Can the states by themselves now unravel ObamaCare? (1 Viewer)

[James Cessna]

If the recalcitrant states stick by their guns, Obamacare will easily become a thing of the past by 2014. And here is how.

"If states decide to neither expand Medicaid nor set up health care exchanges, these acts would effectively block most if not all of ObamaCare's new entitlement spending."


Several authorities have pointed out that the Medicaid expansion under ObamaCare would cost New York state, for example, up to $52 billion over ten years. If New York and other states balk at the cost most of those who would've been eligible for Medicaid will now become eligible for subsidies through ObamaCare's health-insurance exchanges. And for several years those subsidies are paid in full by the feds.

Of course, these authorities conclude if states do shift those costs back to the feds, that will cause the federal cost of ObamaCare to skyrocket. If every state were to refuse to expand its Medicaid program, the feds would save roughly $130 billion in their share of Medicaid costs in 2014, but would have to pay $230 billion more in new exchange-based subsidies - for a net added cost of $100 billion. And that's just for the first year.

Article follows.

Only 13 states to date have set up state exchanges, with Tanner estimating that "as few as" 15 states will have done so by the 2014 deadline. The feds are empowered by the law to come in and set up exchanges in the recalcitrant states. But even if they manage to do so, which is an uncertain premise, they may have a small problem on their hands, according to Tanner federal subsidies are available only through exchanges that the states set up. The feds can't offer subsidies through a federally run exchange.

Thus, if states neither expanded Medicaid nor set up exchanges, that would effectively block most of ObamaCare's new entitlement spending. On top of that, the employer mandate penalty, for employers with more than 50 employees who do not provide "adequate" health insurance, kicks in only when at least one employee "qualifies for subsidies under the exchange:"

Since subsidies can only be provided via a state-authorized exchange, a state that refuses to set one up could end up blocking the employer mandate altogether. Whether this whole string of reasoning holds together in reality remains to be seen, but at the very least, unless we are spared by a timely repeal, we can look forward to a long line of lawsuits and legal wrangling that will hopefully take years to resolve.

Source: Blog: Can the states unravel ObamaCare?

 

[AdamT]

States can opt out of the Medicare expansion, though they would be idiotic to do so (because it costs them nothing for three years and only 10% after that). But they cannot avoid exchanges. If they fail to set up their own then state residents will be able to take advantage of a federal exchange.

 

[James Cessna]

States can opt out of the Medicare expansion, though they would be idiotic to do so (because it costs them nothing for three years and only 10% after that). But they cannot avoid exchanges. If they fail to set up their own then state residents will be able to take advantage of a federal exchange.

You are mistaken, AdamT.

The costs of Obamacare will skyrocket by at least a trillion dollars as soon as the Medicaid expansion is implemented in 2014.

Here is a crucial statistic from CNN.

The world of the U.S. health care issue – Global Public Square - CNN.com Blogs

New Jersey’s Camden Coalition of Healthcare Providers founder and family medicine practitioner, Jeffrey Brenner, used medical billing records to find that just 1% of patients accounted for 30% of health care costs in Camden. And that's not all he discovered in the city's three hospitals. He says: "We learned that someone went 113 times in one year. Someone went 324 times in five years. In similar workup in Trenton, they found someone who went 450 times in one year." These were people with complicated medical histories and chronic illnesses. One patient alone racked up $3.5 million in medical bills over a five year period. As Brenner says, :"They're the difficult patients to treat, and no one is being paid and incentivized to pay attention to them."

What's more, Camden's problem is America's problem. Just 5% of Americans accounted for half of our nation's health care costs in 2009. This is perhaps the crucial statistic to understand about America's health care problem.

Obamacare does absolutely nothing to resolve this problem. In fact, it makes the problem worse by adding millions of indigent people to the Medicaid rolls who will abuse and overuse the heath care system like many of them do now.

Abuse and overuse of the health care system will produce much higher costs ($ trillions) to the U.S. taxpayers.

 

[AdamT]

No, I'm not wrong. For the first three years the federal government will finance 100% of the Medicade expansion. After that states will only pay 10% of the cost. So if a state opts out, it will be turning down tens of billions of dollars in federal aid that would go to providing health care to the working poor -- thus taking pressure off hospitals and clinics that now have to eat those costs.

