Florida, Other States Opting Out Of Medicaid Expansion Four Years Before They Are Expected To Pay A Dime

Even though the expansion of Medicaid to cover several million more low-income Americans isn’t slated to begin until January 2014 — and even though states aren’t scheduled to begin contributing anything to the expansion until 2016 — some states have already declared their intention to not take part in the program.

Not surprisingly, Florida, which led the charge in the 26-state lawsuit to strike down the Affordable Care Act, was the first one out of the gate to issue an official statement.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” explained Florida Governor Rick Scott. “Neither of these major provisions in ObamaCare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

While Scott says Floridians don’t want the expansion, the Washington Post reports that 951,622 additional residents of the state — and possibly growing, depending on where the poverty line shifts — now face not being able to get Medicaid if the state opts out.

Meanwhile, South Carolina leaders have also announced the state’s intention to not take part in the expansion, leaving 330,932 people without Medicaid.

The AP reports the Mississippi is saying it can’t afford to spend $1.7 billion over the course of 10 years to pay for Medicaid to cover an additional 400,000 residents.

Missouri would add another 225,000 people to the list of the insured because of the expansion, but the state house’s majority leader tells the AP, “we’re not going to consider going down that path.”

Texas hasn’t decided yet what it’s going to do, probably because the state would need to explain to 2 million currently uninsured Texans why they won’t be covered by Medicaid expansion.

Given the amount of time between now and January 2014 — not to mention the ever-shifting political landscape — it’s all a bit too premature for anyone to be opting out of a program before it exists.

But, should Medicaid expansion come to pass — and should these states remain steadfast in their decisions to not take part — what will those uninsured people hovering around the poverty line do?

For those earning more than $11,170, the ACA allows people to use subsidies to buy insurance on the new “exchange” market (which Governor Scott also says Florida will not be involved in), but for those on the other side of that line, explains the Washington Post:

Poorer Americans—those who live below the poverty line— could be caught in a sort of “no man’s land.” They’re not eligible for subsides under health overhaul because the law worked with the assumption that they would fall under the Medicaid plan.

“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,” DeAnn Friedholm, Consumers Union’s Campaign Director of Health Care Reform, told Consumerist last week in the wake of the Supreme Court ruling that upheld the mandatory coverage portion of the ACA but struck down the law’s penalties for states that don’t comply with Medicaid expansion.

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  1. StarKillerX says:

    The problem here is the same one created by the stimulus money for hiring more teachers. Once a a government program is put in place and/or expanded, the chances of it being eliminated or trimmed is almost non-existant so a few years from now the Governors of each state will either need to raise taxes, and be the bad guy, or cut the program, and be the bad guy.

    Ironically a couple Governers tried to turn down the money for basically that very reason and the left tore them apart claiming that wouldn’t happen, but were silient when it did start happening, although it was delaying a year by a second round of federal cash for teachers (got to pay off those unions.)

  2. bnceo says:

    ACA, the gift that keeps on giving.

    See, here’s the point. I would LOVE to be able to be in a country where everyone doesn’t have to worry about healthcare or getting sick. But, we can’t have that system here in its current form. Firstly, government does not control the cycle and thus can’t control the costs. Morever, this government has not shown to do anything efficiently or at costs. If you want this, we have to pay for it. Cut something. Cut spending somewhere. And by cut I do mean a lot.

    Great idea, but our financial situation is not ready for it. And don’t you dare punish me for being successful by taxing me to no end. How about the government actually learn how to spend its money properly and on a budget. You know, like responsible people.

    • Evil_Otto would rather pay taxes than make someone else rich says:

      “And don’t you dare punish me for being successful by taxing me to no end.” Want some cheese to go with that whine?

      “Morever, this government has not shown to do anything efficiently or at costs.” *cough*cough*Medicare*cough*cough*3 percent overhead*cough*cough*

      “Cut something. Cut spending somewhere. And by cut I do mean a lot.” Such as….

      • aerodawg says:

        ““Morever, this government has not shown to do anything efficiently or at costs.” *cough*cough*Medicare*cough*cough*3 percent overhead*cough*cough*

        Spoken just like someone who never actually has to deal with Medicare on a regular basis. It’s no damn coincidence that more and more Doctors are dropping acceptance for both it and Medicaid…

        • Kate Blue says:

          The doctors are dropping acceptance because the republicans forced the reimbursement rate down too far. duh.

          And I hate to tell you, no doctor likes any insurance program – they all are a major pain in the you know where.

          • wackydan says:

            Funny.. the Republicans had nothing to do with the Medicare cuts in the ACA… Because it was crafted completely by the Dems, big Pharma and the health insurance industry.

          • Jenny8675309 says:

            I work for a chiropractor and our local Medicare Limiting Charge is $28.42 for a $45.00 visit which is the lowest reimbursement rate of all our payer’s. We cannot opt out of Medicare. Trust me we’ve looked into it.

            • RvLeshrac says:

              Why is the office visit $45? Why can’t it be closer to the reimbursement rate?

              How much does it cost to file a Medicare claim vs. filing a claim with those other insurers?

              How often does Medicare reject the claim, vs. other insurers?

              • Jenny8675309 says:

                Why is the office visit $45? Why can’t it be closer to the reimbursement rate?

                Because it’s a medical visit, not a visit to a fast food restaurant. Really?

            • Mike Zeidler says:

              I’m shocked you get as much as you do, with chiropractic “medicine” being such quackery.

              • Jenny8675309 says:

                I’m shocked you get as much as you do, with chiropractic “medicine” being such quackery.

                It’s 2012, and you’re still using that ancient statement? Stick with back surgery and pain med’s and see how that works out for you.

            • Smiling says:

              That seems about right to me. First, Chiro isn’t a real M.D. and should not charge like they are. Second, every chiro I have been to seems to run on a factory model of some kind. You get 5 minutes with the actual chiro if you are lucky, and spend 10-15 minutes being hooked up to various contraptions by assistants. This happens in a very steady stream. At any given time, there may be 5-10 others doing the same thing. If you get even 5 other customers in an hour who spend 5 minutes with the chiro, that is $140 in an hour, with only about 1/2 that where the chiro actually does anything.

              • Jenny8675309 says:

                There are plenty of chiropractic offices that aren’t “factories”. I work with one doctor and she does all the patient care. It’s easy enough to locate a competent chiropractor that isn’t a part of your so called “factory”. As far as the office fee, we do not determine the charge. The state we are in determines that. That being said, why has this turned into a chiropractic discussion when the article is about states opting out of Medicaid expansion. I guess everyone just wants to bitch about something.

      • PunditGuy says:

        Defense spending, silly! Government spending doesn’t create jobs, after all.

      • aerodawg says:

        And FYI, Medicare only has 3% overhead because they piggyback off the Social Security Administration. If you normalize for that and the fact that you have no choice in whether you’re enrolled in Medicare Part A or not, surprise surprise, the overhead expenses are equivalent to worse than private insurance.

        I mean, who knew that overhead costs can look a lot better when you can hide most of it on someone else’s books? I bet if BCBS could shift their overhead to General Motors books it would look a lot lower too…

        • JJFIII says:

          So the government doing something EFFICIENT, like piggybacking on SS is bad? Wow, who knew. I guess if KFC piggybacks on the accounting systems for Taco Bell (both owned and run by the same company) that would be bad too?
          As for the rest, Rick Scott will not likely be governor in 2016, so for him to declare what is going to happen then is RIDICULOUS.
          I will also point out that the most highly regarded health care provider in all the US is called the VA. It is PURELY socialist. The doctors are employees of the government. The people receiving the care are also employed by the government. Why should a person from the military be entitled to better care than I am?

          As for those who bitch about the “mandate”; there is currently a MANDATE for all men to register with the selective service when they reach 18 years of age. Why didn’t these right wing douche bags challenge that?

          • Bsamm09 says:

            It’s not a question of efficiency, it is a question of comparing costs of two entities based on similar criteria. Medicare has another agency that collects its premiums for them. The IRS doesn’t send them a bill for this.

            Your KFC argument doesn’t hold water since since those costs are reported on the income statement of YUM! brands. It would be like them producing a segmented income statement and putting all those costs on Taco Bell thereby making KFC appear better and have $0 costs for accounting systems which is false since a system had to produce the statement.

            I don’t know about you but I didn’t pay anything or purchase anything when I registered for selective service, did you?

          • bnceo says:

            That’s the point. Because in this case, the government does not really control the entire cycle of healthcare, this act won’t work. Too many variables out of the goverments control. In the VA, government does control more aspects.

            As far as the military goes, because they volunteered and given their time to possibly be in a position to fight for us. Military should get top notch everything involving healthcare and care in general.

          • wackydan says:

            Efficient because they hide their true cost on other’s books… That by nature isn’t efficient. It is disingenuous with gov’t does it just as it is disingenuous when a business does it.

            As for the VA – In some parts of this country, it is wonderful and in other parts like larger metro areas the level of service and wait for care is crappy. Why should a person who has served their country – especially in combat get better healthcare than you? Did you really just ask that? Maybe you shoudl ask why your elected officials exempted themselves from the ACA and why they get better care than you.

            FYI – The mandate was indeed declared unconstitutional under the commerce clause. An important distinction for you to remember. Selective Service has nothing to do with that.

            • JJFIII says:

              Selective service IS a potential cost to those people of military age. Sorry to break it to you, but MANY people who were part of this MANDATE paid a lot more than extra taxes because of it you idiot. They died or may be disabled. So I will ask again,are you against all mandates from the government, or just the ones from the black president?
              By the way, NOT ALL VETERANS volunteered you idiot. Some were drafted, but you are too stupid to know your facts. BUT if they DID volunteer, why should they get special treatment? If I volunteer to be a cop, I am protecting people just as much as a member of the army. If I volunteer to be a lawyer I am protecting people from over zealous prosecutors who may want to take away my freedom more than any “terrorist”. If your belief is that members of the military are a special class off citizen, I say BULLSHIT.
              The facts remain, VA is rated higher than ANY insurer in the US. PERIOD. You can say it is not great every where, but SO FUCKING WHAT. The people who use it like it, yet they receive SOCIALIZED medicine. If your argument is that the VA is worse care, you are wrong on facts, based on patient surveys. If you say they deserve BETTER care, then you are saying socialized medicine gives better care. I can not wait to hear the teabaggers use that line.
              Socialized medicine provides BETTER outcomes, BETTER satisfaction ratings and BETTER cost controls.

              • wackydan says:

                First, I am called an idiot… Then I am called a racist. Did I hit a nerve?

                So the message from you is, health care via the VA hospitals and care givers may not always be great but so what? VIVA LA SOCIALIZED HEALTHCARE!!!! Who is the idiot?

        • who? says:

          Not surprisingly, actual researchers has been done to check the numbers on Medicare overhead, so, looing at the research, not just Fox news talking points… Medicare overhead only gets *up* to 3% when you split it out from Social Security. It’s 1-2% otherwise. Private insurance overhead is somewhere around 11%.

      • bnceo says:

        I’m whining? Really? Just because I want more money in my pocket. You know, the money I earned. Is that such a foreign concept to you or do you just like asking for the “rich” to give more and more until we have no incentive to work hard and earn it.

        3 percent overhead? Are you serious? You must not be.

        Oh, I don’t know. Keeping military at home (you know, like defense, not offense), no more pensions for any federal employee. It’s called 401k. Or learn to save on your own. Destroy endless bureaucracy. In my neck of the woods, rules are put in place to simply appease people and with utter disregard the actual real world process. Lots of useless jobs at there in a lot of useless departments.

        • FatLynn says:

          I own a small business. I pay a lot in taxes. I also grew up never having to worry about where my next meal came from, went to college largely courtesy of taxpayers and a little bit from my parents, and would never turn around and claim that I have what I do because I worked harder than the next guy.

          • bnceo says:

            I went to college mostly my own paychecks from saving during high school working at a supermarket. I took out 2 small loans for the year I dormed. With the money I saved every year, I paid my tuition and paid my small loans withing 6 months of graduating. I took the bus for 4 of the 5 years I was at school. I knew my limits and went to a local school and not University of Miami.

            So yeah, in my eyes, I worked harder and got luckier all at the same time. I was given the pursuit of happiness and had a few breaks go my way. Happiness was not handed to me.

            • who? says:

              You went to a public college, right? The kind that’s paid for (or at least used to be) by taxes?

              • bnceo says:

                It’s partially paid for. In the last 10 or so years, the % that is funded by the state is getting small. I’m speaking to those who go to big fancy colleges and take out 100K in loans and cry when they have to pay interest on said loan.

