How Will The Supreme Court’s Medicaid Decision Affect You?

While supporters of the Affordable Care Act have spent the day reveling in this morning’s Supreme Court ruling and its detractors have vowed that they will continue to fight the law through legislative means — there is also a third group of people who think that moving to Canada would somehow teach America a lesson about a national health care law — what’s been left out of most of the discussion are the ramifications of the Supremes’ ruling against the portion of the bill that penalizes states that don’t contribute to Medicaid expansion.

Under the ACA, the federal government foots the bill for most of the expansion. However, states are expected to kick in some funds for the effort. As it was written, the law would penalize states that did not contribute by withholding federal funding.

Chief Justice Roberts wrote in the court’s ruling that this “gun to the head” approach was unconstitutional, leaving it up to each state to decide its level of participation. The court ruled it would be appropriate to offer benefits to participating states but not to threaten non-participating states with penalties.

The question is, which states will hold out and how many people would be affected?

As written, the ACA requires states to extend Medicaid coverage to non-elderly individuals with incomes up to 133% of the poverty line. For a family of four, that would peg that number at around $30,700.

If all states were to be involved, this would extend Medicaid coverage to around 16 million people by 2019.

But remember that attorneys general for 26 states — Florida, South Carolina, Nebraska, Alaska, Texas, Utah, Louisiana, Alabama, Michigan, Nevada, Arizona, North Dakota, Indiana, Mississippi, Georgia, Colorado, Pennsylvania, Washington, Idaho, South Dakota, Maine, Wisconsin, Ohio, Kansas, Iowa and Wyoming — took part in the lawsuit challenging the individual coverage mandate.

According to an analysis by ProPublica, there are about 8.5 million people in those 26 states who would currently benefit from the Medicaid expansion. This doesn’t include Virginia and Oklahoma, which filed their own legal grievances regarding the ACA.

According to a separate Kaiser foundation report, “Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured. The ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups.”

A report by the Center on Budget and Policy Priorities estimates that between 2014 and 2022, the ACA would have the federal government paying for about 93% ($931 billion) of the nearly $1 trillion cost for the expansion, with states kicking in around $73 billion during that period.

Through 2016, the feds are supposed to pay for all the people newly covered by Medicaid, with that $73 billion from the state gradually phased in during the next six years. The goal is to have the federal portion only be 90% by 2020.

If the 28 states involved in the various lawsuits decide to not contribute to the expansion, it would throw a bit of a wrench into this plan, as the federal government would need to account for at least half of that $73 billion.

This could mean the federal government extends itself even further, subsidizing a larger portion of the Medicaid bill than it had planned, or perhaps revising down the number of people eligible for expanded Medicaid coverage.

Since the feds have been enjoined against penalizing non-participating states, it will more likely result in states being offered incentives that would be hard to pass up.

“While 28 states had opposed the requirement to expand Medicaid programs for citizens with low incomes, it is not at all clear what they will actually do now that it is no longer a mandate,” explains DeAnn Friedholm, Consumers Union’s Campaign Director of Health Care Reform, in a statement to Consumerist. “States will face the reality that they will be giving up millions or billions of federal dollars and still end up with hundreds or thousands of uninsured people who will drive up health care costs for everyone else.”

Of course, none of this is set in stone. Political winds can change direction unpredictably and quickly. Who knows who will be running these states — or even the White House — two years from now when this expansion is slated to start.

Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion? [ProPublica]

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  1. az123 says:

    “States will face the reality that they will be giving up millions or billions of federal dollars and still end up with hundreds or thousands of uninsured people who will drive up health care costs for everyone else.”

    This really is not right, because it will be illegal to not have health care. The reality is that without this expansion the Obamacare (as outlined by the supreme courts ruling) is basically screwing over the low-income americans by forcing them to buy insurance they cannot afford….

    • Oranges w/ Cheese says:

      There are subsidies written into the law so that low income families are not penalized if their income is below a certain point.

      What’s worse? Having insurance and not going bankrupt or irrevocably ruining your life because you had to go to the ER once?

      • Mr. Fix-It is trapped in a collection of half-working appliances says:

        Except that minimum income level is comically high for a single individual…

        • ChuckECheese says:

          133% of the Federal poverty level for a single adult is $14,856. That’s not comically high.

          • sendmoney2me says:

            I’m single. my rent alone is $13,800 a year. my health insurance is another $1272 a year. that’s higher than the poverty level and I haven’t even paid any of my other basic bills like Power or car insurance.

      • Not Given says:

        Having insurance and going bankrupt anyway.