 

[James Cessna]

No, I'm not wrong. For the first three years the federal government will finance 100% of the Medicade expansion. After that states will only pay 10% of the cost. So if a state opts out, it will be turning down tens of billions of dollars in federal aid that would go to providing health care to the working poor -- thus taking pressure off hospitals and clinics that now have to eat those costs.

No, you are mistaken and here is why.

The money the feds "gives" to the states to expand their Medicaid program in 2014 comes from the federal taxes that are paid by the state residents.

Consequently, the state residents end up paying for the full cost of the expanded Medicaid program! The federal government just collects and gives some of their money back to them to run the expanded state program!

Of course, these authorities conclude if states do shift those costs back to the feds, that will cause the federal cost of ObamaCare to skyrocket. If every state were to refuse to expand its Medicaid program, the feds would save roughly $130 billion in their share of Medicaid costs in 2014, but would have to pay $230 billion more in new exchange-based subsidies - for a net added cost of $100 billion. And that's just for the first year.

 

[AdamT]

Do you think the states will get a rebate check if they opt out of the expansion? They will not. They will simply lose the benefits they are entitled to. And I'm thinking they will also lose a lot of elections if they allow this partisan stupidity to trump what's best for their people.

And of course the exchange subsidies are paid for by the federal government whether the state sets up the exchange or the feds set up the exchange.

 

[James Cessna]

Do you think the states will get a rebate check if they opt out of the expansion? They will not. They will simply lose the benefits they are entitled to. And I'm thinking they will also lose a lot of elections if they allow this partisan stupidity to trump what's best for their people.

And of course the exchange subsidies are paid for by the federal government whether the state sets up the exchange or the feds set up the exchange.

The answer to your question is very simple.

The residents of the states save money if they opt out of the Medicaid expansion.

 

[AdamT]

The answer to your question is very simple.

The residents of the states save money if they opt out of the Medicaid expansion.

The residents of a state that opts out will lose tens of billions of dollars and there is absolutely no way around that.

 

[MarineTpartier]

No, I'm not wrong.

:alert:stop: You have just been fined $5,000 for violation of the double negative statute. Be well.

 

[MarineTpartier]

The residents of a state that opts out will lose tens of billions of dollars and there is absolutely no way around that.

IMO, that states that opt out of are going to be the ones whose citizens overwhelmingly disagree with the ACA anyway. States like Texas, Alabama, Louisiana, South Carolina, etc. You know as well as I do that politicians, of whatever lean, are going to calculate their ability to be re-elected into any decision they make. The Congress's and Governors of these states know full well that fighting the ACA is exactly what their citizens want them to do. I don't believe there will be an issue with re-elections. The real issue will be an even bigger wedge driven between the population. We already have a pretty big wedge driven between everyone south of the Mason-Dixon, west to Oklahoma and Texas, and Alaska and the rest of the country. Its just going to get worse with this. Thats just the way it is. Some people like more gov't involvement, some don't. Thats the way our country is supposed to be. States governments reflect their citizens. That is what is happening now. What doesn't need to happen is that carrying over into our Federal politics and essentially shutting everything down. We'll see in November though.

 

[James Cessna]

The residents of a state that opts out will lose tens of billions of dollars and there is absolutely no way around that.

You are mistaken, AdamT.

Where do think the government gets the tens of billions of dollars that they return to the states to administer the program?

They get it by taxing the residents of the state! It is as if you give me $10.00 and then I give it back to you to purchase a product. Do you really believe you are now buying this product at a $10.00 discount?

No! You are paying the full price for the product! This is the same "shell game" that the Obamacare "reimbursements" to the states are based on. Most people are not smart enough to understand these facts and will not understand them until their federal taxes go up!

MarineTpartier, do you understand what I am saying? Please explain it to AdamT so he will understand he too is being taken to the cleaners by the Obama administration.

 

[MarineTpartier]

MarineTpartier, do you understand what I am saying? Please explain it to AdamT so he will understand he too is being taken to the cleaners by the Obama administration.

AdamT's a good dude man. However, he's a President Obama kool-aid drinker. No matter what you say, you aren't changing his mind lol. Move along, nothing to see here.

