Red-State Obamacare: 'Screw You' If You Have a Republican Governor

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How's Obamacare Turning Out? Great If You Live in a Blue State, and 'Screw You' If You Have a Republican Governor

Coverage for uninsured is cheaper than expected for millions, but red-state residents in poverty are facing pain.

Obamacare implementation is becoming the latest dividing line between blue- and red-state America, with Democrat-led states making progress to expand healthcare to the uninsured and the poor—and Republican-led states saying "screw you" to millions of their most vulnerable and needy residents.

The latest sign of the Republican Party’s increasingly secessionist tendencies comes as Obamacare passed a major milestone in California, which late last week announced lower-than-expected healthcare premiums for its 5.3 million uninsured, less than many small businesses now pay in group plans.

“Covered California’s Silver Plan… offers premiums that can be 29 percent lower than comparable plans provided on today’s small group market,” the state’s new insurance exchange announced Thursday, referring to the least-expensive option of four state-administered plans and posting this price comparison chart (http://www.coveredca.com/news/PDFs/SilverPlanRatesChart.pdf).

In contrast, the refusal by red-state America to create these health exchanges, which would be more local control—a supposed Republican value—and to accept federal funds to expand state-run Medicaid programs for the poor, means that about half the states are turning their backs on their residents, especially millions of the poorest people.

The exchanges are one of two major pathways to expanding coverage. The other is via state-run Medicaid programs, which is health care for the poorest. TheNew York Times reports (http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html) [11] that Republican governors have not set up exchanges—and federal officials have yet to fill that void, even though the law says that they will. Those states also rejected expanding Medicaid to “millions of poor people,” even as the law offers nearly full federal subsidies for the first half-dozen years.

“That benefit is not just to individuals but to local economies,” said Alwyn Cassil, spokeswoman for the Washington-based Center For Studying Health System Change (http://www.hschange.com/index.cgi?func=pubs&what=6) [12]. “The hospitals are very angry with those folks.”

http://www.alternet.org/news-amp-politics/hows-obamacare-turning-out-great-if-you-live-blue-state-and-its-screw-you-if-you?akid=10486.187590.n8C9pC&rd=1&src=newsletter845794&t=9

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Some very good news for ObamacareIn 2009, the Congressional Budget Office predicted that a medium-level “silver” plan — which covers 70 percent of a beneficiary’s expected health costs — on the California health exchange would cost $5,200 annually. More recently, a report from the consulting firm Milliman predicted it would carry a $450 monthly premium. Yesterday, we got the real numbers. And they’re lower than anyone thought.

As always, Sarah Kliff has the details (http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/23/california-obamacare-premiums-no-rate-shock-here/?wprss=rss_ezra-klein). The California exchange will have 13 insurance options, and the heavy competition appears to be driving down prices. The most affordable silver-level plan is charging $276-a-month. The second-most affordable plan is charging $294. And all this is before subsidies. Someone making twice the poverty line, say, will only pay $104-a-month.

Sparer plans are even cheaper. A young person buying the cheapest “bronze”-level plan will pay $172 — and that, again, is before any subsidies.

California is a particularly important test for Obamacare. It’s not just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. Under Gov. Arnold Schwarzenegger — remember how that really happened? — California was the first state to begin building its insurance exchanges. The state’s outreach efforts are unparalleled. Its insurance regulators are working hard to bring in good plans and make sure they’re playing fair. If California can’t make the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.

And perhaps others will. We’re beginning to see competition drive down proposed rates in some exchanges around the country. Remember Maryland, where CareFirst grabbed headlines (http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/25/wonkbook-ready-for-obamacare-rashomon/) with a shocking 25 percent proposed increase in rates? More plans have streamed in with lower bids. Kaiser Permanente, for instance, is only increasing its rates next year by 4.3 percent — a modest increase that will make CareFirst’s proposal almost impossible to sustain. My guess is when the exchange actually opens in October, CareFirst will have dropped its price substantially. If they don’t, then Kaiser and others will grab all the market share.


http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/24/wonkbook-some-very-good-news-for-obamacare/?hpid=z8

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and the big boys opt out of the CA health exchanges, competition prevents them from screwing health exchange clients, but it won't prevent them from hiking premiums while blaming it on Obamacare (as if they needed Obamacare these past 35 years to hike premiums)

UnitedHealth, Aetna and Cigna opt out of California insurance exchange

Some prominent health insurers, including industry giant UnitedHealth Group Inc., are not participating in California's new state-run health insurance market, possibly limiting the number of choices for millions of consumers.

