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NationofChange / Op-Ed
Published: Friday 6 July 2012
Conservative governors have latched onto the ruling that states won’t lose their existing Medicaid funding if they don't expand their Medicaid coverage as envisioned by the Affordable Care Act.
Health Care Politics Go into Extra Innings
There was never much doubt that the individual mandate in "Obamacare" was constitutional. As Harvard Law School professor Einer Elhauge had noted, the first Congress in 1790 passed a law ordering ship owners to buy medical insurance for their seamen. Twenty framers of the U.S. Constitution were members, and President George Washington signed the law.
No, the emotional claim that forcing people to buy a commercial product stomps on basic American rights was a cover for a political campaign to kill the reforms. The Supreme Court removed that fig leaf last week, but the naked politicking goes on.
The next showdown on the program is less dignified. Conservative governors have latched onto the ruling that states won't lose their existing Medicaid funding if they don't expand their Medicaid coverage as envisioned by the Affordable Care Act. Thus, they won't.
In South Carolina, Gov. Nikki Haley's spokesman defiantly announced, "We're not going to shove more South Carolinians into a broken system ... ." Gosh, wouldn't bringing coverage to the uninsured make the system less broken? More to the point, exactly who would be "shoved"?
Contrary to right-wing mythology, America's uninsured are not the idle poor. They already have government-guaranteed health care, as do the elderly, the disabled, government workers and prisoners. Left out are the modest folk who earn too much to qualify under the old Medicaid rules but not enough to afford insurance in the private market (and, by the way, who subsidize others' coverage). The Medicaid expansion is for them.
Nebraska's Republican Gov. Dave Heineman also opposes letting more struggling workers into Medicaid: "As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased."
An interesting threat, except for one thing.
Medicaid expansion is funded, certainly by any normal definition. The federal government assumes all the costs in the early years, then 90 percent after that. Furthermore, continuing to drive the uninsured to expensive emergency rooms for routine care is itself a major cost.
Speaking of affordability, the reforms make health care more affordable for government, as well as for families. The Congressional Budget Office projects that the Affordable Care Act will actually cut federal deficits. Here's how:
While the federal government will be spending billions to make insurance obtainable to those without, it will save more than that through other parts of the law that curb costs and add revenues, an estimated $525 billion.
For example, as Medicare now stands, the program must pay for almost any treatment that works, regardless of whether the same could be done for much less. The law prepares government (and private insurers) for more careful spending by funding research to identify $10,000 treatments that do just as fine a job as the $40,000 variety.
Obamacare is also bottom-line good for business and the American economy. It extends tax credits to small companies that cover their workers. (Those that don't are not penalized.) Would-be entrepreneurs will be able to leave their corporate jobs, thanks to reasonably priced family coverage. And everyone who pays for insurance will enjoy the slowdown in spiraling health care costs.
But why let the facts dampen tea party passions? "We can't afford it," insists New Hampshire state Rep. Andrew Manuse, now working with other Republicans to reject the millions the feds are offering for Medicaid expansion. "Thank God the Supreme Court gave us an option."
Yes, the Supreme Court gave states an option — the option to be both foolish and cruel at the same time. Go ahead and stay behind. Everyone else is moving forward.
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ABOUT Froma Harrop
Froma Harrop’s nationally syndicated column appears in over 150 newspapers, including The Dallas Morning News, Houston Chronicle, Seattle Times, Denver Post and Newsday. The twice-a-week column is distributed by Creators Syndicate, in Los Angeles.
Harrop has written for numerous other publications, ranging from The New York Times and Institutional Investor, to Harper’s Bazaar and Metropolitan Home. Previously, she covered business for Reuters Ltd., in New York, and was a financial editor for The New York Times News Service.
A Loeb Award finalist for economic commentary, Harrop was also honored by the National Society of Newspaper Columnists. Over the years, the New England Associated Press News Executives Association has named her for five awards.
10 comments on "Health Care Politics Go into Extra Innings"
December 28, 2012 11:56pm
After winning the presidential race American president Obama passes a number of health care policies are reforms through health organizations are liable to provides a number of beneficial way in which a common man get proper compensation and facilities in health care issues. Under Obamacare act we found several health related policies and facilities that assured us for a healthy lifestyle.
http://urgentcarenow.com/directory/va/arlington
July 07, 2012 2:09pm
12 of the 30 million are illegals when they come in for h c stabilize and ship home bho tax cuts [ bush cuts end long ago] will end 01/01/13 another tax rise is soc sec reduction ends another rise is obamacare while doing away with soc cap is a feel good item it will do nothing for medicare and little for for monthly pay
July 07, 2012 5:08pm
OMG, not "illegals!" Go ask an oldhat apache how "legal" your arse is!
July 07, 2012 4:07pm
"There was never much doubt that the individual mandate in "Obamacare" was constitutional. As Harvard Law School professor Einer Elhauge had noted, the first Congress in 1790 passed a law ordering ship owners to buy medical insurance for their seamen. Twenty framers of the U.S. Constitution were members, and President George Washington signed the law."
Not so fast.
There is a clear difference between regulating business, "ordering ship owners to buy medical insurance for their seamen," and mandating private citizens to consume or purchase a product that they may or may not require, need, or have reasonable use for.
And it is a mistake to pass so quickly -- as if completely irrelevant or unnecessary -- over the part where "legislators," regardless of their contributions as "framers" of the Constitution or as generals, or even President, without addressing whether that law was Constitutional.
And even if it was Constitutional -- it is not my argument that it was not -- the two points are: The two legislative acts, while both regarding mandated insurance purchases, are not equivalent or analogous. And second, legislative acts -- even if by some founding members -- are not necessarily Constitutional.
Also, I am surprised that nobody appears to have considered whether "individual mandates" to purchase a product from a private corporation is a First Amendment violation.
Money is a form of speech. And some purchases -- or the act of declining -- are statements.
And while corporations are not people, and just as there are certain limitations on speech, there should be limitations upon corrupting corporate influences -- financial limitations -- on campaign spending.
The slap-happy (so-called) leftists would be better served to apply actual principles to thinking, rather than abdication of it for rationalized, comparative celebrations, and take a good, long look at consequences of this "victory."
Justice Roberts' majority decision is chocked with potentially consequential language that will undermine environmental, food-safety issues, and other progressive causes that are held up by the Commerce Clause.
I realize that there is so little to celebrate for progressives that any (actual) victory should be savored. But given that the the insurance industry has just been codified into law, the fact that "insurance" is not "health care" -- it is a mandated, privatized, middle-man bureaucracy that EVEN WITH INSURANCE results in financial hardship and poor health care -- the (real) fight is virtually the same, for health care.
Not everyone is moving on. Those for whom this is business as usual, sure.
But these many who have been wrong on agenda, wrong on strategy, and wrong on virtually every aspect of the political fight, those who, while ignoring, dismissing, or are completely oblivious to consequential effects of the ACA and the subsequent Supreme Court ruling, and those who have profited from their opinions (and their parrots) that perpetuate a failed insurance and political system -- the worst of whom are on the Democratic side (because they should know better and it is they who are truly responsible for holding the line and pursuing progressive principles) -- continue down the road of spouting frivolous and short-sighted rhetoric and regressing the fight to a battle of like minds but diminished ends.
July 07, 2012 5:04pm
Crazy cruel, inhuman and foolish talk....parrot or no you sound more animal than human...money = speech if your a tyrannical fruit loop. speech = speech and money - money. foolish. cruel.
