Texas Governor Says No To Medicaid Expansion

Last week, while states like Florida and South Carolina were stating their intentions to opt out of the portion of the Affordable Care Act that expands Medicaid coverage to millions of Americans, Texas — where approximately 2 million currently uninsured residents would have been eligible for coverage. remained oddly quiet on the matter. That is, until Governor Rick Perry declared his intention this morning.

“If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare,” wrote Perry in a statement released Monday. “I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government. I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a ‘state’ exchange nor the expansion of Medicaid under this program would result in better ‘patient protection’ or in more ‘affordable care.’ They would only make Texas a mere appendage of the federal government when it comes to health care.”

The ACA had originally compelled states to participate in Medicaid expansion by penalizing those states that opted out. In June, the U.S. Supreme Court struck down the penalty as unconstitutional, but said the federal government could offer incentives for participation.

Medicaid expansion, which would increase the number of Americans eligible for coverage by making it available to anyone with incomes up to 133% of the poverty line. It is scheduled to begin in 2014, with the feds paying all the costs through 2016. Between 2016 and 2022, the state contribution is slated to ramp up to 7% of the total cost (approximately $73 billion over the six years).

Opponents say the states can’t afford any additional costs being added to their Medicaid tabs, while supporters of Medicaid expansion argue that states are only going to end up paying more as the number of uninsured Americans grows.

“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,” explains DeAnn Friedholm, Consumers Union’s Campaign Director of Health Care Reform.


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  1. SkokieGuy says:

    Rick’s statement is so full of lies and fail, but without even bothering to correct, an interesting fun fact:

    In Texas, Medicaid eligibility is based on 25% of the poverty rate. That means is you earn MORE than 25% of the poverty rate, you are too “wealthy” to qualify for Medicaid.

    For a single adult, this means if you make $3,000 a year, you make too much money and will not qualify for Medicaid.

    Texas has one of the highest rates of uninsured residents in the nation.

    How keep in mind, these uninsured can go to an emergency room, cannot be turned away, and receive much more costly care that the state will have to pay for anyway, so given them actual coverage (and preventative care and treatment in clinics and doctor’s offices) would be much more cost effective – not to mention humane.

    But Rick will happily let the poor and uninsured in his state suffer and die in order to make points on how “tough” he is on Obama.

    • TheMansfieldMauler says:

      Texas has one of the highest rates of uninsured residents in the nation.

      Residents, yes. Citizens, no. The numbers are skewed courtesy of our open border to the south, and because of Katrina a few years ago, the open border to the east as well.

      • dush says:

        Are you really equating displaced refugees from Louisiana to illegal immigrants?

        • TheMansfieldMauler says:

          No, not really. Why do you ask?

          The point is, the numbers are skewed for multiple reasons, and for multiple statistics as well.

          • who? says:

            Katrina refugees are generally citizens. And at this point, if they’re still in Texas, they probably sould be considered permanent residents. Katrina was 7 years ago.

            • Cacao says:

              Mansfield is referring to the Independent Republic of Texas, which is not part of the Union and hence has its own citizens. :-P (Either you is a Texan, or you ain’t)

      • clarkis117 says:

        If they are a US Citizen who cares that their not a resident of the state.

        • RvLeshrac says:

          If you’re black, hispanic, gay, or poor, you’re not wanted in the Republic of Texas.

          • jiubreyn says:

            That is unless you live in Austin. :o) (Yes, I live in Austin. I am also two of the four descriptions you listed.)

      • jpdickson says:

        Please do your homework. Those numbers ARE citizens.The illegal immigrant situation only compounds the problem. Under federal law, Public hospitals are REQUIRED to provide medical services. Only a portion of the cost is returned by Federal monies. Overall this is politics over good sense and money. Texans will be paying higher federal taxes and fees, without any benefit. Although “Obamacare” has big problems, it also has some real benefits for Texans. As a longtime volunteer in the ER of a Texas public hospital, I see this problem all the time.

    • AcctbyDay says:

      I’m not disagreeing with anything you say except where the state has to pay for indigent care of people who have no coverage. Unless it’s a county (free) hospital in Texas, the hospital EATS indigent care costs not the state.