UnitedHealth, the nation's largest private insurer, Aetna Inc. (http://www.latimes.com/topic/economy-business-finance/aetna-inc.-ORCRP000343.topic)and Cigna Corp. (http://www.latimes.com/topic/economy-business-finance/cigna-corporation-ORCRP003269.topic) are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law.

Meanwhile, the biggest insurers in the state — Kaiser Permanente, Anthem Blue Cross and Blue Shield of California — are all expected to participate in the state-run market for individual health coverage.

there could be advantages and disadvantages if the state's three largest insurers — Kaiser, Anthem Blue Cross and Blue Shield — grab even more business through the exchange. Their increased market power could give them even better bargaining leverage with hospitals and doctors, helping them to drive down healthcare costs.

But Melnick said it remained to be seen whether "the market is competitive enough that those companies will pass along those savings."

Melnick said UnitedHealth, Aetna and Cigna may be making a mistake by sitting on the sidelines given California's size and importance in the healthcare overhaul nationwide. "California is going to be a trendsetter," he said.

http://www.latimes.com/business/la-fi-health-insure-20130523,0,1895918.story

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more on how Repug states are fucking their "47%"

States’ Policies on Health Care Exclude Some of the Poorest

The refusal by about half the states to expand Medicaid (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier) will leave millions of poor people ineligible for government-subsidized health insurance (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/index.html?inline=nyt-classifier) under President Obama’s health care law (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier) even as many others with higher incomes receive federal subsidies to buy insurance.

options will be unavailable to some of the neediest people in states like Texas, Florida, Kansas, Alabama, Louisiana, Mississippi and Georgia, which are refusing to expand Medicaid.

More than half of all people without health insurance live in states that are not planning to expand Medicaid.

People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.


Obama administration is urging people who “need health insurance” to report their telephone numbers and e-mail addresses to the government via a Web site, healthcare.gov (http://healthcare.gov/), so they can be notified of new insurance options.

Consumers will not necessarily know whether they are eligible for premium tax credits, Medicaid or the Children’s Health Insurance Program (http://topics.nytimes.com/top/reference/timestopics/subjects/s/state_childrens_health_insurance_program_schip/index.html?inline=nyt-classifier).

So if a person applies for one program, federal and state officials will check eligibility for all three.

People who are currently eligible but not enrolled may sign up for Medicaid, even in states that do not expand the program.

Still, Roy S. Mitchell, the executive director of the Mississippi Health Advocacy Program, a nonprofit group that supports the expansion of Medicaid, said “there’s going to be a huge void” as many uninsured poor people find that they are not eligible for Medicaid or insurance subsidies.

“There will be an outcry,” Mr. Mitchell said. “It may bolster our advocacy efforts.”

http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all&_r=2&

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5 Great Signs For Obamacare


1 Great News Out Of California

2 Medicaid: A Lifesaver For The Working Poor

3 The Biggest Myth About The Law Is Falling Apart


Republicans like to pretend that businesses aren’t hiring because of the pending implementation of Obamacare. The fact is there will only be additional employer spending required from a tiny fraction of businesses — just 1 percent, according to CNN Money‘s Jose Pagliery (http://money.cnn.com/2013/05/21/smallbusiness/obamacare/index.html?hpt=hp_t3):

As of 2010, there were roughly 5.7 million small employers, defined as those with fewer than 500 workers. Some 97 percent of them have fewer than 50 employees. That means Obamacare’s employer mandate applies only to 3 percent of America’s small businesses.
That’s about 200,000 companies.
…nearly all of those businesses already do provide insurance: 96 percent of those with 50-plus workers currently offer health plans anyway, according to government data.
…
More than 99 percent of those in work-sponsored plans have insurance that meets most Obamacare coverage standards, according to last year’s study (http://content.healthaffairs.org/content/31/6/1339.full.pdf+html) by NORC at the University of Chicago.
Putting it all together, the data shows that only a tiny sliver of the nation’s small businesses face the new rules — and even fewer face any changes. Of the country’s 6.5 million workplaces, only 1 percent must actually start providing insurance next year.


4 GOP Governors In Purple States Know That Rejecting Medicaid Expansion Is Insane

http://nationalmemo.wpengine.netdna-cdn.com/wp-content/uploads/2013/05/DB_medicaid_map.jpg

5 Republicans Can’t Hate It Any More Than They Already Do

http://nationalmemo.wpengine.netdna-cdn.com/wp-content/uploads/2013/01/michele-bachmann.jpg

http://www.nationalmemo.com/5-really-good-signs-for-obamacare/

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Texas Will Deny Health Coverage To 1.5 Million Low-Income Residents (http://thinkprogress.org/health/2013/05/27/2064061/texas-will-deny-health-coverage-to-15-million-low-income-residents/)1.5 million low-income Texans may go without health care coverage after lawmakers in the state voted against (http://www.huffingtonpost.com/2013/05/27/texas-medicaid_n_3341034.html) expanding Medicaid using $100 billion in federal funds offered under President Obama’s health care law. The decision comes almost a year after the Supreme Court ruled that the federal government cannot require states to enroll more Medicaid beneficiaries.

The proposal, sent to Gov. Rick Perry (R) on Sunday, says state health officials “may only provide medical assistance to a person who would have been otherwise eligible for medical assistance or for whom federal matching funds were available under the eligibility criteria for medical assistance in effect on December 31, 2013.”

Under the Affordable Care Act, the federal government fully funds Medicaid expansion until 2016 and gradually reduces its contribution to 90 percent in 2020 and subsequent years. Texas — which has the highest percentage of uninsured residents — would never pay more than 7 percent of the cost of providing coverage to Texans, but Texas Republicans argued that “even $1 in the name of ‘Obamacare’ was a dollar too much.”

“Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans to a broken system,” Perry said. The decision means a loss of approximately $7 billion for Texas hospitals, which comes on top of the $700 million a year reduction in Medicaid payments from state budget shortfalls and cuts under sequestration.

Low-income Texans will also continue to struggle to afford coverage, since the law does not offer federal tax credits to purchase private health insurance coverage for most people below the poverty line. People living in the 26 states that have refused to expand Medicaid and have incomes “from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits (http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all&_r=0).”

etc

http://thinkprogress.org/health/2013/05/27/2064061/texas-will-deny-health-coverage-to-15-million-low-income-residents/

[CosmicCowboy]

The exchanges are one of two major pathways to expanding coverage. The other is via state-run Medicaid programs, which is health care for the poorest. TheNew York Times reports [11] that Republican governors have not set up exchanges—and federal officials have yet to fill that void, even though the law says that they will. Those states also rejected expanding Medicaid to “millions of poor people,” even as the law offers nearly full federal subsidies for the first half-dozen years.

And then the states are stuck with the unfunded mandate.

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And then the states are stuck with the unfunded mandate.

and a LOT less taxpayer funded ER visits and a LOT less seeing sickos at an advanced stage. You and other rightie assholes are going to be shocked at how well and how popular ACA will become, in spite of Repug efforts to sabotage it at every level.

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Texas to Deny Poor Residents Medicaid Coverage, While Paying for It AnywayThe Texas bill was passed despite the fact that “the federal government fully funds Medicaid expansion until 2016 and gradually reduces its contribution to 90 percent in 2020 and subsequent years,” as Think Progress’ Igor Volsky notes (http://thinkprogress.org/health/2013/05/27/2064061/texas-will-deny-health-coverage-to-15-million-low-income-residents/).

Texas, which has the highest percentage of uninsured people, would not have to pay more than 7 percent of the cost of the Medicaid expansion.

http://www.alternet.org/news-amp-politics/texas-deny-poor-residents-medicaid-coverage-while-paying-it-anyway

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The Spite Club

House Republicans have voted 37 times to repeal ObamaRomneyCare (http://www.cbsnews.com/8301-250_162-57584732/house-gop-to-vote-on-obamacare-repeal-vol-37/) — the Affordable Care Act, which creates a national health insurance system similar to the one Massachusetts has had since 2006. Nonetheless, almost all of the act will go fully into effect at the beginning of next year.

There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court decision upholding the law’s constitutionality also gave states the right to opt out of one piece of the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first.

And why would they do this? They won’t save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I’ll explain later, it will probably hurt Republicans for years to come.

No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won’t just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens.

Some background: Obamacare rests on three pillars.

First, insurers must offer the same coverage to everyone regardless of medical history.

