The North Carolina state House Republicans have introduced a bill to expand Medicaid in the state. It is an interesting bill that models a committment to draft a waiver that will include work requirements. I wonder if there is a deal to get a one year traditional expansion in quickly that the governor wants and then a waiver based expansion that the House Republicans want.
Here are the highlights of the bill:
- To be done in conjunction with previous waiver application to move towards Medicaid Managed Care
- Severable if the federal match ever drops below 90%
- Premium payments totaling 2% of income for those making more than 50% Federal Poverty Level (FPL) with program lock-out for non-payment
- HSA/HIA based like Indiana HIP 2.0
- Work requirements
- State portion to be funded by a hospital assessment
The key questions in evaluating any proposal is what is the counterfactual? My counterfactual is “no expansion”. Other advocates’ counterfactuals are stringless expansions. These two very different counterfactual assumptions lead to very different analysis.
Within my counterfactual, there is a significant improvement in the medical care available to the people who are currently uncovered and who would be eligible for Medicaid via an expansion. The one area that I would want to have a major fight on is the payment of premiums for people making less than 100% FPL.
We have good evidence that administrative hassle is not a revenue driver. It is an enrollment limiter. The administrative cost to collect $9 a month, notify people that their payment is past due and then collect payments in arrears eats up almost the entire cost of the $9. Instead it knocks people out of the program. It won’t knock persistently high cost people out of the program as they will either make sure they pay, or their providers (doctors and hospitals) will pay for them make sure that they get paid. It knocks out a disproportionate number of low cost individuals so the total cost to the state will very slowly decrease even as the per member per month costs increase.
Everything else in the proposal can be made to work. The bill calls for a draft waiver by January 1, 2018. This probably means Medicaid Expansion in North Carolina would either be an October 1, 2018 or January 1, 2019 start.
satby
Better than nothing, in other words.
rikyrah
@satby:
Why must we be ok with better than nothing?
AnderJ
@rikyrah: No-one must be ok with better than nothing, although the alternative may be just nothing. Nonetheless one can push NC Republicans for a better proposal…
MomSense
These work requirements really piss me off. It’s like they have created these biases about people on Medicaid being lazy, just need to get a job, etc. and then craft policy to fit their biases.
The Republicans attached work or volunteer requirements to food assistance in Maine and then were shocked, shocked when there were news stories profiling poor people who lost their food assistance because they had to decide between using gas to get to a volunteer gig so they could receive help with food or using that gas to get to a job interview and going without food.
The problem is that the Republicans sell their sociopathic policies of denying people food and health care with all of these made up assumptions about the people who receive these benefits. They either succeed in denying people their basic needs or they waste a ton of money and create really bad policy that makes good programs worse.
Chris
I have had multiple conversations with my friends (I’m from NC) explaining to them why our insurance on the exchange is so expensive. (51 y.o. male…860/month for a high end silver) I keep trying to tell them that the medicaid expansion would improve our risk pool..and HOPEFULLY lower our premiums. But nooooooooo Obamacare bad!!! Even my PCP (who being in the 1% and a Talabangelical, naturally dont like paying) doesnt support O-care at all. I wonder..doesnt he get paid better now that more people have insurance? Hate is a terrible blinding thing….Cleeks law all the way down….
satby
@rikyrah: we shouldn’t. It’s a pathetic bill, but it will marginally get a few more people the help they need. So, better than nothing, but not by much. IF it even passes, no sure bet in a Republican controlled legislature.
rikyrah
@MomSense:
You keep on telling the truth!!!
satby
@Chris: the doctor I work for isn’t a provider under Indiana’s HIP yet, and the women I worked with yesterday were both saying they’ll quit when she does become a provider. Ironically, one was on HIP for medical insurance until her husband got insurance through his job. So she doesn’t want to service people like her own family.
Fucking floors me, the knee-jerk reactions.
rikyrah
@MomSense:
And, the most $$$$ in Medicaid don’t go to the stereotype that the GOP has created for themselves.