      Also, as a point of reference I think the poor are suffering here no disagreement there. However, going from 25% of the poverty line to 133% of the poverty line in terms of pool of people who can participate in the program very may well bankrupt the state when the state starts having to foot the bill for all those additional people on the program. Is it unfair? Yes. Is he telling the truth and trying to protect the state from bankruptcy as well? Yes. The solution to accepting the program from the feds would be to raise taxes in Texas in order to foot the bill for the increased medicare bill. I like the idea of helping the poor just as much as the next man, but here in Texas the government is having a hard time paying for basic services such as police, fire and courts. How could it possibly make sense to add additional services that there is already no money for? As an example, Houston wants to add a new tax to strip clubs to pay to process rape kits in it’s crime labs. We can’t dispense justice as there isn’t enough tax revenue, how could anyone possibly suggest providing more services where there isn’t revenue to support it?

      The solution to raise taxes to provide for these services does not address the services it is ALREADY failing to provide due to lack of funding.

      Maybe I’m going on too long of a rant and I would welcome corrections, but there is no bile in what I have to say. Just, where is the money coming from that these programs are supposed to be paid for with?

      • Necoras says:

        Perry has constantly worked to cut property taxes over the past 10 years. You’re right that the state (and smaller local governments) can’t pay for basic services in many places.

        That said, the Federal Government would pay for 100% of the Medicaid expansion (that is 100% of all Medicaid) initially, and gradually shift some of those costs onto the states up to 7% by 2022. That’s 10 years in which the states have time to slowly increase the tax income to pay for that 7%.

        As for whether or not local (from the State level down) politics will be able to get the necessary tax increases in place or not, that’s a different issue. Personally I think the increasing influence of SuperPacs on local politics (see Wisconsin) makes that unlikely. But these costs *will* pile up, and the care *will* be given through local emergency rooms. Whether or not the state or anyone else eats the cost is irrelevant. Someone will pay for it. Tax rates are at historic lows, across the board. We need to have discussions as to whether or not we want to concentrate money in a very few number of people, or through government ensure that the majority of people have basic services, from health care, to law enforcement, to functioning roads.

        It’s irresponsible for politicians to stick their heads in the sand and ignore these facts. It’s immoral and corrupt for them to do it because they’re being paid to do so by large corporations and super wealthy individuals indirectly through SuperPac advertising dollars.

        • AcctbyDay says:

          Agreed on all points.

          I look at the existing services and say “These are inadequate.”

          Taxes need to be raised to fund basic services – Police, Fire, Courts, Roads, Water Etc…

          However, I say no to adding additional services (more free healthcare for instance in THIS case – it could be free Universities in another argument in another state) when the services we have NOW are underfunded. The budgeting then becomes, what can we cut to fund healthcare? What can we cut to fund this? How about, we fund the basic governmental services and then take it to a vote about whether or not the government adds additional services for additional taxes. I’m not saying healthcare is important and needed, I’m saying I don’t want taxes I send in to pay for school/fire/police to be used for healthcare when the fire department doesn’t show up to in time to save homes and the courts can’t administrate justice (unprocessed rape kits etc..)

        • wackydan says:

          Key point… “gradually increase the tax income to pay for it”… That is the problem most people have with the ACA… Your state taxes will also increase to pay for it… and that will also hit the middle class square in the wallet.

      • icerabbit says:

        The cost of care that is not reimbursed, is rolled into higher cost for all services provided for everybody else, with or without insurance; and those who pay fee for service / cash face staggering costs.

    • Necoras says:

      As a Texan, I’m happy to say that Perry’s a moron. I’ve met the guy and he’s the slimyest person I’ve ever met. With any luck he’ll be forced out in 2014.

      • DrLumen says:

        Church! How he and some of the state reps have stayed in office is a complete mystery to me.

        • rookie says:

          Easy answer, there are plenty of democrats in the state of Texas to counter the garbage they’re fed by the current administration.


          They could be bothered to vote…

    • There's room to move as a fry cook says:

      An emergency room will fix your broken leg and send you on your way but the hospital won’t treat your cancer if you can’t pay for it. If you don’t have insurance, or have it but have reached your limit, then you are dead meat. RIP a local kid (Texas) who was cut off half way through this cancer treatments when he’d met the insurance co’s limit.

