Right now, it looks like the signature drive to get Medicaid Expansion on the Oklahoma ballot will collect more than enough valid signatures:
In Red State Oklahoma, Medicaid Expansion Nears 2020 Ballot via @forbes https://t.co/PvkXzP0VXw #ACA
— Bruce Japsen (@brucejapsen) October 24, 2019
This is first step for the expansion effort. The second step is to win the vote. The third step is to win the implementation.
That third step is tricky. Three states’ voters west of the Mississippi River passed Medicaid Expansion in the November 2018 general election.
Utah has engaged in a complex series of expansion waiver efforts. The state government started with a proposed partial expansion to only 100% Federal Poverty Line. The Center for Medicare and Medicaid Services (CMS) rebuffed that waiver. Now Utah has a roll-out of full expansion but with significant work requirements and benefit clawbacks via waiver.
Idaho has submitted a number of waivers. They will not be getting a straight up expansion via state plan amendment that the voters approved.
Nebraska has taken their time. The first enrollment in the Medicaid Expansion approved in November 2018 won’t happen until October 1, 2020. Nebraska will also have a complex system of benefits, reporting requirements and paperwork friction:
Just read NE Medicaid waiver in full – its so complex! I count about 10 different kinds of rules that a Medicaid beneficiary must comply with to get the "Prime" benefits package.
Lots of people won't bcuz its so confusing and then will lose their dental/vision benefit. Ouch https://t.co/3htUEJeCAb
— Joan Alker (@JoanAlker1) October 27, 2019
Winning a spot on the ballot is a necessary but grossly insufficient step to implementing Medicaid Expansion when state elites are strongly dis-interested in that policy choice.
On The Road: Finishing Up
rikyrah
Yes?????
Mike S (Now with a Democratic Congressperson!)
Is there any simple way to state in an expansion ballot initiative something like “Do the whole enchilada!” and no a la carte picking and choosing?
BC in Illinois
There is a Missouri drive to put Medicaid Expansion on our 2020 ballot.
I was at a fund-raiser on Saturday for our local Missouri State Rep. (We raise funds for her, so she can share them with candidates who need it. She’ll be unopposed, whether there is another name on the ballot or not.) The talk — including other State Reps and former Reps in attendance — went to Medicaid expansion.
“We told them, that if we didn’t have Medicaid expansion, then rural hospitals would close. They denied that would happen.”
* [” At least nine rural hospitals have closed in Missouri since 2014. “] *
“But now that the hospitals and ERs are closing, what do they say? Are the voters connecting the dots?”
“Well, we’re trying to connect the dots for them . . .”
Ohio Mom
This is off-topic. As I might have mentioned earlier, Medicare awaits me next year, and I am beginning to map out what my options will be.
My first impression (not very original) is, “Boy, is this complicated!” Now I know that the original Medicare program evolved over the years, mainly by adding Parts.
And I have experience with SSI on Ohio Son’s behalf so dealing with a government program’s arcane rules is not new to me.
Looking at Medicare for me is one of those things you think you know about until you have a personal experience and then YOU KNOW on a deeper level.
Anyway, as a sideline to my research efforts, I’ve started asking friends and relatives who are slightly older than I am how they went about choosing their Medicare plan. Some of the answers I’ve gotten so far are:
“Choose whatever plan is most dominant in your area.” This is from someone who lives in a small, isolated city, and I see the logic, he wants to have as much of a choice of doctors as he can get.
“I just went with what my parents had” (They were still alive when she came of age). “But then I needed to see a doctor when I was visiting my sister out of town and it wasn’t covered.”
“It comes from (the college I recently retired from). But I can’t figure out how to get reimbursed for everything.”
These are all people with advanced degrees!
Anyway, this got me thinking. I’d been wondering why during all of the changes to Medicare over the years, there hadn’t been any effort toward streamlining it. Now I think I know (adjusts aluminum hat): Breakage.
Just as merchants make money off of gift cards that aren’t used for one reason or another, the health insurance industry must be making out like bandits on people who are overpaying for Medicare plans they didn’t choose wisely enough, and don’t completely know how to utilize.
