Monday, July 9, 2012

Perry Announces Texas Won't Comply with Obamacare Medicaid Expansion


ThinkProgress is up in arms over Texas Governor Rick Perry's announcement the state won't comply with the unfunded medicaid mandate that is part of Obamacare.
Perry’s announcement is an especially harmful move because Texas will benefit more from the Affordable Care Act than any other state...   After five years of the Affordable Care Act, Texas would be able to insure 1,798,314 more Americans under the Medicaid expansion alone – more than any state in the nation. 
Forget the fact that Obamacare's expansion of Medicaid would require the state to cover everyone whose income is 133% of the poverty line or less and doesn't reimburse states for those increased costs for long.  For the first two years the federal government would reimburse the states 100%, for the next three years that figure drops to 95%, after that states will be one their own.  

That leaves a huge unfunded burden on the states after just 5 years.  Needless to say, that's one very good reason not to enact the medicaid expansion mandate.  However, Texas has one even better reason.

According to ThinkProgress Texas would be able to extend coverage to 1.7 million more uninsured living in Texas.  According to 2004 data, there were 1.2 million illegal immigrants living in Texas, compromising 5.4 percent of the total population.  That number has only increased over the last 8 years, as of 2010 illegal immigrants made up 6.0 percent of the Texas population.  

By complying with the Obamacare Medicaid expansion, Texas would be required to use tax payer dollars to fund free medical care for illegal immigrants.


8 comments:

smoore123 said...

Interesting James. I guess we're just making shit up today?

Perhaps you could point me to the part of the Act that allows funds to be used to cover illegal immigrants under Medicaid. If you can't find it try looking for the part of the act that expressly prohibits states from using medicaid dollars to cover illegal immigrants. You should have an easier time finding this since it actually exists.

And the funding for the Medicaid expansion never drops below 90% even after five years. The Kaiser Family Foundation reports that "Texas could see an increase in enrollment of 46 percent but an increase in state spending of about 3 percent."

http://www.kff.org/healthreform/upload/medicaid-coverage-and-spending-in-health-reform-national-and-state-by-state-results-for-adults-at-or-below-133-fpl.pdf

theKansasCitian said...

According to the congressional research service:

"all U.S. citizens and Medicaid-eligible noncitizens with incomes at or below 133% of
FPL will be eligible for Medicaid, while similarly situated Medicaid-ineligible lawfully present
noncitizens will be eligible to participate in an exchange and possibly to receive the credits or
subsidies."

Further, illegal immigrants are only exempt from the coverage mandate, itself. They are still part of the 133%, but the federal government will not reimburse states for those costs:

"Aliens who are “lawfully present in the United States” are subject to the heath insurance mandate
and are eligible, if otherwise qualified, to participate in the high-risk pools and the exchanges, and
they are eligible for premium credits and cost-sharing subsidies. PPACA expressly exempts
unauthorized (illegal) aliens from the mandate to have health coverage and bars them from a
health insurance exchange. Unauthorized aliens are not eligible for the federal premium credits or
cost-sharing subsidies. Unauthorized aliens are also barred from participating in the temporary
high-risk pools."

The 90% figure you state is only for new enrollments during those years and does not count funds for those added in previous years. It also means there is a 10% unfunded cost to states that will come from other state services or higher taxes.

Coincidentally, at the same time the so called closing of the donut hole will be removed and seniors will be in the same problem they are now but with less coverage.

smoore123 said...

James, I think you need to read over your post again and then read my comment and your response. Words have meaning. You know that there is a difference between lawful noncitizens and illegal immigrants, right? There is generally nothing new or controversial about treatment of legal noncitizens in the ACA.

These statements that you make are demonstrably false:
"By complying with the Obamacare Medicaid expansion, Texas would be required to use tax payer dollars to fund free medical care for illegal immigrants."

Further, illegal immigrants are only exempt from the coverage mandate, itself. They are still part of the 133%, but the federal government will not reimburse states for those costs:


Go and read the Medicaid eligibility rules. Illegal immigrants are not eligible. I’m not completely sure on the details but I’ve seen it mentioned that states can use Medicaid dollars to reimburse hospitals for uncompensated care that arises from treating illegal immigrants in emergency rooms (since such treatment is required by law). Maybe this is what you’re talking about, but ERs have to take all comers. Aside from this, no, they are not part of the “133%”. What the hell are you talking about?