        • TasteyCat says:

          This. The majority of bankruptcies are related to medical costs. Of those, the majority of people have health insurance. Insurance may provide a buffer, but the lack of affordable care often does not allow that to make a difference. With or without insurance, you’re screwed either way. It would be nice if they passed a law to reform healthcare costs.

          • suezahn says:

            Happened to me. Thank god that fact did not hinder me from getting a better job a year later–it very well could have since they all run credit checks now.

          • smo0 says:

            That’s exactly what happened to me.
            However, the tipping point was when my insurance company decided to NOT pay for a pre-approved surgery and left me holding a $40,000 bill.
            I’m for this.

          • muzzleme says:

            Thank You. It is the COST. The ACA is an insurance bill. The only difference here is that insurance premiums over time will take a little longer to bankrupt you.

            The people caught in the middle will be hurt the most as usual. So if your income is near or right above the thresholds you will pay. If you have irregular income you will pay. And if forced to apply your income might be low but if you have any assets you will be forced to spend them or burn them up on insurance premiums thus jeopordizing your financial future.

            If forced to pay a tax/fine or pay premiums over time the financial stress would do more harm than having access to medical care.

      • TheUncleBob says:

        Subsidies for the low income. Super-rich don’t need up. Middle Class? ‘meh. Either give the evil health insurance providers your money, or give the government your money…

        What was that about not raising taxes on the middle class?

      • azgirl says:

        Just because you have health insurance doesn’t mean you can’t go bankrupt.. most of these policies are still high deductibles with 20-30% co insurance payments- meaning you still pay a bunch when something goes bad…

    • eeelaine says:

      Its won’t be illegal to not have health care, but you will have to pay a penalty for not having health insurance. Think of it like a tax credit. No health insurance? Pay tax. Health insurance? Tax credit.

      • Akuma Matata says:

        >>Think of it like a tax credit. No health insurance? Pay tax. Health insurance? Tax credit.

        But it’s not a tax credit because you don’t get money back if you have qualifying health insurance.

        • Jawaka says:

          Who are all these people out there who would rather not have health insurance?

          • MutantMonkey says:

            I throw on a dart league in NC and occasionally political, and I use the term loosely, conversations break out. Health care is one that creeps up most often and a good number of these guys refuse to get health insurance because it costs them too much and they don’t see the point as they are “healthy as a horse”.

            It is worth noting that most of them, from what I gather by talking to them, are contractors and are not involved in big corporations.

            To that end, I do not see anyone who works at BOA forgoing their health insurance. It seems like it is mainly relegated to self employed people or those that work for very small companies like 10 people or less.

            • Jawaka says:

              Sure, they’re healthy as an ox but who’s going to pay for it when one of them gets hit by a car on the way home from dark league some day or slips on his kids baseball in the yard and breaks his ankle?

              • MutantMonkey says:

                Well that part is obvious to you and me, but this jackass, who smoke 2 pack in 3 hours, sees himself as invincible. You can’t really reach these people until it’s way too late, and even then you may have a hard time.

                • MutantMonkey says:

                  OK, seriously now, Consumerist just went through a comment system upgrade and still no edit button. WTF is the reasoning behind this omission?

                  “…smokes 2 packs…”

          • dangermike says:

            Young, healthy people, mostly. Many with college educations and mountains of debt from obtaining those degrees.

          • TuxthePenguin says:

            The same people who decide that the tax they’ll pay otherwise is far less than the cost to get healthcare. Remember, its now guarantee issue. So why bother paying an insurance company to cover your annuals and such, instead you just play roulette that you can buy insurance before going to the doctor for something major…

          • pgr says:

            The conservative “Me” right-wingers. Those who believe in fencing in their quarter acre of land out in East Bum Fuck, USA and guarding the perimeter with an AK47 day and night. The “I” crowd – no one counts but “ME” I don’t want to pay no stinkin’ taxes or be told how to live. I want to hide out from life and the world.

            Oh, but make sure the mailman puts that Social Security check in my mail box (just outside the fence) and tell the fire department they can come in if I need them and let the highway commissioner know about that big pothole at the end of my driveway that “I” need filled in and don’t forget to send the ambulance when I shoot myself in the crotch because my concealed loaded pistol went off in my pocket!

            That’s who they are. Your typical anti-folks ;)

            • wackydan says:

              Please… No conservative actually thinks they shouldn’t pay taxes for roads and infrastructure that they use… There may be some fanatics out there that do, but this fire department BS is getting old. The point is limits on gov’t… which seem to be eroding and becoming ever more intrusive into our personal lives and wallets.

          • muzzleme says:

            Many who don’t have health insurance simply can’t afford it. Not all employers give you health insurance or offer discounted insurance. Corbra or self pay for those already under financial stress makes health insurance unattainable and/or impractical.