                • Kate Blue says:

                  Ah, big fancy colleges like well, all of them now. 100k is not the complaint level – all of them are the complaint level for many reasons.

                  Simplistic thinking does not serve you well.

                  • bnceo says:

                    Sometime simple is the best way. Less time. And time = money. Cut the fat and get right down to what’s important.

                    • RvLeshrac says:

                      And, sometimes, “simple” leads you to thinking that is completely incorrect, refuted by every available fact.

                • MarkFL says:

                  “In the last 10 or so years, the % that is funded by the state is getting small.”

                  And that’s not in any way due to states cutting taxes and therefore having less revenue, right? It’s nice to have more money in your pocket, but it’s also nice to have schools, police departments, traffic lights, firefighters, libraries, tap water, sewers, trash removal, airports, surveillance cameras at every intersection (no, wait scratch that one, but there seems to be unlimited money for that somehow), building inspectors, streetlights, bridges, voting booths, parks — you get the idea.

        • Jaynor says:

          Asking for taxes to be paid on capital gains at an income tax rate is not exactly extortion… it’s more like closing a loophole.

          It’s odd that “flat tax” has become a liberal concept.

          • bnceo says:

            I actually would love a flat tax. The % won’t change for anyone. Even people making $1k a year will pay something.

            And yes, I’m all for closing loopholes and subsidies for silly things like corn to make ethanol (utterly useless tech). Corporate loopholes are literally saying they play by different rules.

            • Kate Blue says:

              A tax being merely made flat does not close the loophole. Removing the loophole closes the loophole.

              A progressive tax rate makes sense. Why take money away from the low income people when they can’t pay for food and rent in the first place.

              • JEDIDIAH says:

                An aggressive tax code that punishes the middle class also discourages people from working or being as much of a contributor to the economy as they could be.

              • bnceo says:

                You crossed two points. A flat tax is one point. And I am also in favor of closing all the various loopholes that corporations basically bought with all their lobbying cash.

                If they make so low in income, they will pay less cause their income is less But it will be something. No more zero tax bills. Everyone does their part (which I believe the President loves saying)

                • galm666 says:

                  You miss the weak point of a flat tax in that it hurts more the less that someone has for income. In other words, the tax cuts closer and closer to the bone. And all this before you count any state or local taxes, like for purchases, property, etc.

                  For the sake of argument, let’s say the flat tax is 5%.

                  At 5%, someone making $20,000 a year loses $1000 in taxes. Sure, it’s only $1000, but when you consider that the poverty line in the U.S. is very close to $20,000, that $1000 makes a huge difference. That’s $1000 that can’t be used on healthcare, or food, bills, clothing or other need items.

                  But for someone that makes $200,000 a year, they lose $10,000. This puts that person at $190,000 a year, and though they pay more in taxes, that $10,000 doesn’t put them as close to the poverty line as being down to $19,000.

                  In short, money exists on a curve where a dollar is a lot more valuable to a person as they have less and less money.

                  • bnceo says:

                    Yay. More money for me to SPEND as opposed for the government to spend when it can’t do so responsibly. Do you have any idea what I would do with the extra money? How much I would put back into the economy. More cleanings at my home. More eating out. More fancy gadgets. More more more! All supporting workers and small businesses (because that’s who I try to do most business with).

                    • RvLeshrac says:

                      “More cleanings at my home” – Most likely by illegal immigrants being paid $Nothing/hr, because we still don’t require that all employers check immigration status (because that would be such a burden on small business!). (And that’s who most home cleaning services employ, because Americans do a really shitty job of cleaning when you pay them $5/hr.)

                      “More eating out” – See Above

                      “More fancy gadgets” – Made by companies in China, because businesses aren’t willing to pay Americans even minimum wage, despite the fact that a wage of $15-20/hr would only add ~20% to the price of electronics.

                      “All supporting workers and small businesses” – But not actually supporting the US economy.

                  • frank64 says:

                    You put a deductible in and it takes care of that.

                    I know you weren’t pretending that 5% was the rate, but it would be more like 20%.

                    • RvLeshrac says:

                      If there’s a deductible, you’re back to a progressive system.

                      There is no way to make a “flat tax” work without starving the poor and dramatically increasing the number of homeless.

                  • Smiling says:

                    Maybe they could figure out a way to make more money then so they can pay their fair share. I am a high school drop out from a very poor family. I managed to graduate from college with honors and get a good job with no one giving me a dime. I am about to get my masters to get a little bit better job. Again, no one gave me a dime. My husband graduated from high school with honors, but is in the same boat as me with the poor family. He also did what he had to to get through. Life is all about choices. I don’t like the idea of paying more than others because they made choices in life that caused them to have to work low paying jobs. I know some people face circumstances, especially since I had terrible circumstances myself (teen mom, dad was a dropout, etc…) I know about the sob stories b/c I have one. I just decided to take control and stop the cycle. Others have that option as well but choose to do other things instead of making a better life for themselves.

        • frank64 says:

          Also, the truth is we as middle class are going to have to pay more taxes. We can’t get what we want from the rich, we need to much. Once we are told WE are going to actually have to pay for what we ask for, we may find we ask for less.

          ACA does raise taxes in many round about ways, or sap money from other programs, Like taking money from Medicare, the tanning tax, a cap gain surcharge t tax for income of those making over $250K (added to the cap gain rate increases not related). There is a tax on medical device manufactures and a tax on some health insurance plans. There are multiple taxes, with many directly avoiding the general population to make it more palatable. Just that we need to go after many stealthy streams should alert us this is not going to be a money saver, if it was the revenue streams would be such we would be asking what we are going to be doing with all the cash we are saving.

          • Kate Blue says:

            The top money makers pay almost no taxes. This makes them far richer every year and increases their power over congress.

            There’s a point to making the tax rates fairer – it’s called stopping the runaway income gap.

            • frank64 says:

              What we are talking about is how to pay for spending. They don’t have enough money to pay for all of what we need. That is know, asking them to is a diversion. We need to pay something, and the spending decisions seem to change when we are the ones actually paying it.

              What upper income individuals pay almost no taxes? I would actually like to make the rates fairer, I am all for a flat tax with no deductions.You could have a delectable for everyone to have some progressives..