      Perry will take federal interference when it suits him. Texas was the biggest recipient of stimulus funds and they were used to plug shortfalls and meet payroll in Rick’s state budget.

    • jpdickson says:

      you nailed it. I volunteer in the emergency room. I see the burden Texans must shoulder. Personal power games and politics by Governor Perry and others over our best interests. Geez, and I VOTED FOR THIS GUY, DUH, that was stupid.

  2. The Beer Baron says:

    Bully! I would prefer that the Federal Government refrain from meddling in my Medicaid.

  3. Sunshine1970 says:

    Ahh, yes. Governor Good Hair strikes again….

    Why Texans keep voting him in is beyond me…Hopefully his antics during his presidential run will doom him from winning in the next governor’s election, and we get someone smarter to take over.

    • bnceo says:

      Keeps their tax bill low. No income tax in the state. More $$ in your pocket from what you earn. People that live in Texas (and vote for him) like that part I guess.

      Which is fine. I wish I didn’t have to pay income tax

      • MrEvil says:

        Texas can’t enact an income tax without a popular vote for the income tax. Income tax can’t even be slipped inside other legislation. Saying Rick Perry is the one man keeping Texas free of state income tax is like saying President Obama is keeping us from being invaded by Canada.

      • Necoras says:

        Perry has rich and powerful friends in the Republican Party. He does nice things for them. That’s why he’s still the governor.

      • Not Given says:

        There is also no sales tax on groceries.

        • Misha says:

          I think most states don’t charge sales tax on groceries. Soda and candy and some other junk foods, often yes, but not on produce and meat and components of actual meals.

          • Not Given says:

            Oklahoma charges sales tax on groceries, alcohol, almost everything. Tobacco had it’s own extra tax rolled into the price a while back so they took sales tax off it. There is no tax on periodicals, so newspapers, magazines and catalogs are tax free. Also no tax on prescription only drugs, even for veterinary use.

          • RvLeshrac says:

            Most states charge sales tax on groceries. They charge a *LOWER* tax on groceries, usually 1%.

      • Sunshine1970 says:

        We don’t have an income tax, but we make up for it in property taxes. Austin has the highest ones.

        I’d take an income tax over property tax any day. Would help keep property taxes lower

        • Chris says:

          I wouldn’t. Our Houston property tax is only 1.5% of our income and it’s 2.5% of the value of the house. I’d much rather pay the current taxes than a 5%-9% state income tax most states have plus a 1% property tax.

          If your property taxes are too high, buy a cheaper house. Or rent.

  4. Coffee says:

    The ACA had originally compelled states to participate in Medicaid expansion by penalizing those states that opted out. In June, the U.S. Supreme Court struck down the penalty as unconstitutional, but said the federal government could offer incentives for participation.

    Don’t think that the inability to fine states will stop the federal government from imposing its will on states who refuse to participate. Back in the day, many states had a drinking age of 18, and the federal government was unable to do anything to change that…

    …except pull federal funding of road construction in all states that refused to change their minimum age to 21. Not surprisingly, states fell in line pretty quickly when they realized that they would lose billions in funding.

    I wouldn’t be surprised at all if the same thing doesn’t happen at the state level here. I’m sure that there are billions in federal funding propping up many of these states’ medical programs, and if the fed says “Fuck you…pay for everything yourself then,” minds may be changed quickly.

    • az123 says:

      What you are stating is exactly what they were told they could not do, the “compelled” part of that was withholding funding if they did not participate, not fines… The supreme court said that the feds could not do that.

      • Coffee says:

        Yes, and the way you do that is eliminate existing subsidies, the reallocate the money in the form of program incentives. The money is redistributed and you’re not “penalizing” anyone, but rather rewarding those who choose to participate. I’m just saying, don’t be surprised.

    • bnceo says:

      And that my friend was a sorry way to go about the age limit. You can die for your country at age 18, but can’t enjoy a brew at the local pub. The federal government unrightfully bullied their way into that. Total disgrace.

      • incident_man says:

        And we have enough drunk drivers on the roads with the legal drinking age at 21; we don’t need more with it at 18.

        • HogwartsProfessor says:

          Agreed. We should raise the induction/draft age to 21 instead of the other.

