How to Protect Yourself From Obamacare

[Townsend]

Medicaid expansion scorecard: 17 states say yes, 9 say no

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/07/medicaid-expansion-scorecard-17-states-say-yes-9-say-no/

More than half the states have made their decisions on whether to participate in the health law's Medicaid expansion – the provision aimed at extending health benefits to 17 million Americans.

Twice as many states have said yes than have declined, according to Avalere Health, a consulting firm here in Washington. Here's their map of where states currently stand.



Right now, 17 states have said they will participate in the Medicaid expansion, which will extend coverage to everyone whose income falls below 133 percent of the federal poverty line ($14,893 a year for an individual).

Tallying up state decisions on the Medicaid expansion is a bit of a squishy science. States don't have to make any official declarations, so we have to rely on what governors pledge. That doesn't necessarily predict the future. Take Missouri, for example: Democratic Gov. Jay Nixon has pledged to participate in the Medicaid expansion...but still needs funding from Missouri's Republican-controlled legislature to move forward.

Florida's Republican Gov. Rick Scott, on the other hand, had come out squarely against the expansion but has recently shown some openness to the idea.

What we do know for sure is this: The Medicaid expansion still breaks down along partisan lines. We haven't seen one Republican governor decide to expand nor one Democrat decide not to.

It's also worth keeping in mind that the number of states that participate in the Medicaid expansion isn't a great measure at all of how many Americans will enroll. The states that have opted out are a lot bigger than those who have opted in. In Vermont, which has signed up for the expansion, the Kaiser Family Foundation expects that 3,000 residents will gain coverage. In Texas, which has rejected the provision, that number stands at 1.8 million.

All told, the nine states that have decided to opt out would be expected to cover more Americans than the 17 states that have opted in. The Kaiser Family Foundation estimates enrollment would be 4.3 million among the opt-in states, compared with 5.3 million among the opt-outs. Much of that difference is explained by the fact that the states who have opposed the provision tend to have less expansive Medicaid programs, meaning the Affordable Care Act expansion would have an even greater impact.

[Gaspar]

The deadline is near and the final number is currently only 15 states who will participate in the Obamacare exchanges.
http://www.cnbc.com/id/100311739

That was just such a super idea.

[Teatownclown]

The deadline is near and the final number is currently only 15 states who will participate in the Obamacare exchanges.
http://www.cnbc.com/id/100311739

That was just such a super idea.

The GOP/Teabaggers hope lies in the states they have control over.

It really has nothing to do with what the people need and want.

Another attempt by you at make believing the best program for the needy is depriving them of a cost controlled single payer system. 

[nathanm]

Another attempt by you at make believing the best program for the needy is depriving them of a cost controlled single payer system. 

In Gaspar's world, the needy are to be provided for solely through charity. Oddly, his favorite writer thinks that charity is immoral, but whatever. (Also oddly, his go-to economists are in favor of things like a minimum income, but nobody ever said it was a consistent world view)

[Conan71]

...the best program for the needy is depriving them of a cost controlled single payer system. 

That's what Medicaid and Medicare are.  No need to re-jigger the entire system to the favor of a small handful of private insurers for the rest of us though.

[Townsend]

Implications of the Affordable Care Act for American Business

http://www.urban.org/publications/412675.html

Updated results from our Health Insurance Policy Simulation model show that, contrary to critics' claims, the law has a negligible impact on total employer-sponsored coverage and costs, leaves large business costs-per-person-insured largely untouched and makes small businesses-for whom coverage expands the most-financially better off, through tax credits and market efficiencies that lower premiums. Only among mid-size businesses does the ACA noticeably increase costs, largely due to increased enrollment. Our simulation does not reflect ACA cost containment provisions that may contain private as well as public cost growth-potentially slowing the decline of employer-sponsored health insurance that has been occurring for more than a decade

[Townsend]

Oklahoma Policy Institute FB post:

Quote of the day: "John is unable to afford the medication to treat his condition. He certainly can't afford a liver transplant. Unless John moves to a state that is expanding Medicaid under the ACA, he could die of this treatable disease. Living in Oklahoma may be John's death sentence."

-Rep. Doug Cox (R), MD, on the Governor's decision to reject federal money to expand Medicaid to cover more low-income adults

[Conan71]

Implications of the Affordable Care Act for American Business

http://www.urban.org/publications/412675.html

Imagine that, a liberal think-tank's model says the impact is negligible.  Did you notice it's a "simulation" and not based on any actual reports from businesses?

