How the decision will affect poor people who need healthcare is the next Medicaid story the media should consider. The New York Times’s good second day piece laid out the problem: “Under the law, subsidies are available to people with incomes from the poverty level up to four times that amount, but not to people with incomes below the poverty level ($23,050 for a family of four).” What happens to them?
Speculation about what this governor or that governor will do—or what the consultants and pressure groups, such as hospitals that need patients who can pay, will tell them to do—is fine. But it is not the essential Medicaid story that needs to be told.
That story is about people: What will really happen to low-income people who would have been captured in the expansion of the safety net had the court ruled another way, or now if they lived in a bluer state. How will they pay for their health care? How do they do so currently, if they do? Will they be eligible for subsidies the law makes available for the uninsured? If so, will such subsidies be large enough to buy decent insurance?
What will substitute programs like the one Mitch Daniels talks about for Indiana actually provide? This is the nitty gritty of local reporting, and political speculation does not substitute for it.
Then there’s the larger question that Darshak Sanghavi, writing for Slate.com, zoomed in on: “State reluctance to expand Medicaid gets at the core problem in health care today—it’s just too damn expensive and the ACA does very little about that.”
Serious exploration of the law’s weak cost control measures might be in order too.
It looks like Florida will refuse additional money for additional Medicaid patients. But all that is going to do is raise the cost of caring for those patients when they go to the emergency rooms in the various hospitals and they HAVE TO be cared for. That's why medicine is not part of the free market. Most businesses can turn away their customers if the customer is short on funds--even grocery and drug stores but not hospitals. How are these going to be covered--by everyone else just as before. Much of the purpose of ACA was to avoid this dilemma. Scott in Florida can't put it on the back of Obama--the governor is the one who said no. If the other 25 states do the same as Florida has stated, then they too will have to cover the emergency room costs. The Federal money that was to go for them will be used in the remaining 24 states that have requested it--like CA. There are plenty of poor folk here of 40-50 nationalities (all citizens) that would love to be able to have the necessary Medicaid money. After all, CA is one of the most populous states--BUT also one that is closest to being ready with the exchange groups for all sorts of insurance policies and procedures, thanks to the Gov. Brown. Gov. Scott is doing nothing more than stabbing his own constituents in the back and allowing the other states to care for their own even more thoroughly. Not very logical!!
#1 Posted by Trish, CJR on Thu 5 Jul 2012 at 03:32 PM
" Under the court’s ruling, states will be free to elect not to cover all of their poor residents through their Medicaid programs."
Ezra Klein has been publishing work from kaiser and others on this beat.
http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/05/what-happens-if-a-state-opts-out-of-medicaid-in-one-chart/
And if the red states, with their higher poverty levels, do decide to cut of their noses to save their political face, they will be doing something that is so apparently stupid it will be hard to justify it to voters.
http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/03/the-affordable-care-acts-giveaway-to-stingy-red-states/
Like those red state politicians who decried the evils of stimulus and took credit for the projects brought together by stimulus dollars, they will take the money and credit eventually, all the while screaming two faced about big government socialism.
A-holes.
#2 Posted by Thimbles, CJR on Fri 6 Jul 2012 at 12:51 PM
The ACA will not control costs. The Affordable Care Act is relying on dozens of pilot programs and demonstration projects to find better ways of delivering care, the results of which have been disappointing. Further, we will still be left with a system in which no one will be choosing between health care and other uses of money. And if no one is making those choices, health care spending will keep rising in the future with all the relentless persistence it has shown in the past (http://go.cms.gov/KuroN5).
#3 Posted by Carly EngageAmerica, CJR on Thu 12 Jul 2012 at 11:26 AM
One of the big issues press tried to address last week in its coverage of ruling court.Medicaid is not a free market and it is business one.
#4 Posted by Medicare Wyoming, CJR on Sat 22 Dec 2012 at 01:27 AM