        • RvLeshrac says:

          Totally. Because countries with a lower drinking age haven’t shown that lowering the drinking age reduces drunk-driving among new drivers because they know when they’ve had “too much” or anything.

    • Sudonum says:

      They don’t have to do anything more at all, Texas is already set to lose almost $1billion under the ACA for not expanding coverage:

      “It all centers on something called DSH payments (pronounced “dish” payments, in health-wonk parlance). That stands for Disproportionate Share Payments, extra money that Medicaid sends to hospitals that provide a higher level of uncompensated care. Those payments, which totaled $11.3 billion in 2011, are meant to offset the bills of the uninsured.
      The Affordable Care Act phases out these payments. If most Americans are covered under the Affordable Care Act, after all, hospitals would presumably see a reduction in unpaid bills. They wouldn’t need the supplemental payments anymore.”

      • Coffee says:

        Thank you for posting that…this is, indeed, interesting. I really need to spend some time understanding the intricacies of this plan…one of my chief concerns is that states that opt out will somehow reap the benefits of the program without having to contribute into it. It seems like this happens far too often, and the taxpayers in some states end up propping up others.

        • Sudonum says:

          What I find amazing (or maybe not so much considering who’s doing the whining) is that most of the states and governors opting out are doing so under the mantra of a Fed takeover of the healthcare system. The fact of the matter is that failing to act IS inviting the Fed into take over in the form of setting up and operating the exchanges. I would think that the states would want to take ownership and set up the exchanges in a way most friendly to their political beliefs rather than leave it to “The Socialist In Chief”

        • RvLeshrac says:

          States are free to opt-out of Medicaid expansion. That’s *IN NO WAY WHAT RICK PERRY IS TALKING ABOUT*.

          He’s talking about refusing to implement a State Insurance Exchange. You know, so people can *PAY MONEY* for affordable insurance.

          • RvLeshrac says:

            (OK, to be fair, he mentions it – once. But no one is really concerned with Medicaid expansion, they’re concerned with the State Exchanges offering low-income families an alternative to expensive insurance plans)

          • partofme says:

            So many lulz. Did you read the TWO page letter? It mentions them both in lock-step. Even after dedicating a paragraph to the exchanges… it dedicates a paragraph to the Medicaid expansion!

            Also, states are free to not set up exchanges… this is why the law says that if they don’t, the federal government will. There are no penalties assessed for this choice.

    • ARP3 says:

      A bit flippant, but so what? If these states are so gung-ho about getting the Federal Government out of their lives, they can opt-out of all the funding and have their “freedomz.” Most red states take more federal money than they pay in.

      • Coffee says:

        Yes, yes they do, and I would have mentioned that, but I think Texas is one of the few states that’s approximately 1:1 in terms of federal contributions/usage.

      • Fineous K. Douchenstein says:

        That’s because the Republican party (and more specifically the Tea Party) depends on poor, uneducated people to believe their load of verbal crap. This is specifically why the states that are heavily funded by the federal government are red.

  5. az123 says:

    And the response to this is misleading as well. Being eligible for this based on poverty is not just what you income is. It is a total of your income and assets / cash in bank then subtracting out your medical expenses puts you below the established level, which for a single person in TX is 27%, however for family with small children / pregnant women etc… is actually at 133% of the poverty level.

    Of course this is way to complex to get into, but clearly the above response is about as misleading and lacking all the facts as he is accusing the governor of being

    • 180CS says:

      I know that if you see this, you’ll probably take offense, but I still have to say it. Your argument looses most of it’s credibility by your numerous grammatical mistakes, slang, & run-on sentences.

    • RvLeshrac says:

      I… what? So if *all of your assets combined* are 25% of the level determined to meet the needs of a single individual, throwing you to the wolves is OK?

      You’re one of those assholes who insists that people “Should be saving money,” aren’t you? How, exactly, do you do that on a total combined income of $3,000/year from all sources?

      “Subtracting your medical expenses” is pointless until after the expenses have been incurred, which is too late for them to be covered by Medicaid.

      133% of the poverty level for a family of three is just barely enough to pay for food and clothing – for the child.

  6. dolemite says:

    Isn’t the only portion of the bill that addresses skyrocketing healthcare costs the “exchange” system? So if every state opts out, there will be no savings. It’s great we are trying to cover people without insurance currently, but I’d say the fact healthcare in general will be unaffordable for the majority of Americans in the next 10-25 years is a more serious concern.

    • EarlNowak says:

      The bill allows the feds to step in and set up exchanges if a state refuses to do so.

    • Stickdude says:

      That was the point of the individual mandate – get the healthy people who can afford health insurance but choose not to carry it to subsidize* all the people with pre-existing conditions that the insurance companies are now forced to cover

      (*subsidize in the sense that they will pay more in premiums than they will use in claims, so their excess premiums will be used to pay claims for others – just like other kinds of insurance)

    • SkokieGuy says:

      I think the biggest issue impacting costs is the requirement that 80% of premiums must be spent in delivering care. If premiums exceed the ratio, the insurance companies must actually refund the difference. Checks are being mailed.

      In the past, there was no cap on how much could be spent on overhead, administration and profit.

      • Firethorn6 says:

        The more I think about this, the more I think it’s a semi-good idea.
        Good: The ratio limit means that healthcare companies are encouraged to keep it simple. Previously, if spending $9 on admin to run a complex program to deny covering $10 of medical care, it was worth it, even if it was exceptionally sucky for the consumer.

        Now? They’re encouraged to cover EVERYTHING, because they only have to spend $1 to process $100 of healthcare claims. BONUS: That $100 means they can ‘profit’ $25.

        Now the only thing that would limit profit margins while they offer ‘all encompassing’ plans is the sheer expense of the plans – competition ala car insurance would keep that down, but there’s no where near as many health insurance companies as there are car insurance ones.

  7. There's room to move as a fry cook says:

    I live in Texas and I’m screwed. State exchanges would not cost Perry money – it’s an exchange of low cost private insurance plans with federal subsidies to help with premiums.

    • 180CS says:

      Honestly, if a program like this where going to help me and my state rejected it, I would look at moving to another state.

    • adamstew says:

      If your state decides not to do the Insurance Exchanges, then the Affordable Care Act authorizes the Federal Government to do it in any states that don’t. So basically, if Texas doesn’t set it up, then the Feds will set up an exchange for Texas.

    • JEDIDIAH says:

      It sounds like nothing more than an online store, an e-commerce storefront.

      So it’s nothing really. It just takes some of the legwork out of the situation. The product still remains, you just have to go look for it. So I really don’t see the point about whining over these exchanges.

      You’re too lazy to use Google?

      • PunditGuy says:

        Plans have to meet minimum requirements to be part of the exchange. You’re much more likely to be comparing apples to apples in the exchange than outside of it.

  8. 180CS says:

    Personally, I’m all ‘meh’ about this. I live in a state that is embracing the healthcare reform and the exchanges. I think it will actually be good to see states that accept it, and ones that reject it. It’s like a clinical drug test. Come back in 5 or 10 years, and see if the ones who rejected it are the same/better off than those who accepted it, or vice a versa.

    I’m all for it, happy that the reform happened, and wish more states would accept it, but to each is own. That’s the nice thing about states, we may be at each others throats sometimes, but that’s just because we cater to different ideologies, and that, IMO, makes us all the better.

    • MaxH42 thinks RecordStoreToughGuy got a raw deal says:

      Part of me does want to see what happens, too…but there’s a reason that human drug trials have very strict review standards. This will not go before any IRB, though.

    • who? says:

      That’s fine, and I agree to an extent. The problem is that TX is already pretty much the worst of the worst for taking care of it’s poor and sick, and from what I see, they seem to revel in their badness. Proving that not taking care of its citizens will cause bad outcomes is all well and good, but if the state government doesn’t give a crap, then nothing will get fixed as a result.

  9. ARP3 says:

    1) I was not aware Obama passed this law without the aid of the Congress. I guess Obama singlehandedly cut payroll taxes as well, right? He forgot the Fox News talking point of it being “rammed down our throats” much like the Bush tax cuts were rammed down our throats (they both used reconcilliation)

    2) Texas instituted “tort reform,” yet its healthcare costs aren’t materially lower than states that have not.

    3) It looks like ER’s will continue to be the doctor’s office for many. Since they can’t be turned away, the rest of you will pay more for medical care via taxes for state grants to hospitals and increased fees to make up for those who don’t pay.