 

[James Cessna]

AdamT's a good dude man. However, he's a President Obama kool-aid drinker. No matter what you say, you aren't changing his mind lol. Move along, nothing to see here.

I'm afraid you are correct my friend.

 

[Helix]

if the states won't participate (and i expect my state will be one of these), then we'll have no choice but to do it federally. if it doesn't work, then we scrap it and move towards single payer.

the mandate is really the last chance Republicans have of keeping the failing employer-based private health insurance boondoggle. without the states, it collapses under its own weight, and we move towards something similar to what other first world countries are doing. either way, the genie is out of the lamp.

 

[James Cessna]

if the states won't participate (and i expect my state will be one of these), then we'll have no choice but to do it federally. if it doesn't work, then we scrap it and move towards single payer.

the mandate is really the last chance Republicans have of keeping the failing employer-based private health insurance boondoggle. without the states, it collapses under its own weight, and we move towards something similar to what other first world countries are doing. either way, the genie is out of the lamp.

Obamacare must be repealed.

The Republicans will pass a new law to replace it that will allow people to buy health insurance across state lines. This fact will reduce the cost of the insurance policies by a significant amount. They will also allow people to purchaser a range of policies form a very basic one to one that has lots of "bells and whistles".

Obamacare does none of these things and this in one reason it is so very expensive. Are you aware Obamacare requires young healthy males to purchase a policy that covers the costs of mammograms and pap smears for women!

 

[Kandahar]

No states are seriously going to hold out and NOT agree to the Medicaid expansion. Remember that the Supreme Court made its ruling less than a week ago; the threats to not participate were most likely just some pissed off Republican governors blowing off steam. Any governor would have to be an idiot to not participate in the expansion; they get free federal money for the first couple years, and the federal government still picks up 90% of the tab after the first few years. That's an insanely good deal for the states...and the governors can't really afford NOT to take it. It's an even better deal for the states that already have stingy Medicaid programs (i.e. the red states), because the federal government pays the total cost of bringing them up from wherever they are now, to the new federal level.

Sure, there might be a couple governors in states that really hate Obama who will resist for a couple years. But that won't last long. The voters will force them to participate, and/or the health care providers will lobby them to participate.

 

[Helix]

Obamacare must be repealed.

The Republicans will pass a new law to replace it that will allow people to buy health insurance across state lines. This fact will reduce the cost of the insurance policies by a significant amount. They will also allow people to purchaser a range of policies form a very basic one to one that has lots of "bells and whistles".

Obamacare does none of these things and this in one reason it is so very expensive. Are you aware Obamacare requires young healthy males to purchase a policy that covers the costs of mammograms and pap smears for women!

i've heard all of the talking points against the PPACA. the only good thing i can say about it is that it eliminates some slimy insurance practices. those should have been passed in a different bill, though.

to fix our health care problems, we need basic coverage for all Americans, and the coverage should in no way be tied to specific employment. also, we have to vastly increase the number of primary care physicians, which is artificially low. we have to expand our medical schools and make them more affordable. and we have to reduce the cost of bringing a drug to market, which means patients are going to have to accept a higher degree of risk.

put simply, our system is failing, and it's taking down other sectors with it. a mandate to buy private insurance is barely a band aid. the starting point of negotiations should have been medicare for all, and the compromise should have been a public option for everyone who fell through the cracks. but, unfortunately, the opposition wanted either nothing or a bill that was so fatally flawed that it couldn't possibly work, so we got the mandate.

at least it's a step. eventually, people will tire of going bankrupt over their kid's broken arm when that's not the status quo in any other first world country. at that point, maybe we'll really try to solve the problem.

 

[Bronson]

You are mistaken, AdamT.

The costs of Obamacare will skyrocket by at least a trillion dollars as soon as the Medicaid expansion is implemented in 2014.

Here is a crucial statistic from CNN.

