from as far away as South Carolina and Georgia. A lot of these folks will benefit from Obamacare even with all of the obstacles their governors have put in the way.
We shall see. I met with an ACA Navigator in WV yesterday to talk plans, and had a pleasant talk. One of the things we talked about is people wanting coverage under ACA but not wanting “that Obamacare.” She has had clients who simply refused to believe they are the same thing. Thrilled about one, angry/furious about the other. That pattern is showing up in polling pretty consistently, including in Kentucky. I can readily imagine the low information bubba voter being manipulated by their favorite media outlets into continuing with this belief and ultimately believing this is a republican plan.
Well, after all these years we still see signs saying “get the gubmt out of my medicare” so let’s not get our hopes up.
Dems can counter this, though, by claiming it over and over again, by both names in states which have both.
Absolutely, but that means not running and hiding when things don’t go perfectly at the start – as too many have already done.
one of the talk show comedians [Stephen Colbert?] had someone ask ppl on the street whether they preferred Obamacare or the Affordable Care Act and why. Everyone said Obamacare was no good, etc etc but Affordable Care Act was good [because it was affordable and was care iirc]
It was actually Jimmy Kimmel and you’re exactly right what happened.
Sad really.
A lot of this is the “takers” meme, that the people getting free health care are lazy grifters who don’t “deserve it” and ObamaCare is this grand conspiracy to make them like the Democrats.
Aside from this being counter-factual and utterly cruel, there’s also the matter that how uninsured people had been getting insurance was through the emergency room – which not only has much poorer results (who cares about them?), but drives up costs for everyone else in a way that ObamaCare does not.
In other words, the “takers” are even “taking” less now. Facts never, ever get in the way of a good hate with these people. So long as the health care system is associated with a black dude, a fair number of Bubbas will still fume about it, even as it improves their lives.
Whoa! The expanded Medicaid program is not Medicaid? It’s a private plan with co-pays and deductibles? That looks like the privatization of Medicaid to me.
I had thought that the extended Medicaid was a good thing, but if it’s just a bullshit Bronze plan then it’s a cruel hoax on the poor.
Where you been for the past decade or so? Outsourcing Medicaid/S-Chip to private insurance companies has been an on-going effort. As has Medicare Advantage and Medicare Part D.
However, it’s not a “bullshit Bronze plan.” There are no co-pays, deductibles, co-insurance payments for designated vulnerable groups such as pregnant women and children. Maximum out-of-pocket costs are low — no where near the ACA plan limits.
“Medicaid for all” would be better than “Medicare for all.”
Medicaid.gov
Well I was on Medicaid in 2003. No private insurance company was involved. No networks etc. What do insurance companies bring to the table except fat paychecks for execs and profits for shareholders? Just another example of the outsourcing of Government.
My disabled grandson is still on Medicaid. No insurance company is involved AFAIK. He gets a card monthly that is mailed from “Illinois Department of Public Aid”, but maybe it is really mailed by a contractor.
There is a $1 deductible for adults. Probably just to make sure that the totally destitute don’t get any healthcare.
Illinois is one of the laggards — a mere 4.1% of Medicaid managed by insurance companies.
Arkansas was only 0.5% in 2010, but it appears they are moving forward on that. And if I were a gambler, I’d wager that its per capita Medicaid spending on adults and children will rise.
Again, what do private insurance companies bring to the table other than their appetite?
Americans hate government and insurance companies and expect miracles from medical care, even for imaginary ailments. The unreasonable expectations add 15-20% to our national health care costs. The drug, medical device, and all those specialty stand alone operations (imaging, kidney dialysis) industries add another 15-20%. The variety of different health care systems and funding schemes adds another 15-20% through lost efficiency.
For a mere 15% to 20% in excess cost, insurance companies assume the ire of patients, doctors, and hospitals. They can all complain but not as directly to their elected representatives as they would with a government run insurance operation or — god forbid — socialized medicine. One reason why per capita Medicare costs are so high is that it’s less hassle to pay the bills than question the treatments. The private insurance company operated form of Medicare (Advantage) has to follow Medicare’s lead or those beneficiaries would return to traditional Medicare.
We could have UHC with health outcomes similar to that in France for half of what we currently spend. But only with either Finland’s model or the pre-Thatcher UK NHS. Single payer advocates fail to explain who gets to seek treatment at the high-end facilities and who has to go to “county.” (And no, there’s not enough surplus money in the system to convert all to high-end. Regardless of whatever system the US goes with, aggregate costs will rise for the simple reason that the proportion of seniors will rise for decades. Japan and Northern European countries are close to age demographic stability.)
Single payer advocates fail to explain who gets to seek treatment at the high-end facilities and who has to go to “county.”
Probably the way the Veterans Administraion deals with this daily,
Allowing Doctors to medically evaluate who need said procedures and who doesn’t based on the medical evidence.
I have had both in the VA specialist treatment and outside treatment prescribed by my doctor, based on the medical evidence.
If the medical NOT political evidence dictates, the price goers down, and probably outcomes are the best achievable from our current state of the art in medical treatment.
The VA doesn’t deal with the question I posed. It makes medical treatment decisions for a select population and can outsource the actual treatment in certain situations. Those with additional health insurance that don’t like the decision can go wherever his/her private insurer allows.
However, the VA model is primarily that of socialized medicine. It’s government funded and operated; health insurance is not part of the equation.
health insurance is not part of the equation.
BINGO
One very important reason it works as well as it does, and why the right wingers are trying to privatize the VA health care system, so the vets can get screwed by private insurers just like the general public has been for years.
While I would never privatize the VA health care system (nor any of the “commons” which are already too small a portion of our economy), a re-think is in order. It, like the exclusion of employer health insurance benefits from income, is a WWII legacy. A time when public and private health care resources were inadequate to also supply care for the large portion of the population that had served in WWII. And putting that cost on the federal dime was also an incentive to hire Vets at a time jobs were needed.
Twenty years from there will be a much smaller portion of the population that are Vets. And between now and then the GOP will find ways to whittle down and sell off the VA assets. Won’t even have to begin with privatizing the system — just declare underused facilities as surplus. So, the time for “re-think” is now.
I disagree about counting benefits as income. I always resented counting insurance benefits as income. I didn’t ask for insurance in lieu of wages. If employer supplied insurance is income, then my employer is forcing me to buy something I might rather buy elsewhere. Is my Christmas turkey, taxable income? Free parking in the plant parking lot? Some people have said yes to the parking part.
Health insurance benefits aren’t counted as income for federal income tax purposes; so, not understanding when you resented it.
Had people been in control of the income those benefits cost their employer, the US medical/insurance industry wouldn’t have spun so far out of control over the decades since WWII.
Life insurance is. If Medical was as well, I’d be even more resentful.
As it should be. Life insurance is discretionary. It’s also a highly profitable product for insurers.
With our all volunteer army, we all now pay (to a private, for profit insurance company) to insure service members. Cause of death is not a factor. The payout is $400,000. There’s another $100,000 awarded for in war theater death — payments of this death benefit were delayed by the sequester and had Congress all up in arms about it.
Some are questioning if the higher military suicide rate is related to the life insurance. The Pentagon’s answer is no.
And you think this is a good thing?
No. Just explaining reasons why the monster was allowed to develop. And the PPACA will make it that much more entrenched.
IMHO the problem in this country is that we don’t have Universal Health Care. And not that we don’t have sort-of-universal health insurance. But have to admire the insurance companies PR that has convinced the American people that health insurance is what they desire.
Oh, in your earlier posts it seemed like you were saying that it was an improvement.