    4) The law was declared constitutional, so offcially, it is constitutional. I hate the Citizens United ruling and think it was the wrong decision, so I do understand his sentiment.

    5) I’m a little confused by the exhange comment. If the state doesn’t set up exhanges, the Fed’s will. So, they’re contributing to greater federal influence over its citizens. How does that interplay with the Medicaid expansion.

    • TheMansfieldMauler says:

      The law was declared constitutional, so offcially, it is constitutional.

      Just a small point, but I don’t think laws are declared constitutional. They are declared not unconstitutional. There is a difference, however minor.

    • 180CS says:

      #3, THIS. This is my biggest issue. It even spills over to your average joe with insurance when he sees his family practitioner, because since he’s probably part of a provider network that has hospitals, and that provider network sets costs…. when the hospital can’t pay its bills because of all the uninsured, it jacks up the WHOLE networks costs to makeup for it. It’s like a bomb. The hikes hit the hospital worst, but everyone ‘around’ it will get hurt by the debris too.

      Also, a lot of people seem to think that hospitals will always get government funding to make up for any deficits they have. NOPE, again, higher premiums, and if that doesn’t do it, they close their doors. Go to any first year nursing college course, and you’ll spend a month on these case studies and how it causes healthcare costs to go up while limiting it’s availability as well.

      I don’t think the healthcare bill does enough to address #3 because honestly, until you can penalize people who show up without healthcare/force illegals who do to somehow pay for their care, the only other option to safeguard the hospital is to let the people who can’t pay die in the streets. Healthcare reform, or let people die in the streets. I’ll take reform, thanks.

      • MaxH42 thinks RecordStoreToughGuy got a raw deal says:

        Just to clarify, insured patients are absorbing the cost of care for the uninsured by paying 2-5 times more than self-pay patients. The insurance companies pay through the nose, and that causes everyone’s premiums go up. Unfortunately, without a safety net for the uninsured, the cost gets distributed to wherever it can be recovered, and insured patients are easy targets, since they generally don’t know anything about the cost of their care at all.

        • Not Given says:

          I’ve got a multi page EOB for lab work, provider billed $1581.32, plan paid $467.20, I didn’t have to pay any of it. The providers are raising the prices to cover the nonpayers and giving the insurance companies a deal because they don’t have to work as hard to get paid eventually.

          • Coffee says:

            The providers don’t give the insurance companies a deal. That’s not how it works. Here’s how it works:

            Provider: Here is what I charge.
            Blue Cross/Blue Shield: Here is what we reimburse. You will charge us the allowable amount.
            Provider: Oh yeah? And if I don’t?
            BC/BS: You will no longer be part of our network and you will lose 22% of your patients.
            Provider: Oh…well, then. Okay.

        • JEDIDIAH says:

          That’s just nonsense.

          Insurance companies negotiate big discounts for themselves because they are large entities that represent a great deal of business to any particular doctor or hospital. These discounts by themselves can make an insurance plan worthwhile even if you intend to still pay cash.

          Big government and Big insurance can both push lower prices for themselves.

          Doctors get squeezed on both ends with this (low reimbursements vs high med-mal premiums).

      • RvLeshrac says:

        Uh, no. You’re absolutely wrong. Have you idiots even *READ* the bill?

        The reason the fines and State Exchanges exist is to pay for the ER visits – visits which are *CURRENTLY* allowed under the law. When everyone is paying for inexpensive insurance under the State Exchanges, there are no longer people receiving “free” ER care – they’re paying into the pool.

        The Medicaid expansion was also intended to assist with any rising numbers of ER visits.

    • partofme says:

      For (1), to be fair, he’s talking from the perspective of the states rather than individuals. This precise point is why many of the biggest states’ rights-ers talk about repeal of the 17th Amendment. No one in Congress represents the interests of state governments (if state legislatures still elected Senators, do you really think Congress would keep leaving them with big bills.. under the threat of pulling large amounts of other funding?). As such, Congress certainly can ram things down their inadequately represented throats. Finally then, we can see how the Bush tax cuts are not a good analogy for this particular matter.

