CMS approved a waiver for Arkansas for Medicaid expansion. Instead of doing the mechanically simple thing of just expanding Arkansas Medicaid for individuals up to 133% of poverty line, Arkansas will engage in premium support. Individuals who are newly qualified for Medicaid in Arkansas will get a voucher to buy a policy on the Exchange.
The Hill blog:
Under the waiver, Arkansas will expand Medicaid to cover individuals whose income is less than 133 percent of the federal poverty line — the expansion contained in the Affordable Care Act.
But rather than placing those newly eligible residents on traditional Medicaid, Arkansas will offer them private coverage. Residents will be able to buy the private healthcare plans offered in the state’s insurance exchange — the other half of ObamaCare’s coverage expansion.
Iowa, following Arkansas’s lead, has already proposed a similar waiver, and state officials have said Arkansas’s plan could serve as a broader model.
Baud
Eventually, I would think the three programs — Medicaid, Medicare, and exchanges — will have to merge into a single health care system.
But maybe that makes too much sense.
santiago
That is very intelligent and it didn’t go over my head.
Thank you.
Groucho48
The link didn’t really say how it would work. Would Arkansas pay the entire cost of, say, the lowest Bronze plan? Or give a voucher that covers it now but isn’t tied to price increases down the line?
MomSense
@Baud:
Sssshhhhhh, loose lips sink single payer ships.
Maeve
Let a thousand flowers bloom
fuckwit
Wow. Do you know what this means? It means the teabaggers have lost Arkansas (and Iowa, etc). Arkansas R’s are signing on to Obamacare, of course adding in their own way to enrich their cronies, but they’re still buying in.
This Obamacare is not going to stop. It’s on rails and rolling. The train has left the station. I’m trying to find some more metaphors, just for shits and giggles, and also for an excuse to say shits and giggles, which I love deeply.
I just picture someone sitting on the can, chuckling quietly. Just for shits and giggles, of course.
fuckwit
Also, for a while I thought the teabagger insanity was rooted in redistricting. Here’s another theory: that it’s instead rooted in unlimited Citizens United campaign cash, which has weakened the party to the point of impotence http://www.ginandtacos.com/2013/09/25/ass-bitten/
sharl
I’m glad you’re here, Mr. Mayhew.
Just from a few Google searches on ACA-related topics, it appears the opponents continue in pull-out-all-the-stops mode. In response to some Weigel-linked pseudo-pro-ACA image snark, someone responded with a link to a HuffPo-Canada post discussing a long wait time for cancer drugs in Canada. Even if true, not much of a hit on ACA, and in any event there is likely no such thing as a “perfect” national health care plan that will deliver cheap & on-demand service.
More hilariously, On The Media’s Bob Garfield did a pretty good job in his interview with the leader of the anti-ACA Koch-funded front group Generation Opportunity, calling him out on his position and his evasiveness about where his funding comes from (grassroots my ass); that part took place in approx. the 5-10min period of that 13+min segment.
[Later in that same segment Brooke Gladstone holds Chuck Todd’s feet to the fire on how media has handled the ACA roll-out; but that putz basically stuck to his guns with a response that was disingenuous at best.]
pseudonymous in nc
In NC, there’s been a small furore about how the person hired to oversee the shift to private provision for Medicaid just left her job after eight months… to work for one of the private firms that’s likely to be bidding on the state contracts.
There’s a weird asymmetry between the desire of states to reject Medicaid expansion and hand over the exchanges to the federal government, but still come up with wheel-reinventing stuff that creates nasty little distinctions and arbitrage opportunities. All about the imprimatur at election time, I suppose. It’s also the American way to come up with inefficiencies on the macro and micro level for things like this.
Splitting Image
So the way the rollout is heading is that the blue states will generally have fairly efficient systems run by the Gubbermint, and the red states will generally have less efficient, more costly systems with more private involvement?
Surely there is a down side to this that I am not seeing.
Higgs Boson's Mate
Thank you, Mr. Mayhew! Your knowledgeable and comprehensible posts on health care are water in the desert.
Mr. Schitzengiggles
@fuckwit: Please cease and desist.
Bob's Had Enough
Where’s the political upside for the anti-Obamacare politicians in Arkansas?
They’ve avoided putting people on Medicaid, a non-Obama program.
Instead they’ve put people on Obama’s exchanges. They’re saying that Obamacare is better than Medicaid, enough better that they’re willing to pay extra to help out their poor.
They’ve locked the state into paying out money they didn’t have to. That will come up later.
(Yes, I realize this steers some Arkansas state taxpayer money to private insurance companies and I realize that will mean more campaign contributions and better padded post-government jobs for politicians.)
burnspbesq
@Bob’s Had Enough:
The idea, I think, is to maximize the number of people who have access to affordable care, and do it as quickly as possible. Short of outright bribery/extortion/fraud, I’m relatively indifferent as to how it happens.
mdblanche
@fuckwit: Gerrymandering is what makes it hard to uproot the crazy in the House and the states and doesn’t affect the Senate at all. If 2010 hadn’t ended in a zero we would probably have the House and maybe a few states flipped back now. But Citizens United didn’t just weaken the party, it weakened the party’s traditional money men. It’s the ideologues, the Kochs and the Adelsons, who have outbid the traditional Chamber of Commerce strand of plutocrats for control of today’s GOP. Unlimited corporate cash hasn’t bought a government working for the corporations, it’s bought a party working for a few rich cranks.
JoyfulA
Corbett filed two weeks ago, with that private insurance company Medicaid approach, complete with a “must be doing job search” provision. I bet he doesn’t hire anyone extra to process all the “I already have a crappy job” forms hundreds of thousands of people will have to fill out.
Before Corbett took office, Pennsylvania had a special insurance plan for low-paid working people. Corbett cut it out of the budget.
Suffern ACE
@fuckwit: Combo of both, really. You’ve got a lot of traditional voting republicans plus the fact that most Congressmen might as well be anonymous, even in their own districts. If you polled their constituents, how many would know whether or not their rep claimed to be a Koch voter, unless they were one of the high profile ones.
Yatsuno
@Suffern ACE: How many would care, so long as he had an R after his name?
? Martin
@burnspbesq:
If it works, even imperfectly, then it can be improved and some voters will be won over. There are countless such compromises in ACA – getting it working was mission #1. Getting it right can come later, because even imperfect it’s better than what we have now.
Villago Delenda Est
@Splitting Image:
Pretty much the exact opposite of Rethug/Loonytarian ideology.
The important thing here is to funnel health care dollars to parasites beholden to the politicians (and vice versa) who benefit from it.
Roger Moore
@sharl:
No hit at all on ACA, since the discussion is about regulatory approval of new drugs by the Canadian equivalent of the FDA. We’re still going to have FDA as our regulator, for good or for bad, so this has zero to do with what will happen after Obamacare comes into effect.
fuckwit
@Roger Moore: Also, the FDA takes fucking forever to approve a drug. Nobody can possibly be slower. Sheesh.
Yatsuno
@Roger Moore: It’s supposed to show the true ebil of socialised medicine. Or something. Though it has to do with how the drugs are regulated, but still, it’s ebil.
JoyfulA
@efgoldman: Yes, indeed. Here in Pennsyltucky, everyone despises him in newspaper comments, and an assortment of pollsters deem him the most likely governor to get voted out in 2014. Which will be historic, because since two terms were first allowed, several decades ago, no governor has failed to get reelected.
He’s been a truly awful governor, but much of what he’s hated for is what he did and didn’t do as attorney general, which didn’t see the light of day until he was governor.
fuckwit
@JoyfulA: That’s severely fucked up. Yeah, as you lay in your fucking hospital bed, your ass had better be doing a job search, or we’re cutting off your medical help.
I’ve said it for years, but I really think what these teabagging assholes want to do is just line us up against the wall and shoot us poor folks, contemptible untermenschen that we are, and be rid of us once and for all. One might even call it a final solution to the problem of poverty.
sharl
@Roger Moore: That’s a valid criticism; I did incorrectly conflate the drug availability issue with the opposition to ACA/Obamacare. I need to tread more carefully in this area, since it’s not an area of expertise for me (to put it mildly), and in all the loud back-and-forth I find that – for me at least – things often tend to blur together.
That’s why I’m grateful for the presence of Richard as a front-pager.
[I went to the TL of the tweep who posted that HuffPo-Can link, and in this case presumed a bit too much based on the wingnutty proclivities I found there.]
piratedan
@fuckwit: well that happens when side effects for taking a drug for three plus years are only discovered after taking the drug for three plus years… the FDA is in a thankless position and the happy people at Big Pharm abuse those folks much like Wall Street does the SEC. Not to mention that the FDA doesn’t just do Food and drugs, they also regulate all kinds of medical instruments and laboratory software.
fuckwit
One more thing. Just went to Yahoo to check mail, and they’re flogging on their front page some WSJ asshole saying that Obamacare is an unmitigated disaster, but it’ll take years to get rid of it as those “welfare state” programs are pernicious and hard to do away with.
Our American media has become nothing but lies and corporate propaganda. It’s become a joke. It’s as useless and meaningless as reading Pravda in 1986.
The Raven on the Hill
I have a bad feeling about this. Won’t the vouchers will be for bronze plans, with 40% coinsurance? But this is exactly the group that can’t pay coinsurance. Is this anything more than another way for insurance companies to make money off the poor and desperate? Tax money, no less.
Looks like a damn boondoggle to me.
TriassicSands
I guess you’re using the word “minimal” instead of the more accurate “zero.” If not, then I’d love to have you explain what value they provide.
@? Martin:
The problem with that approach is that as long as the GOP controls one of the three entities necessary to create and/or revise legislation, no improvements are possible. They have yet another good shot at taking control of the Senate in 2014, as, once again, the deck is stacked against the Democrats.
Sadly, the Democratic hope to maintain control depends to some extent on the Republicans nominating more bat shit crazy candidates who lack the necessary self-control to keep their craziest ideas to themselves. Unfortunately, Republicans like Cruz and Paul make it clear that even the most radical Republicans can win Senate seats. Cruz is just as insane as defeated GOP candidates, but he is either a little more careful about what he says or the Texas electorate simply doesn’t have enough Democrats (willing to vote) and independents to throw an election to a Democratic candidate. (That appears to be a real problem.)
I don’t know if the near future has ever looked murkier than it does now, but it’s hard to envision a chance to fix problems in the PPACA anytime soon. Even if the Democrats take back the House (very difficult) and hold the Senate (difficult), a Republican Senate minority can continue to use the filibuster to prevent positive legislation.
In the past, when major social legislation became law, there were both Democratic congressional majorities and Republican presidents willing to accept legislative improvements. Today, it’s may be the case that the only way to get PPACA fixes enacted would be with a Democratic majority in the House, a filibuster-proof Democratic majority in the Senate, and a Democratic president. The odds against all three being the case must be astronomical. Therefore, your plan for improving the PPACA may depend on its problems being tolerable enough to withstand many years of voter dissatisfaction. At my age, I may not be around to see that happen.
I agree with you that as it stands, Obamacare is vastly better than what we’ve had. If I hadn’t had so much experience being stunned by the ignorance and stupidity of millions of American voters, I’d have a difficult time understanding why that isn’t crystal clear to everyone with an IQ over 75. One huge impediment to acceptance of the PPACA seems to be that we have too many people who given the choice between having 45-50 million people without insurance and having to pay $2 more a month for coverage for themselves, they’d opt for the uninsured. We’ve gotten to the point in this country where giving up anything for the greater good is considered the death of freedom. And the Modern Republican Party beats that drum every minute of every day.
Bob h
@Baud: the more the Home Depots throw employees onto the exchanges, the more central they become, and the closer the day when the whole system is unified.
sparrow
@The Raven on the Hill: I think at it’s heart it IS a boondoggle, because of course it is, these are republicans we’re talking about.
But I believe the worst coinsurance rate is 30%. And plans will have maximum out-of-pocket amounts. So while it will absolutely suck, and may bankrupt a poor person (which is immoral, in my book, don’t get me wrong), they will still get treated and depending on the illness be able to pay it off. But the first part (able to be treated) is not something to overlook.
I mean if the option is “congratulations you have cancer” with no insurance, and no hope of getting treated beyond stabilizing care (basically a death sentence) versus “congratulations you have cancer” with a total out-of-pocket cap of $10,000, well I’ll take the latter, even if it does mean that I have to sell my car and furniture.
El Caganer
Corbett is a dick, the mid-Atlantic version of Rick Scott (a corrupt panderer to wingnuts). I hope he gets his ass kicked in the next election, no matter who’s running against him
Raven on the Hill
@sparrow: On a Bronze plan it’s 40% (really, the Bronze plans ought not be part of the system at all.) But Mr. Mayhew has more this morning, so let’s go parse that.