            Insurance until this law was actually an optional form of payment for which the medical industry and patients chose to exploit and feel entitled.

      • spamtasticus says:

        Not illegal? Really? Please tell me what will happen if someone does not buy health insurance and then does not pay the fine they are issued? What will happen then?

      • wackydan says:

        Yet if you can’t pay your taxes you most certainly can end up in jail… May take a while, but that it indeed possible.

    • MutantMonkey says:

      This only applies to people that make a certain amount of money. There will still be many people that are not forced into individual mandate because of their income. Those people will be able to take advantage of Medicaid.

      At the end of the day this will help prevent people, who do not have insurance, from going to emergency rooms because they have a cold or a rash which in turn jacks up the premiums for people who do have insurance, which is often cited as a reason for premium increases by the insurance company, which is essentially a hidden tax on individuals paying for insurance.

    • VeryFroid says:

      “because it will be illegal to not have health care”

      No, it will not be illegal to not have health care. Quoting directly from the decision :

      “While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful”

    • UncleAl says:

      Sounds like someone missed the point of today’s SCOTUS ruling. It is in fact perfectly legal to not have healthcare insurance under the mandate; you simply pay a tax penalty for going without coverage. Had the tax penalty instead been a fine not collected by the IRS, then the mandate would have been ruled unconstitutional, at least based on the logic in the ruling.

    • The Porkchop Express says:

      I agree that it will screw them into getting coverage that they can not afford. But it may also keep some people, whoe may be just on the edge of being able to afford coverage, from being screwed when they need coverage the most.

      What noboby realizes is that people without insurance of any kind cause all of us to pay more for whatever insurance we have. people without auto coverage can raise rates for auto coverage by not being able to make any payments on damage that they have caused to other people’s cars or property. people with no health insurance go to the hopspital and get treated, then don’t pay…health insurance goes up because the cost of treatment goes up.
      so basically, we are all paying for others in the long run.

  2. Oranges w/ Cheese says:

    The disgusting thing is that the people in these states will have to deal with their politician’s heartlessness, even if there’s nothing they can do to move out of the state. How these rich hooligans sleep at night is beyond me.

    BE A HUMAN BEING for a change instead of some corporate shill.

    • partofme says:

      Even human beings have to balance state budgets… as many state constitutions require them to.

  3. Emerson says:

    It is all good. My state (SC) will be one of the first that will opt out.

  4. Ben says:

    This ruling is going to affect a lot of Republicans who will have to move to Canada to escape the horror of socialized medicine!!!

    • pgr says:

      I actually met a Right-Winger from my home state (NH) in the airport in Lisbon a few months ago who told me he was “moving” all this money & assets to Canada so he could escape the new socialism of the USA! I had a hard time controlling myself, thinking “I’d love to move to Canada for the exact opposite reasons”!

      Later on, when I got home I met someone who actually knew him and they told me he keeps a “special” room in his house filled with survivalist supplies for when “they” take over!

      The world (and especially the USA) is full of crackpots who go around masquerading as normal, intelligent, productive members of society till they open their mouths ;)!!!

  5. corridor7f says:

    It’s not going to work unless everyone pays into it. It sucks that there are penalties, but you can’t cash in on it unless you contribute.

  6. PragmaticGuy says:

    My office is in a “poor” neighborhood and I’m a notary. Most of the time people that come in here show their medicaid cards as ID. They’re not sick, they’re lazy or uneducated because they were too busy doing other things than going to school but my tax dollars are paying their way. One gal called her card her “Platinum Visa” and she was so proud to have it rather than contribute to her well being instead of leeching off the government. Let’s keep people from getting too many benefits because it’s not helping. People need to control their own destiny, not have government do it.

    • MutantMonkey says:

      My, that’s quite a big blanket you have there.

    • Janus, Should I laugh or cry? says:

      From Wiki:

      The United States currently pays around $20 billion per year to farmers in direct subsidies as “farm income stabilization

      From the NYT:

      When he releases his new budget in two weeks, President Obama will propose doing away with roughly $4 billion a year in subsidies and tax breaks for oil companies, in his third effort to eliminate federal support for an industry that remains hugely profitable.

      I could go on endlessly about these corporate/military welfare programs, but it’s the little guy who’s getting away with chump change that seems to really rattle some people.

      • Buckus says:

        If I could give you a thumbs up, I would.

        I think it’s because most people can fathom having, say, an extra $2,000. So when someone cheats the system and gets $2,000 in benefits they shouldn’t have, people get angry, because, hey, they could use that $2,000 instead!

        But when you start talking billions…people’s brains go numb. They can’t get a grasp on that much money. If they had a billion dollars all of a sudden, they wouldn’t know what to do with it. So there’s a cognitive dissonance between a few thousand and a few billion.

