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March 12, 2013 10:17 AM GOP’s Health Reform Plan B in Action?

By Ed Kilgore

When the U.S. Department of Health and Human Services gave Arkansas the green light for a deal that would allow for expanded “Medicaid coverage” via enrollment of the uninsured in private insurance plans created by Obamacare’s health exchanges, I wondered if this might reflect a sort of Plan B for conservative health policy. It is certainly consistent with the much-discussed strategy recently laid out by Douglas Holtz-Eakin and Avik Roy, in which minimization of the “public” elements of Obamacare was step one.

To be a bit more cynical about it, this approach gives Republicans at the state level the best of both worlds: a rejection of the original Medicaid expansion scheme but then also vast federal subsidies that will benefit not just hospitals and other health care providers but private health insurers as well. Again, there’s nothing new and dramatic about Medicaid beneficiaries being enrolled in private health plans (an estimated 70% nationally already are), but it seems some GOPers are actually using the ACA-sanctioned “Medicaid expansion” to kill off traditional Medicaid almost entirely.

In any event, Arkansas’ plan (a compromise between Republican legislators who wanted to reject the expansion entirely and a Democratic governor who wanted to accept it) was approved; Ohio is seeking a similar arrangement; and now that may be where Florida is headed as well, per action by a state Senate committee rejecting Gov. Rick Scott’s proposal to just go along with the original Medicaid expansion for a limited time.

If an Arkansas-style privatized-Medicaid plan is what ultimately emerges in Florida, it’s a lot better than the status quo. But some of the cheerleading we hear for the irresistible progress of the Medicaid expansion should probably be muted just a bit.

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  • bleh on March 12, 2013 10:31 AM:

    This sounds to me like "Medicaid Advantage," and one can't help but expect a similar outcome -- a cost to taxpayers that is doube-digit-percentage more expensive thanks to the presence of profit-taking middlemen (among whom one also notes the presence of many Southern Republican politicians, including Rick Scott).

    Republicans: always looking for government handouts to established businesses and wealthy individuals.

  • audax minor on March 12, 2013 10:32 AM:

    I can see why the administration might be willing to go along with the Arkansas proposal: you have a Democratic governor trying to do the right thing by his state's medically underserved who presumably judges this to be the best he can hope to get through his Republican legislature. I see no reason to give Ohio (whose Tea Party governor I thought had already signed on to Medicare expansion without any special provisions) another bite of the apple and even less reason to help Florida's right wing legislature out of the politically disastrous corner it has painted itself into.
    Even the Arkansas arrangement, which will cost a couple of thousand bucks extra for each insured person, is not really sustainable fiscally in the long run. Unnecessary spending at other states with even less political justification is simply ridiculous in an age when we are taking the meat cleaver to other vital social services in the name of austerity forever.

  • c u n d gulag on March 12, 2013 10:35 AM:

    I live in NY State, and I'm on Medicaid - through MVP.

    And let me tell you, is it better than having NO insurance at all?
    Hell YES!

    Is it the coverage good?
    Hell NO!!!

    They wouldn't approve a brace for my ankle, that might alleviate the horrible pain I have when I walk, because it costs over $4,500.
    And without one, I have a great deal of difficulty getting around.

    In pretty much any other civilized country in the world, I'd either be given a brace, or an operation.

    But not here in the Good Ol' USofA!
    Because LiberTEA!
    FreeDUMB!
    And, most important of all, PROFITS!!!

    No, here we have to let private corporations skim government (OUR) tax money, instead of having Single-Payer - aka: Medicare for all.

    This is just as stupid as as what we did with college loans, allowing banks to skim tax money on them. Oh, and no forgiveness for your college loan debts - so, deal with it!

    One of these days, our whole feckin' eejit health care system will collapse, and we'll have Medicare for all.

    Sadly, me, my bad ankle, and painful hip and back, will be long dead by then.

    As Churchill once said:
    "America always does the right thing!
    After eliminating all of the other possibilies..."