I was informed our company's premium is set to increase by 23% in March.  According to at least one agent we've talked to, many small businesses are electing to simply pay the penalty as it's cheaper for them to do so.  Either that or they are giving employees an allowance to help purchase insurance privately.  It's not a rosy picture, at least according to agents MC has screened for us to talk to.

[TulsaRufnex]

In Gaspar's world, the needy are to be provided for solely through charity. Oddly, his favorite writer thinks that charity is immoral, but whatever. (Also oddly, his go-to economists are in favor of things like a minimum income, but nobody ever said it was a consistent world view)

+1

[Townsend]

Imagine that, a liberal think-tank's model says the impact is negligible.  Did you notice it's a "simulation" and not based on any actual reports from businesses?

Well I guess you have to post one thing or the other.  It's either working or it's sending us all to Hell.

There's no middle ground.  Huckabee's gone insane with this and the tax deal.

We can always go to his site and have a sunshiny day there.

Here we go:

http://www.conservapedia.com/Main_Page

[Teatownclown]

Aw shucks...you mean there's a shift towards single payer mindset, Conan?

Interim pain...long term gain. If I were a middle man (person) selling health insurance I think I'd advise to expand into life and casualty or find a more lucrative living.

[Conan71]

Aw shucks...you mean there's a shift towards single payer mindset, Conan?

Interim pain...long term gain. If I were a middle man (person) selling health insurance I think I'd advise to expand into life and casualty or find a more lucrative living.

That's why I'm glad MC focuses on commercial and personal P & C, and only does the occasional individual HC policy.  Tough waters to navigate right now.

[Townsend]

Why GOP Governors Are Coming Around on the Medicaid Expansion

http://www.governing.com/blogs/view/gov-why-gop-governors-are-coming-around-on-medicaid-expansion.html

Listen closely and each time a Republican governor decides to expand Medicaid under the Affordable Care Act (ACA), you can hear advocates for President Barack Obama's health reform law and the low-income insurance program softly whisper: We told you so.

In the wake of the U.S. Supreme Court's decision last June to give states the option of expanding Medicaid, most GOP governors and legislators rejected the idea, which would increase eligibility to 133 percent of the federal poverty level and add up to 17 million to state Medicaid rolls. But lobbying from key stakeholders (hospitals and doctors chief among them) and the possibility of missing out on hundreds of millions of federal dollars has softened that opposition.

Arizona's Jan Brewer, Nevada's Brian Sandoval and New Mexico's Susana Martinez were the first Republican governors to break from the national party and embrace the expansion -- and they probably won't be the last. Their stated reasons for their change of heart echo what policy analysts and advocates told Governing they would be long before the governors made up their minds.

It all comes down to dollar signs. If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA.

"For many states, it's going to be very difficult for them to leave that money on the table," Linda Blumberg, a health economist and senior fellow at the Urban Institute, told Governing on June 28, the day of the Supreme Court ruling. "I think there is going to be considerable financial pressure -- both from providers and the reality of state budgets -- to go with this."

A few months later, Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, said the same thing. He pointed to a past example: the creation of Medicaid back in 1965. In the program's first year, only about half of the states signed on. But within a few years, 49 had come onboard (Arizona was the last to join in 1982). Political will gave way to fiscal realities.

"They all did the math and had to ask, 'Why am I leaving all this money on the table?'" Nichols told Governing. "It's a deal that most states will not be able to refuse in the long run. That's why the administration is acting confident that all states will come in."

Now those premonitions are turning out to be true.

Sandoval (a 2012 Governing Public Official of the Year) was the first Republican governor to officially embrace the Medicaid expansion, back in mid-December. It wasn't exactly an enthusiastic endorsement -- Nevada officials warned that it could place a burden on the state budget when the 100 percent federal match starts to phase down to 90 percent by 2017 -- but there was also recognition that it would be unwise to forego an infusion of federal dollars into the state economy. Sandoval's office estimates that the expansion will enroll 78,000 people and bring more than $700 million federal dollars into the state over the first three years.

"That's a massive leverage of federal dollars," said Jeff Mohlenkamp, Sandoval's budget director. "Considering how many federal dollars we are leveraging, the cost (of expansion) is fairly small."