            • bnceo says:

              Oh, I don’t know. I see myself in the six figures and I see a ton of $$ taken out. You know, money that I would have spent myself on goods and services. Instead, I have to hand it to the government and hope they use my money efficiently. Keyword: hope.

            • frank64 says:

              Another way to answer this is, the answer to all problems can’t always be get it from the rich. That is the answer to many problems. There are extremely few rich that pay no taxes on income.

              The “fairness” issue should be discussed separately in the general tax code, and not every-time an expense comes up. It really is a diversion that usually means the problem never gets settled. Every difficult spending problems is “just get the rich to pay”, and it really won’t work.

            • wackydan says:

              Funny… I make six figures and pay plenty of taxes… You may argue that my tax rate should be higher… And under ACA it will be… The FSA cap is going to cost me 1% of my gross pay when you factor in what the gov’t will now be able to tax and my higher out of pocket costs for health care…

              And here I thought FSA’s were about controlling out of pocket costs… For families like ours with a special needs daughter, the FSA helped a lot.

              Oh… and at six figures… I am far from rich or ever being rich.

              • RvLeshrac says:

                You make $100k. 1% is $1,000. Your total rate should be around 25%, so you take home $64k. You pay, what, $1000 on a mortgage? So you have $53k left after you pay for housing. Your insurance is $300/mo, and you can afford to put a good $10k into your FSA. So that leaves you with ~$39k for Everything Else.

                Now, let’s take a low income earner. They make $35k. At 15%, that’s $30k they take home. They pay ~$800 for a two-bedroom apartment in a part of town that isn’t populated entirely with drug-addicts. That’s $24k. Oh, and they have a special-needs child, too. They make too much money (in their area) to qualify for any programs which would provide assistance, and can’t save in a FSA because there isn’t enough left over to dent the medical bills, but they fortunately have insurance at work. Unfortunately, that insurance is another $200/mo. So that’s $22k. That insurance has a $10k yearly deductible. Fortunately, the family usually only has to spend about $5k on the medical, because they try to avoid any trip to the doctor or specialist that isn’t for something life-threatening, so that’s ~$17k left over to pay for Everything Else.

                The difference is that while you have a large amount of money to cover the emergency care when your child needs it, the poorer family winds up watching their child die because they were unable to afford the maintenance care necessary for their child’s needs.

      • scantron says:

        3 percent overhead and 18% fraud/unnecessary spending

      • scantron says:

        3 percent overhead and 18% fraud/unnecessary spending

    • the Persistent Sound of Sensationalism says:

      You forget that Obama’s administration has seen the lowest increase in spending since the Eisenhower administration. Get off your high horse. If you made what the 1% makes, you wouldn’t notice half your money gone to taxes because unless you wouldn’t have time to spend it all! http://www.politifact.com/truth-o-meter/statements/2012/may/23/facebook-posts/viral-facebook-post-says-barack-obama-has-lowest-s/

      • wackydan says:

        Yet his deficits are the highest. Missed the connection there. That article and ones like it have already been proven bunk.

        • MarkFL says:

          OK, suppose last year I make $100,000 and spend $80,000. (Not that I make close to that, I’m just trying to keep round numbers.) This year I increase my spending by 5% — that’s $84,000. My pay increases by 2%, so I’m now making $102K.

          Next year, however, my car breaks down, and my kid starts college. I cut back on a lot of things, but overall my spending still increases by 2%, so now it’s $85,680. But my boss decides to cut my pay by 10%, so I’m only making $91,800. If this happens over a period of time, I’m going to end up in a hole. In fact, I could reduce my spending every year and still work my way into a hole if my income keeps going down, which is what happens when you keep cutting taxes.

          Of course, if my pay is cut sufficiently, I really can’t afford a large and long-term commitment, like a mortgage. But that’s exactly what happened during the Bush Administration passed that huge Medicare bill without any way to fund it. And by the way, under the rules put into place in 2010 by House Republicans, that bill could never have passed — it would have to be funded first. But hey, gotta get those senior votes, right?

      • bnceo says:

        lowest increase in spend? Great. How about greatest increase in spending cuts. Oh that’s right. Gotta appease all those 99% ers who voted for you. So let’s get them momentary relieve and forget about that whole national debt thing. Nope, we can never be Greece. That can never happen to us. Our credit card will never run out.

        So where is this change I see? Seems like business as usual to me. Obama lovers, you have been fooled. But it seems a lot of you just can’t admit it.

    • MarkFL says:

      Taxing you to no end? The wealthy paid more taxes during the Reagan/Bush era than they do now. The proposed increases wouldn’t even bring the back to that level.

      Besides, when Mitt Romney and Warren Buffet are paying a lower effective tax rate than middle-class Americans, then my question is just who is it that is being taxed to no end?

      • RvLeshrac says:

        We should return to the period just after WWII, when our economy couldn’t grow any faster, and the rich were taxed at more than 60%.

  3. wackydan says:

    Why should they add to the Medicaid enrollments when they ultimately will have to pay for all the new enrollees?

    Next, keep in mind that the state will pay for these newly entitled Medicaid recipients by raising taxes and fees on the state taxpayer… ACA doesn’t raise taxes on the middle class – remember?

    • who? says:

      “Why should they add to the Medicaid enrollments when they ultimately will have to pay for all the new enrollees?”

      I dunno, sometimes people do things because it’s the right thing to do. Maybe taking care of our poor is one of the things that we should just do.

      Actually, I agree that the states shouldn’t be footing the bill for this. But the states should be agitating to get it paid for another way, not trying to get the whole thing dumped.

      • NebraskaDan says:

        I agree, but should we also not take care of people who bust their asses to maintain the lifestyle they have? My wife and I both work 45-55 hours a week, and we end up making around 175k. Please tell me why my family should have to pay for able bodied people who choose not to work?

        • RvLeshrac says:

          “Able bodied people who choose not to work”

          Are you fucking serious? If you get welfare, you’re required to show that you’re searching for work. If you get UI, you’re required to show that you’re searching for work.

          If you refuse work, your benefits are IMMEDIATELY revoked.

        • Smiling says:

          Most welfare recipients work and collect b/c they have very low paying jobs that out the below the poverty level. But, that does not negate your point. I don’t like subsidizing people who chose not to get the skills to get a decent paying wage. I did not come from privilege. I did not even graduate from high school. Yet, I managed to fight my way into the higher educations system entirely on my own dime and get the skills I needed to get a good job. I know several other people who have my same situation. I have met many people who came from the ghetto and managed to rise above it all. Some people can fall on hard times though, so I feel like welfare should be extremely short term for dire situations, rather than a subsidy for people’s poor personal choices.

