Republican governors face law of the land on Obamacare
Deciding whether to take part in health insurance exchanges confronts them with a difficult decision.
November 11, 2012 By CHRISTINE VESTAL/Stateline.org
Since the day it was enacted, many of the Affordable Care Act’s opponents have preferred to treat it as provisional. First, they argued, the Supreme Court might overturn the whole law. When that didn’t happen in June, opponents turned to the hope that maybe Mitt Romney would win the presidency and repeal it.
Now, there are no more maybes.
“With an Obama victory one has to come to terms that the Affordable Care Act is the law of the land,” says Henry Aaron, a senior fellow at the Brookings Institution. “Maybe it’s time to start living in reality rather than fantasy.”
Still, in the new reality, there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama’s victory.
The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn’t mean that Republican governors have to be full participants.
If they decline to be involved, however, they have to be willing to forgo billions of federal dollars while at the same time inviting more federal involvement in their state health policies.
At issue is whether states will be willing and able to run their own health insurance exchanges — the ACA’s envisioned online marketplaces where some 30 million Americans will be able to comparison shop for private insurance plans and apply for Medicaid and federal tax credits. If states choose not to run their own exchanges, the law requires the federal government to do it for them.
States must also decide whether they want to accept generous federal funding to expand their Medicaid programs to cover millions more people. In addition to the political liability that may represent for Republicans, the expansion also comes with a future price tag some states are taking very seriously.
States were expected to make the initial decision on establishing exchanges by Nov. 16, but the Obama administration announced Friday it was extending the deadline to Dec. 14. There is no deadline for states in considering whether to participate in the ACA’s expanded Medicaid program, but it is a decision many of them will want to make sooner rather than later. Choices made on both health exchanges and Medicaid expansion will have major effects on consumers and the entire health care industry, as well as state budgets, for years to come.
From here on out, states will be the primary drivers of the health law’s implementation. To achieve its intended goal of covering 30 million uninsured people with affordable health care, the Obama administration will have to engage in some give-and-take in order to ensure the cooperation of as many states as possible.
The federal health law originally required states to expand their Medicaid programs, starting in 2014, to people with incomes at or below 133 percent of the federal poverty level, about $31,000 for a family of four and $15,000 for an individual. That expansion by itself was expected to take in some 16 million uninsured people nationwide, about half of the population the law aimed to cover.
But this year’s Supreme Court decision, which largely upheld the law, made the Medicaid expansion optional for the states. That spawned a series of refusals to participate by GOP governors who opposed the law. Most Democratic governors are expected eventually to agree to implement the provision.
For states that take up the Medicaid option, the federal government will pay 100 percent of the costs for the first three years; after that states are responsible for up to 10 percent of the costs. Although the offer seems generous, some states genuinely worry that the increased expenses in the fourth year and beyond will strain their already costly Medicaid programs.
But the real decision will come early next year when state legislatures weigh in on the issue. In the meantime, many analysts expect the objections by GOP governors to fade away. Aaron, for example, maintains that the offer “is so hugely attractive to each state financially that refusal to expand coverage … (would be) an act of fiscal self-mutilation.”
Ezra Klein Slams Boehner for Pretending They Can Still Repeal
Published on Nov 24, 2012 by Buzz sourse
Ezra Klein took a shot at John Boehner and the Republicans for pretending that they can still repeal Obamacare through the congressional oversight process. As ridiculous as that assertion is, that doesn’t mean they’re not going to do their best to still attempt to chip away at it where possible, but at this point, pretending that they can use the oversight process to somehow repeal the law, is just ludicrous.
Can’t Afford Healthcare? Obamacare ‘On the Table’
Published on Nov 21, 2012 by TheYoungTurks
“After Mitt Romney lost on Election Day, it appeared that the health care law was here to stay. States are scrambling to meet federally-imposed deadlines to implement state exchanges and the administration announced coverage mandates. But House Speaker John Boehner signaled Tuesday that he is not giving up efforts to repeal the bill.
In an op-ed in the Cincinnati Enquirer, Boehner wrote that “we can’t afford” the Affordable Care act, and said, “That’s why I’ve been clear that the law has to stay on the table as both parties discuss ways to solve our nation’s massive debt challenge.”
Congress and the White House are involved in negotiations over the so-called “fiscal cliff.” Spending cuts are a major component of the talks as Republicans are pushing for less spending in lieu of raising taxes. Boehner has spoken in general terms about his priorities for deficit reduction; this op-ed signals that health care is another element he wants thrown in the pot.
The Congressional Budget Office, however, has estimated that the cost of the main component of the health care law, the health insurance exchanges, will lower the government’s share of health care costs because fewer people will be enrolled in the Medicaid program. Another CBO report says repealing the health care law would cost taxpayers $109 billion.”*
Steve Oh (COO of The Young Turks) and Jimmy Dore (The Jimmy Dore Show) break down Boehner’s claims that “we can’t afford healthcare.” Should Obamacare be on the table in fiscal cliff negotiations? Should it be decided upon state by state?
How the Health Care Law Benefits You
The Affordable Care Act forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.
All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings.
Health reform is already making a difference by:
- Increasing Access to Affordable Care
- Making Care More Affordable
- Strengthening Medicare
- Holding Insurance Companies Accountable
- Laying the Foundation for 2014
Millions of Americans have gained new access to more affordable health coverage and care.
- Coverage for young adults: 3.1 million young adults who were uninsured have gained coverage by being able to stay on their parent’s health plan, giving their families peace of mind.
- Access to free preventive services: 54 million additional Americans now receive coverage through their private health insurance plan for many preventive services without cost sharing such as copays or deductibles. That means that more Americans will receive wellness visits, cancer screenings and other services that will help them get and stay healthy. Women can now get coverage— without cost-sharing—of even more preventive services they need. Approximately 47 million women now have guaranteed access to additional preventive services without cost-sharing for policies renewing on or after August 1, 2012.
- Coverage for people with pre-existing conditions: 86,000 Americans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan. This temporary program makes health coverage available and more affordable for individuals who are uninsured and have been denied health insurance because of a pre-existing condition.
- Investing in primary care: The health care law invests in training and supporting thousands of new primary care doctors and nurses by providing bonus payments, scholarships and loan repayment, and new training opportunities.
- Community Health Centers: Community Health Centers improve the health of the nation and assure access to quality primary health care services at more than 8,500 service delivery sites around the country. Since the beginning of 2009, health centers have increased the total number of patients served on an annual basis by 3.1 million
“I think it [affordable healthcare] should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills–for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”