This week, Brewer made headlines nationwide when she sanctioned the Medicaid expansion in her State of the State address. Her reasoning followed another familiar line from those who were confident that most states would expand: It will be good for hospitals and other health-care providers. Governing reported in the days after the Supreme Court decision that hospitals, traditionally one of the strongest lobbying groups in statehouses, would be pushing hard for expansion. One of their favorite talking points is uncompensated care. If more people are covered by Medicaid, hospitals will perform fewer unpaid services that usually get passed onto insurance premiums and taxpayers to fund.

Brewer cited all of the above in her reasons for backing the expansion.

"We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured,'' she said. "Health-care premiums are raised year after year to account for expenses incurred by our hospitals."

Likewise, Martinez's announcement underscored both motivations, according to the Albuquerque Journal. Expanding Medicaid will be budget-neutral, the governor said, and her decision was praised by New Mexico's health-care providers.

"It does appear to be clear that expanding Medicaid would not jeopardize the state's long-term budget outlook," Martinez said. "We will not only save money each year, but can expect revenue increases, and that will offset the cost of providing these services in the future."

More movement on the Medicaid expansion is likely in the coming weeks, as governors deliver their proposed budgets and state legislative sessions get underway. Democratic-controlled states are expected to sign off on the expansion with relative ease, and there's reason to think that more GOP governors will follow in the path of Brewer, Sandoval and Martinez.

Texas Gov. Rick Perry has become the national figure for opposing all implementation of the ACA, especially the Medicaid expansion. But at a National Conference of State Legislatures forum in November, a Texas legislator said that Perry's staff was quietly meeting with lawmakers to at least explore the possibility of expanding. Wisconsin Gov. Scott Walker, another outspoken opponent of the law, declined to outright denounce the expansion in his State of the State address (which is becoming a popular forum for governors to make their announcement). And in Ohio, where Gov. John Kasich has also stopped short of saying his state won't expand, a nonpartisan study estimates that the state could actually reap $1.4 billion in saved spending and new tax revenue under the expansion, according to the Associated Press.

With those kinds of numbers at stake, it's easy to understand why the Republican tune on the Medicaid expansion is changing. As George Mason's Nichols told Governing last year: "Usually, in the history of the world, math trumps ideology."

[Teatownclown]

Anybody notice Jake Henry's induction speech yesterday at the REGIONAL Chamber of Commerce?

It sounded like he was pushing for single payer.

[Townsend]

Easiest Path to Mental Health Funding May Be Medicaid Expansion

http://www.pewstates.org/projects/stateline/headlines/easiest-path-to-mental-health-funding-may-be-medicaid-expansion-85899443812

The recent mass killings in Tucson, Aurora and Newtown have sparked public conversations about the deficiencies in state-run mental health systems across the United States. But few states are poised to spend their own money to reverse as much as a decade of budget cutbacks in those areas.

Instead, many of them are counting on an infusion of federal mental-health dollars. Because Medicaid includes mental-health benefits, those states that opt into the Medicaid expansion included in President Obama's Affordable Care Act will be able to make mental health coverage available to thousands of their citizens who do not now have it.

For the first three years that additional coverage would cost the states nothing: Under terms of the Affordable Care Act, the federal government  will cover 100 percent of the costs of new Medicaid enrollees for the first three years and 90 percent after 2020.

So far, 20 governors, some of them Republicans who opposed the health care law, have committed their states to the Medicaid expansion. Ten Republican governors have announced they will not participate. If all states opted into the expansion, an estimated 13 million more Americans would receive mental health benefits through Medicaid next year, according to a report by the Congressional Budget Office. The number would rise to 17 million in 2022.

"This is a golden opportunity to shore up the state public mental health systems where they have seen these major cuts in the last ten years," says Joel Miller, senior director of policy and health care reform at the National Association of State Mental Health Program Directors (NASMHPD).

Even in states that decline to participate in the Medicaid expansion, the Affordable Care Act will extend mental-health benefits to more people. Under the law, people who don't get health insurance through their employers will be able to purchase it on new insurance exchanges. Because policies on those exchanges are required to offer mental health coverage, another 8 million Americans currently without mental health benefits will have them starting next year, according to Congressional Budget Office figures. That number would grow to 22 million in 2022.

The combined effect of the Medicaid expansion and the health insurance exchanges will begin to reverse what has been a withering in public investment in mental health in the 21st century. Cuts began during the post-9/11 recession and accelerated during the recent economic downturn.