          • Smiling says:

            Oops, I misspoke. I was thinking food stamps and what not. Most food stamp recipients work, as do many section 8 and Medicaid recipients. Still, that is what unemployment is for. Unemployment runs for a long time. That should be long enough. And, I have a friend who is on unemployment who does not intend to go back to work (SAHM) who is easily proving she is “actively looking for work.” It’s pretty easy to “look for work” without getting a job.

      • Kate Blue says:

        All the states would be required to pay is 10 percent of that – after 4 years. That’s not exactly a big burden.

      • Kate Blue says:

        All the states would be required to pay is 10 percent of that – after 4 years. That’s not exactly a big burden.

      • JEDIDIAH says:

        Someone has to pay for this.

        That seems to be a point that many people would like to ignore.

        It doesn’t matter how “nice” it is. Someone has to pay the bills. This should be painfully obvious to anyone as European welfare states are currently imploding. Someone has to pay the bill. It can’t just be ignored.

        • RvLeshrac says:

          To put it plainly, there are millions of the poor. There are dozens of the rich. It is within the best-interests of the rich to keep the poor happy.

      • MarkFL says:

        “Maybe taking care of our poor is one of the things that we should just do.”

        You realize, of course, this will get you tarred and feathered as a socialist.

  4. jojo319 says:

    I would just like to know when the “Affordable Care Act” is going to be you know, affordable. Premiums are rising as fast if not faster than ever before.

    • PunditGuy says:

      What was that? I can’t hear you over the sound of actual data:

      http://ycharts.com/indicators/us_health_care_inflation_rate

      • Blueskylaw says:

        I can prove via statistics that a virgin female is actually 67% pregnant.

      • jojo319 says:

        There sure is a lot of pretentious a**holes on this site. My copays have gone UP my premiums have gone UP.

        • jojo319 says:

          Here’s a fancy chart that proves my point. We can find them for pretty much everything. http://www.factcheck.org/2011/10/factchecking-health-insurance-premiums/

          • PunditGuy says:

            I’m assuming you didn’t read very far into the text of your link.

            • jojo319 says:

              I’m referring to this: Health insurance premiums for employer-sponsored family plans jumped a startling 9 percent from 2010 to 2011, and Republicans have blamed the federal health care law. But they exaggerate. The law — the bulk of which has yet to be implemented — has caused only about a 1 percent to 3 percent increase in premiums, according to several independent experts. The rest of the 9 percent rise is due to rising health care costs, as usual.

              Regardless of how much is attributed to the ACA, it still would appear that they are going up, no?

              • PunditGuy says:

                They’re not going up any more than they did without the ACA. Even if an insurance company can blame 1-3% of the cost increase on the ACA, does that mean that costs would have risen 1-3% less without the ACA? In a perfect world, yes. In our world, not so much.

                Ultimately, this is about insurance company greed and employers shifting costs to employees — just like it was before the ACA.

                “While insurer costs climbed 2.6 percent in 2010, employees’ share rose by 7.1 percent.” (http://www.bloomberg.com/news/2012-05-21/health-care-costs-rise-faster-than-u-s-inflation-rate.html) This was before the ACA.

                • jojo319 says:

                  So how does the law make care more affordable for you and me?

                  • PunditGuy says:

                    Can you get back to me in 2015, when the law has actually been in effect for a year? My assumption is that the exchanges and higher number of insureds will lower the inflation cost. They won’t lower the dollar cost — those are going to continue to rise.

                    • jojo319 says:

                      I appreciate the debate. I’m not a “right winger”, just a little concerned because it really did seem rushed. There could be a lot of unintended consequences. Hopefully it all works out. I’m just a little skeptical when politicians are involved.

        • PunditGuy says:

          Your experience doesn’t equate to some universal state. “Premiums are rising as fast if not faster than ever before” is considerably different from “my premiums are rising as fast if not faster than ever before,”

          • Blueskylaw says:
            • PunditGuy says:

              Thank you. Everyone seems to think we were in a health care nirvana until Obamacare came around and ruined it for everyone. My premiums doubled between 2004 and 2008, and in exchange I got worse coverage.

              • NebraskaDan says:

                I don’t think anyone thinks that at all. What I do know is that the ACA is just taking the only real solution off the table. Single payer is the only feasible option. Or just regulating (and enforcing!) the ever loving shit out of the insurance companies. Any good needed to live should never be done on a for-profit basis.

                • PunditGuy says:

                  My premiums doubled between 2004 and 2008, with a non-profit insurance company doing the deed.

                  Fundamentally, though, I agree with you. Insurance spreads risk. What could be better than spreading the risk 300 million ways? Existing health insurance companies can sell supplemental insurance or die in a fire — I don’t really care which.

                • MarkFL says:

                  “What I do know is that the ACA is just taking the only real solution off the table. Single payer is the only feasible option.”

                  Probably so, but keep in mind that the Republicans did everything they could to make the plan as bad as possible so they could label it a failure and get rid of it. Then they can institute their plan. I’m sure you remember when they said “Let’s start over with a blank sheet of paper.” That blank sheet of paper they held up was their healthcare reform plan for the previous 16 years — which bears a striking resemblance to the alternative plan they offered to ACA.

            • jojo319 says:

              Is the same chart available through 2011?

        • SabreDC says:

          My copay has stayed the same but I received a letter from Aetna in February that my premiums were going down and my coverage remained the same.

        • delicatedisarray says:

          And your experience is universal? For this upcoming year my premiums are going down $20 and my copay is staying the same.

      • JJFIII says:

        Stop it, you will ruin the right wing talking points with facts and such. Do not confuse real facts with what the right wingers think

    • Kuri says:

      So because it hasn’t had the intended effect less than a week after it was enacted, it’s ineffective and should be repealed.

      • jojo319 says:

        I never said anything about repealing, and it’s been in effect for over 2 years.

        • Kuri says:

          My mistake then ,and I wasn’t aware of it being in effect for over two years.

        • MarkFL says:

          You do realize that only a few provisions of the act are in effect. The majority — including the parts referenced in the original article — don’t take effect for another year and a half.

  5. Evil_Otto would rather pay taxes than make someone else rich says:

    tl;dr: Florida lost their case. They’re throwing a hissy fit.

