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TL;DR: In states where Republican governors are choosing not to accept federal money to expand Medicaid, the very poor are getting screwed. From the calculator

by daguar 13y ago

TL;DR: In states where Republican governors are choosing not to accept federal money to expand Medicaid, the very poor are getting screwed. From the calculator: "If your state does not expand Medicaid You will not be eligible for subsidies in the exchanges because your income is below 100% of the federal poverty level." The reason for this is that the law provided federal dollars to states to expand Medicaid coverage (pretty much free coverage for enrollees) to all people making < 138% of the federal poverty level (FPL), and so the EXCHANGE SUBSIDIES were only written to apply to folks above 138% FPL. Problem is, the law didn't say that these (very poor) people could receive subsidies for the Exchanges if the Governor refused to accept federal dollars to expand Medicaid -- basically because no one thought governors would be so brash as to refuse free money to pay for the health care of the very poor. So, yeah. Kinda sucks to live in a Republican state right now if you're poor and uninsured.

icelancer 13y ago
>basically because no one thought governors would be so brash as to refuse free money to pay for the health care of the very poor. Is it truly "free money?" I am sure stipulations come with it.
- uxp 13y ago
  It's more or less a match contribution. My governor is one of the few that has not made a decision to expand Medicade. That expansion will cost money, but the Feds will then contribute back to put towards enrolling low-income but not less than 138% of the poverty level people into health exchanges, which is something that the states are required to do. So no, it's not free money. It's a standard "Do X and we'll fund Y in your state."
  - icelancer 13y ago
    Thanks for the clarification. If the ACA proponents were banking on shaming governors into doing something to have full rollout of their plan, then that's fairly shortsighted, IMO. It's a classic "Let's blame these people for screwing over poor people" when the governors in question had no say in the original law being passed. Either put it in the bill and face the consequences (possible rejection) or leave it out and don't claim that governors are "refusing free money."
    - ewoodrich 13y ago
      That was how the bill was written until the Supreme Court partially upheld it and allowed states to opt-out of the Medicaid expansion. http://en.wikipedia.org/wiki/National_Federation_of_Independent_Business_v._Sebelius http://en.wikipedia.org/wiki/National_Federation_of_Independ...
_delirium 13y ago
If you're very poor, in the sense of no assets and very little income, you do still get the regular, pre-expansion, single-payer Medicaid. I agree it leaves some problematic gaps. People between 100% and 138% of the poverty line aren't eligible for either pre-expansion Medicare or the exchange subsidies. Perhaps even worse off are people below 100% of the poverty line but with very modest savings (in many states the limit is $2000). These people are probably best served by burning their savings so they can qualify for Medicaid. The expanded Medicaid does away with the asset test because of the perverse incentives it creates: someone who spends all their paycheck on entertainment qualifies for Medicaid, but someone who saves even $3000 to have a small cushion (e.g. to make sure they can cover rent between jobs) loses eligibility.
- daguar 13y ago
  Thanks for the clarification. Unfortunately, under pre-Obamacare Medicaid rules, in most states you have to have dependents, be pregnant, or be disabled to qualify for Medicaid: "Prior to the ACA, states could not receive federal Medicaid matching funds to cover non-disabled adults without dependent children... [O]verall, Medicaid coverage for low-income adults remains very limited. As of January 2013, only nine states, including DC, provide full Medicaid coverage to low-income adults, and enrollment is closed in two of these states(Figure 4, Table 3). Sixteen states solely provide more limited coverage to adults, and enrollment is closed in seven of these states." [1] http://kaiserfamilyfoundation.files.wordpress.com/2013/04/7993-03.pdf http://kaiserfamilyfoundation.files.wordpress.com/2013/04/79... (page 2)
briandear 13y ago
I really think that the 'free money' is part of the $2000+ per month withheld from my paychecks. It's hardly free. It's very easy to spend other people's money. I'm willing to bet not a single person reading this voluntarily sent the government and extra payment last year. The interesting thing is that the majority of economic growth has been in republican states,, specifically Texas. and North Dakota. So perhaps the poor are worse off, but at least there are more jobs that can provide the opportunity for them to not remain poor. This article compares Texas and California economically: http://thehill.com/blogs/congress-blog/economy-a-budget/307111-economic-growth-texas-california-and-revisions http://thehill.com/blogs/congress-blog/economy-a-budget/3071...
- deleted 13y ago
  [deleted]