According to a study by Miller and others at NASMHPD, state investment in mental health services dropped by $4.35 billion between 2009 and 2012 even as an additional one million people sought treatment in publicly financed inpatient and out-patient behavioral treatment services during that same period.

In the report, Miller and his colleagues make the case that treating people for mental illness pays huge dividends. For example, they cite studies showing that diagnosis and treatment for depression has an economic return on investment of $7 for every $1 spent. Comprehensive community-based mental health services for the young can cut public hospital admissions and lengths of stay by about 40 percent. And those treated for depression, according to the studies, have experienced huge savings in their overall health care costs, even when they have had other ailments, such as cancer and heart disease.

Nevertheless, most states have followed the opposite path. According to the National Alliance on Mental Illness (NAMI), California cut its mental health budget by $587.4 million between 2009 and 2011, New York by $132 million, and Illinois by $113.7 million. In those same years, Alaska slashed its mental health budget by 35 percent and South Carolina and Arizona by 23 percent each.

The result: "Waiting lists are longer," says Mike Fitzpatrick, executive director of NAMI. "There are fewer beds, fewer case workers, fewer programs."

That is why Fitzpatrick and other mental health advocates are pushing hard for all states to opt into the Medicaid expansion. "For people with mental illnesses, this could be a life-changer," he says.

Colorado, scene of a mass killing at an Aurora movie theater in July, is one of the few states that plan to use state money to expand mental health services. Last month, Democratic Governor John Hickenlooper proposed an $18.5 million plan to bolster the state's mental health services. His proposal would create a single, statewide mental-health crisis hotline, establish five around-the-clock mental-health crisis centers, increase the number of state-supported psychiatric beds, and develop housing alternatives for those suffering from mental illness.

In announcing his proposals, Hickenlooper left no doubt that he was prompted by the tragic events in Aurora. He labeled the plan, "Strengthening Colorado's Mental Health System: A Plan to Safeguard All Coloradans."

"This is all very exciting," says state Representative Tracy Kraft-Tharp, who used to lobby on behalf of mental health programs.   But the newly-elected Democrat acknowledges that the new money won't come close to restoring the mental health budget to its pre-9/11 levels.

That is true of other states that are also trying to squeeze some additional resources into mental health. In Ohio, Republican Governor John Kasich has authorized $5 million for intervention in cases where families feel threatened by a family member suffering from mental illness. The money would go for emergency treatment, medication, temporary housing and respite care for beleaguered parents.

Other states are also focusing on early intervention. Maryland's Governor Martin O'Malley, a Democrat, has announced several steps related to crisis intervention. "We will invest more to improve mental health services so we can intervene early and reduce the potential for violent behavior," O'Malley said at a Monday news conference, where he also offered gun control measures. "We'll expand crisis intervention teams, expand response services and establish a center for excellence on early intervention for serious mental illness."

Craig Stenning, director of Rhode Island's Department of Mental Health, Retardation and Hospitals, says his state is also undertaking programs to better identify the early signs of mental illness in young people and to get them into effective treatment. He notes that the Medicaid expansion in his state is going to enable it to shift more resources into housing, employment and education programs related to keeping those with mental illness stable. This last effort, he says, wouldn't have been possible if Rhode Island hadn't chosen to opt into the expansion.

South Carolina Governor Nikki Haley, a Republican, has already announced that her state will not be part of the Medicaid expansion. Haley has proposed increasing state spending for the Department of Mental Health by $11.5 million next year, but South Carolina's annual appropriations for mental health services have dropped $88 million since 2008. The state has been able to offset some of those reductions through a one-time recovery of substantial federal Medicaid dollars.

Aside from increased spending, some states are looking to make changes in laws pertaining to mentally ill people whose behavior is so extreme that they could be considered a risk to others. These measures would make it easier to have those people placed under civil commitment in psychiatric wards and to restrict their ability to purchase guns.

New York was first in line with these measures. Early this week, along with its stringent new gun laws, the legislature passed a law that requires health care professionals to report to law enforcement agencies on mentally ill patients whom they consider dangerous. Maryland will also consider laws to reduce the chance that some severely mentally ill people will purchase guns. And Colorado's General Assembly will take up bills that would make it easier to have those considered dangerous as a result of mental illness civilly committed and prevented from buying guns.

As states take up this legislation, mental health advocates and some state officials express wariness about aggravating the uneasiness many people already feel toward those with mental illness. "People begin to equate mental illness with violence or evil," says NAMI's Fitzpatrick, "but there are very few people with mental illness who become violent."