        • JulesNoctambule says:

          I think that disconnect is also part of the problem with the ‘Citizens United’ issue. Ordinary people just can’t fathom that the super-wealthy can, and will, spend more backing a candidate than they and their entire family will see in their combined lifetimes — and they’ll have plenty of billions left over for other things, too.

        • LabGnome says:

          I think it’s also a matter of how much exposure one gets to certain media. Conservative biased news is never going to report on all the tax money we give to profitable companies (unless they are companies doing heavy alternative energy R&D). The Liberal biased news is too busy trying to defend ‘the underprivileged’ to point out this abuse of our tax money either.

      • Peggee has pearls and will clutch them when cashiers ask "YOU GOT A WIC CHECK MA'AM?" says:

        But but job creators arglebargle…

    • Kuri says:

      Nope, we should let corporations control it instead, which happens much more often.

      • dush says:

        Don’t let the govt expansion fool you. It is the corporations controlling this. Big Pharma and Big Insurance.

        • Kuri says:

          Oh I know, if the insurance companies weren’t involved we would have had the public option and this mandate wouldn’t have even been considered

    • who? says:

      I call BS on your story, because I actually know some “welfare queens”, and queen is the last thing that comes to mind when I see their situation. In today’s world, becoming a long-term recipient (or victim, in your mind) of one of the entitlement programs for the poor requires more than just not having an income. You have to have something else going on, like physical illness, mental illness, or be caring for a child in that situation. And people on those programs are very, very poor, even with the benefits. The reason they’re using their medicaid cards as ID is because they can’t afford the $10 or $20 for an official state ID. And the woman who is calling her medicaid card her “platinum visa” is just as capable of sarcasm as Consumerist commenters.

      Researchers have been doing an actual study with actual facts. A couple of years ago, Oregon rationed Medicaid via a lottery, which gave researchers a chance to compare outcomes of poor people who got Medicaid vs. poor people who didn’t get Medicaid. The results have been coming in in recent months, showing conclusively that Medicaid actually helps the people it serves. In particular, it makes their financial situation much more stable, and makes them much more likely to get preventative care, take all their pills, etc. The study has also shown that it costs money. The insured person uses an average of $778 per year in health care, about $200/year more than an uninsured person.

      You can decide, for one reason or another, that the money spent on Medicaid isn’t worth the benefit it provides. But after this study, it would be pretty hard to argue that Medicaid doesn’t provide a definite benefit to the people who have it.

      http://www.nytimes.com/2012/06/23/health/oregon-study-reveals-benefits-and-costs-of-insuring-the-uninsured.html?pagewanted=all

      • JJFIII says:

        Oh stop that craziness of throwing facts and figures around. They saw it in THEIR world, so it means it is everybody. The right wing has no use for facts; they believe the world was created in 7 days

    • iblamehistory says:

      How am I lazy and uneducated after spending 6 years earning a bachelor’s degree (psychology) and a master’s degree (social work) as well as passing a licensure exam (LSW) that all did nothing to help me find ANY sort of employment whatsoever, still, 14 months after graduation, and has instead resulted in me depending on food stamps and Medicaid?

      Unless you’re hiring, don’t suggest retail or food service–been turned down countless times because they don’t want people with graduate degrees and professional licensure who have never touched a cash register before.

      • PHRoG says:

        …or, the fact that you’ll leave without a second thought as soon as a real paying job pops up.

        • iblamehistory says:

          I’m sure all the high schoolers and kids home from college and looking for “summer jobs” will be sticking around for 20 year stints at Target, too.

          I am not all that convinced that any real job will be popping up for me anytime soon. Especially since I have been sitting without work for over a year. Volunteer positions don’t count, either; I was required to have 1200 internship hours in grad school, during which I spent most of that time as a social worker in a major hospital. But it was unpaid–and I have been consistently told that I don’t have the required experience because it was not paid employment.

      • wackydan says:

        You are not lazy… You are using the system as it is intended… To assist you during a rough period of life. You will ultimately find employment given your education and contribute tax dollars back to the system so that it may help others or you again in the future.

        That said, there are a lot of people that were born into these programs who never ever leave them. There are no requirements on them other than their state of poverty, and the supposed limits on how long they can receive these benefits is never enforced… We do call these people welfare queens, lifers… and that part of our culture needs to be addressed… The more life long welfare recipients we have, the less we can help people like you…. Imagine how many more people like you could be helped if we limited the amount of lifers on social programs to those that really needed it for life.. Perhaps the income thresholds could actually be higher.

        * Oh… And I say that as a father to a 20 month old daughter who due to her premature birth and low birth weight has a Medicaid card… So I get to dwell within that system all the time even though I have health insurance through my employer ( that also pays for her care)

      • dcatz says:

        Let’s see.

        How many companies need to hire people with a Masters in Social Work? How many companies need to hire social workers?

        The notion that one needs a four year+ college education to get a good job/make a lot of money is false. The vocational (two year) professions are in very high demand right now. You don’t see too many unemployed plumbers, mechanics, electricians, IT people, or nurses. I went to a two-year college and now I make more than my four-year college educated peers and have no student loan debt to boot.

  7. Extended-Warranty says:

    I’m glad I already have coverage

  8. icerabbit says:

    Hopefully it will give us access to a more affordable and better value plan than our private policy High Deductible Health Care plan that costs us over $1k/mo for a family of 2 with a $5k deductible per person per year.

    • Extended-Warranty says:

      Wow, my HDHP costs me $15 a month for one person. My deductible is $2,000.

    • sherrietee says:

      The last time I attempted to get health insurance for our family was about 5 years ago, before the wonders of no pre-existing conditions for children under 19. I was quoted $2k a month for a family of five, with a $5k deductible, but no coverage for anything related to ulcerative colitis, Crohn’s, high blood pressure, depression, etc., basically, anything that my kids actually needed coverage FOR. I continued to pay out the nose for the COBRA coverage instead. Thank the gods that I was able to get a new job less than 18 months after that, that offered employer-subsidized health insurance so that I didn’t have to worry about pre-existing conditions anyway.

  9. KyBash says:

    I’m sure it varies wildly, but around here, being on Medicaid is the same as being uninsured — no decent doctor will take you on as a patient.

    The only ‘advantage’ is that hospital bills don’t require you to file separately (Medicaid will pay an uninsured’s medical bills if the bills are greater than their income; you just have to apply for it).

    • Willow16 says:

      We were on Medicaid a few years ago and we had a very difficult time finding a doctor. The doctors that accepted Medicaid weren’t taking new patients. We finally found a family practice doctor who had just opened her practice and would take the whole family.

      • dangermike says:

        “The doctors that accepted Medicaid weren’t taking new patient”

        And this says it all. Economics 101 tells us that there are price curves for supply and demand. In a free market, where these curves cross, we find the pricing for the good or service being examined. Setting caps on prices or offering subsidies allows the demand curve to rise. Normally, as demand rises, so will prices as supplies become exhausted. Without letting these prices rise, consumption will eventually exceed capacity. You see the same thing with rent control. I’ve heard of 30+ year waiting lists for rent controlled apartments in NYC. In medical care, it means that while you’ll conceivably be able to afford that doctor visit, good luck finding a doctor to visit. Taken to its extreme, lack of financial opportunity will dissuade potential medical practitioners from pursuing such a career.

        It really is true that the road to hell is paved with good intentions…

        • JulesNoctambule says:

          How strange that all those countries with ‘socialized’ medicine don’t seem to suffer a shortage of doctors, nurses, or medical students.

        • KyBash says:

          I haven’t seen the actual data, but I’ve read from many sources that there was a serious downturn in medical students after HMOs came in. The attempt to curtail costs apparently led to less people seeing medicine as a profitable career path.

          That’s led to a serious shortage of practitioners, which has caused prices to rise even farther.

          • deniseb says:

            A downturn in medical students? – what does that mean? That there were empty seats in medical schools? What hogwash.

        • JJFIII says:

          And the insurance companies never dictate a price to a doctor? in fact, I know of dentists that will not accept any insurance. YOU are responsible to pay, and then file with your insurance company. The insurance company is dictating prices today. A single payer system would end all this bullshit. Everybody gets paid the same for the same procedure, and maybe throw in a cost of living in certain areas for that siingle payer system. End of problem.
          By the way, why is socialized medicine good enough for members of our military, but not the rest of us?

      • Easton says:

        You nailed it right there. I work in a 65 physician clinic. NONE of the family physicians or general internists are taking new Medicare or Medicaid patients.

        From a business standpoint, there’s absolutely no reason to see Medicare/Caid. Doing so subjects you to all sorts of audits, regulations, and bureaucracy. On top of that, they only pay a few pennies on the dollar, compared to commercial insurance.

        So, why would a doctor want to work with an entity that pays more poorly and inflicts more regulations and paperwork on you? That’s right. They don’t. Primary care physicians already have very full practices. Many don’t need new patients, and the new physicians fill up quickly.

        The post from dangermike about rent control is a very good analogy.

    • Janus, Should I laugh or cry? says:

      “I’m sure it varies wildly, but around here, being on Medicaid is the same as being uninsured — no decent doctor will take you on as a patient. ”

      I know someone on Medicare (yes, I know you’re referring to Medicaid) and I saw what the government reimbursed the doctors and laboratories — pennies on the dollar. I have no idea how any doctor can stay financially solvent with a significant number of patients on Medicare/Medicaid. Which is probably why so many doctors don’t accept Medi* patients.

      • pgr says:

        I have been on Medicare for 4 years now and NOTHING has changed other than I don’t have to pay that pesky $5 co-payment charge anymore. I se the same doctor I have had for over 35 years, I get the same tests and treatment. We need Medicare for everyone is what we really need!

  10. jackbishop says:

    A report by the Center on Budget and Policy Priorities estimates that between 2014 and 2022, the ACA would have the federal government paying for about 93% ($931 billion) of the nearly $1 trillion cost for the expansion, with states kicking in around $73 billion during that period.

    Through 2016, the feds are supposed to pay for all the people newly covered by Medicaid, with that $73 billion from the state gradually phased in during the next six years. The goal is to have the federal portion only be 90% by 2020.

    If the 28 states involved in the various lawsuits decide to not contribute to the expansion, it would throw a bit of a wrench into this plan, as the federal government would need to account for at least half of that $73 billion.

    This doesn’t seem correct: the original cost figures were for nationwide expansion. States which opt out, while they continue to receive their current level of Medicaid funding for currently-eligible Medicaid recipients, will not be subject to expanded eligibility criteria, so the federal funding won’t actually increase for those states. Presumably, not actually expanding in half of the states of the nation will reduce the cost considerably, so the feds probably aren’t going to need to scare up extra funds beyond the commitment level they expected to need, and may well not even need that much.

    • partofme says:

      Actually, the states don’t have to set up the heath insurance exchange. The law specifically said that the feds would do it if the state opted out. Even if the state does set up the exchange, I believe the feds foot the bill for the subsidies that will fund those people who would have been covered by the Medicare expansion.

  11. anchorworm is really sick of Minnesota weather says:

    For me personally, this will not change things much. I am lucky enough to have a job where full coverage (medical, dental, vision, life) insurance is provided at no cost to me. For my children, however, this could prove to be a lifesaver. Two of them have pre-existing conditions that had prevented them from getting health care and the third will benefit from the subsidies. Both her and her husband work full time and insurance costs are eating up much of their income. This means that I am torn on the issue. I believe that the federal government has been getting too powerful for a long time, but, if things work the way we are told, this will benefit my children and grandchildren. I put the odds on things working the way they are supposed to work out at about 30%. Does that make me jaded?

  12. AtlantaCPA says:

    “and still end up with hundreds or thousands of uninsured people who will drive up health care costs for everyone else”
    And that is the crux of everything. We will all pay for healthcare for everyone one way or another. The choice is do we do it the hard way (current system) or the easy way (universal heathcare anyone?).

    • MutantMonkey says:

      Hopefully the ACA will help manage that burden. As for full universal healthcare, we will have to baby step our way to that one. Both sides want it, they just don’t want the other side to get credit for it.

      • Kuri says:

        OR even share credit for it. I’d give major kudos to both sides if they both worked together to do it.

    • KyBash says:

      The choice is do we do it the hard way (current system) or the easy way (universal heathcare anyone?).

      No — the choice is whether we do it the current way or we see health care go completely down the tubes.

      A relative of mine had the same condition I had. I got an MRI the same day, and I was in an operating room a few hours later. He would have had to wait 4 days for an MRI through NHS, a wait he avoided by dying.

      How can anyone support Universal Health Care when people who work for NHS demand that private care be part of their benefit package?

      The major problems with our health care began when pencilpushers wormed their way into the decision-making process and created shortages of doctors and staff.

      • MutantMonkey says:

        So because a handful of people get caught up in the negative side of a system, millions of people should be encouraged to go uninsured, due to costs, and create a burden on the rest?

        This is why the government option should exist. Something that offers those who cannot afford typical, corporate sponsored healthcare. However the republicans shot that down because the existing insurance companies don’t want competition that would highlight how out of whack current health care currently is.

        UHC may not be cure-all, but it is a hell of a lot better that what we were stuck with pre-ACA. It is a step in the right direction to a hopeful perfect solution or at least a more perfect solution.

        It really sucks about what happened to your family member, but all systems have holes that unfortunate people fall into.

        • KyBash says:

          Every country with socialized medicine is a hell-hole when compared to the care you can get, even if you’re uninsured, here.

          When bean counters determine how much equipment is available and when people should see doctors, you’re looking at doom waiting to happen.

          • Kuri says:

            So, basically what you’re saying is not here here would really change, just it might cost us less.

          • VeryFroid says:

            “Every country with socialized medicine is a hell-hole”

            Every first world country, with the exception of the US, has a socialized form of healthcare. They are not ‘hell-holes’.

