RSS

TennCare

A Test of Ideology

Paul WaldmanJul 10, 2012
Flickr/Gage Skidmore

Texas has a higher proportion of its population living without health insurance than any other state. But like many other states with lots of poor people, it has the misfortune of being governed by Republicans, which explains why yesterday, Governor Rick Perry announced that the state will refuse to accept the money the federal government is offering to expand Medicaid eligibility to everyone who makes up to 133 percent of the federal poverty level. Perry says that this expansion of Medicaid, which is almost entirely paid for by the federal government, will nevertheless bankrupt the state and put the oppressive boot on the necks of Texans. So he's happy to keep 25 percent of his population uninsured.

In case you're wondering, Texas currently sets eligibility for Medicaid at 26 percent of the federal poverty level, which means that if you earn more than $6,000 a year for a family of four, you're not eligible. That's not a typo. Six thousand dollars a year for a family of four is what the state of Texas considers too rich to get on Medicaid. Look down the list of eligibility levels, and you find that only Alabama, Arkansas, Indiana, and Louisiana set their eligibility lower. It is just so weird how those poor Southern states are the stingiest with health care benefits, isn't it?

It's possible that eventually, Texas and the other states will come around to the expansion of Medicaid. Sarah Kliff explains how this happened with Medicaid's enactment in the 1960s and the Children's Health Insurance Program (CHIP) in the 1990s; conservatives initially resisted, but the money and the opportunity to insure their population eventually became irresistable. One of the key factors then and now is the presence of organized, influential interest groups—particularly the hospitals that have to deliver uncompensated care to the uninsured, costing them billions—that can exert their influence on the government's decisions.

But the Republicans who resisted and then gave in were different from the Republicans of today, and this will be a test of just how far they'll go to make a statement about their hatred of the federal government in general and their hatred of Barack Obama in particular. Today's Republicans are the ones who would turn down a deal offering ten dollars of spending cuts for one dollar of tax increases. But that was a hypothetical question, and this question is very real. There are actual human beings whose lives are at stake. I'd love to hear someone ask Rick Perry this question: Which do you think is worse, someone living without health insurance, or someone getting health insurance through a government program? I'm not sure what he'd say, but his actions say quite clearly that he'd prefer that the person have no health insurance. Of course, we're not talking about him personally, or his kids, or anybody he knows having to go without insurance. We're talking about poor people. So screw them.

Starve a Cold, and Your Taxes

Abby RapoportJul 09, 2012
(Flickr / Gage Skidmore)

It's a well-known rule in journalism that when you don't want to write the story your editor assigned you, you suggest a new one—an equally good, if not better, alternative.

Supreme Surprise

Paul StarrJun 29, 2012
(AP Photo)

The verdict of the Supreme Court upholding nearly all of the Affordable Care Act is a victory to be savored in the full knowledge that it may be only temporary and includes potentially damaging changes in constitutional interpretation.

It is a victory, first of all, for the millions of people excluded from health insurance who stand to gain protection despite their medical history or low incomes.

It is a victory for the rule of law in the face of a group of partisan conservative justices who want to immobilize federal power in social policy.

It is a victory for the millions of people who have struggled for decades to achieve equal access to health care.

If Texas Doesn't Expand Medicaid, Two Million Will Be Without Options

Abby RapoportJun 29, 2012
(Flickr/ José Goulão)

It's no secret there's a health-care crisis in Texas. The state has the biggest uninsured population in the country with around 6.2 million—or a quarter of all residents—lacking insurance. As a Kaiser Health News report highlighted, poor and uninsured Texans must sometimes wait more than 24 hours in emergency rooms, where treatment is most expensive, while more cost-effective health-care options, like preventative care, are out of reach. 

On Medicaid, Republicans Explore New Moral Depths

Paul WaldmanJun 29, 2012
Florida governor and aspiring Bond villain Rick Scott, looking forward to denying poor Floridians health insurance. (Flickr/Gage Skidmore)

As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you're poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren't really poor, right?

Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to make things easier on the states, the bill provided that the federal government would pick up almost all of the tab. The federal government pays 100 percent of the cost of paying for the new enrollees through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent from then on. In other words, the federal government is saying to states, "Here's a bunch of free money to insure a whole lot of your citizens, which will make them healthier and more productive." And almost every state run by Republicans replied, "How dare you do such a thing to us! It's unconstitutional! We're suing!"

Why It's Still in States' Interests to Expand Medicaid

Abby RapoportJun 28, 2012
(Flickr/ernstl)

For supporters of the Affordable Care Act, it was hard to hear—over the cheering—anything besides the fact that the Supreme Court today kept the law almost entirely intact. But the Court did make a slight change to a crucial part of the ACA: Medicaid expansion. Under the law, by 2014, states are supposed to extend their Medicaid programs to cover people under 65 with incomes up to 133 percent of the federal poverty line. An analysis from the Center on Budget and Policy Priorities shows that means 17 million more people would have access to health care over the next 10 years.  Before today, it looked like states didn't have much choice in the matter.

Beware Republicans Bearing "Flexibility"

PaulMay 31, 2011

flexibility.jpg

The Medicaid Costs Are Too Damn High.

Jamelle BouieFeb 28, 2011

State governors are practically begging the federal government for permission to cut hundreds of thousands from their Medicaid rolls. Why? Thanks to the recession, declining revenues, and the rising price of health care, state governments are increasingly unable to bear the burden of Medicaid costs. The Wall Street Journal explains:

About eight million Americans joined the Medicaid rolls between 2007 and 2010, many because they lost jobs. The federal government picks up 57% of states' Medicaid tab, on average. But in July, $26 billion in additional federal Medicaid funding will expire, leaving states to plug a big budget hole.

Ben Nelson Has a Good Idea.

Paul WaldmanJan 08, 2010

That's not a headline I ever thought I'd write. But political controversy, it seems, is the mother of invention. You'll recall that in exchange for his vote on health-care reform, Sen. Ben Nelson obtained from Harry Reid a provision under which the federal government would pick up the full cost of the bill's expansion of Medicaid – in Nebraska, but not in other states. Lots of people squawked: Why should Nebraska get special treatment, they asked. Of course, states and districts with powerful members (or those whose votes are particularly valuable at a given moment) get special treatment all the time. But that doesn't mean it wasn't a legitimate criticism.

Fixing Medicaid's Inconsistencies.

ldeanDec 07, 2009

The latest from a really helpful ProPublica project that breaks down how health-care reform would affect specific groups illustrates how the bill seeks to standardize state participation in Medicaid programs. The piece profiles a young single woman unable to work because of Chronic Fatigue Syndrome, who was forced to move from Maine -- where she was only eligible for temporary Medicaid -- to Pennsylvania, one of only 15 states in which low-income adults are eligible for Medicaid benefits. At present: