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1530342 tn?1405020090

AP Exclusive: Medicaid for the middle class?


By RICARDO ALONSO-ZALDIVAR, Associated Press – Tue Jun 21, 6:01 pm ET

WASHINGTON – President Barack Obama's health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services department.

After initially downplaying any concern, the Obama administration said late Tuesday it would look for a fix.

Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps.

Medicare chief actuary Richard Foster says the situation keeps him up at night.

"I don't generally comment on the pros or cons of policy, but that just doesn't make sense," Foster said during a question-and-answer session at a recent professional society meeting.

"This is a situation that got no attention at all," added Foster. "And even now, as I raise the issue with various policymakers, people are not rushing to say ... we need to do something about this."

Administration officials said Tuesday they now see the problem. "We are concerned that, as a matter of law, some middle-income Americans may be receiving coverage through Medicaid, which is meant to serve only the neediest Americans," said Health and Human Services spokesman Richard Sorian. "We are exploring options to address this issue."

Administration officials and senior Democratic lawmakers initially defended the change, saying it wasn't a loophole but the result of a well-meaning effort to simplify the rules for deciding who would get help under the new health care law. Instead of a hodgepodge, there would be one national policy.

But Sen. Orrin Hatch of Utah, the ranking Republican on the Senate Finance Committee, called the situation "unacceptable" and said he intended to look into it.

Governors have been clamoring for relief from Medicaid costs, complaining that federal rules drive up spending and limit state options. The program is now one of the top issues in budget negotiations between the White House and Congress. Republicans want to roll back federal requirements that block states from limiting eligibility.

Medicaid is a safety net program that serves more than 50 million vulnerable Americans, from low-income children and pregnant women to Alzheimer's patients in nursing homes. It's designed as a federal-state partnership, with Washington paying close to 60 percent of the total cost.

Early retirees would be a new group for Medicaid. While retirees can now start collecting Social Security at age 62, they must wait another three years to get Medicare, unless they're disabled.

Some early retirees who worked all their lives may not want to join a program for the poor, but others might see it as a relatively painless way to satisfy the new law's requirement that most Americans carry health insurance starting in 2014. It would help tide them over until they qualify for Medicare.

The actuary's office said the early retirees eligible for Medicaid would be on top of an estimated 16 million to 20 million new people that Obama's law already brings into the program, by opening it to childless adults with incomes near the poverty level.

It's unclear how much it would cost to cover the retirees. Federal taxpayers will cover the entire initial cost of the expansion.

Republicans already see a problem.

Former Utah governor Mike Leavitt said bringing early retirees in will "just add fuel to the fire," bolstering the argument from Republican governors that some of Washington's rules don't make sense.

"The fact that this is being discovered now tells you, what else is baked into this law?" said Leavitt, who served as Health and Human Services secretary under President George H.W. Bush. "It clearly begins to reveal that the nature of the law was to put more and more people under eligibility for government insurance."

The Medicare actuary's office roughed out some examples to illustrate how the provision would work. A married couple retiring at 62 in 2014 and receiving the maximum Social Security benefit of $23,500 apiece could get $17,000 from other sources and still qualify for Medicaid with a total income of $64,000.

That $64,000 would put them at about four times the federal poverty level, which for a two-person household is $14,710 this year. The Medicaid expansion in the health care law was supposed to benefit childless adults with incomes up to 133 percent of the poverty level. A fudge factor built into the law bumps that up to 138 percent.

The actuary's office acknowledged its $64,000 example would represent an unusual case, but nonetheless the hypothetical couple would still qualify for Medicaid.
22 Responses
1530342 tn?1405020090
Ok someone tell me what's wrong with this? Why is it wrong for the middle class to get medicaid? I consider myself and husband Middle class, as far as we know, we ALWAYS get the $#@% end of the stick....Middle class in my opinion is fading out. There's the RICH and then everyone else. Why in the world would people not want EVERYONE to have health insurance??????? I don't think it's OBAMA trying to shut this down. It sounds to me like it's the republicans AGAIN!!! PLEASE correct me if I'm wrong!!!
1530342 tn?1405020090
BTW didn't EVERYONE read this bill before they signed it? Why NOW is it a problem? Um maybe because the election is around the corner...So sad!!!
306455 tn?1288865671
THIS IS ALLABOUTMARY ON FLMAGI'S COMPUTER  (just so everyone knows it's me and not Magi posting)   Magi is my sister and lives next door.

