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No. of Recommendations: 55
Kentucky is going full-bore on Medicaid expansion under Democratic Gov Steve Beshear and has one of the most successful health insurance exchanges in the nation. Meanwhile, in neighboring Indiana Republican Gov. Mike Pence is deep into the Tea-Bag and favors tax cuts for the wealthy over health care for the State's working poor.

This article details the wide difference in the fortunes of working people in the two states.

http://www.indystar.com/story/news/politics/2013/12/01/medic...

Lorinda Fox of New Albany, Ind., hasn’t been to a doctor since her last child was born 21 years ago. Poor and uninsured, she treats her illnesses with over-the-counter remedies.

At age 58, she knows she’s taking chances with her health, especially since she recently began having heart palpitations and chest pain.

“I’ll do the same thing I always do — gut it out,” said Fox, who lives with her hearing-impaired daughter and earns about $12,000 a year working in retail. “I don’t know what else I can do.”

If Fox lived in Kentucky, she would qualify for expanded Medicaid next year under the Affordable Care Act. But she lives in a state where she makes too much to qualify for traditional Medicaid, and politicians have chosen not to expand Medicaid as Obamacare intended, contending that Indiana taxpayers can’t afford it.


</snip>

intercst
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No. of Recommendations: 39
This is more rational and accurate:

http://www.minnpost.com/eric-black-ink/2013/11/scott-walkers...

'Three years ago, Minnesota elected a DFL governor (Mark Dayton) whose slogan was "tax the rich," and in 2012 it gave his DFL party control of the Legislature. Three years ago, Wisconsin elected a Republican governor (Scott Walker) with a Republican Legislature pledged to implement the anti-tax, anti-union, least-government approach that 21st century conservatism says is the best way to produce jobs and economic growth and the greatest good for the great number.

In a must-read op-ed in Sunday's New York Times, University of Minnesota political scientist Larry Jacobs stepped back to see which approach was getting better results so far.'
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No. of Recommendations: 0
Of course expanding medicaid costs money. States can't just print and borrown unlimited funds like the Feds do.

I wonder what Kentucky is going to do when the three year Fed subsidy ends on the Medicaid expansion. (Assuming that the Feds don't expand the subsidy another 5 or 10 years, which Democrats would want to do).

If the Federal money stops as planned, do what are these States going to do?
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No. of Recommendations: 1
I wonder what Kentucky is going to do when the three year Fed subsidy ends on the Medicaid expansion. (Assuming that the Feds don't expand the subsidy another 5 or 10 years, which Democrats would want to do).

If the Federal money stops as planned, do what are these States going to do?


The Federal subsidy for newly-eligible Medicaid enrollees does not simply "end" in three years. The ACA provides that the federal share will remain at 100% until 2017, and after that it phases down to 90% by 2020. That is still significantly higher than the generally 50/50 split between state and Federal funding for Medicaid (the actual amount varies by state), though it is a non-trivial expense that states will have to bear.

Albaby
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and after that it phases down to 90% by 2020

__________________


Amd if you like your plan you can keep it. States are going to end having to pick up the entire tab of expansion.
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Albaby:"The Federal subsidy for newly-eligible Medicaid enrollees does not simply "end" in three years. The ACA provides that the federal share will remain at 100% until 2017, and after that it phases down to 90% by 2020. That is still significantly higher than the generally 50/50 split between state and Federal funding for Medicaid (the actual amount varies by state), though it is a non-trivial expense that states will have to bear."


You are quickly going to find out the government won't have the money to continue the 90% funding after 2017. THey'll drop the percentage to probably 75% by 2020...and back to half by 2013.

Meaning states like KY and CA that expanded Medicaid will be picking up half of it.....hundreds of millions a year that they don't have, but will suddenly have to 'find' or else chop Medicaid by half......

Yeah..this lady if she lived in KY might be able to 'sign up' for Medicaid, but finding doctors that will take it (along with the other 10,000 new 'patients' in KY) might be a real challenge.

It's simply a 3 year bribe to start up a program that will be 'unaffordable' in less than 3 years and demand massive state tax increases. Can't you see CA raising the sales tax another 2% to cover it? heh heh.....or KY jacking up taxes 33% to cover it?