    • wackydan says:

      Actually… the mandate was declared unconstitutional… and was rewritten in effect by Justice Roberts defining it a tax instead.

      There is a distinction there.

      • RvLeshrac says:

        The mandate was declared constitutional. Roberts “rewrote” nothing. He declared that:

        a) The lawsuit could proceed because the law *does not use the word* tax. Had the law used the word “tax,” the ENTIRE BILL would have been declared legal, including the Medicaid expansion, because it is *NOT LEGAL* to sue the government over a tax.

        b) He declared that, while you can *call* a tax anything, using the IRS to collect it makes it a tax.

        • partofme says:

          zOMG… two posts up you’re calling people idiots for not having read the whole 903 page law… yet you seem to not have read the 193 page decision (or even at the very least, the first 65 pages including the summary and the CJ’s opinion).

          a) Had the law designated the mandate portion of the bill a “tax”, then the AIA would have prevented someone from suing about a tax until they have already paid it and are seeking to recover it. This has nothing to do with the legality of the tax, nor would it have any effect on the Medicaid expansion discussion. They would simply have had to wait two years to bring the exact same claim about the mandated tax… after they’ve paid it. (Actually, they might have brought a slightly different claim if Congress had called it a tax… but this would be my speculation, and I’m going to stick to facts for the moment.)

          b) “He declared that, while you can *call* a tax anything…” Ok. Good so far. Roberts is about to take a functional approach. “…using the IRS to collect it makes it a tax.” And fail! Roberts presented a three-prong test, of which a single prong is that the IRS collects it (you’re missing that he cared about its magnitude and the presence of a scienter requirement).

          Oh, and concerning the argument about whether he rewrote the law, he didn’t change the functionality. However, his opinion fairly painstakingly developed the idea that this intepretation is only a “saving construction”, for the purpose of saving a statute from unconstitutionality. That he rested on functionalism rather than textualism is what leads the claim that he “rewrote” the law. Inherent in functionalism is the idea, “I don’t care what it says; I care what it does.” In which case, one who accepts functionalism must at some level accept that they’re ignoring the words of the text and substituting their own. This is not a problem for a functionalist… though I suppose it would be a reason why a textualist would call it “rewriting”, while a functionalist would just ignore the charge of “rewriting” in the same way that he’d ignore the text of the statute, lolz. The charge of “rewriting” has no functional meaning to a functionalist!

        • partofme says:

          …of course, you’re right that the manda-tax (a merging of sections 5000A and 5000B) was declared constitutional. Under Roberts’ ruling, there’s no longer a distinction between the sections, like there might have been for the mandate and penalty.

  10. Deeya says:

    The government doesn’t “pay” the bills of those people who wind up being unable to afford their medical bills from emergency room visits, except in a few disproportionate share hospitals. The vast majority of these bills are sent to collections, and written off as a business loss. Those losses are then passed on to other customers via price increases.

    I wish I could get the Federal government to levy a tax increase to protect me business losses from non-payment, must be nice!

    • TheMansfieldMauler says:

      I wish I could get the Federal government to levy a tax increase to protect me business losses from non-payment, must be nice!

      Get hold of the guys at Solyndra or General Motors, they can show you how to do it.

      • PunditGuy says:

        AIG, BoA, Citi, Chase, Goldman Sachs.

        Silverado, Lincoln…

        • RvLeshrac says:

          Exxon-Mobil, BP, Chevron, Georgia Power, ConEd, Halliburton, Lockheed-Martin, Boeing/Rockwell, Delta…

          Oh, wait, that’s right, all the companies bailed out every single year for decades by Republican politicians don’t count. My bad.

  11. RevancheRM says:

    Actually, these states are a great opportunity to study the success of ObamaCare versus say PerryCare or ScottCare (Florida).

    By 2020, comparison of the individual cost to the state taxpayer can be definitively shown. It’s academic right now, but come the future we’ll be able to see if the preventative costs are less than, greater than or equal to the costs of emergency care, simply by looking at the per capita budgets of each of those states.

    I’m fine if Texas and Florida want to play that role.

    • 180CS says:


      As big of a supporter as I am for healthcare reform, I’m honestly fine with states opting out. In fact, I wish they could opt out completely, because I would be interested to see where they are vs states that accepted the change 10 years down the road. Besides that, it gives people who are 100% sure it won’t work places in our country where they won’t feel like somethings being forced down their throats.