Like I said in the other post. I think everyone should be able to get on Medicare, for a fee, say a sliding scale.
What kills me is the FOR PROFIT insurance companies.  We don't have for profit police, fire departments or public schools.  Can you imagine your house on fire but you didn't have the cash or insurance to have it put out.  That sounds crazy ..right ?  Well so does for profit health care.
So yes i agree everyone should have health care.
Avatar universal
Yep Im middle class too. Isnt that the only group hurting for medical care tho? I mean the poor get it paid, the rich obviously have no problem, so just who else is there? (looking side to side and up and down). hmmmm, got me!
973741 tn?1342346373
Isn't it a requirement to carry insurance on your home when you apply for a mortgage?
Avatar universal
And something else no one is getting! I am willing to pay for insurance and no one will insure me! How about you gals? U want free? Who is talking free other than them gop idgits. So much for the greatest healthcare in the world!
973741 tn?1342346373
I do agree that the ones who really need help with getting medical coverage are the middle class.  I think they should bump up the medicaid level to include more and yes, I would like more options for those middle class.   (me)

306455 tn?1288865671
Mary on Magi's computer.

Yes you must have homeowners if you have a mortgage.  You must have auto insurance to drive also. So I get what your saying .....they are for profit. (don't get me wrong I hate all insurance companies  lol)    Then again, why is everyone against the health insurance mandate in the new health care bill ?  
Avatar universal
No worries, the loophole will be fixed. As long as no major corporate entity is involved, Congress will go out of its way to eliminate much needed help to the lower middle class.

973741 tn?1342346373
Oh that's it-----------------   you are right!!  I am a hypocrite!!!  Ha.  Seriously, I'm not a fan of the health care mandate that everyone be required to buy insurance because it basically means there has to be a single payer system in order for that to happen.  Not everyone has to own a car or buy a home.  But just because you breath------------ you HAVE to have insurance under that order.
1530342 tn?1405020090
I agree with a sliding scale... I would definitely pay for it (as we do now through my husbands job) But we pay $225 a pay period (every 2 weeks) for Just medical then another $50 for dental and vision...I think that is ridiculous..Healthcare should NOT be that expensive ESPECIALLY if you are working...I know TONS of people who are NOT working and get "free" medical and let me tell you their medical is waaayyyy better than what my husbands job offers. I know a girl that just had a baby. She was working and then decided that she was "tired of working" She went to a "shady" Dr and was excused from work due to stress..Now I know there are cases where work can stress you out but in her case (like plenty of other people do) she was just "tired" of working. In any event, she collected TDI (Temporary disability) for 6 months, got pregnant while on TDI, once her TDI ran out she ended up on unemployment. She can now collect and was qualified for state medical, WIC (free formula, milk, eggs, bread and cheese), and Food stamps (because she says she's single....but explain how she got pregnant being single. They didn't probe that though!!!) She had a baby at NO CHARGE whatsoever. No co-payments, no bill after delivery....Now myself and my husband are TTC. He works very HARD and if I were to have a baby, each Dr's visit would be $25 and my out of pocket expense after give birth would be $900.00 (yes that's not bad but compared to people not paying anything and scamming the system, I say it's bad)..Tell me that's not *&^%$# up!!!
1530342 tn?1405020090
sorry I may sound jealous but I think I have the right to be...It's just not fair and we have people and politicians who oppose everyone having "free" healthcare...The politicians free healthcare is paid by who? THE MIDDLE CLASS!!!!
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