J.K. Wall has a good article for the IBJ (h/t Indiana Law Blog entitled Ruling Could Leave 290k Hoosiers Uncovered. It’s a good article that you should read, but I disagree with the title. It’s not the ruling that would leave Hoosiers uncovered. The fault, dear Brutus, is not in our stars, but in ourselves; or rather, it would be in our lawmakers.
After last week’s U.S. Supreme Court ruling gave Indiana the option not to expand its Medicaid program and some state legislators promised to do exactly that, Indiana hospitals started to worry.
That’s because a decision by Indiana to leave its Medicaid program unchanged could leave as many as 290,000 Hoosier adults, who would have been newly eligible for Medicaid coverage, with no good options.
Out of mostly political pique, lawmakers could decide to take it out on those 300k Hoosiers who don’t qualify for Medicaid as currently structured but who would qualify for the Medicaid expansion because their income is 133% of the poverty level or less (about $32,000 for a family of four). I believe the rest of the health care reform law focuses on solutions for people with incomes above that level with the underlying assumption being that those earning below that level would have been covered by the Medicaid expansion. This gap includes pretty much all of the non-disabled, childless poor as well as adults with children if the family income is between about $6,000 and that $32,000 mark. In particular, it is:
[I]t is parents with incomes below 100 percent of the poverty limit and above 24 percent of the limit—as well as all childless adults below the poverty limit—that would be left out if Indiana did not expand its Medicaid program.
The reason federal lawmakers made the assumption that states would expand is because, as written, the law was pretty draconian in its response to states that did not expand — it defunded even current federal Medicaid contributions. The Supreme Court deemed that too coercive and struck the defunding provision, giving states much more freedom to decline expansion. There may be dispassionate policy arguments against expansion; but we are unlikely to get a dispassionate approach to this issue from lawmakers. Health care policy has been heavily politicized, and declining or agreeing to participate in the Medicaid expansion will be as much a tribal marker as anything else. If you’re not of Obama’s tribe, you’ll vote against expansion. If you are of Obama’s tribe, you’ll vote for it. Policy reasons will be given; but it’s difficult to believe at this juncture that those ostensible reasons will be much more than pretextual.
Apparently this would represent a serious blow to hospitals who would get Medicaid reimbursements of about $0.60 on the dollar for this group of people (leaving aside for a moment the huge issue about setting the proper baseline for medical costs) instead of the approximately $0.10 on the dollar they currently are able to realize on bad debt associated with this population. A study commissioned by Gov. Daniels (not necessarily a neutral actor) had Indiana’s share of expanded coverage at about $160 million per year between 2014 – 2020. (By my back of the napkin math, this represents about $533 per covered individual or about $23 per Hoosier per year; however you want to cut it.)
Not only that, but covering them costs little state money. If you sign on at first, the Feds will reimburse 100%. If you sign on later, they will pay 90%. 50 million dollars is a lot to pay for a fit of pique.
Especially, since the people could benefit so clearly from this.
Reasons for opting out of medicare expansion? (select 1)
. Spite
. Malice
. Revenge
. Boredom
. Profit
I’d say “Select all that Apply” would be more accurate.
So, is it that the legislature must vote either to include or to not include the thousands of people who are not now covered but could be under the new arrangement, or is there a default at work? Is there a count somewhere of how many of the members of the legislature don’t themselves have any health care insurance? Because if they don’t, then their self-sacrifice on behalf of the taxpayers must be truly appreciated. But if they do have insurance and deny it to others, for shame. And they would also be hurting all others, who will be charged more one way or another to make up for the hospitals’ losses.
I think they have to vote to participate in the Medicaid expansion; it’s not the default.
I also think that members of the General Assembly get insurance coverage by virtue of their holding office. There was a kerfuffle some years ago about health care benefits for retired members of the General Assembly that caused a bit of a shake up – it’s possible that affected coverage for current members, but I don’t think so.
In Mike Young’s epic hissy fit on Thursday, he mentioned that the State of Indiana does not provide insurance to him. Then again, he’s lied to my face before
Not sure who that is, but I guess he’s living on the poverty line?
Legislators most definitely get health insurance through the State, so don’t let Mike Young lie to you. He may not accept it, but he is offered it. In fact, at least a few years ago, if not still today, the legislators had the option of using whichever insurance plan they wanted, State Police, State Employee, etc. They could pick and choose which plan they liked best for their needs.
Don’t forget the addition of paying patients may create a few jobs. More nurses, lab techs, and other medical professionals?
Oh, noes! there’s not enough doctors and nurses to go around! They’ll have to RATION care! Death Panels!
Evidently, the idea that you train more medical personnel never occurred to the Authoritarian Right.
$23 a person? You’re talking about a population that is characterized by people who call paying 1/950 of a Cent. for my paycheck “having my hard-earned Money taken at the Point of a Gun”.
The idea of paying $23 a year of that HEMTATPOG for people who wouldn’t be poor if they hadn’t angered GAWD somehow would make blood spurt from their eyes.
The Bubbas in Indy are acting mean and miserly? They’re just echoing the desires of their constituents.