Second, everyone must purchase coverage — the famous “mandate” — so that the young and healthy don’t opt out until they get older and/or sicker.

Third, premiums will be subsidized, so as to make insurance affordable for everyone. And this system is going into effect next year, whether Republicans like it or not.

Under this system, by the way, a few people — basically young, healthy individuals (http://www.newrepublic.com/node/113362) who don’t already get insurance from their employers, and whose incomes are high enough that they won’t benefit from subsidies — will end up paying more for insurance than they do now. Right-wingers are hyping this observation as if it were some kind of shocking surprise, when it was, in fact, well-known to everyone from the beginning of the debate. And, as far as anyone can tell, we’re talking about a small number of people who are, by definition, relatively well off.

Back to the Medicaid expansion. Obamacare, as I’ve just explained, relies on subsidies to make insurance affordable for lower-income Americans. But we already have a program, Medicaid, providing health coverage to very-low-income Americans, at a cost private insurers can’t match. So the Affordable Care Act, sensibly, relies on an expansion of Medicaid rather than the mandate-plus-subsidy arrangement to guarantee care to the poor and near-poor.

But Medicaid is a joint federal-state program, and the Supreme Court made it possible for states to opt out of the expansion. And it appears that a number of states will take advantage of that “opportunity.” What will that mean?
A new study (http://www.rand.org/pubs/external_publications/EP50279.html) from the RAND Corporation, a nonpartisan research institution, examines the consequences if 14 states whose governors have declared their opposition to Medicaid expansion do, in fact, reject the expansion. The result, the study concluded, would be a huge financial hit: the rejectionist states would lose more than $8 billion a year in federal aid, and would also find themselves on the hook for roughly $1 billion more to cover the losses hospitals incur when treating the uninsured.

Meanwhile, Medicaid rejectionism will deny health coverage to roughly 3.6 million Americans, with essentially all of the victims living near or below the poverty line. And since past experience shows that Medicaid expansion is associated with significant declines in mortality, this would mean a lot of avoidable deaths: about 19,000 a year, the study estimated. REPUG DEATH PANELS!

Just think about this for a minute. It’s one thing when politicians refuse to spend money helping the poor and vulnerable; that’s just business as usual. But here we have a case in which politicians are, in effect, spending large sums, in the form of rejected aid, not to help the poor but to hurt them.

And as I said, it doesn’t even make sense as cynical politics. If Obamacare works (which it will), millions of middle-income voters — the kind of people who might support either party in future elections — will see major benefits, even in rejectionist states. So rejectionism won’t discredit health reform. What it might do, however, is drive home to lower-income voters — many of them nonwhite — just how little the G.O.P. cares about their well-being, and reinforce the already strong Democratic advantage among Latinos, in particular.

Rationally, in other words, Republicans should accept defeat on health care, at least for now, and move on. Instead, however, their spitefulness appears to override all other considerations. And millions of Americans will pay the price.

http://mobile.nytimes.com/2013/06/07/opinion/krugman-the-spite-club.html

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but but but ...

Anti-Obamacare Republicans Who Want To Repeal The Health Law Are Still Taking Money From It (http://thinkprogress.org/health/2013/06/07/2123271/anti-obamacare-republicans-money/)

House Republicans are launching a coordinated campaign (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html) against Obamacare, hoping to emphasize the negative effects of the health law to their constituents at upcoming town hall meetings. At the same time, however, they’re fully prepared to tell those same constituents to enjoy all the benefits available to them under health reform — ultimately taking advantage of Obamacare funding in their home districts.

As Politico reports (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html), several of the GOP members of the new coalition — called the “House Obamacare Accountability Project,” or HOAP — went on the record to confirm they will help their constituents figure out how to get the benefits funded through the health reform law. The Republicans said that if they’re asked, they will help people get access to the insurance premium subsidies or the Medicaid coverage that’s available to them under Obamacare. “That’s an important part of constituent services,” Rep. Kevin Brady (R-TX) explained (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html).


They’re not the only lawmakers who have advocated for getting rid of the health law even while simultaneously enjoying its benefits. As Lee Fang reports in the Nation (http://www.thenation.com/article/174669/obamacares-gop-fans), several anti-Obamacare Republicans like Sens. John Cornyn (R-TX) and Rob Portman (R-OH) have requested grants funded through the health reform law for their districts. GOP lawmakers who decry Obamacare in public have requested Obamacare money (http://www.thenation.com/article/174669/obamacares-gop-fans) to bolster their states’ health clinics, extend health services to uninsured residents, and launch public health campaigns.

http://thinkprogress.org/health/2013/06/07/2123271/anti-obamacare-republicans-money/

when the federal $$$ show up, the Repugs grovel grovel grovel, and claim all credit, just like they did opposing the Obama stimulus, but loved and claimed credit for the results.

