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Iowa has received a waiver from the federal government to implement a program and accept the Medicaid expansion available under Obamacare. Like the plan approved for Arkansas, low-income Iowans who don't qualify for traditional Medicaid would have their purchase of health insurance on the exchange covered by the expansion money. The government didn't approve the entirety of Iowa's plan, however.
The waiver approval also allows Iowa to move ahead on an initiative aimed at encouraging healthier behaviors, and it would let the state charge a fee to people who make more than 100 percent of the poverty line.

The Iowa proposal had asked for approval to charge about a 3 percent premium on people who made more than 50 percent of the federal poverty line.

That fee, which would have amounted to about 3 percent of income, would be waived if participants engaged in certain healthy behaviors.

The administration’s decision gave approval for a fee to be charged only on those above the poverty line.

That means that at least 150,000 more people who have been locked out of the system are going to be getting health care coverage now. That's 150,000 more people to be thankful for Obamacare. While the precedent of Medicaid privatization now seems firmly established, it does mean that potentially hundreds of thousands more people in states that have so far refused the expansion could be brought into the system.

Originally posted to Joan McCarter on Tue Dec 10, 2013 at 03:32 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (32+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Dec 10, 2013 at 03:32:51 PM PST

  •  Medicaid privatization precedent firmly establishe (4+ / 0-)
    Recommended by:
    Stude Dude, marina, Lujane, Nance

    Other than that Mrs. Lincoln, how did you enjoy the play?

    "When dealing with terrorism, civil and human rights are not applicable." Egyptian military spokesman.

    by Paleo on Tue Dec 10, 2013 at 03:40:17 PM PST

    •  Medicaid has been going through companies for (1+ / 0-)
      Recommended by:

      years (pdf):

      The Balanced Budget Act (BBA) of 1997 gave states authority to mandate enrollment in MCOs for Medicaid beneficiaries without obtaining a federal waiver (except for special needs children,
      Medicare beneficiaries and Native Americans).

      "Harass us, because we really do pay attention. Look at who's on the ballot, and vote for the candidate you agree with the most. The next time, you get better choices." - Barney Frank

      by anonevent on Wed Dec 11, 2013 at 07:36:41 PM PST

      [ Parent ]

  •  Thank you Ronald W. Obama (1+ / 0-)
    Recommended by:
    Stude Dude

    "When dealing with terrorism, civil and human rights are not applicable." Egyptian military spokesman.

    by Paleo on Tue Dec 10, 2013 at 03:40:56 PM PST

    •  Far better to stand on principle... (1+ / 0-)
      Recommended by:

      ...even if the result is that those 150,000 people in Iowa get nothing?

      Letting people below the poverty line get heavily subsidized coverage through the exchange doesn't seem like a bad outcome to me, especially when the alternative is that they get nothing.

      Political Compass: -6.75, -3.08

      by TexasTom on Wed Dec 11, 2013 at 09:02:55 PM PST

      [ Parent ]

      •  Far better that the murder by spreadsheet (1+ / 0-)
        Recommended by:

        shitbags get a fat pay day, and poor people are still kept away from care by co-pays and deductibles they can't meet while having wages that are far below what it takes to keep body and soul together to begin with assessed for co-insurance?

        You've obviously never been poor enough to understand that even a "modest" deductible might as well mean not having insurance.

        "I read New republic and Nation/I've learned to take every view.." P. Ochs

        by JesseCW on Wed Dec 11, 2013 at 10:58:22 PM PST

        [ Parent ]

        •  I went through a couple years... (0+ / 0-)

          ...where I had really crappy insurance and little to no income, and pretty much avoided going to the doctor as a result.  So kindly take your presumptions about what I may or may not have experienced and shove them where the sun don't shine.

          And, needless to say, if a "modest" deductible is crippling, then having no insurance whatsoever is even more crippling.  

          Political Compass: -6.75, -3.08

          by TexasTom on Thu Dec 12, 2013 at 06:20:59 AM PST

          [ Parent ]

  •  So those in the (5+ / 0-)

    100% to 138% of the poverty level group -- all the folks here in the Medicaid gap -- now have to do what to prove we are healthy enough to not have to pay the extra 3% which we can't afford because, you know, we are in the frigging Medicaid gap?