            It is possible to have for profit high quality healthcare co-exist with a socialized healthcare system.

            • pgr says:

              The French have one of the highest amount of healthy citizens in the world n that “hell-hole” country they live in.

              Must be all the fries and snails they eat????

          • MutantMonkey says:

            You are taking a personal situation and extending it out to an entire system. It’s disingenuous, irrational and emotional, not the least of all, it’s inaccurate. I have never seen any evidence of 1st world nations health systems being considered “hell-holes”, from what I have seen, most people involved find them to meet their needs.

            Granted there are some that do slip through the system’s cracks, but those few do not define all.

          • icerabbit says:

            Quit spreading FUD regarding other countries with a single payer system where you get health coverage from before you are born until you die, no questions asked, no fears of financial ruin, …

          • AtlantaCPA says:

            I’d also like to point out that anyone can come up with someone they know who didn’t get XYZ covered by private health insurance, sometimes something that was essential and they had to fight to get it. Don’t those examples prove that private health insurance is a ‘hell-hole’ by your reasoning (ie one example standing in for an entire system)?

      • VeryFroid says:

        >He would have had to wait 4 days for an MRI through NHS,

        Sorry to hear this; that said, he didnt HAVE to wait 4 days, he could have had an MRI the same day. This could be done by paying for private MRI. In much the same way as in the US.

        >How can anyone support Universal Health Care when people who work for NHS demand that private care be part of their benefit package?
        Because the private care can provide benefits and luxuries not available through a public universal system.

        Presence of a single payer, universal health care system does not preclude existence of private care.

  13. MCerberus says:

    Republicans should be happy, their substitute for the government option was just upheld. Of course they still like to say it was made without their input, especially after the RNC circulated methodology for people to disrupt discussion of it on local, state and federal levels.

  14. VeryFroid says:

    This will affect all Americans; the exact effect will depend upon their own individual circumstances. Those who have been denied affordable insurance due to pre-existing conditions will soon be able to have healthcare insurance on a similar basis to the healthy.
    Those who enjoy employer provided coverage will see less clear impacts. Those few who actually choose to go without health insurance will pay a penalty similar in many ways to paying a tax.
    Will it actually bring healthcare costs under better control ? I think there is a good chance it will reduce the total healthcare cost but really only time will tell.

    • TuxthePenguin says:

      I would bet you a year’s salary right now that it won’t do anything to bring costs under control. ACA, for all its reforms, does nothing to address the obvious problems in the healthcare/health insurance market – third party payer problems (you are less cost conscious when the costs are not directly related to the consumption) as well as hidden costs from employer picking up costs. And now we still might have a adverse selection issue depending on how severe the tax is.

      • pegasi says:

        Nothing can be done to bring costs under control until the entire healthcare industry is forced to bring transparency to costs, and to cite costs up front before the person is already obligated to pay. The way it works now, you can’t even find out how much something will cost until you’ve already had whatever procedure and are stuck. there is no cost transparency – you can’t call 5 facilities and ask how much does an MRI cost for a knee series and get an answer. they won’t tell you. The only way you can find out what it costs is to have it done… then you’re stuck for whatever they want to charge.

        How can you shop for cheaper prices at different facilities, even if you have insurance, if you can’t find out what the price is? If the insurance company said that they’d give you back half of the cost savings by finding the cheapest place in your area to have the scan done- if you got price quotes in writing… then you bet people would shop around, but no one will tell you anything!

        Try asking what a facility’s average charge for an uncomplicated knee replacement is – again – they won’t tell you – they cite “too many variables” – sooo… what about about using statistics and data to take 500 patients, look at the materials, time, etc and come up with an “average” cost as a basis for comparison??? No reason they couldn’t do that… but then again, that would make too much sense.

  15. dush says:

    “the nearly $1 trillion cost for the expansion”
    This will affect me due to the massive borrowing the federal govt will need to do.

    • MutantMonkey says:

      Maybe if we encouraged congress to cut down on publicly funded fear mongering, military spending and unnecessary policies and projects, a bulk of the added burden of a health system would be offset.

      • Janus, Should I laugh or cry? says:

        “Maybe if we encouraged congress to cut down on publicly funded fear mongering, military spending and unnecessary policies and projects, a bulk of the added burden of a health system would be offset.”

        I wonder what is the true cost of “the war on drugs” when you factor in prisons, enforcement, corruption, loss of opportunities and a thousand other intangibles? I wonder how many billions (trillions?) of dollars are being flushed down the toilet each year for the TSA, the war on immigrants, the Afghanistan war and corporate welfare programs?

        What’s a few trillion dollars for health care compared to all of the above?

