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View Diary: Do your part. GOP talking about killing Obamacare is a liability (122 comments)

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  •  No Income and 55+? (0+ / 0-)

    You will get auto enrolled in Medicaid.  No subsidized insurance gambling for you.  You get a collateral loan which you just pay back from your assets at death.  Such a deal!  Thanks Obama!

    Why Digby & Krugman are wrong.

    Collateral Loan

    [I]f an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open
    market. ...
    Such a deal for the 55+-65 crowd!
    •  you don't have to pay back medicaid (0+ / 0-)

      my kids are on it.

      It was part of the expanded CHIP.

      “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

      by ban nock on Sun Sep 15, 2013 at 06:33:03 PM PDT

      [ Parent ]

      •  Wrong. (1+ / 0-)
        Recommended by:
        AnnCetera

        At 55+ program turns into just a collateral loan.  Younger?  You are a targeted demographic (voter).  To happyville you go.  55+?  You will not be able to give your kids the house.  Read the links.

        •  It's ok for you to delude yourself with R wing (1+ / 0-)
          Recommended by:
          True North

          scare misinformation but you shouldn't drag others down that worm hole with you.

          “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

          by ban nock on Sun Sep 15, 2013 at 08:07:40 PM PDT

          [ Parent ]

          •  Ban, What proof do you need? (0+ / 0-)

            Here is New Jersey...

            • Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form.
            • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time.
            • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery.
            DSHS pdf.
            WHOSE ESTATES ARE SUBJECT TO RECOVERY?

            Recoveries may only be made from the estates of deceased recipients who were 55 or older when they received Medicaid benefits or who, regardless of age, were permanently institutionalized. However, states may exempt recipients if their only Medicaid benefit is payment of Medicare cost sharing (i.e., Medicare Part B premiums).

            If a state has elected to impose TEFRA liens12 on recipients’ homes, then it must also recover from the estates of those recipients. States may impose liens on property of Medicaid recipients of any age if they are permanent residents of a nursing home or other medical institution, and if they are expected to pay a share of the cost of institutional care.

            Just use the google and you will find every state has coverage of this Federal requirement.  I know you are an enthusiast for free Medicaid, but the program shifts to a loan after 55!
            •  links to a modern source that address the specific (0+ / 0-)

              issue of medicaid to 55+ under the ACA.

              Your first source is extremely doubtful, it reads like some of the stuff I read here. Web sites from partisan sources whether L or R always cause me to be sceptical.

              The R feeds on scare even more than the L.

              “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

              by ban nock on Mon Sep 16, 2013 at 04:33:51 AM PDT

              [ Parent ]

              •  Nothing has changed under ACA. (0+ / 0-)

                Don't take my word just call the O'care question hotline or ask online about it.  You are projecting free lifetime Medicaid into O 'care.  After 55+ it's going to eat everything you have.

                That is why we need single payer non profit healthcare like in Canada where there is no medical bankruptcy.

              •  Found link for Colorado. (0+ / 0-)

                Colorado Medicaid Estate Recovery alive and well.  Will post it when I can...

                •  Colorado Obamacare/Medicaid Estate Recovery (0+ / 0-)

                  Link to Colorado O'care Estate Recovery

                  Estate Recoveries

                  The Estate Recovery project is a federally mandated program that requires the State to recover the cost of benefits paid on behalf of a Medicaid client from their estate. Estate recovery is handled primarily 2 ways. First, liens can be placed on property owned by the Medicaid client if it has been determined that this individual is unlikely to return home from a nursing facility. Second, upon the death of certain Medicaid clients, Medicaid files a claim against the estate of this client for the Medicaid benefits paid on his/her behalf.

                  For more information:
                  Estate Recoveries

                  Or contact: Mark Seevers Mark.Seevers@state.co.us
                   

                  Mark will no doubt be able to answer all your questions!  Please report back to us!
            •  Interesting and sad.... (0+ / 0-)

              however, looking at the link you provided above, DSHS.pdf these rules appear to predate the ACA, said link is dated 2005.  I should not be stunned that we would do that to people over 55 who have been on Medicaid but I am.  :-/

              Looks like a problem which if it's not been addressed needs to be.

              As an aside, I'm trying to extrapolate the reasoning behind these Medicaid estate rules, it seems logical to assume that someone poor enough to need Medicaid at the age of 55 isn't going to have much of an estate to worry about it.

              Getting blood from turnips comes to mind.

              •  Obamacare Enthusiastically Incorporated Clawback. (0+ / 0-)

                It is a feature of the program.

                •  Evidence .... (0+ / 0-)

                  of this beyond very creative rhetoric?

                  It doesn't make sense, even in your own quoted material below:  "However, it is clear that the much-vaunted savings have not become a reality."  So no real monetary incentive there.

                  Furthermore the links you provided clearly cite state level initiatives, not federal.

                  Therefore I'm not buying that it's been 'enthusiastically' incorporated in any way.

                  It does sound like it could be a problem though, which needs to be addressed.

                  •  Call your Navigator! (0+ / 0-)

                    Use the web question format to find the answer.  Clawback has been seen as a problem from day one.  Remember it was Democrats who passed it in '93 on a partisan vote with Al Gore breaking the tie.  It's a neoliberal standard which of course is part of O'care by design.  Good luck trying to change it!

                    •  States respond to FEDERAL MANDATE. (0+ / 0-)

                      Passed by Democrats in 1993...  It has long been a barbaric requirement placed on steroids in O'care.

                    •  It's not.... (0+ / 0-)

                      logical though.  If it's not going to provide a benefit to the gov't (i.e. savings/funds) why would they 'enthusiastically' embrace it now? Additionally if it's of no benefit to the program, people or the feds then it shouldn't be 'that' hard of a problem to correct.

                      Anyhoo, I don't know you and therefore can't tell what your motives are BUT I really do think it's good that you bring this to light.  Problems cannot be fixed if we aren't aware of them.  ;-)

                      ACA is going to be implemented.  Good things will come of it and problems will crop up and have to be addressed. The anti-everything-Obama crowd will point to those problems with loud 'I told you so's'.  They'll get fixed and the cycle will repeat until most of the bugs are ironed out. That's just life!

                      •  This is where (0+ / 0-)

                        All the laid off and no longer employable 55+-65 year olds are going to end up.  It amounts to a huge wealth extraction regime.  Remember the means test for Medicaid eligibility has been waived.  Now, if you have savings, a house but no income you will be placed in Medicaid.  You can't buy a pos insurance plan with a subsidy.  Your income makes you not eligible.  (i.e. not enough).
                        I suggest you expand your horizons a little.  Start reading Naked Capitalism and Correntewire.
                        Naked Capitalism

                        Correntewire

                        Warning these are not enthusiast sites.  You may learn some unpleasant facts.

                        Disclosure:  I am enrolled in Medicare, 67 yoa, and also pay for supplemental coverage through my union TH plan.  I have good health care now.  But all of us are under attack.

                        Read this:

                        Throwing the over 55′s into Medicaid and taking their property to pay for it is very reminiscent of the workhouse and relief rules the Irish had to contend with [in the potato famine]. If you had a quarter acre of land, you were not too poor to support yourself. In order to get any kind of relief at all, you had to give that up. Then you were eligible for the workhouse where you might get some food in exchange for losing every other possession you had. In the Medicaid opt-out states, you won’t even get relief. You’ll just get access to the emergency room and bill collectors. Back in the 1840s, most people looked upon this as wretched and bad but the ones who were not suffering put up with it. Opting out of Medicaid is like the landlords pulling down the roofs of starving tenants. It happened and people were both homeless and starving but no one stopped the billhooks.
                        •  Well Dicken's would be proud.... (0+ / 0-)

                          of your vivid explanation however it still has nothing to do with the ACA.  You're trying to conflate the ACA with problems which may or may not really exist in addition to imputing the worst possible outcomes.

                          I also note your admission that you're on medicare, congrats, you got yours eh?  

                          In the meantime I guess you'd have the 55 and overs go without because of a potential worst case possible scenario then? A possible, potential, worst case scenario that you also say would be near impossible to fix!

