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1530342 tn?1405016490

And then there were six

http://www.msnbc.com/rachel-maddow-show/and-then-there-were-six



About two months ago, Nevada’s Republican governor, Brian Sandoval, did something no other Republican governor in the country had done: he endorsed President Obama’s Medicaid expansion plan. While clearly the right move on policy grounds, Sandoval’s decision was a political surprise – conservative groups have made it abundantly clear to GOP governors that activists on the right consider this policy an outrageous betrayal of conservative principles that would not be tolerated.

It took a month for Sandoval to get some company, but New Mexico’s Republican governor, Susana Martinez, ended up endorsing Medicaid expansion, too. A few days later, so did North Dakota Gov. Jack Dalrymple (R). Arizona Gov. Jan Brewer (R) grudgingly reached the same conclusion, as did Ohio Gov. John Kasich (R).

This week, Michigan’s Rick Snyder became the sixth Republican in the club.

    A day before he delivers his budget message to the state Legislature, Gov. Rick Snyder gave his unconditional support for an expansion of Medicaid to include about 450,000 more uninsured, low-income Michiganders into the program.

    “We’re all here to support expanding Medicaid,” Snyder said at a news conference called by a coalition of groups that support the expansion. “This is very exciting today. We’re moving forward with care for people who need it.”

    The expansion will allow roughly 470,000 more uninsured low-income Michiganders to be covered by Medicaid.

This probably isn’t a coincidence. Once some Republican governors took the plunge, it apparently led some of their GOP counterparts in other states to notice the water was fine. And just like that, a policy that Republican chief executives were supposed to avoid like the plague – a policy that implements the dreaded “Obamacare” – is no longer GOP anathema.

”The logjam has broken,” Ron Pollack, executive director of Families USA, said. Bill Pierce, a former Health and Human Services official under George W. Bush, added, “It’s a tipping point. You’ve now got a real conservative state, a battleground state and a blue state all signed up. If you’re a Republican governor thinking about this, you fit into one of those categories.”

However, for those who want to see more American be able to afford basic medical care, the news is not all good.

As Joan McCarter explained this week, Pennsylvania Gov. Tom Corbett (R), for reasons that defy comprehension, rejected Medicaid expansion in his state.

    The Medicaid expansion would have provided coverage to 542,000 additional people in the state over the next decade, according to analysis from the Kaiser Family Foundation. That would have cost the state $2.8 billion over a decade, with the federal government kicking in $37.8 billion to the state. More than 1.3 million Pennsylvanians are uninsured, nearly 13 percent of the state’s non-elderly population.

    Between Corbett’s voter suppression and vote rigging schemes and his hard-right, destructive course on Obamacare, this blue state Republican might be making 2014 a bit of a challenge for himself. Here’s something for Pennsylvania Democrats to consider: this decision is not irrevocable. States can decide to participate in the expansion at any point, though after 2016 the federal government won’t pick up 100 percent of the tab.

Making matters worse, Indiana Gov. Mike Pence (R) also made the wrong call.

    Gov. Mike Pence said Wednesday that he has ruled out expanding Medicaid under the federal health care law unless Indiana gets approval to use state health savings accounts for the expansion. […]

    “It was important to me that we do fully fund Medicaid, but we did not fund a Medicaid expansion, nor do I think that under the current framework for Medicaid that it would be advisable for Indiana to do that,” he said.

It’s worth noting that the Indiana fight may not be completely over just yet. State legislators are still eyeing expansion, and some Republican lawmakers appear open to moving forward with legislation. State Senate Minority Leader Tim Lanane (D) emphasized Medicaid expansion in neighboring states, arguing, “I don’t think we ought to be known as the island of the uninsured.”

While we wait to see what happens, it’s still something of a relief to see a growing number of Republican governors do the right thing on this. To reiterate a point from the other day, the way the Affordable Care Act is structured, Medicaid expansion is a great deal for states, and should be a no-brainer for governors who care about lowering health care costs, insuring low-income families, improving state finances, and helping state hospitals.

The only reasons Republican governors would balk is if (a) they’re afraid of their party’s base; (b) they plan to run for president and don’t want this to be used against them in a primary; or (c) they’re bad at math; or (d) some combination therein.

As a practical matter, it’s become something of a test: how many GOP governors value arithmetic over ideology? As of today, the number is six. Here’s hoping it continues to grow.
12 Responses
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1530342 tn?1405016490
You're very welcome..I understand your hesitation and skepticism but this will work. The ACA will reduce the deficit and generate revenue at the same time covering millions of people that cant get coverage or are getting dropped by their current carrier....I will say it again and again, the Administration did a horrible job presenting the ACA to the people. They let the right control the conversation with lies about the ACA that pretty much stuck with people. Then to top it off with the website that was even more horrible...They have learned though, and people are enrolling and getting coverage and saving money, we will start to see and read the reports...
Helpful - 0
Avatar universal
Thanks for the link.  It was helpful.  I'm now looking for a place were I can buy some faith in this thing working right, getting people insured without cleaning other people out.
Helpful - 0
1530342 tn?1405016490
Sorry for the way it posted. Click the link to read how the ACA is funded.
Helpful - 0
1530342 tn?1405016490
http://www.acponline.org/advocacy/where_we_stand/assets/i2-how-is-the-aca-funded.pdf

