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Clearly, it’s gratifying to see that, after all of our hard work, the Supreme Court didn’t throw out the entire Affordable Care Act. But as we noted, one part of the decision held some cause for concern: the Court weakened the requirement that states expand Medicaid coverage, using federal funding, so that millions of people at or near the poverty line could get health care.

The Court ruled, narrowly, that states could opt out of providing the additional Medicaid eligibility, which would leave a substantial gap in the number of people with coverage. Since the federal government would be providing all of the funding for this expansion for the first few years and 90% of it going forward, however, there would be little reason to decline the expansion of Medicaid, outside of a combination of ideological extremism, disinterest in covering the most vulnerable people and pure spite over the passage of the ACA.

Well, we’ve learned to never underestimate that combination. Gov. Rick Scott of Florida announced Sunday he would turn down federal funding and block the Medicaid expansion.

A study by the Urban Institute suggests that in Florida alone, 1.8 million people would be eligible for the expanded Medicaid coverage—and, because of Scott’s stubbornness, nearly a million and a half of those people would be left uninsured, with exactly the same bad set of options they have today.

The rejection of the Medicaid expansion has been the biggest danger underlying Thursday’s ruling. Medicaid expansion was supposed to cover everyone with incomes below 133% of the federal poverty level. It’s really the only option available for those under the poverty level, which is just over $11,000 for a single person and just over $23,000 for a family of four. Without the expansion, people at this level of income (and that includes millions of minimum-wage earners and people who work part-time) are very nearly out of luck.  

Other governors who have suggested they might not take the Medicaid expansion include Louisiana Gov. Bobby Jindal and—surprise!—the ever-frustrating Gov. Scott Walker of Wisconsin. The biggest question mark here is Texas, a huge state with a big uninsured population and a governor given to loud displays of ideological purity.

In Virginia, Gov. Bob McDonnell is faced with the same choice; while he’s spoken publicly about repealing the ACA, his state is implementing the law, and health care experts there call denying the expansion “catastrophic” and “foolish.”

David Dayen of Firedoglake has offered some very good analysis of the stakes of this Medicaid fight, and why these governors might make a show of refusing. Other analysts have suggested that, since the Medicaid expansion is a good deal for states, they’ll end up taking it eventually—but it will take time and pressure to get us there.

As Salon’s Steve Kornacki notes, this is mostly about politics for governors like Scott.

Essentially, the court handed Republican politicians a high-profile opportunity to define themselves in opposition to President Obama’s signature accomplishment, a law for which their party’s has particular contempt. So there’s an element of posturing here…as long as Obama is president and his name is linked to it, there’s always going to be some kind of an opening for a Republican politician to make a name for himself by vowing to stop or reverse the expansion.
As a game played among boldfaced names in political reporting, this is bad enough. But it’s much worse when you consider that the playing pieces in Rick Scott’s little chess game are people trying to feed their families on $20,000 a year.

This is the next fight for health care—to make sure that our elected leaders are doing their job and actually implementing this bill. This is an opportunity to put pressure on our representatives in state capitols. Politicians like Rick Scott can’t be allowed to let their spite and their ideological obsessions prevent millions of people from the promise of health care.

by Seth D. Michaels - Originally posted on Working America's Main Street Blog

Join Working America's fight for affordable health care

Originally posted to Working America on Mon Jul 02, 2012 at 10:58 AM PDT.

Also republished by DKos Florida.

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Comment Preferences

  •  Wisconsin has become Wississippi (5+ / 0-)
    Recommended by:
    Gooserock, a2nite, GeoffT, janislav, kideni

    under the Walker regime and now he's in office until 2014.  Even if the John Doe perp walks him out of the Governors Mansion, Tea Bagging Lt. Gov. Rebecca Kleefisch stands ready to implement the rest of his radical agenda.

    It doesn't surprise me that Scott Walker would "opt out".  After all, he's the guy who began his Governorship by providing massive tax breaks to large corporations and the wealthy and used the deficit that action created to strip pubic employees of their unions and about 18% of their take home pay for "benefits" that they sustained for years by giving up up pay raises.  And taking $1.8 from our schools and massively raising tuition at our state university system will ensure plenty of future ignorant citizes who will vote however the bilionaires tell them to through floods of Citizens United ads.

    We have a Republican Party that has gone ape-shit.  Instead of fighting poverty, they are all in for making more of it.

    There already is class warfare in America. Unfortunately, the rich are winning.

    by Puddytat on Mon Jul 02, 2012 at 11:15:26 AM PDT

    •  That's their plan. The return to slavery. (2+ / 0-)
      Recommended by:
      Puddytat, a2nite

      We will all be nothing more than slaves to them, with them able to pay us what they want with no complaints, only getting the education they think we should have, only reading what they want us to read...