  • Peter C on March 12, 2013 10:45 AM:

    If we regain the House in 2014, we need to push for the inclusion of Medicare-for-all (an un-age-restricted buy-in to Medicare) in the state exchanges. If Republicans want to do away with Medicaid and throw the poor to the exchanges, we need a public option to provide everyone an affordable comprehensive solution. With the medicaid populations of Arkansas, Ohio and Florida, there will be enough economies of scale to make a public option viable.

    We Liberals were told to be patient about the public option when the ACA came out without one. We were told that the exchanges would facilitate it. Most red states have ceded their ability to construct exchanges back to the Federal Government. We'll have the power to construct the exchanges so that they can facilitate the inclusion of a public option.

    If the Republicans want to kill off Medicaid, I want to expand Medicare into a public option. I'm pretty confident that without insurance company profit and with sufficient buying power, Medicare can hold its own in competition with commercial health insurance plans.

    So, let's gain control in 2014 and institute a public option which can grow into the single-payer solution that we really need as a nation.

  • paul on March 12, 2013 10:47 AM:

    The only bright light in this is that (presumably) the insurance companies will be held to the same 80% of premiums going to payouts as in other parts of the ACA system. So maybe twice the administrative cost and half the bargaining power.

  • golack on March 12, 2013 10:49 AM:

    hmmm.... hard ball negotiations with drug companies, device manufacturers, hospitals, doctors....or donate to your local representative for "favorable business conditions"...

    spend resources to help the sick get well, deal with family members of the patient, help patients get the best treatment possible for themselves...or dump the sick ones on someone else....

    take time to set up an efficient organization so claims get approved, bills are paid quickly, decisions are made in a timely manner (with a transparent appeals process)....or hold on to all the money a long as possible and delay and deny, deny, deny....

  • gdb on March 12, 2013 10:50 AM:

    Actually what you are seeing is a constant chipping away at Obamacare... which is more insurance reform than health care reform (and most of it hard to understand). Dems will continue to lose until they recognize that Repubs are an inteactable right-wing opposition that needs strong ideological opposition-- and BHO is a very bright political fool in this and other matters. The sooner a Progressive steps forward to challenge BHO policies from the center (there IS no viable left), the better the Dems and the country will be.

  • cmdicely on March 12, 2013 11:04 AM:

    but it seems some GOPers are actually using the ACA-sanctioned "Medicaid expansion" to kill off traditional Medicaid almost entirely.

    Neither "GOPers" nor "Medicaid expansion" have much to do with it: the transition from the direct benefit model to the capitated-payment managed care model for Medicaid is going on at a fairly rapid pace everywhere, including California, where Democrats control the legislature and the executive, and the trend was strong across the nation even before the ACA was passed, much less before the recent moves toward implementation.

    Using the ACA's benefit exchanges may actually be better for beneficiaries than the common managed-care Medicaid trend, in that the exchanges may actually provide choice among plans, where the general move in Medicaid is to single (or multiple-but-geographically-allocated) managed care plans with no beneficiary choice.

  • LaFollette Progressive on March 12, 2013 12:02 PM:

    Yeah, this is definitely a better arrangement in terms of coverage than the status quo, but for the broader objectives of reducing health care costs to a sustainable level for the long term, it's a disaster.

    What we're seeing here is a perfect crystallization of what the conservative movement has always been about, and what the Tea Party Movement takes to ridiculous extremes: a bunch of sound and fury about how horrible big government is, which is used disingenuously to advance the cause of expanding wasteful big government spending that goes directly to big corporations and wealthy, well-connected individuals.

    We see it in the increased use of contractors, especially the use of mercenaries by the DoD. We see it in the Ag bill. We saw it in Medicare Advantage and the middlemen in subsidized student loans. And now the privatization of Medicaid services. All of which INCREASE the cost to taxpayers, by giving a cut to Republican donors. It's corruption, pure and simple, and the unwillingness of the media to call this out is inexcusable.

    Hell, Florida elected the worst Medicare fraudster in history to be their governor. And he, in turn, is now trying to generate the biggest Medicaid fraud in history, right out in the open. All in the name of "less government". Boggles the mind.

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