      • dush says:

        The problem is all the current policies do is ask, how do we get everyone on insurance?

        What policy makers should be asking is why is the healthcare so expensive that insurance has become absolutely necessary?

  16. mcgyver210 says:

    This is Obama’s stepping stone to becoming a Dictator. He will continue to undermine our Constitution along with an Incompetent Politically Motivated SCOTUS. Which has now opened the door for Unlimited Taxation because now you can be taxed for not buying the size house Congress tells you to.

    I was speaking with some fellow Business owners that as soon as the SCOTUS Upheld this as a rewritten TAX all their employees just lost their Medical & no hiring would happen due to cost.

    Obama has KILLED our Recovering Economy which IMO was his true agenda on his way to his ultimate goal.

    • icerabbit says:

      Really?

    • Peggee has pearls and will clutch them when cashiers ask "YOU GOT A WIC CHECK MA'AM?" says:

      When was the economy recovering?

    • PHRoG says:

      Ahh, yes…I know this guy. Mr. Guy doesn’t give a damn about his employees. The reading of the SCOTUS decision made no immediate financial threat to him. Instead, this guy is, “gonna show them gub’ment folks,” by acting irrationally.

      Bravo guy…bravo. I hope every single employee you have walks and every single client too! ;)

      I dropped a client last month for making similar statements and suggestions about their employees because of “Obamacare”.

  17. frodolives35 says:

    Between health,car,home.and life I pay a full 1/3 of my take home pay to evil insurance companies. They are leeches on society that add nothing of value. They don’t even give you peace of mind anymore as you have to worry how they will screw you out of benefits with 1 vague sentence in a 30 page booklet at the drop of a hat.

  18. CarlS says:

    “Chief Justice Roberts wrote in the court’s ruling that this “gun to the head” approach was unconstitutional . . . The court ruled it would be appropriate to offer benefits to participating states but not to threaten non-participating states with penalties.”

    How then can it be correct to threaten individuals?

    The Court is no better than a criminal gang, and deserves less respect, becasue at least criminal gangs are forthright about their intentions.

    In effect, the Court has ruled that Law does not matter. Now, hoever, the Law Of Unintended Consequences may start raising its’ ugly head.

    • VeryFroid says:

      CarlS,
      I believe you are inaccurately applying the ‘gun to the head’ statement.
      Chief Justice Roberts mentioned ‘gun to the head’ in reference to the federal government proposing to states, “Participate in the expansion of medicare or we will withdraw previously agreed and eligible and offered funding for existing medicare provisions”
      This is very different to the ACA ‘mandate’ else face IRS tax penalty.
      A ‘gun to the head’ for individuals might be, ‘buy health insurance or we will withdrawal your pre-existing eligibility for social security’.
      The detail is very important.

    • StarKillerX says:

      “Now, hoever, the Law Of Unintended Consequences may start raising its’ ugly head.”

      Actually it will start rearing it’s ugly head, the only real question is when exactly that will begin.

      This ruling would now allow Congress to decide that everyone should belong to a union “:for the good of the country of course” and anyone who stay in good standings with the union by paying their dues will be fined $500 for each month they are not in good standing. Or they could decide that every household needs to buy a new US made car every ten years or be finned taxed/fined $30k.

      I know these examples sound silly, but do they sound any sillier then it would have sounded if in during 2000 someone told you that in a few years people traveling by air will be required to go into a machine that can see through their clothes and that federal employees would be working in the airports frisking people? Anyone who made that claim 12 years ago would have been called a nutbar and/or a wako conspiracy theorist but now we know better.

  19. Libertas1 says:

    Don’t know. My insurance is going to double this year, which is why I might just drop it altogether.

  20. RAEdwards says:

    The Federal Government may not be able to withhold Medicare funds from non-participating states, but I bet the next time a Hurricane hits Florida that needs FEMA money if they choose not to participate, there will be a sudden “Shortage” of funding available.

  21. energynotsaved says:

    My COBRA ends tomorrow. There is no extension available. Private insurance won’t cover me. There is some kind of policy I’ve found that will consider me after I am uninsured for 6 months. I think the policy will cost nearly $900 a month–more than my mortgage and car payment combined.

    I am too well off for Medicaid. Too young for Medicare. And have too many pre-existing conditions for the private insurance companies. I haven’t lived in this state long enough to enter into the high risk pool. I am SOL.

    Some of us gamble on our health care because we have no other options.

  22. DragonThermo says:

    Please stop calling it the “Affordable Care Act”. There is nothing “affordable” about it. At best, it is the largest tax on the middle class in American history.

  23. soj4life says:

    The 10th amendment needs to either be reworded or removed, something that should have been done 147 years ago.