The 90% figure you state is only for new enrollments during those years and does not count funds for those added in previous years.

What the fuck does this even mean/have to do with the expansion? What do people that TX might have added under the existing program have to do with the ACA expansion. Your article was about the expansion. It’s right there in the title, “Perry Announces Texas Won't Comply with Obamacare Medicaid Expansion.”

Note too that you said states would be on their own after three years. Again this is not true. The expansion reimbursement would continue at somewhere above 90%. You didn’t respond to my quote from the Kaiser Family Foundation. 46% increase in coverage and a 3% overall increase in state spending. Are they full of shit?

Even if what you say is true then still what is your point? You mean covering uninsured people costs money? Get the fuck out.

Coincidentally, at the same time the so called closing of the donut hole will be removed and seniors will be in the same problem they are now but with less coverage.

I don’t think you understand what the closing of the donut hole means. How can closing the coverage gap leave them in the same place? That seems logically impossible. Perhaps I’m wrong so could you please direct me to something describing how closing the coverage gap in Medicare D is actually not a change at all or a reduction in coverage limits or whatever?

theKansasCitian said...

In 2020, the $250 rebate coverage that closes the donut hole is removed. So it is closed for about 5 years, then it is reopened. The claims it will be totally closed are based on Obama's cost projections which haven't even been close to being born out. From the doubling of the overall costs of Obamacare to the 7.4% increase in healthcare costs to individuals that Obama said would go down, not up.

Anonymous said...

What happens to an illegal if they show up at a hospital? Are they treated or turned away? Must they pay, or do they get to walk? If they are billed, what mechanism is in place to ensure they do pay?

smoore123 said...

Why is it so hard to stick to one line of reasoning and try to defend it, James? You keep spitting out ideas that pop into your head without addressing my refutations of your earlier points. This is like having a conversation with a creationist. Since you haven’t addressed my objections to the premise of your initial post then I have to assume that you concede that you were totally wrong about illegal immigrants being eligible for Medicaid. On to your latest brain spasm.


In 2020, the $250 rebate coverage that closes the donut hole is removed. So it is closed for about 5 years, then it is reopened.

Again, I don’t think you understand what is going on with the donut hole fix. The $250 rebate check is not what closes the hole. According to http://www.healthcare.gov/law/features/65-older/donut-hole-rebate/index.html, the rebate checks were only for 2010 anyway. So what closes the hole is the gradual increase in coverage for drug costs that would have hit the donut hole. This is phased in over 10 years. The phase in tables are too complex to post in a blog comment but go look at them and look at estimates of what seniors will save on average over the next 10 years. http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html

The claims it will be totally closed are based on Obama's cost projections which haven't even been close to being born out.

You understand that a cost projection is different than a drug benefit cost sharing schedule, right? One is an estimate based on current information and the other is a table of reimbursement rates written into law to phase in over time. These tables are actual numbers that reflect what seniors will pay out of pocket for drugs that cost within a certain range. The actual cost of the program to the government does not bare on the mechanics of how the hole is closed. Your statement here just doesn’t make any sense.


From the doubling of the overall costs of Obamacare to the 7.4% increase in healthcare costs to individuals that Obama said would go down, not up.

Interesting points. Again, I’d love it if you could substantiate these. When you say “costs” do you mean the net budgetary impact of the coverage provisions or do you mean the net budgetary impact of all provisions? That’s a big difference. Still, I don’t see how you get a doubling of anything. Look at the CBO estimates. Check out the last two graphs here. http://cbo.gov/publication/43104. Nothing is doubling, James. In fact, the CBO is estimating a lower cost of the coverage provisions now than they were in 2010 and 11 and the ACA is still estimated to reduce the deficit slightly over 10 years. What data sources do you have and why are they better than the CBO?

The 7.4% increase number you cite is an estimate of what the US as a whole would be spending on healthcare in 2014. It does not mean that individuals will see premiums rise by 7.4%. Again, I’m not surprised that extending health insurance to 30 million currently uninsured would cost money. Shit cost money.

theKansasCitian said...