                          Really, you bring up wealth extraction in the context of the ACA too?  How about the fact that a hip replacement surgery in the U.S. costs upwards of $100K and in Belgium at a top notch hospital with better outcomes then many U.S. hospitals it's under $15K?  Now that's wealth extraction right here in the good ole US of A.  Or the same name brand medicine my cousin gets in Canada costs 2/3rds the amount of what I would pay.  Isn't that the real wealth extraction?  What about that 56 year old that got laid off and then diagnosed with cancer and has to file bankruptcy.  That's not wealth extraction?

                          I'm not saying the ACA is perfect, far from it, but thanks to the a-la-cart profit taking at every level of our health care system that's where the real wealth extraction takes place.  You are the one who should expand his/her horizons.

                          •  Medicare for All! (0+ / 0-)

                            100% for single payer here.  I'm only 20 minutes from Canada here in Bellingham WA so I know how it works.   ACA is imo just a joke doing nothing to lower costs outside of cutting benefits.  The rentiers still get their 30% off the top.
                            Read all the Correntewire links I posted and we will talk some more.

                          •  Well I am with you... (0+ / 0-)

                            on that!  Medicare for all...BUT...if you read my post, the last comment at the bottom as of this moment, persons like my friend and our conservative legislators is why we don't have it.

                            ACA is a HUGE compromise for the private sector because too many people in this country are worried some 'undeserving' person may get health care for free that the shouldn't (a.k.a. the socialism boogey man).  The conservatives in power have no reason to fight that meme.

                            Now my turn for disclosure.  I'm the poster child for everything that's wrong in our healthcare system.  I'm self employed, just turning 50 and have been struggling in what I call the 'private insurance shark tank' for many years, as did my mother and father before me.  All these years people like me and my family have been asking for help.  We've been raked over the coals and every effort to make changes was thwarted, every call for change or reform tossed aside and the problems got worse and worse.

                            I was born with a heart murmur.  I don't need meds for it but talk to an insurance company and you'd think I was on death's door step.  My insurance rates have been going up relentlessly since long before Pres. Obama and the ACA.  My father, after being diagnosed with HBP couldn't find insurance.  BCBS said they would take him but not cover his HBP or any heart problems for two years and then he would be covered.  For two years he paid and then after the two year mark they jacked up his rates so high he couldn't afford the policy.  They pushed him out with pricing and he was back to square one.

                            Like I said, the ACA is monstrosity mostly due to the concessions made to the profiteers but that doesn't mean we can't make things better.  I know of people who have already benefitted, such as my friend who was able to keep her child on state Medicaid even though she is now over 18 years old, her daughter has a learning disability and probably will not be able to have a good job with benefits. So for her and her daughter this has been literally a life saver.  

                            So we're stuck with this huge concession to the private health care industry and we're going to have to make it work as best we can.  Which means highlighting potential problems as you have done, but we can't use problems like that to put a complete stop to the ACA.  It's an ugly baby but it's better then what we had before and hopefully it'll turn into something like medicare for all!

                          •  Canada saves $600 billion/year. (0+ / 0-)

                            Everyone covered, no copays or deductibles, no medical bankruptcy.  Costs average around 6k per participant/year.  Let's go straight to single payer!
                            If I could just make one change right now I would reduce eligibility for medicare to 50.  I have been lucky to work in one industry to retirement while many of my friends have passed on due to the health hazards in the work.  Asbestos, fumes, accidents, all have taken their toll.  The medicaid situation for the 55+-65 is simply barbaric.  I don't see O'care evolving to anything without a strong movement straight to single payer.  Where I sit, so far from God and so close to the USA.  Just 20 minutes North there is happyville!

                          •  I respect... (0+ / 0-)

                            your intentions completely but we gotta face reality.  We aren't in Canada** and culturally we're very different. There are too many people like my friends and neighbors here in GA who really are willing to cut their noses off to spite their faces or are just flat out ignorant (heck I personally know people on Medicaid who refuse to admit they are on Medicaid).  That's the real problem, our cultural hang ups..

                            So we have to deal with that reality.  Rolling back ACA will just leave us back with absolutely....nothing.... unless there's a big shift culturally soon and I don't see that happening.

                            (**btw I don't know that I'd call Canada happyville LOL!, they have problems too, nothing is perfect but at least they aren't as hung up worrying about if the guy next door is getting healthcare he somehow doesn't 'deserve'.)

    •  Do you have a real source for that? (0+ / 0-)

      splashoil, I clicked on the link and it went to a blog.

      Do you have a link to an authoritative source?

      •  Yes, You can just google.... (0+ / 0-)

        Medicaid Estate Recovery 55+.  I found the pdf online and provided it to Lambert.

        US DSHS pdf....

        The main features of the OBRA ‘93 Medicaid estate recovery mandate are described below.7

        Highlights of the 1993 Estate Recovery Mandate:

        States must pursue recovering costs for medical assistance consisting of:

        Nursing home or other long-term institutional services;
        Home- and community-based services;
        Hospital and prescription drug services provided while the recipient was receiving nursing facility or home- and community-based services; and
        At State option, any other items covered by the Medicaid State Plan.
        At a minimum, states must recover from assets that pass through probate (which is governed by state law). At a maximum, states may recover any assets of the deceased recipient.

        Much of the original enthusiasm for mandatory estate recovery was based on the results in Oregon, where estate recovery was implemented in the 1940s as part of a comprehensive program to help senior citizens keep enough money to meet their own needs and protect their assets from unscrupulous uses by others.8 An extraordinary jump in Medicaid savings was predicted if all states were to follow the Oregon model.9 A more recent study estimates that one state (Nebraska) could increase Medicaid savings fivefold if it adopted all of Oregon’s estate recovery practices.10 However, it is clear that the much-vaunted savings have not become a reality. In 2003, estate recoveries amounted to $330 million, or 0.13% of total Medicaid spending in all states, with individual state collections ranging from 0.0 - 0.64%.11

        This is a huge hit for 55+-65 folks who have lost their jobs and  will never be hired.

        New Jersey (typical, link at end):

        • Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form.
        • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time.
        • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery.
        This information is not covered well on enthusiast sites!
        •  My Thoughts... (0+ / 0-)
          Lambert just lit my light bulb. It's rather dim, but now I understand the big push for the Medicaid expansion. It is about us, 50 and up! A managed care Medicaid is the perfect place for the maximum extraction and would keep folks out the profitable insurance pools. Add in the clawback and it's a two-fer.
          This explains the plaintive articles put up on the enthusiast sites which ignore this issue and tell you Medicare for all will never happen. All about the rents baby! Got to keep the cages,
          I mean buckets separate because they are all specialized.
          Time to go pull more weeds.
          Riverdaughter:
          ’m referring to the millions of long term unemployed, many of whom are over 50, who are now forced to cobble together some kind of living as self-employed.  That affects just about everyone I know who was laid off since 2008.  To these people, the premiums are not just a nuisance.  They are extremely burdensome.  And if Lambert has been reading the tea leaves correctly, lumping these people into the Medicaid pot puts whatever estate they have left at risk.  So, to recap, Obamacare is putting an extra burden on these people who are now forced to a.) work for themselves, b.) pay all of the payroll tax by themselves and c.) pay for their own retirements.
          Please don't take my word, look into it.  Ask O'care!
          •  add'l comment.. (0+ / 0-)

            I read through more of your posts and clearly the estate recovery does predates the ACA.

            So I better understand your argument now, if more people over 55 have access to Medicaid then more people/families may be exposed to the estate recovery.

            IF this hasn't been addressed by the ACA already it should, so it's good that you bring this to light!

            Any implication, however, that the estate recovery tax is the fault of 'O'Care' is inaccurate.  

            There are going to be problems like this that crop up and have to be worked through.  That's a normal part of implementing new systems of any kind.

          •  I would take this question (0+ / 0-)

            directly to CMS instead of navigators, blog posts, or trying to understand excerpts from laws.  With the latter there are always advisories, regulations, and references to other laws, especially one originally passed in the 90's, that are involved in completely understanding how it will work.

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