    • TheMansfieldMauler says:

      Opting out of something that allows you to opt out is hardly throwing a hissy fit. Do you throw a hissy fit every time you opt out of some email newsletter? Or are you simply exercising the best option legally available to you at the time?

  6. clarkis117 says:

    Getting more low-income families on medicare will drive down the cost, a lot of them rely on the ER of public hospitals for medical care and treatment because they don’t have money to pay for primary care a a doctor’s office. Then they usually don’t pay the hospital because they can’t afford the several thousand dollar ER bill. Then the Hospital has to raise the price of treatment for everyone else. The ACA does a lot more and I am willing to answer any questions to the best of my ability.

    • who? says:

      As much as I’d like for this to be true, it just isn’t. The Oregon study is showing that Medicaid costs money. The Oregon study is also showing that Medicaid provides a lot of benefit for the people who receive it, debunking the right wing’s canard that Medicaid hurts people.

      We need to decide what kind of country we’re going to be. Is there such a thing as the common good anymore, or are we just all in it for ourselves? Apparently most of the South is just in it for themselves. I personally don’t want to live in that kind of place.

      • clarkis117 says:

        Refering to my former post, its just one piece of the puzzle it is only a small percent of the problem of the high cost of healthcare (and the one piece of the puzzle I’m most famillar with as Emergency Medical Tech.). I personally belive in FDR’s second bill of rights (Economic Bill of Rights), but the right wing nut-jobs have been against it scince the 1940′s, http://en.wikipedia.org/wiki/Second_Bill_of_Rights

      • NebraskaDan says:

        All that good will for your fellow man is fantastic, I agree. I’m pretty sure I pay more than my fair share to those people. All I ask is that those same people show an interest in something besides sucking off the teat. Some motivation, at least.

        • MarkFL says:

          You seem oblivious to the fact that there are lots of people who work that many hours, sometimes working multiple jobs, just to make ends meet, but because they are classified as part-time, they aren’t eligible for benefits. Which is why they are classified as part-time, of course. Do you think these people are “sucking off the teat” because they want to not be living on the streets (or more likely dying on the streets) if they get sick?

      • frodolives35 says:

        Don’t worry we here in the welfare state south(receive more federal dollars then we contribute) have confused religious conservatism with political conservatism and are busy trying to cut out all that gubmint money Washington is sending our way. But by gawd it increases family values when 4 generations of family live together because no one can afford to move out. It kills me all the right wing people who long for the good ole days then tell their stories about pulling a 14 ft cotton sack before school with bleeding fingers and wearing flower sack dresses. Yep the good ole days when you got to take your kids to work every day 7 days a week in the fields or the coal mine.

      • RvLeshrac says:

        Medicaid is only going to cost substantially more for the first few years. The issue is that you’re now providing the option of care to people who have never before had that option. They’re going to encounter many treatable issues which are expensive in the short-term.

        Once you’ve improved the overall health of that segment now served, they’re going to cost less.

    • wackydan says:

      Problem is until the gov’t addresses the illegal immigration issue, we’ll still have upwards of 10+ million people that still use the ER for free… They’ll continue to drive costs as they have been.

    • Smiling says:

      Fewer people screwing hospitals over won’t necessarily drive down costs. I am guessing from past experience that now that prices have been “driven up” that they will stay up. It’s rare for prices to go down. Generally once “they” know they can get paid a certain amount for something, they keep it at that price and just make a bigger profit once costs go down.

  7. SavijMuhdrox says:

    So who’s going to pay for all this new healthcare insurance coverage that everyone has?

    And how come whenever we need to cut something, it’s always really important programs?

    Can’t we just cut the salaries of people in the government?

    Why do towns have to approve school budgets, yet state legislators vote on their own increases in pay?

    i like the idea of healthcare coverage for all, i just don’t like the idea of being the one who has to pay for it.. when the government wastes money and the healthcare industry overcharges for everything… these are my concerns, i hope there’s candidate in November who hears them.

    • clarkis117 says:

      Bureaucracy of the healthcare system is being cut inorder to pay for a lot of provisions of the bill

      • SavijMuhdrox says:

        I really hope so. not to be snark, but that would be an amazing accomplishment.

        • clarkis117 says:

          I hope so too, but the healthcare system is a public system and is up to all of us to make reform work. Mainly, All American have to start taking better care of our bodies and focus on preventative care instead of reactive care. Preventative care is cheaper than letting a problem go untill it becomes life threatening. Examples: Obesity, Smoking, etc

    • TBGBoodler says:

      You’re already paying for it. Every time an uninsured American goes to the ER because they can’t afford to go to a doctor, you and I pay for it.

      • SavijMuhdrox says:

        and my concern would thus be that I will now pay MORE for it. It’s only a concern, and could be wrong.. but I’m still wary about how the government spends my money (and that could be on anything, not just healthcare)

        • Bunnies Attack! says:

          The difference is… right now that person just gets sicker and sicker and sicker until they go to the ER and get a $50,000 operation which they can’t pay for and then the rest of us pay for.

          With insurance, that person goes to the doctor when they start getting sick, get a $10 prescription and they’re done.

          • wackydan says:

            What is left out is that our insurance also pays because of medicaid… The level of reimbursement is so low that the hospitals and providers make it up on the backs of the insured….

            Now we’ll even have more on Medicaid at cut throat rates to the the health care providers….The equation doesn’t change at all.

          • rmorin says:

            You are correct that preventative care is much more economical. I have to ask you though, if preventative care is covered by a government financially, what is the solution to a non-compliant patient?

            Most people adhere to a plan of care. What about those who do not? Do we just “write it off”? Financially penalize them?

            In other instances of government assistance (throughout the world, not just here in America) there are caveats to receiving all types of aid. What caveats can we possibly attach to healthcare while still respecting the privacy, wishes and fundamental rights of patients? Unless there is some system of accountability for patients, then we are simply not looking out for the greater good because we are just giving money disproportionately to those not being true to plans of care.

            • RvLeshrac says:

              “Inability to pay for medication” is a major reason many patients are non-compliant. They may string out a supply over a longer period, thus making it ineffective, or not pay for it at all.

              Once we’ve removed the cost barriers for healthcare, we can start worrying about the people who are simply contrary.