Not going to be fun.

You can keep your healthcare plan...the government will contribute 100% to 2017....and then, who knows? Solyndra...cooked employment numbers before the last election.....caught again....

Yep, you can really trust this government..... NOT


t.
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You are quickly going to find out the government won't have the money to continue the 90% funding after 2017. THey'll drop the percentage to probably 75% by 2020...and back to half by 2013.
________________________________________________

But it's in the law

And that can only be changed if the President feels like it.,
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You are quickly going to find out the government won't have the money to continue the 90% funding after 2017. THey'll drop the percentage to probably 75% by 2020...and back to half by 2013.

Perhaps - that's certainly one of the considerations that red-state leaders have cited in declining to expand. Still, there will be politically powerful constituencies - all the states that did expand - that will be pushing back on efforts to reduce that funding mechanism.

Albaby
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While I am generally conservative and libertarian, this is one issue where I cross political lines.

I support the expansion off Medicaid under the eventual 90% deal.

1) It is already the law. It is not likely to be repealled so it makes little sense to fight it on simply partisan grounds. As a governor, you win no points by refusing it.

2) Even at 90%, the states that elected to receive the expansion will see increased tax revenue from the various taxes that inflow of money generates. To me, that makes good economic and political sense.

3) If you don't expand, you increase your portion of the outlow of federal taxes from your state to other states. Federal taxes in those states are not going to decrease for those states that don't take the expansion so as a duty to your state and its citizens, you should accept this expansion to increase the amount of federal tax dollars being returned to your state.
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"Perhaps - that's certainly one of the considerations that red-state leaders have cited in declining to expand. Still, there will be politically powerful constituencies - all the states that did expand - that will be pushing back on efforts to reduce that funding mechanism.

Albaby
"


By 2017, we will be around 20 trillion in debt with interest rates rising, which will consume a greater % of the federal budget crowding out other spending priorities. So, if you can see a way where we can afford it, I sure would like to know how?
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As a governor, you win no points by refusing it.

______________

Unless you see a migration of those that aren't as sucessful towards states that are more generous. You already have seen it with immigration. Illegal immigrants move towards sancutary States/Cities so why wouldn't low wage workers and the unemployed move to States that are more generous with their benefits? Especially if they're moving to bordering States.

Look at Maryland and Virginia. They border each other and one expanded and one didn't. Why wouldn't you move to Maryland for better benefits? You could even keep your job in some parts while living in another State.

If a State could push a percentage of their welfare costs to another State, why not?

People move to States for tax benefits, schools and other things, so why shouldn't Medicaid count as well?
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Homeless (those already qualified for Medicaid) are far more mobile that the working poor (those that qualify for the expansion). Welfare is not the same as expanded Medicaid.

I have no fear of a bunch of working poor moving to my state due to the expansion of medicaid.

Even if a few did, the state is still getting $9 for every $1 spent so it might still be worth it when you consider the added tax benefits
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Perhaps - that's certainly one of the considerations that red-state leaders have cited in declining to expand. Still, there will be politically powerful constituencies - all the states that did expand - that will be pushing back on efforts to reduce that funding mechanism.


There is no evidence what will happen after 2020.

And the red states are happy with 90-10 when it involves building highways.

So I find the "concern" about what happens 11 years after ACA is passed to be totally phony.
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"Even if a few did, the state is still getting $9 for every $1 spent so it might still be worth it when you consider the added tax benefits
"

people forget that you are paying federal taxes on increased Medicaid spending. There are NO "added tax benefits".
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There is no evidence what will happen after 2020.

And the red states are happy with 90-10 when it involves building highways.

So I find the "concern" about what happens 11 years after ACA is passed to be totally phony.


I don't see why you think it's phony. Highways are constructed over a finite time horizon, and the funding sources are locked in - for good - up front. Medicaid is an ongoing program, about which (like Medicare and Social Security) there are constant discussion about "reforms."

Under the current cost structure, if fully adopted, Medicaid expansion would be very expensive for the federal government - about $950 billion over 2013-2022 (compared to about $76 billion for the states). That's to cover an additional 10 million enrollees (about 20% more coverage than current levels), but it increases federal outlays by nearly twice that much (close to 40%).

Meanwhile, Medicaid is a rapidly growing expense on the state ledger - for the last several years, states have now been spending more money on Medicaid than education:

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/07/17/t...

So there's going to be enormous pressure on all sides of the equation. You're right that we don't know how it will work out - but if that 90% doesn't hold, then it can have enormous fiscal implications for states that expand.

Albaby
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people forget that you are paying federal taxes on increased Medicaid spending. There are NO "added tax benefits".

The added benefits are a return of federal taxes paid to the state. As I stated previously, states that turn down the expansion do not see a reduction in their federal taxes paid. States that accept the expansion will see an improvement in their ratio of Federal Taxes Paid vs. Federal Spending Received by State.

http://taxfoundation.org/article/federal-taxes-paid-vs-feder...

In other words, those red states that turn down the expansion will be paying for the expansion in the blue states.
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And that is death spiral.

When 4 of every 5 enrollees to Obamacare are old, sick, poor, subsidized there won't be enough money to pay for it.
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"The Federal subsidy for newly-eligible Medicaid enrollees does not simply "end" in three years. The ACA provides that the federal share will remain at 100% until 2017, and after that it phases down to 90% by 2020. That is still significantly higher than the generally 50/50 split between state and Federal funding for Medicaid (the actual amount varies by state), though it is a non-trivial expense that states will have to bear."

Is it safe to assume the government will print/borrow money to pay for this? We all know Obabacare is going to be extremely top heavy with older, sicker, poorer, subsidized enrollees with nowhere enough healthy people to pay for it.
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Is it safe to assume the government will print/borrow money to pay for this? We all know Obabacare is going to be extremely top heavy with older, sicker, poorer, subsidized enrollees with nowhere enough healthy people to pay for it.

As to the first point, much (though not all) of the money paying for the Medicaid expansion is just coming out of a different government account. The government already funnels billions of dollars to hospitals to cover the cost of treating the uninsured - roughly $42 billion per year (or about 75% of the cost) is paid for by state and local government:

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/78...

So a big chunk of the money to make up that extra Medicaid expense is already on the government tab, but paid to hospitals in direct grants rather than through Medicaid enrollment. The hospital just gets paid a different way. Some of the other money will come from taxes levied by the ACA, fines imposed on the uninsured, and just general fund revenue - which will constituted printing/borrowing.

It is still far too early to tell whether the enrollment pools will be too heavily skewed to the older and sicker enrollees to be sustainable.

Albaby
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"The added benefits are a return of federal taxes paid to the state. As I stated previously, states that turn down the expansion do not see a reduction in their federal taxes paid. States that accept the expansion will see an improvement in their ratio of Federal Taxes Paid vs. Federal Spending Received by State.

"

Still coming out of your pay check regardless of state or federal. Still spending money that we DON'T have.

Bad bad idea!
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Still coming out of your pay check regardless of state or federal. Still spending money that we DON'T have.

Again, nothing a governor does will change that. The money will come out regardless. I refer you back to my first point. This is the law; tilting at windmills benefits no one. It is up to Congress to deal with any money we don't have. The role of the governor should be to bring back as much money to their state that they can.
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"I refer you back to my first point. This is the law; tilting at windmills benefits no one."

All it is doing is increasing the medicaid rolls for people who arguably don't need it. This is all about wealth redistribution on part of Obama.

Look, Obama knows it, you know it and i know it...You get above 50% of the nation dependent on the government and you lock in the democratic vote. This has nothing to do with helping people who need it. It is all politics.

Prediction: Those states that accepted it, will in 3 years as a result, will be facing major budget shortfalls becaust the federal gov. reduced reimbursement rates to the states.


The bottom line: This is a socialist program that is broken and needs major reforms for it to be effective.
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yeah i live in indiana...he gave me a dollar a week tax cut, gutted education and made mitch daniels look great...

we jokingly call indiana the mississippi of the north!
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