[Wild Cobra]

Texas to Deny Poor Residents Medicaid Coverage, While Paying for It AnywayThe Texas bill was passed despite the fact that “the federal government fully funds Medicaid expansion until 2016 and gradually reduces its contribution to 90 percent in 2020 and subsequent years,” as Think Progress’ Igor Volsky notes (http://thinkprogress.org/health/2013/05/27/2064061/texas-will-deny-health-coverage-to-15-million-low-income-residents/).

Texas, which has the highest percentage of uninsured people, would not have to pay more than 7 percent of the cost of the Medicaid expansion.

http://www.alternet.org/news-amp-politics/texas-deny-poor-residents-medicaid-coverage-while-paying-it-anyway
7% of medicaid is a large chunk of money, especially with how large it will expand to.

[Wild Cobra]

and a LOT less taxpayer funded ER visits and a LOT less seeing sickos at an advanced stage. You and other rightie assholes are going to be shocked at how well and how popular ACA will become, in spite of Repug efforts to sabotage it at every level.
I simply don't understand something.

Since you hate everything that has built America to it's greatness, why don't you move, to Cuba, or somewhere else that the likes of Michael Moore say are better.

[Wild Cobra]

but but but ...

Anti-Obamacare Republicans Who Want To Repeal The Health Law Are Still Taking Money From It (http://thinkprogress.org/health/2013/06/07/2123271/anti-obamacare-republicans-money/)

House Republicans are launching a coordinated campaign (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html) against Obamacare, hoping to emphasize the negative effects of the health law to their constituents at upcoming town hall meetings. At the same time, however, they’re fully prepared to tell those same constituents to enjoy all the benefits available to them under health reform — ultimately taking advantage of Obamacare funding in their home districts.

As Politico reports (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html), several of the GOP members of the new coalition — called the “House Obamacare Accountability Project,” or HOAP — went on the record to confirm they will help their constituents figure out how to get the benefits funded through the health reform law. The Republicans said that if they’re asked, they will help people get access to the insurance premium subsidies or the Medicaid coverage that’s available to them under Obamacare. “That’s an important part of constituent services,” Rep. Kevin Brady (R-TX) explained (http://www.politico.com/story/2013/06/house-gops-new-anti-obamacare-group-92377.html).


They’re not the only lawmakers who have advocated for getting rid of the health law even while simultaneously enjoying its benefits. As Lee Fang reports in the Nation (http://www.thenation.com/article/174669/obamacares-gop-fans), several anti-Obamacare Republicans like Sens. John Cornyn (R-TX) and Rob Portman (R-OH) have requested grants funded through the health reform law for their districts. GOP lawmakers who decry Obamacare in public have requested Obamacare money (http://www.thenation.com/article/174669/obamacares-gop-fans) to bolster their states’ health clinics, extend health services to uninsured residents, and launch public health campaigns.

http://thinkprogress.org/health/2013/06/07/2123271/anti-obamacare-republicans-money/

when the federal $$$ show up, the Repugs grovel grovel grovel, and claim all credit, just like they did opposing the Obama stimulus, but loved and claimed credit for the results.

Why shouldn't they?

Money comes from their states as well. may as well get some back.

[boutons_deux]

"Since you hate everything that has built America to it's greatness,"

You Lie

I "hate" everything that the right-wing/Repugs/conservatives/1%/corps have done and are doing, but that't not EVERYTHING about America.

"Love it or leave it" was ignorant bullshit in the '60s. It was proven wrong then, and it's bullshit wrong now.'

[TSA]

I "hate" everything that the right-wing/Repugs/conservatives/1%/corps have done and are doing, but that't not EVERYTHING about America.


Boths sides are fucking up everything, I suggest a move as well. I'm not far behind, so let me know where you move first so I don't end up in the same place.

[boutons_deux]

Boths sides are fucking up everything, I suggest a move as well. I'm not far behind, so let me know where you move first so I don't end up in the same place.

false equivalence, and bon voyage