The world of the U.S. health care issue – Global Public Square - CNN.com Blogs

New Jersey’s Camden Coalition of Healthcare Providers founder and family medicine practitioner, Jeffrey Brenner, used medical billing records to find that just 1% of patients accounted for 30% of health care costs in Camden. And that's not all he discovered in the city's three hospitals. He says: "We learned that someone went 113 times in one year. Someone went 324 times in five years. In similar workup in Trenton, they found someone who went 450 times in one year." These were people with complicated medical histories and chronic illnesses. One patient alone racked up $3.5 million in medical bills over a five year period. As Brenner says, :"They're the difficult patients to treat, and no one is being paid and incentivized to pay attention to them."

What's more, Camden's problem is America's problem. Just 5% of Americans accounted for half of our nation's health care costs in 2009. This is perhaps the crucial statistic to understand about America's health care problem.

Obamacare does absolutely nothing to resolve this problem. In fact, it makes the problem worse by adding millions of indigent people to the Medicaid rolls who will abuse and overuse the heath care system like many of them do now.

Abuse and overuse of the health care system will produce much higher costs ($ trillions) to the U.S. taxpayers.

Obamatax is going to raise taxes on the poor and middle class, while at the same time increase their costs of HC

We are not allowed to judge liberals on the results of their policies though, only their "good intentions" right?

 

[haymarket]

This is the 1850's all over again.

The idea that extremist right wing politicians in certain states would chose party over people is disgusting.

 

[winston53660]

No states are seriously going to hold out and NOT agree to the Medicaid expansion. Remember that the Supreme Court made its ruling less than a week ago; the threats to not participate were most likely just some pissed off Republican governors blowing off steam. Any governor would have to be an idiot to not participate in the expansion; they get free federal money for the first couple years, and the federal government still picks up 90% of the tab after the first few years. That's an insanely good deal for the states...and the governors can't really afford NOT to take it. It's an even better deal for the states that already have stingy Medicaid programs (i.e. the red states), because the federal government pays the total cost of bringing them up from wherever they are now, to the new federal level.

Sure, there might be a couple governors in states that really hate Obama who will resist for a couple years. But that won't last long. The voters will force them to participate, and/or the health care providers will lobby them to participate.

This petty bickering really concerns people like me who deal with serious medical issues.

 

[johnny_rebson]

Obamacare must be repealed.

The Republicans will pass a new law to replace it that will allow people to buy health insurance across state lines. This fact will reduce the cost of the insurance policies by a significant amount. They will also allow people to purchaser a range of policies form a very basic one to one that has lots of "bells and whistles".

Obamacare does none of these things and this in one reason it is so very expensive. Are you aware Obamacare requires young healthy males to purchase a policy that covers the costs of mammograms and pap smears for women!

And we need tort reform to make it illegal to sue a hospital or a doctor or any other medical professional.

 

[James Cessna]

And we need tort reform to make it illegal to sue a hospital or a doctor or any other medical professional.

You are indeed correct JR.

The good thing about tort reform is it will bring down the cost of malpractice insurance our doctors have to pay. Our doctors will never be sued, but nevertheless they are required to carry this expensive insurance. The premiums can run as high as $100,000 a year for doctors who deliver babies (pediatricians).

These costs are passed on to our insurance providers by our doctors and cause our premiums to be much higher than they should be.

 

[Gibberish]

Obamatax is going to raise taxes on the poor and middle class, while at the same time increase their costs of HC

We are not allowed to judge liberals on the results of their policies though, only their "good intentions" right?

Can you point out where people will be charged higher HC costs AND be taxed on top of that?

 

[winston53660]

You are indeed correct JR.

The good thing about tort reform is it will bring down the cost of malpractice insurance our doctors have to pay. Our doctors will never be sued, but nevertheless they are required to carry this expensive insurance. The premiums can run as high as $100,000 a year for doctors who deliver babies (pediatricians).

These costs are passed on to our insurance providers by our doctors and cause our premiums to be much higher than they should be.

New study: Tort reform has not reduced health care costs in Texas

 

[Gibberish]

And we need tort reform to make it illegal to sue a hospital or a doctor or any other medical professional.

Seriously? What do you propose we do for the nurse or doctor that kills someone or cuts off the wrong leg by their own mistake? Do you suggest medical professionals be allowed X number of negligent deaths before negative consequences? How does the family get retribution? Just a friendly "we are sorry your sister died but you made the choice coming here".