              • rmorin says:

                See I work in healthcare in a state that has the highest insurance coverage in the nation (MA). Despite free or significantly reduced care through MassHealth (aka Romney Care) there are still poor rates of getting recommended routine health visits.

                You are advocating throwing money at a multi-faceted problem and then figuring things out afterwards. That is not an appropriate use of funds. We must address and define what we are attempting to accomplish via these changes before putting a dime into it.

                For example, we require children to have some sort of schooling in every state (exact law varies, but it’s there). Everyone pays taxes supporting it and education is essential for children. You can opt into private or home schooling, but there are still some regulations that you get schooling.

                If we are paying for healthcare, should not children be required to adhere to recommended plans of care in regards to annual physicals and the like? You see there are more answers that need to be addressed before we start putting money towards anything, or we are not being responsible with our money.

    • JJFIII says:

      You currently pay for it. When your employer pays a premium, and you pay part of it, who do you think pays for those who end up skipping out on the bills? The hospital will still charge for it, but now it is spread out amongst all their users. IF hospital visits were cut down, guess who pays less.

      • frank64 says:

        Then why the extra taxes to pay for something we already pay for? Shouldn’t it be revenue neutral?

        • RvLeshrac says:

          Because right now, people aren’t paying anything. There are no additional fees on those who *HAVE* insurance, there’s a fee on those who *DON’T* have insurance. By charging those who are not currently paying into the system, you equalise.

          • frank64 says:

            No, I was talking about the tan tax, the HSA tax(HSAs are being taxed for the first time), the special 3.5% increase in the cap gain tax, the taking of the 500 billion from medicare, the medical device tax. There are more I haven’t thought of.

      • bnceo says:

        Sort of like a $40 ace bandage, eh?

    • SabreDC says:

      And how come whenever we need to cut something, it’s always something of which I approve?

      FTFY.

      What’s important to you may not be important to someone else. And what’s important to them may not be important to you. One state’s “pork” is another state’s necessity.

      • SavijMuhdrox says:

        I was gonna fire back at your cynicism with more cynicism.. (yaaay internet). My original intention was that politicians only cut programs that can’t defend themselves.. and they never bother to cut things like their own salaries..

        but lo and behold, and one DuckDuckGo search later.. I’ll put down the names of people who have taken paycuts to their own salaries to help a balance budgets.. and hopefully actually add something to the internet for once.

        Jack Markell. Fla, 20% , 2009
        Scott Walker, Wis,numerous years, between 50%-10%
        Steve Oelrich, Fla, campaign claim, couldn’t verify
        Tim Kaine, Va, 5% 2007-2008

        I don’t care what party these people are from and hope there are more like them.

        • RvLeshrac says:

          Why is it cynical? The statement was correct – what one person considers “pork” (New Yorker complaining about the Farm Bill subsidies) is someone else’s “Important Program” (Peanut farmers in Georgia supporting them).

          That’s why we have a Union. That’s what the Union is supposed to be – I pay for your tanks, you pay for my abortions. I pay for your Coastal Hurricane Insurance Subsidy, you pay for my Midwest Fire Insurance Subsidy. The problem is when we start losing that give-and-take, and are unwilling to, say, cut a program (Defense) in exchange for cutting another program (Welfare).

          And no, you don’t want people like them. They’re not losing any money by taking a salary cut – politicians don’t make that much. But when you say you’re a politician who took a salary cut, you get re-elected. The more you get re-elected, the more you can take advantage of all the other perks of office – such as free fancy dinners with constituents, and cushy seven-figure jobs when you finally lose an election.

  8. golddog says:

    So will the families/individuals who would have been covered by Medicaid expansion but aren’t b/c their State opted out have to pay the no insurance tax/penalty?

    • who? says:

      No. The penalty is based on income, and there are exemptions for financial hardship. I would assume that meeting the income requirements for Medicaid would trigger the financial hardship exemption.

      • eeelaine says:

        And even if not, this is an known issue that can (hopefully) be fixed in the several years until the program kicks in

        • RvLeshrac says:

          Depends on whether or not the ‘Party of No’ gets re-elected. They’ve made it clear that they’re unwilling to vote on or discuss *ANYTHING* except repealing the law entirely.

  9. TBGBoodler says:

    I’m paraphrasing an anonymous comment I saw on another site, but I wish Obama would come out in favor of breathing so these Republican governors would suffocate themselves.

    Unfortunately, they would probably suffocate their citizens, too, judging by their behavior on this.

  10. JJFIII says:

    Its clear to any person with a brain that universal single payer (Medicare for all) is the best system in terms of $, and any measurable outcome when it comes to healthcare. There is NOTHING that the US is a leader in when it comes to results, other than spending more money. If Romney is a business man, as he claims, what CEO would see the numbers of comparable organizations, and say continue to do it as it has been done.
    http://en.wikipedia.org/wiki/Health_care_compared#International_comparisons

    I would even allow that those who want their own private insurance can still purchase it. Just like those that want private school for their children. The government runs two of the most successful health care programs in the country, Medicare and the VA. I will take them over Aetna or UHS, or BCBS any fucking day

    • Kuri says:

      Sad part is it’s unlikely to happen. When even the idea of it was brought up the opposition said no at every turn, and they themselves have had numerous chances to do it themselves and get credit for it.

      The “our side must win and damn the consequences” mentality will keep it form happening.

    • wackydan says:

      How do you get there? Does the gov’t take over all the private hospitals and turn the health care doctors and workers into gov’t employees? Because really, that is what would have to happen… and You can see why I’m skeptical of that.

      I’m a conservative and in favor of single payer – to a degree. I’m in favor of a single payer system that recognizes the contributions from taxpayers by leveraging better tiers of coverage…. If you want to live on welfare you will get coverage, you will be treated, but may not get the most expensive options… where as if you are a productive member of society or have proven to be in the past you will get the more expensive drugs, etc…

      I know that those on the left won’t agree with that, but if you want single payer and the conservatives like me to agree, then that seems fair. We have a very large number of citizens who don’t pay federal income taxes but are capable of working and paying into the system… Why should they receive the same level of care? That sounds horrible and I made it intentionally so… But the question is… would that be acceptable to the left?