Smore, I know what you think and what Democrats claim closes the hole, a combination of forced price reductions and forced medicare coverage. During the 5 year period the rebate is used to fill the hole while those adjustments take effect. But all those adjustments rely on projections made by the Obama administration that have been off on every single cost analysis they have performed. Why do you ignore that?

The 7.4% increase is the insurance costs to consumers. The budgetary costs have also gone way out of whack from what Obama projected, largely because they predicted lower health care costs than have occurred and used the 10 yr revenue projections to pay for 5 years of coverage.

As for your blind faith that illegals don't get medicaid, the facts just don't bear it out. From the Miami Herald:

A longtime federal fugitive who was an undocumented immigrant cost taxpayers more than $350,000 in healthcare at Miami-Dade hospitals before he died last year, a county investigative report has revealed.

The Miami-Dade Office of the Inspector General said the patient was a Colombian who fled the United States in 1983 after a cocaine smuggling conviction but returned under a false name. In 26 visits to the Jackson Health System from 2003 through 2010, his care cost $201,716 — $155,334 in charity care paid by Miami-Dade taxpayers and $46,382 paid by Medicaid, the state-federal program for the poor.

The man also ran up $163,734 in bills from other healthcare providers that were paid by Medicaid.

The OIG report identified the man only by his initials, citing federal patient privacy laws, but the U.S. Marshals Service said Friday that the man was Luis Hernando Franco-Pinilla, who used the alias Eliseo Delatorre Castro.

With Jackson struggling to overcome more than $400 million in losses the past three years and Florida legislators trying to reduce ever-increasing Medicaid costs, the case raises crucial questions about providing healthcare to people who are in the United States illegally and verifying patient identities. “Do we just let them suffer?” asked Alan Sager, a health policy expert at Boston University. “There are many issues here. If this individual had been apprehended, his care would have been paid for in prison.”

There are broader healthcare concerns, too, he said, such as stopping spread of contagious diseases and providing primary care so patients don’t end up in expensive hospital stays.

State Sen. Alan Hays, R-Umatilla, called this case “a horrible thing... You’re just scratching the surface of a very deep and enormous problem... a very vivid example of why persons like this should never have been in the United States in the first place. I am tired of our citizens having to support the healthcare of these kind of people.”

His double life didn’t unravel until shortly after he died at age 63 surrounded by family members in Jackson Memorial Hospital at 2 a.m. Dec. 10. Relatives asked Jackson staff members to change the name on his death certificate to facilitate shipping the body to Colombia for burial, according to the OIG report. Jackson refused, reporting the odd request and starting the investigation.

The inspector general’s office learned that Franco-Pinilla had been arrested in December 1982 by federal agents, who charged him with conspiracy to smuggle cocaine and possession with intent to sell. He was convicted. Before sentencing, he fled the United States, the report said.

In October 1996, he was arrested by the U.S. Border Patrol for trying to enter the country illegally. He pleaded guilty and was deported, the report said, noting it wasn’t clear whether the agency knew he was a fugitive on the drug charges.

In May 2000, he reentered the U.S. with a passport and visa in the name of his alias. For seven years, he was treated in local facilities. In June 2010, the staff at Palmetto General Hospital told him he had cancer, the report said. On Nov. 29, he entered Palmetto, then was transferred to Jackson Memorial, where he died.

Ajay Jain said...

Hello Friends,

Governor Rick Perry millions of under-privileged poor Texans who do not have any Health Coverage will be covered under The Affordable Care ACT (ACA) expansion of MEDICAID!

My Physician wife's practice is partly dependent on MEDICAID and its viability. Please allow the expansion of MEDICAID to occur in Texas under The Affordable Care ACT.

[b] FACT: If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA. [/b]

That's why I created a petition to Governor Rick Perry, Texas Governor, The Texas State House, The Texas State Senate, and Governor Rick Perry, which says:

"Please ACCEPT the FREE EXPANSION of MEDICAID under The Affordable Care ACT."

Will you sign this petition? Click here:
http://signon.org/sign/accept-free-expansion?source=c.em.cp&r_by=7268737

Thanks!

Ajay Jain
ajain31@gmail.com
Twitter Handle ajain31
Mobile: 214-207-9781