  12. Pete the Geek says:

    This is where I just don’t understand the American capitalist model. Sure, make your own money and pay your own way, but two million residents don’t have medical coverage because they are poor or just can’t find a job with medical benefits. Residents of Texas don’t build their own highways or waste treatment plants, so why would they object to socialized medical coverage? Is it just fear of creeping socialism? If any of those two million goes to the emergency room, would they be turned away or would the state will just end up paying the bill at the “à la carte” rate?

    • JEDIDIAH says:

      I see Greece, Italy, and Spain and it becomes pretty obvious that ignoring costs simply doesn’t work in the end. Eventually someone will have to foot the bill. You can’t just give things away for free and expect everything to work out in the end. It will blow up in your face sooner or later.

      Costs need to be managed. If people can’t fend for themselves, then making them perpetually dependent isn’t the first best answer.

      • who? says:

        Greece, Italy, and Spain’s governments have structural problems, like an inability to collect taxes, and banking problems that make our banks look incredibly healthy. None of this has very much to do with health care one way or the other.

        • RvLeshrac says:

          That’s the Texas problem: Texas suffers from an inability to tax residents to pay for anything.

      • Kate Blue says:

        What do you mean make someone perpetually dependent for health care? We all need health care and those who need it the most obviously can’t work at that point. We all are perpetually dependent on the rest of us when we get sick or injured in one way or another. Either we are dependent on people coming up with a way we can bet them that we don’t get sick and if so they pay for it, or we are dependent when that’s not possible for a huge variety of reasons. You aren’t going to suddenly be healthy all the time because you had to go without it due to one of those reasons.

        That kind of reasoning makes absolutely no sense.

  13. Scully says:

    “In June, the U.S. Supreme Court struck down the penalty as unconstitutional, but said the federal government could offer incentives for participation.”

    Not true. SCOTUS said the feds could not withhold all Medicaid funds; they can still withhold all new fund they would have received if they complied with the ACA.

    • AstroPig7 says:

      New funding would be an incentive, wouldn’t it? Also, that quote says nothing about withholding all Medicaid funds.

  14. Gman says:

    Translation: “I am proud to announce that I have made a decision on this healthcare law not based on what is best for my state residents, but based on political maneuvering and what is best for my political party”

    [Then again this goes for nearly all politicians today]

    • Kuri says:

      Can I add to that?

      “On second thought ,screw my party, I’m doing what is best for ME”

  15. deathbecomesme says:

    So “Mr. Hair” can spend $3.5 million of our tax payer money to run for president but we can’t have health care for the people who need it most. Nice

  16. crispyduck13 says:

    “I will not be party to socializing healthcare…”

    I hope to meet this fellow one day so I can call him a fucking dumbass to his smug face on that perfectly coiffed head.

  17. Kuri says:

    Yeah, I wouldn’t trust a guy who thinks it’s a good idea to pray instead of seeing if water can be brought in during a drought to make decisions about my health-care.

    • AcctbyDay says:

      The drought last year was everyone’s problem, but it isn’t for the government to pay to bring water into the state. Which would have been the greater loss, the crops/animals or the IMMENSE cost of transporting water to EVERY farm and homestead that needed it?

      It would have given everybody the warm fuzzies, but bankrupted all involved. There are insurance products sold to farmers to ensure losses due to droughts and other things.

  18. jpdickson says:

    TIME TO DO YOUR HOMEWORK. With all the flaws, Texas would benefit more than most states due to the large number on uninsured and illegal immigrants we must pay for.

    A report by the Center for Public Policy Priorities, a nonpartisan think tank based in Austin, found in June of this year that Texas will reap $20 billion in new federal funds a year under the health-care reform law, $13 billion of which will go to residents of the state living at or below the poverty line.

    FOR EVERY ADDITIONAL DOLLAR Texas will spend, we would receive $20 back.

    In 2008, Texas hospitals spent 13.8 billion in uncompensated care to the uninsured.


    Perry sticking to his rhetoric from his failed run for nomination. You may notice he receives his care free from the insurance program offered to high ranking state officials. GEE, ISN’T THAT NICE.