According to the Congressional Budget Office (CBO), the ACA
’s coverage expansion
is estimated to cost
roughly
$1
.
363
billion over
the period of 201
4
-
202
3
in mandatory expenditures.
This estimate, released in
May
2013
, reflects the Supreme Court’s decision that
allows states to choose whether to expand Medicaid and
other
responses to the law, such as lower revenue derived from the
excise
tax on high
-
cost employer
-
based health
insuranc
e plans
.
The cost of the law may fluctuate depending on the amount of funding Congress appropriates
to health
-
related discretionary programs and other factors, such as how many persons enroll in the new
coverage options created by the ACA, changes in heal
th care spending, growth in the overall economy, and
other variables. Discretionary funding means that Congress must decide, usually on an annual basis through the
“appropriations” process, how much money it will put into funding each “discretionary” progr
am authorized by
the ACA. “Mandatory” funding means that the federal government automatically is required to spend the
amount of money required to support a particular program created by the ACA, such as benefits paid out under
Medicare and Medicaid.
The ACA and its companion reconciliation legislation contain a number of provisions designed to raise revenue
to offset the cost of the health reform law. After the revenue raisers are initiated, the law is estimated to reduce
the federal deficit by $1
09
billion over the 201
3
-
20
22
period according to CBO
and the Joint Economic
Committee
.
i
The CBO/JCT has not updated its estimate on the ACA’s effect on the federal deficit, although in
the May 2013 estimate they reaffirm that “(t)aking the coverage provision
s and other provisions together, CBO
and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent
decade.”
ii
Annual Fee on Health Insurance Providers
:
Starting in 2014, health insurers will have to pay a fee to the
federal government. The amount of the fee
depends on the amount of “net premiums written” by the insurer during the year. Net premiums written is the
amount of premiums paid to the insurer by plan enrollees and adjusted for the cost of any reinsurance (wh
ich
guards the insurer from major financial loss) held by the insurer.
Will all insurers have to pay the fee?
Some insurers with relatively low net premiums written amounts will be exempt from the assessment. Insurers
with at least $50 million in net
premiums written for the year will have to pay the full fee. Non
-
profit insurers
will only have 50 percent of their net premiums written accounted for when the fee is being determined.
The following insurers are exempt from the fee:

Self
-
insured plans
(typically large employers who fund the insurance of their employees)

Any government entity
How much revenue will this raise?
The
CBO/
Joint Committee on Taxation predicts the fee will raise $
102
billion over
the period of 2013
-
2022
.
i
Excise Tax on Indoor Tanning Services
Among the smaller revenue provisions in the
ACA is a 10 percent excise tax on indoor tanning services.
Helpful - 0
649848 tn?1534633700
Excellent link if you want to know about ACA or Medicaid expansion, but again, unfortunately, there's no FAC that asks "How is this going to be paid for?".  
Helpful - 0
Avatar universal
I see nothing that explains where the federal government (or the states, for that matter) are going to get the money to pay for it.

Seems that all the articles seem to dance around that issue quite nicely.




http://www.apha.org/advocacy/Health+Reform/ACAbasics/medicaid.htm
Helpful - 0
649848 tn?1534633700
While the link explains the benefits of ACA and Medicaid expansion, I see nothing that explains where the federal government (or the states, for that matter) are going to get the money to pay for it.

Seems that all the articles seem to dance around that issue quite nicely.
Helpful - 0
Avatar universal
Thanks for the link but I didn't see the information I was looking for.  What concerns me is where the federal funding is going to come from.  Maybe its just me, but it looks like we have a knack to spend money with no accountability and we keep passing on those hardships to the tax payer.  I don't know how that is right.

I am probably reading this all wrong, but using the numbers from the original post, some part of this is going to cost $2.8 billion and the government is going to kick in $37.8 billion.... and I believe that is for only 1 state?  That sounds like a financial train wreck to me.
Helpful - 0
206807 tn?1331936184
Running late for work so I don’t have time to open and read the link. I just have two questions so far (they may have been answered in the link).

Where is the Government getting the money from to fund-
“"Overall, the federal government will finance about 95 percent of the cost of the Medicaid expansion from 2014 to 2019. The federal government will cover 100 percent of the states’ cost of covering newly eligible Medicaid beneficiaries from 2014 to 2016 and will then phase down its federal contribution to 90 percent by 2020.”

2nd Is this a loan to the States or is the Government giving this money to them with no strings attached?
Helpful - 0
1530342 tn?1405016490
"Overall, the federal government will finance about 95 percent of the cost of the Medicaid expansion from 2014 to 2019. The federal government will cover 100 percent of the states’ cost of covering newly eligible Medicaid beneficiaries from 2014 to 2016 and will then phase down its federal contribution to 90 percent by 2020. Coverage for previously eligible Medicaid beneficiaries will continue to be financed through a matching system between the states and the federal government which currently ranges from 50% to 74% federal funding.

The Medicaid coverage expansion has significant potential to reduce the number of uninsured and reduce disparities in coverage across states. With many uninsured adults expected to gain coverage and many likely to have unmet health needs, it will be important to connect newly eligible individuals to coverage and care in 2014."

http://kff.org/health-reform/fact-sheet/who-benefits-from-the-aca-medicaid-expansion/
Helpful - 0
206807 tn?1331936184
Glad I only wasted a little time on this article. I only read about a 1/3 of it then scrolled up and saw “MSNBC The Rachel Maddow Show.” I generally check the source before wasting my time reading things.
Helpful - 0
Avatar universal
"The only reasons Republican governors would balk is if (a) they’re afraid of their party’s base; (b) they plan to run for president and don’t want this to be used against them in a primary; or (c) they’re bad at math; or (d) some combination therein."

Or they simply do not know where the money is going to come from to pay for this.  

"The Medicaid expansion would have provided coverage to 542,000 additional people in the state over the next decade, according to analysis from the Kaiser Family Foundation. That would have cost the state $2.8 billion over a decade, with the federal government kicking in $37.8 billion to the state...."

So this was going to cost the state $2.8 billion and the federal government is/as going to kick in $37.8 billion?  WTF is wrong with the math there?  Someone help me understand why something would cost $2.8 billion and the government was going to chip in $37.8 billion?  
Helpful - 0
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