    Because I've got all kinds of time to join a gym or lose weight or exercise more or eat more veggies -- and all the money that will take -- that's what we have lots of here in the Medicaid gap -- extra time and money. Gee I can't wait for some bureaucrat to tell me how many sit ups I should be doing.

    •  For private insurance it looks something like this (2+ / 0-)
      Recommended by:
      Lujane, operculum

      1. Fill out a form online with what you know of your health history (not terribly detailed; took maybe 15 minutes).
      2. Get a checkup and fax or email in a form that the doctor's office signs (and the checkup is, of course, FREE as part of your ACA coverage).
      3. Get a dental checkup and fax or email in a form that the dentist signs.
      4. They have a form where you can fill in exercise, even if it's just walking for 30 minutes. It doesn't have to be at a gym. When you have 50 entries, fax or email that in.
      5. Get a flu shot and fax or email proof of that.

      (This is from my employer's current Blue Cross, which I don't participate in because it would cost me too much as a part-timer. I believe my new ACA Blue Cross has something like it but haven't seen the details yet.)

      So you don't have to prove you're healthy; what they're interested in is people taking steps that do correlate with taking better care of yourself.

      When I began working out regularly about 20 years ago, I had insurance with one of these incentive programs. It did help get me to the gym regularly. Bribery does seem to be effective for many of us.

      •  In other words (3+ / 0-)

        They get up all in your business, which the Republicans constantly complain about the government doing.

        Women create the entire labor force.
        Sympathy is the strongest instinct in human nature. - Charles Darwin

        by splashy on Tue Dec 10, 2013 at 08:13:13 PM PST

        [ Parent ]

      •  Screw that. (5+ / 0-)

        The ACA is supposed to provide for health insurance for everyone with no difference in pricing based on pre-existing conditions or physical condition -- based only on age and geographical location. The only health-related pricing difference is for smokers.

        Now you think it is reasonable for me to have to report to my insurance probation officer that I have walked for 30 minutes.

        Any of the other things you list would already be known by the insurance company/Medicaid -- they are paying for it.

        When all other citizens are offered discounts when they walk for 30 minutes, not threatened with penalties if they don't, then it will be something else.

        This is just an excuse to abuse poor people and invade our privacy. To give us one more hoop to jump through, one more thing to worry about. To punish us in one more way.

    •  Just reread the 3% line. Amazingly, not just a... (6+ / 0-)

      3% premium hike, but a 3% penalty against the entirety of your income. That's insane! The ACA doesn't even allow that for private plans, which can only provide incentives (discounts), not penalties. Insanity.

      "The Democratic Party is not our friend: it is the only party we can negotiate with."

      by 2020adam on Tue Dec 10, 2013 at 07:43:33 PM PST

      [ Parent ]

      •  sounds like a discount to me (1+ / 0-)
        Recommended by:

        the 3% is waived if you do the "healthy" thing.  I'm sure that' is how it will be codified, the way it is described in the diary.

        Just like my employer-based insurance where I get a $10 biweekly discount if I do the "Vitality Plan".  Last year it meant coming in and getting blood work done.  This year they decided that didn't work because people didn't follow up on problems found in the blood work.  Instead we have to fill out a survey in January.  And they have something where you can earn Vitality Points and trade them for products.  I earned some nice food containers just for doing the blood work.  I could have gotten more if I logged exercise etc.  

        •  Sounds like it should be a discount. It isn't. (0+ / 0-)

          It's a penalty. Every article clearly states that this is an additional income-based premium. And this isn't a small $10 monthly charge. It's 3% of income. Meaning $600/yr if you're making $20,000.

          And remember, this is for MEDICAID recipients, not folks who have a job with benefits and maybe even an extra 3% of their income lying around, desperate for an insurance company to suck it up.