      "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

      by zenbassoon on Mon Jul 02, 2012 at 11:28:11 AM PDT

      [ Parent ]

    •  I was poking around the PPACA the other day (1+ / 0-)
      Recommended by:
      Puddytat

      You know how large group plans have to spend at least 85% and small group/individual plans at least 80% of their revenue on actual, you know, health care?  AKA "getting value for your health insurance premium money"? (Section 2718(b)(1)(A)).  Well, the PPACA allows for exceptions to this if it would destabilize the state health insurance market, i.e. if that requirement might require a good chunk of the current insurers to take their balls and go home.

      So on October 25th 2011 Walker pleaded for the gouging to continue and was shot down on February 16th 2012.  That one flew under my radar at the time.

      I was only researching it because Walker's "E-update" this week said (only check the link if you haven't eaten in the last 6 hours):

      As recently as last year, the State conducted an actuarial analysis of the impact of ObamaCare and found, according to our data, that most people in Wisconsin would pay more money for fewer health care services than they have now.
      How better to achieve most people in Wisconsin paying more money for fewer health care services than, er, asking that your state's insurance companies be allowed to pay for fewer health care services and/or have higher premiums than Obamacare normally requires?

      Rick Scott got smacked down too, as did Rick Snyder, Bobby Jindal and Rick Perry.

      Fake candidates nominated by the GOP for the recalls: 6 out of 7. Fake signatures on the recall petitions: 4 out of 1,860,283.

      by GeoffT on Mon Jul 02, 2012 at 02:25:17 PM PDT

      [ Parent ]

      •  Interesting (1+ / 0-)
        Recommended by:
        GeoffT

        It didn't hit my radar, either.

        I think, though, the RW Governors refusal to expand Medicaid (the opt out Roberts gave them) is all about making sure the ERs are full so the bills of the uninsured will continue to get passed along to everyone else so health care costs continue to increase.  That way they can continue to argue that "Obamacare" doesn't control costs

        Naturally, the most effective way to control costs, aside from universal coverage, would be negotiations on price for drugs and care - something prevented by the heath care industry and big pharma with their armies of lobbyists and campaign payola.

        There already is class warfare in America. Unfortunately, the rich are winning.

        by Puddytat on Mon Jul 02, 2012 at 03:32:58 PM PDT

        [ Parent ]

        •  In Walker's case at least (1+ / 0-)
          Recommended by:
          Puddytat

          I'm pretty sure it's mostly a continuation his policy of making sure that Wisconsinites don't get what we're paying for with our federal taxes (see e.g. high-speed rail).  Scorched earth, like Milwaukee County has found out.

          Fake candidates nominated by the GOP for the recalls: 6 out of 7. Fake signatures on the recall petitions: 4 out of 1,860,283.

          by GeoffT on Mon Jul 02, 2012 at 03:46:56 PM PDT

          [ Parent ]

  •  Double check your poverty $ numbers n/t (0+ / 0-)

    Well, I been around the world, and I've been in the Washington Zoo. And in all my travels, as the facts unravel, I've found this to be true.... ...they don't give a f^ck about anybody else

    by Zwoof on Mon Jul 02, 2012 at 11:48:29 AM PDT

  •  Say this ten times after me.... (0+ / 0-)

    Rick Scott was the CEO of at one time of the largest Urban For Profit Hospital Chain in the country.  He does not care about a healthcare plan in this country uniless you have money.....lots of money.

  •  With exchange coverage (0+ / 0-)

    for the under 133% of FPL crowd, the subsidy would be a flat 94%.

    With the intended Medicaid coverage of the under 133% crowd, it would be 100% subsidy for the first three years stepping down to 90%.

    The Medicaid expansion coverage would be premium free, the exchange coverage would cost the poor 2% of their income.

    •  In order to get exchange subsidies (0+ / 0-)

      the State of Florida would have to either estabish an exchange or a multi-state plan would have to be available for Florida according to my copy of the PPACA law.

      PPACA Section 1401

      ‘‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
      ‘‘(a) IN GENERAL.—In the case of an applicable taxpayer, there shall be allowed as a credit against the tax imposed by this subtitle for any taxable year an amount equal to the premium assistance credit amount of the taxpayer for the taxable year.
      ‘‘(b) PREMIUM ASSISTANCE CREDIT AMOUNT.—For purposes of this section—
      ‘‘(1) IN GENERAL.—The term ‘premium assistance credit
      amount’ means, with respect to any taxable year, the sum of the premium assistance amounts determined under paragraph
      (2) with respect to all coverage months of the taxpayer
      occurring during the taxable year.
      ‘‘(2) PREMIUM ASSISTANCE AMOUNT.—The premium assistance amount determined under this subsection with respect to any coverage month is the amount equal to the lesser of—
      ‘‘(A) the monthly premiums for such month for 1 or
      more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act, or
      SEC. 1334. MULTI-STATE PLANS.
      øSection added by section 10104(q)¿
      (a) OVERSIGHT BY THE OFFICE OF PERSONNEL MANAGEMENT.—
      (1) IN GENERAL.—The Director of the Office of Personnel
      Management (referred to in this section as the ‘‘Director’’) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to section
      5 of title 41, United States Code, or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.
      However insurers may not want Florida's mainly older customers since they would skew premiums upwards making a multi-state plan including Florida hard to sell outside of Florida.

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