Dolly Llama
@rikyrah: See David’s “counterfactual” above. I live in North Carolina. Let’s get this in and then see where the chips fall a year or two from now. As time goes by, I believe our position becomes stronger, and we can change it to everyone’s benefit. It follows the history of every other major social program — Medicare, Medicaid, SS — and continues on until this day.
gene108
@MomSense:
I think it has gone beyond biases and beliefs. To right-wingers, it has become a fact that you must work or starve.
I remember a few years ago a Bible passage that became popular among right-wingers that boiled down to “those, who do not work, do not eat”.
Like abortion and homosexuality, their views on this have transcended mere opinion and become stone cold facts that they must impose on everyone else.
OzarkHillbilly
@gene108:
2 Thessalonians 3:10King James Version (KJV)
For even when we were with you, this we commanded you, that if any would not work, neither should he eat.
Russ
Everybody want health insurance/ healthcare. Nobody wants to pay what it actually costs. At least out of pocket monthly. Do you think there is a reason every other country on the planet that has healthcare taxes for it.
TKinNC
In NC, we did not expand Medicaid – at all – so the working poor fall into John Roberts’ Medicaid Gap. This will address the gap somewhat and may allow working poor with chronic medical conditions to survive until we can oust the Rs. The bill is sponsored by Rs so may stand a chance.
(I knew someone that died of diabetes complications because he didn’t make enough to get a subsidy. The ER does not manage chronic conditions well.)
Ridnik Chrome
@MomSense:
Exactly. They have no clue what the day-to-day life of a poor person is like. And they don’t want to know, either.
EBT
@rikyrah: Because no one engages in rooftop voting these days.
Debbie1
@rikyrah: Why? Well, because Republicans control many state legislatures, they are actively deciding between Trump are/Don’tCare and an imperfect Obamacare expansion (I’ll take the latter, thanks), most importantly some are dying from lack of medical care & can’t wait for a more perfect option.
Mike in NC
Good luck on passing Medicaid expansion in a state controlled by a gang of radical GOP Tea Party extremists.
patrick II
Isn’t expanded medicaid for those between 100% and 138% of the poverty line? Aren’t those people already mostly working? I thought expanded medicaid was for the working poor who could not afford even Obamacare’s supported premiums. Also, I thought it was Obama’s sneaky way to expand medicaid since the loudest objections were against Obamacare.
prob50
@gene108:
Oh, yeah, I remember that one, Jesus said it right before he went around confiscating those loaves of bread and fishes from those he deemed lazy slackards. He did, however, relent for an malnourished urchin who washed J-man’s feet – but he took back 1/2 the stale bread slice ’cause the kid did a shitty job.
Yeah, read it in the Bible, I’m certain of it.
ArchTeryx
For me (as it was with Obama) the work requirement would be an absolute deal-breaker, and not just because it’s my ox that would get gored.
It basically sets up the literal situation, “Work until you drop, then get medical care pulled to make sure you die right after.” It’s the key reason why Medicaid did not have a work requirement in the first place, and why Obama’s HHS refused all waiver requests that had work requirements attached to it.
Of course, Tom Price’s HHS will grant the waiver with work requirements. That just makes NC a ‘soft’ refusenik state instead of a ‘hard’ one, but it remains every bit a refusenik state.
TKinNC
@patrick II: NC’s medicaid is particularly cruel. It only covers children, pregnant women and disabled folks. So adult males – unless disabled – do not get medicaid ever. Or that’s how it was when I was learning about the gap to try to help explain the ACA back in 2012.
Expanded medicaid would cover anyone making under 100% FPL. 100-138% get subsidies on the exchange now along with those making up to 400% FPL IIRC.
John Roberts sucks. And he has blood on his lovely smooth hands.
Bob Hertz
When it comes to Medicaid in deep red states, the secret principle is this:
We will do nothing to make poor and minority people more comfortable in our state. Our goal is force them to move away, perhaps to the northern welfare states. This will reduce our own taxes and and our own crime rate, so that we can attract wealthier retirees from those same northern states.