          "The Democratic Party is not our friend: it is the only party we can negotiate with."

          by 2020adam on Thu Dec 12, 2013 at 08:06:47 AM PST

          [ Parent ]

          •  it is no different (0+ / 0-)

            You can call my plan a $20 a month penalty if I don't do the Vitality plan, or a $20 discount if I do it, the cost is the same thing.  The same for the tobacco penalty/discount.  If I certify I and my spouse are tobacco free we get a $40 a month discount and if we don't say NO to the question we have a $40 penalty from what we would say if we said YES.  It's just semantics.  Medicaid tops out under the new expansion plans around $15,000, no one making $20,000 is on Medicaid,  so 3% more like $450 which is still a chunk of change, I will agree, compared to the $720 penalty/discount I get with higher income for being tobacco free and doing the Vitality activities.  Oh, and if my husband has insurance available at his employment there is another $200 a month penalty. That one is described as an additional premium rather than a discount, but again, what is the difference other than semantics?  I would pay $200 a month more than the rate I pay now.  

  •  Thoroughly ambivalent about Medicaid privatization (2+ / 0-)
    Recommended by:
    Brooke In Seattle, beverlywoods

    If we're subsidizing everyone else's ability to choose their insurance, why are we poor folk stuck with this shit? Doctors hate taking Medicaid. It pays poorly and they respond by simply not taking it. I'd be more than happy joining Medicare if nobody wants to help me get a private plan.

    "The Democratic Party is not our friend: it is the only party we can negotiate with."

    by 2020adam on Tue Dec 10, 2013 at 07:34:30 PM PST

  •  What ARE those "certain healthy behaviors" (4+ / 0-)

    And I thought the Republicans were against the "government" telling people what to do. What else is this but the Iowa government doing that?

    Women create the entire labor force.
    Sympathy is the strongest instinct in human nature. - Charles Darwin

    by splashy on Tue Dec 10, 2013 at 08:11:39 PM PST

  •  pdf of Branstad's (1+ / 0-)
    Recommended by:


    "Personal & Health Responsibility Mechanisms" start on p.4.

    The Healthy Iowa Plan lays the foundation for personal responsibility mechanisms to incentivize members to have an investment in their health, or "skin in the game." The program design is geared toward transforming and empowering Medicaid members to be
    cost-conscious consumers of health care services and accountable for improving their health.

    The program will promote member engagement through innovative cost-sharing and incentive structures that will encourage members to take action to improve and maintain their health. All members will be expected to contribute a little towards the cost of their care;
    however, when compared to a traditional Medicaid co-payment model, the monthly member contributions will be less than a member may expect to pay under a pure co-payment model.

    Financial coverage of benefits begins after a $240 deductible is met and preventive services are provided outside the deductible, so there are no barriers to seeking such services. After the deductible is met, there are no co-payments, other than a $10 copayment for
    inappropriate use of the emergency room. Each member is provided with a Health Responsibility Account (HRA) to help pay for the initial $240 of services. The account, modeled after a Health Savings Account or Health Reimbursement Account, works as follows:

    • Members make required contributions that equate to approximately 3 percent of annual household income. The contributions are broken into monthly affordable amounts that go into their HRA account. Members will have no further financial obligation beyond the
    monthly contributions, other than the co-payment for non-emergency use of the emergency room.

    • The state also supplements the members' contributions and assures there is adequate funding for deductible expenses. State and member contributions together total the $240 required deductible.

    • The member can earn additional dollars by completing actions or behaviors that improve health. For example, a member can earn up to $80 in bonus payments for completing certain requirements, such as a risk assessment, physical, or preventive services, or
    signing and following through on a Temporary Assistance for Needy Families (TANF) family investment agreement (FIA). *

    (*Family investment agreements may include but are not limited to: assessment, job readiness and job-seeking skills training, employment, basic education (high school completion, GED, and ESL), post-secondary education (short-term training and AA, BA, and BS programs), work experience, community service, Family development and Self-Sufficiency (FaDSS) program participation and other family development services, and parenting skills training.)

    • Members receive bonus payments on a Healthy Rewards debit card. The card is restricted to pay for only approved health and fitness related services and products including: over-the-counter medications, gym memberships, and family fitness activities.