by daguar 13y ago

icelancer 13y ago

>basically because no one thought governors would be so brash as to refuse free money to pay for the health care of the very poor. Is it truly "free money?" I am sure stipulations come with it.

uxp 13y ago
It's more or less a match contribution. My governor is one of the few that has not made a decision to expand Medicade. That expansion will cost money, but the Feds will then contribute back to put towards enrolling low-income but not less than 138% of the poverty level people into health exchanges, which is something that the states are required to do. So no, it's not free money. It's a standard "Do X and we'll fund Y in your state."
- icelancer 13y ago
  Thanks for the clarification. If the ACA proponents were banking on shaming governors into doing something to have full rollout of their plan, then that's fairly shortsighted, IMO. It's a classic "Let's blame these people for screwing over poor people" when the governors in question had no say in the original law being passed. Either put it in the bill and face the consequences (possible rejection) or leave it out and don't claim that governors are "refusing free money."
  - ewoodrich 13y ago
    That was how the bill was written until the Supreme Court partially upheld it and allowed states to opt-out of the Medicaid expansion. http://en.wikipedia.org/wiki/National_Federation_of_Independent_Business_v._Sebelius http://en.wikipedia.org/wiki/National_Federation_of_Independ...

_delirium 13y ago

If you're very poor, in the sense of no assets and very little income, you do still get the regular, pre-expansion, single-payer Medicaid. I agree it leaves some problematic gaps. People between 100% and 138% of the poverty line aren't eligible for either pre-expansion Medicare or the exchange subsidies. Perhaps even worse off are people below 100% of the poverty line but with very modest savings (in many states the limit is $2000). These people are probably best served by burning their savings so they can qualify for Medicaid. The expanded Medicaid does away with the asset test because of the perverse incentives it creates: someone who spends all their paycheck on entertainment qualifies for Medicaid, but someone who saves even $3000 to have a small cushion (e.g. to make sure they can cover rent between jobs) loses eligibility.

daguar 13y ago
Thanks for the clarification. Unfortunately, under pre-Obamacare Medicaid rules, in most states you have to have dependents, be pregnant, or be disabled to qualify for Medicaid: "Prior to the ACA, states could not receive federal Medicaid matching funds to cover non-disabled adults without dependent children... [O]verall, Medicaid coverage for low-income adults remains very limited. As of January 2013, only nine states, including DC, provide full Medicaid coverage to low-income adults, and enrollment is closed in two of these states(Figure 4, Table 3). Sixteen states solely provide more limited coverage to adults, and enrollment is closed in seven of these states." [1] http://kaiserfamilyfoundation.files.wordpress.com/2013/04/7993-03.pdf http://kaiserfamilyfoundation.files.wordpress.com/2013/04/79... (page 2)

briandear 13y ago

I really think that the 'free money' is part of the $2000+ per month withheld from my paychecks. It's hardly free. It's very easy to spend other people's money. I'm willing to bet not a single person reading this voluntarily sent the government and extra payment last year. The interesting thing is that the majority of economic growth has been in republican states,, specifically Texas. and North Dakota. So perhaps the poor are worse off, but at least there are more jobs that can provide the opportunity for them to not remain poor. This article compares Texas and California economically: http://thehill.com/blogs/congress-blog/economy-a-budget/307111-economic-growth-texas-california-and-revisions http://thehill.com/blogs/congress-blog/economy-a-budget/3071...

deleted 13y ago
[deleted]