This money (econmics) over simple human compassion for sick and poor people from folks who claim to be human and not ATM's/slot machines (stick money in us and see if your slaves payoff) sickens our country more than bio-disease. If we can't afford to lessens some people's medical problems above board, thus keep a sick inhuman system, then what's the point of economics. sounds a lot like free market capitalist totalitarianism and not a country of brave men and women.
there is not a wit of difference between the first continental congress and washington's idealism- provide people/families w a future if some form of catastrophe happens. it's called humane, people are treated worse than plant/equipment in this coutry and we are beibg forced into revolt because of this insidious propaganda from prominently white elite tyrants.
where is this outrage for the financiers who made your econmy sick/dead...full economic health care for them. fool. cruel.
this type of rhetoric further proves (80% polls for simple single payer health) this is a totalitarian capitalism.
btw, this not 'obamacare' it is called the Affordable Care Act, get it straight and quit being a wingnut, Congress is RESPONSIBLE for ALL legislation...so call your congressman if you got a problem with it and quit balming any president the problem start with We The People not being educated much like your and my posts (i am a painter and not a writer/educator).
Your proclamation, speech=money, hints at an over saturation from the Mind Control Rays radiating from your television, computer monitor, and cell phone . . . but don't trust me: I work for THEM . . . I now return to busily adding to the hall of mirrors.
July 07, 2012 6:29am
Who pays when the uninsured endup in the emergency room. Every one with a health insurance. The hospitals will get their money by bankrupting and foreclosing on the uninsured patient and if not fully paid they will get the difference from increases on the premium of the insured. Who wins in this scenario?. The cash rich investor who can go purchase the foreclosed homes of these unfortunate patients at a huge discount on the front doors of bancrupcy courts. Some times purchased just for the back taxes on the property. Obama care will alleviate some of these disasters. I just wish the Obama people do a better job explaining the details of the health care act to the public and dispel the inaccuracies and lies spread by the selfish republicans.
July 06, 2012 3:03pm
Deficits are caused by Bush's tax cuts to the 1% and corporations not by Obamacare. Health plan will save money. Millions that get free care now at taxpayers' expense will be covered and get off our backs. Only 1/2-wits believe in the Republican hogwash. Romney started it all with Romneycare in Mass. But of course he flip flops on everything: A liar? “Yes,” Newt Gingrich.
July 06, 2012 11:48am
While I support the ACA, I must question the idea that it will solve the medical needs of working Americans. There is a major shortage of doctors and in particular those who practice as primary care providers. Even more worrisome is the lack of doctors in rural areas. Additionally, specialists are increasingly opting out of Medicare and refusing to take Medicaid patients. This is due to what they perceive as inadequite compensation for their services. In some fields this has all but eliminated Medicare providers in certain areas. If a doctor "opts out" of Medicare the patient is prohibited from seeking reimbursement from Medicare on his/her own. In short, if you can't pay the higher fees, too bad. You're out of luck. So until the structural problems are resolved, the effects of ACA will be limited.
July 06, 2012 1:01pm
I don't know where you get your information, but according to the Center for Medicare and Medicaid Services (Wikipedia-Medicare) between 91 and 83% of physician income in many specialties is derived from Medicare and Medicaid. You do not seem to realize that private insurance is no guarantee that the doctor will be paid anything. Further the doctors in the large cities all complain that the problem is a surplus, not a shortage of doctors, with many unable to compete with the large privately and in some cases non-physician owned medical care centers.
If a doctor "ops out" of medicare, whatever that is supposed to mean, I assume you think that a doctor tells his patient he can not or will not provide medical care, that is something the doctor must by law tell the patient up front, not after the services are rendered. In any event once the service is rendered the doctor must look to Medicare or Medicaid, not the patient.
If you don't think the ACA will solve the medical needs of the working Americans" what makes you think the privately run industry will? Or have you forgotten why healthcare reform is an issue?
July 06, 2012 10:43am
Many doctors and other healthcare providers currently do not take on Medicare patients because they complain that the government does not pay them in a timely manner. So what's to guarantee that any of these same providers will take on the millions of new patients who will be added to Medicare??????
That being the case, who will they go to for medical care? There are only so many walk-n clinics. Won't they be back at the ER again anyway????