Even as I type this, I am sure there are actuaries busy calculating how much another small, inexplicable, incomprehensible change in one part of their company’s offerings will yield in profits due to the ensuing “user error.”
David Anderson
@Ohio Mom: to some degree yep, you’re right.
Sure Lurkalot
@Ohio Mom: I’m in the same boat. I’ve done a lot of reading and some pricing, polled friends, but also arranged a phone meeting with my state’s SHIP agency, so I can ask more specific questions about the services in my area. The call is Friday and I hope it helps me finalize my decisions. Good luck to you too.
Elizabelle
@Ohio Mom: That’s a great comment, Think that is very much what is going on. Overpaying and underinsured.
rikyrah
@Ohio Mom:
I have heard the same Medicare saga from others. I think that you are on point.
Good luck ?
Roger Moore
@Mike S (Now with a Democratic Congressperson!):
That’s going to vary a lot from state to state depending on the way the state constitution treats ballot initiatives. Here in California, for instance, we have very strong protections for ballot initiatives: they can write state laws directly, and once the law has been written by the ballot initiative the state legislature can’t change it*. Most states don’t have such strong protections, so their state legislatures can mess up ballot initiatives they don’t like. And, of course, not all states even allow ballot initiatives, or only allow initiatives to change the state constitution rather than statute law.
*This naturally has big drawbacks in the long term. Our state law is a mishmash of legislature- and ballot-written laws, and when a ballot initiative screws up and writes bad law (or the law is simply outdated) the legislature can only fix it by putting another issue on the ballot.
Ohio Mom
@Sure Lurkalot: Yeah, I have my local Council on Aging on my to-do list. I still have enough time left that I am at a leisurely pace.
@David Anderson: Do we (our side, not the insurance industry) have any numbers, or just educated guesses?
Kelly
@Ohio Mom: I’ll be there in 2021. Our Obamacare Kaiser has been OK the last two years so I may stay there. Medigap plans without network limits are attractive. My wife will be in an Obamacare plan until 2025 so we’re gonna be working around a network for a while.
How many people really want this vast range of choices?
Ohio Mom
@Kelly: It has to get a lot worse the older you get. At this point my 88 y.o. MIL needs help ordering her groceries online. She couldn’t begin to wade through the Medicare paperwork, I guess she pays her attorney or an accountant to do that. Which is an expen$e just by itself.
Kelly
I recently read stories where when the older spouse shifted to Medicare midyear the insurance company dropped the younger spouse because the older spouse was the primary name on the policy. Not supposed to happen and can be straightened out once you catch it. We’re put my wife’s name as the primary this year to reduce the odds of a snafu.
Duane
@BC in Illinois: Glad to hear about the Medicaid expansion initiative. Our current system is an absolute disaster. 120K dropped from coverage in the past year. Unnecessarily cruel by republican design. Gov. Parson recently formed a health care commission. Can’t wait to see them dance around expansion.
I'll be Frank
Maybe it will work out like OK med weed.
Fair Economist
The sad part is voters who vote for sensible ballot initiatives like Medicaid expansion or repealing right-to-work-for-less laws, and in the same election vote for Republicans. Even now, a substantial minority has not yet understood that Republican officials are all about screwing them over.
Duane
@Fair Economist: Never could figure why anyone but the rich would vote republican. Now I’ve accepted many people are stupid and evil. Sparrow, curtain rod, hurt the others etc… Sad but true.
burnspbesq
It would seem that the same population that could come up with enough votes to win a referendum on Medicaid expansion could also come up with enough votes to remove governors and legislators who defy the public will by neutering the expansion. Wouldn’t it?
J R in WV
How can we tell that Republicans do NOT believe in Democracy?
Simple: When Democracy happens and a ballot referendum is passed, the Republicans often do more than legally allowed to interfere with that ballot referendum’s results require the state government to do.
We don’t have referendum and recall elections here in WV, our government is pretty clear about who democracy works for — big bidness, and the wealthy land owners, the rest of us need to shut up and stand back in the dimly lit corners of the statehouse.