      • JJFIII says:

        No, that is completely unacceptable,. but if you want to see how it works in the REAL WORLD, try Canada, or Australia. Just as another thought, Canada did not have the huge housing bubble that the US had either, due to smart banking REGULATIONS. When you allow the free market to go unchecked, it will produce horrible results. The housing bubble is a prime example of money being loaned and then insured and gambled in much the same way the mob did it in Vegas

        • RvLeshrac says:

          Thank you for using Canada as a positive example. So sick of hearing people try to claim that Canada has “terrible” healthcare because you have to wait a few hours.

          I spent six hours in the ER waiting on a doctor here in the US, with chest pains, and I still had to shell out over $1500.

    • rmorin says:

      Well your comment is pretty laughable to anyone familiar with our healthcare system.

      1. Medicare has such poor reimbursement rates that it is increasingly harder to find providers that accept them. Not like “have to buy the BMW instead of Porsche” poor, but “literally does not allow us to be financially viable” poor.

      2. VHA (VA is not a health care organization, its the umbrella group for all Veterans Affairs) is radically different in then what you are talking about. The federal government employs individuals that work at their facilities. They are literally a federal government operated facility. For this to be available to all, what exactly are you suggesting? A government takeover of all hospitals? That would be incredibly unconstitutional. We build federally owned hospitals all over? Economically not feasible. Bring this up proves what point exactly?

      • RvLeshrac says:

        Not legal to decline a medicare-covered patient if you accept other insurance.

        • rmorin says:

          False.

          In Texas alone 34% of all doctors decline or limit Medicare patients.

          http://www.chron.com/news/houston-texas/article/Texas-doctors-leaving-Medicare-hits-record-high-1603496.php

          • Syncop8d1 says:

            Ah, that explains why it’s so hard for my partner to find a dermatologist who takes Medicare. She needs some moles looked at (preventative), but dealing with the Medicare referral system has frustrated her.

            As for me, I could just go to the VA and get a referral to a dermatologist. As much as I complain about the VA (wait times can be horrible and lately they’ve been playing “musical doctors” for my primary care), I’ll still take it over nothing. And because my income is low and I have a service-connected disability, I do not have to pay a co-pay. However, those with no service connected disability and higher income, do pay a co-pay for meds. It’s a multi-tiered system. You get placed in a category based on income and degree of disability. http://www.va.gov/healthbenefits/resources/priority_groups.asp

            And at your appointments, the VA clerk always asked if you have other insurance, The presumption that the other insurance get billed first? I don’t know exactly as I’ve never had other insurance since having VA. Just my $.02
            Lydia

  11. wade says:

    Why don’t we just pass a tax on people who don’t have insurance? That seems like it should do the trick.

    • bnceo says:

      Or just cut some spending to accommodate the people who will opt out. Believe me, if the government does things as they are expected to, they could make an opt out very hard and tedious to do. But at least give people an option.

      • RvLeshrac says:

        Uh, allowing people to opt out would make the entire piece of legislation meaningless, and eliminate all savings that the program will generate.

        You might as well ask your state to allow people to opt-out of the requirement that everyone have car insurance.

  12. MarkFL says:

    To those who say that the ACA will cost too much, please explain this:

    When the Republicans regained the majority in the House of Representatives, they put in place a rule that any bill that costs money has to include a provision as to how that money will be paid for. There are several exceptions, for example, tax cuts don’t have to be funded. (I’ll leave that argument for another time.) But one other exemption to this rule is the repeal of the ACA.

    Now, doesn’t it follow that if a law is going to cost money, then repealing it should save money? And yet, repeal of this ONE bill was specifically listed as an exception to the rule. Seems to me the people who made this rule know something they aren’t saying out loud.

    • MarkFL says:

      No takers on this? Come on, surely someone can twist reality to come up with a psuedo-explanation.

  13. AEN says:

    Who says the government is not efficient? When I graduated from college, I got drafted THE NEXT DAY!

  14. Dre' says:

    Scott won’t be here in 4 years. I’ve never seen a politician piss off so many of his own in such a short amount of time.

    • MarkFL says:

      Honestly, I wouldn’t be surprised if the Florida Republicans look to run someone else in 2014. Democrats, of course, hate him, and he has managed to antagonize Republican legislators, while looking bad to everyone.

      Expect the drug test issue to be a big issue if he runs for re-election, especially since he awarded the contract to his own firm.

  15. DragonThermo says:

    Please stop calling it the “Affordable Care Act”. There is nothing “affordable” about it and the amount of “care” is questionable.

    It is clearly and accurately known as ObamaCare, the largest takeover of private industry and individual liberty by the federal government in American history. Thanks to SCOTUS, it is also the largest tax increase on the middle class in American history.

    The only people who support ObamaCare are the leeches, the parasites, the moochers, and those who want to take away your freedom and liberty and make you a slave to the federal government.

    • incident_man says:

      I’n neither a leech or a mooch; I pay my taxes and would not be able to take advantage of subsidised care because of my income level and have no regrets or ill feelings regarding that, but I fully support a national health care program so that EVERYONE can get health care when they need it, without regard to the ability to pay.

      Your comment exemplifies what’s so wrong with the folks who hold the same values you do. You’re whole, “I won’t pay for something I don’t directly benefit from,” mentality is selfish tired, and so 19th century. We’re all part of a civilised society; you don’t want to pay for it? Fine, then go live on a deserted island so you don’t have to be responsible for anyone else.

      I assume you drive on public roads, send your children to public schools, enjoy that police and fire services are available when and where you need them, and presumably are looking forward to collecting Social Security and Medicare when you’re eligible, if you aren’t eligible already. All of those “perks” are part of a civilised society and the result of…..you guessed it…..TAXES that we ALL pay.

      When you’re ready to give up all that, then I’ll be ready to listen with sincerity to your selfish, backwards diatribe, otherwise, please STFU and join the rest of us in the 21st century.

      • MarkFL says:

        You’re wasting your time. The line of thinking you are writing to is this:

        1. Comments do not correspond with mine, therefore,
        2. commenter is a liberal, therefore,
        3. commenter is a socialist and hates America and democracy, therefore
        4. comments are not worthy of consideration, therefore,
        5. comments can not reflect anything that agrees with my reality, therefore,
        6. comments do not correspond to mine, therefore,
        7. repeat endlessly, without actually considering, you know, facts.

  16. incident_man says:

    Sounds a little bit like sour grapes to me: “We didn’t like the outcome of the game, so we’re just gonna take our ball and go home.”

    How very juvenile……..and utterly predictable.

    The tragic part of this is that it’s only going to punish people who need the coverage the most.