    • For members remaining enrolled in the Healthy Iowa Plan, any remaining balance in their HRA at the end of the benefit period may be used to reduce contributions in the following year, or be made available through the Healthy Rewards Card program.

    • Each month the member is provided with a statement that depicts HRA account activity and an explanation of benefits that shows the cost of all services they have utilized.

    • The HRA account cannot be used for co-payments required for non-emergency use of the emergency room. Even with copays for non-emergency room use of the ER, cost sharing for individuals will not exceed 5 percent of income for each household.

    • Members must make their required contributions to the HRA account within 60 days of the due date or they are terminated from the program for a period of 12 months.

    • Members will have the option of requesting a hardship exemption if they are not able to afford the contribution.

    •  Braindead is also 'working' with Wellmark BCBS (1+ / 0-)
      Recommended by:
      Stude Dude

      to create 'blue zones'.  The general idea is that these areas will get some sort of benefit by setting up programs that promote a healthier life style.  It's supposed to encourage organizations and employers to 'offer' incentives to employees and patrons to make 'better' choices.  So far it's been voluntary, I think.  While healthy living is a good thing to do, I this is more like a marketing gimick for Wellmark.

      Here's a link:

    •  I had an HRA (1+ / 0-)
      Recommended by:

      from work for the first time this year.  It was great as I had no co-pays and didn't pay for any physician visits this year, everything was covered from the money the employer put into the HRA "kitty".  I had chiropractic covered completely for the first time.   My spouse had surgery to remove a vocal fold cyst and polyps during his colonoscopy, so he had some small payments from those, but nothing much.  

    •  Thanks for the information (0+ / 0-)

      By definition anyone who makes 100 to 133 percent of the poverty level would have this exemption:

      Members will have the option of requesting a hardship exemption if they are not able to afford the contribution.

      So what's the point?

      Republican tax policies have led to financial conditions which have caused Republicans to demand cuts to programs they have always opposed.

      by AppleP on Thu Dec 12, 2013 at 04:18:07 AM PST

      [ Parent ]

  •  What ever happened to that clause in the ACA (6+ / 0-)

    that said that states could offer alternative programs only if they covered at least as many people at least as well? How does letting the insurance companies skim money off the top qualify?

  •  some details about this statement please... (1+ / 0-)
    Recommended by:
    Brooke In Seattle
    it does mean that potentially hundreds of thousands more people in states that have so far refused the expansion could be brought into the system.
    From a FloriDuh resident

    "You can't think and surf at the same time" Yogi Surfdog

    by surfdog on Wed Dec 11, 2013 at 06:58:06 PM PST

  •  As a Veteran in Oregon I didn't rely (0+ / 0-)

    on the Oregon Health Plan.

    If Oracle fails is there some way Oregon can ride on the Federal plan which is working better.


  •  With Iowa and Arkansas... (0+ / 0-)

    does that put the number of states accepting Medicaid expansion at 27?

    "Really nice, but also very serious about his job." Jackie Evancho on President Obama 6/7/12

    by BarackStarObama on Wed Dec 11, 2013 at 07:08:21 PM PST

  •  I thought ACA was the first step (2+ / 0-)
    Recommended by:
    Glenn45, JesseCW

    towards universal health care.  Silly me. Now we have privatization of Medicaid.  Isn't that a large step backward?  Or is backwards really forwards?

  •  Bailing out a destable industry that was (0+ / 0-)

    on the verge of failure was always the actual point, after all.

    "I read New republic and Nation/I've learned to take every view.." P. Ochs

    by JesseCW on Wed Dec 11, 2013 at 10:56:28 PM PST

  •  I believe this is part of the definitive reason... (0+ / 0-)

    Why, when my significant other and I relocate to the Omaha area in late spring, we're going to be looking on the Iowa side of the state line - not the Nebraska side.

    It also makes a difference in terms of what insurance covers. The Iowa insurance requirements cover a life-extending surgical procedure that I'd likely qualify for. The Nebraska insurance requirements do not cover that same procedure.

    I'm looking forward to becoming an Iowegian!

    "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

    by AnnCetera on Thu Dec 12, 2013 at 05:08:17 AM PST

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