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View Diary: Arkansas gets Medicaid expansion waiver (55 comments)

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  •  Joan, thanks for reporting this. (8+ / 0-)

    I'm glad there was a work around available so that so many could obtain health care insurance.  

    But my 1st thought was to wonder what happens to these privatized waiver programs when the federal funding phases out??  

    If these states balked at the generous funding (100% then 90%) of the original concept of medicaid expansion due to expense, how will a privatized one be less onerous to a state budget?  I just don't get it.  

    •  Agree, how does inserting an insurance middleman (8+ / 0-)

      make the program work better.  It means the state is essentially skimming off a large percentage of Medicaid funding just to hand over to private insurance companies.

      The state already has people who run Medicaid, who process payments and sign people up.  Putting in a middleman just takes more money away from health care providers and patients who need health care.

      Mark this date on your calendar.  This is the date that Medicaid begins to fall apart and eventually disappear.

      "The international world is wondering what happened to America's great heart and soul." Helen Thomas

      by Betty Pinson on Fri Sep 27, 2013 at 02:03:57 PM PDT

      [ Parent ]

      •  My biggest concern is what happens then to all (0+ / 0-)

        those enrolled in this version???  Or if Medicaid "falls apart & disappears".

        Something is very stinky about this waiver-at least it is to me without further info.  If medicaid pays for this insurance without any state funding portion, how is this really any different than what the ACA has set up??  

        And what happens when the 100% fed funding drops to 90%?  Where's the funding coming from to pay that offset to the "middleman"??  And at what expense to those in need???

        Sure hope this state & others who may follow suit have actually considered this & are not just again kicking the proverbial can down the road to the detriment of those they are supposed to serve.

        •  This waiver just means that the federal money that (5+ / 0-)

          would have gone to helping states finance expansion of state Medicaid programs for those making below 138% of the federal poverty line will now go to subsidizing the same private insurance that will be subsidized directly by the federal government in all states for those making over 138% of the federal poverty line. Presumably, the federal government is only funding 100% of what it would cost to expand Medicaid using the traditional Medicaid program, because according to the article in question there is not going to be any effect on the federal budget. It is almost definitely more expensive for the state to insure people using private insurance, so it will be bad for Arkansas's state budget, but that's not the federal government's problem. "100%" funding vs "90%" funding is immaterial--that is, the federal government will probably pay what would be required to expand projected traditional medicaid, and the state will probably be required to make up the rest in order to fulfill the requirements of the waiver, so the effect should be pretty straightforward.

          As to your question, "how is this really any different than what the ACA has set up", all it is doing is using state funding (underwritten by federal grant money) to subsidize insurance in the exchanges to cover people beneath the 138% FPL threshold in addition to those above the 138% FPL threshold who are already covered by direct federal subsidies under the law. That makes it a weird mishmash of state and federal funding, but the actual subsidies should be pretty seamless even if they're coming from different sources. In a lot of ways, the use of the exchange for everyone and not just those above 138% FPL makes it less confusing and disjointed than the system that will be implemented in the states that are maintaining traditional Medicaid in addition to state exchanges. Plus, this isn't exactly an entirely new concept: Massachusetts did some similar experiments using Medicaid grants to fund private health insurance subsidies under the 2006 health insurance reform law, and that was pretty successful in expanding insurance access. Notably, Massachusetts did not eliminate traditional Medicaid altogether, though, so this is still a bit of new experimentation and we still have to wait to see how well or poorly it will work.

          Now, from a practical perspective, I think this is a bad idea because it will increase Arkansas's health care expenses. Private insurance is more expensive than traditional Medicaid, after all. But it seems pretty straightforward and not like a totally awful idea. It's better than the alternative of just not providing any health insurance to poor people.

      •  In the IT world, we call it a "workaround" (3+ / 0-)
        Recommended by:
        nickrud, Mostel26, newliberl

        Some application or system doesn't work the way we'd like it to in an ideal world.  But inevitably, some intrepid soul comes up with a (sometimes inelegant) way to get to approximately the same result that was originally envisioned when the application was birthed.  

        The bottom line is that the application functions, even with the built-in bugs, because those who actually use it a) tend to be industrious about making it work, and b) would rather kludge together a workaround than say "I told you so" or be petulant naysayers whose sole purpose in life is to annoy the help desk.

        You pick whether the GOP is a) or b) above.

        UID: 14791 Join Date: 7/7/2004 Status: Lifetime member Mojo: nearly infinite Any questions?

        by Richard Cranium on Sat Sep 28, 2013 at 08:33:45 PM PDT

        [ Parent ]

    •  they go away of course (0+ / 0-)

      That's the whole idea.

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