Entitlements

Officials in "Roughly a Dozen" States Now Exploring the Option of Dropping Out of Medicaid

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Texas is jumpy as a spit on a hot skillet about its Medicaid expansion.

Two things stick out from this KHN/Texas Tribune report on state lawmakers floating the idea of dropping out of Medicaid in response to the expansion built into the new health care law. First, authors Emily Ramshaw and Marilyn Serafini report that in addition to Texas—which, with one of the country's biggest Medicaid bills, appears to be taking the idea the most seriously, or at least talking about it the most—state leaders in "roughly a dozen other states, including Alabama, Mississippi, Washington and Wyoming" are considering the notion. That's a big deal. When the idea first appeared, a lot of folks ignored it, thinking it was so radical that it couldn't possibly gain any traction. It is a radical idea. But state lawmakers are apparently concerned enough about the PPACA's Medicaid expansion that they are seriously exploring the possibility of taking a radical step in response.

Second, there's some pushback to the idea that, if states did drop out of the program, many would-be Medicaid recipients could take health insurance subsidies through the exchanges. Some independent experts (who have been supportive of the PPACA) argue that those subsidies wouldn't be available to folks under the poverty line. The Department of Health and Human Services says it isn't sure. If HHS decides that lower-income folks aren't eligible for those subsidies, that will make it very tough for states to justify dropping out of the program, politically, unless they can come up with some other way to cover those low-income individuals.

Much more on how the PPACA's Medicaid expansion could affect the states in my feature from the October issue.

NEXT: Reason Writers on the Tube: Veronique de Rugy talks California bailout on Varney & Co.

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  1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

    They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

    Any participation on my part won’t change the political system in any way or how others choose to participate.

    Why should I care about politics at all?

    1. Everyone thinks that anyone with a brain must have seen this post before.

      They are all equally convinced that anyone who hasn’t is a worthless excuse for a human being.

      Any participation on my part won’t change the memory of it in any way or how others perceive it.

      Why should I read it again and again?

      1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

        They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

        Any participation on my part won’t change the political system in any way or how others choose to participate.

        Why should I care about politics at all?

        1. You should only pay attention if you are a loyal party member. Otherwise you might end up in Siberia.

          1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

            They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

            Any participation on my part won’t change the political system in any way or how others choose to participate.

            Why should I care about politics at all?

  2. WA state is looking to opt out? As in the state where I reside? TF?

    1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

      They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

      Any participation on my part won’t change the political system in any way or how others choose to participate.

      Why should I care about politics at all?

      1. Do not pay any attention to politics. Remain useful to society or you will be cleansed.

        1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

          They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

          Any participation on my part won’t change the political system in any way or how others choose to participate.

          Why should I care about politics at all?

          1. You are correct sir. Politics should be left to those with more intellect than you posses. Otherwise you might end up with a murderous cannibal in charge.

            1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

              They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

              Any participation on my part won’t change the political system in any way or how others choose to participate.

              Why should I care about politics at all?

            2. “Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

              They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

              Any participation on my part won’t change the political system in any way or how others choose to participate.

              Why should I care about politics at all?”

  3. Could it be that even blue states are beginning to realize that federalism is a good thing?

    1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

      They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

      Any participation on my part won’t change the political system in any way or how others choose to participate.

      Why should I care about politics at all?

      1. Keep sleeping imperialist dog. When the glorious workers revolution has been accomplished you will be sent for Re-Education.

        1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

          They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

          Any participation on my part won’t change the political system in any way or how others choose to participate.

          Why should I care about politics at all?

          1. Politics is not for you…good. It makes it easier to make the trains run on time.

            1. “Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

              They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

              Any participation on my part won’t change the political system in any way or how others choose to participate.

              Why should I care about politics at all?”

  4. I recently heard about this. I’m actually happy that they’re taking initiative to follow through on limiting federal power while strengthening state power, but at what cost? Texas has the highest uninsured rate in the country. It is also home to some of the largest medical insurers. I just am amazed and mystified at what they could possibly propose that will be better (and cheaper as they say) then the current program. Texas also attempts to brag about their educational system and that ain’t so hot either.

    1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

      They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

      Any participation on my part won’t change the political system in any way or how others choose to participate.

      Why should I care about politics at all?

      1. You shouldn’t. Keep sleeping. My minions will wake you up when your train to the camp is ready.

        1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

          They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

          Any participation on my part won’t change the political system in any way or how others choose to participate.

          Why should I care about politics at all?

          1. Politics is foolishness. Only strong men can lead a country.

              1. “Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

                They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

                Any participation on my part won’t change the political system in any way or how others choose to participate.

                Why should I care about politics at all?”

            1. “Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

              They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

              Any participation on my part won’t change the political system in any way or how others choose to participate.

              Why should I care about politics at all?”

            2. “Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

              They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

              Any participation on my part won’t change the political system in any way or how others choose to participate.

              Why should I care about politics at all?”

  5. those subsidies wouldn’t be available to folks under the poverty line.

    Funny, I’d have figured that’s group of people who would actually be eligible for subsidies…

    1. Everyone thinks that anyone with a brain must agree with them–liberals, conservatives, libertarian–you name it.

      They are all equally convinced that anyone who disagrees with them is a worthless excuse for a human being.

      Any participation on my part won’t change the political system in any way or how others choose to participate.

      Why should I care about politics at all?

    2. The subsidies are for the middle class (up to 400% of the poverty line). Medicaid is the taxpayer-funded program that’s intended to pay for folks below the poverty line. Without Medicaid, it’s not clear what they’re eligible for.

      1. Subsidizing people who have enough money…oh, never mind, my (empty) bottle of crazy pills are right there. Glad that’s cleared up.

        1. Most people have enough money. And buying the vote of -most people- is a good strategy for elected officials.

  6. end the sate!

  7. unless they can come up with some other way to cover those low-income individuals.

    Could pay for a moving truck so they could move to Massachusetts. I hear they already have free healthcare there and all the Unicorn shit tastes just like chocolate.

  8. Clean up this fucking thread already.

  9. It’s a gamble. As I understand it, by opting out of the system, the state’s immediate negative = a loss of federal funds. The state would still be required to provide a safety net, but, free from recent regulations, the state might be able to perfrom this duty so cheaply that the lost federal money is more than offset by savings. But wouldn’t the state be exposed to potential federal liability for failure to meet its responsibilitites? If the state AG (or solititor) loses that case…

    1. Emmer, while running for governor of MN was critisized for saying he didn’t want to accept federal dollars. The critics said that for every dollar of federal money he refused, local taxes would have go up 66 cents. He said Minnesotans would be glad to be saving 34 cents of every dollar.

    2. The state would still be required to provide a safety net

      Required by whom? It is an established principle of US law that Congress cannot require state officials to carry out Federal policies.

  10. Whatever happened to charity care? Are there no charitable providers left? Or have we put them all out of business by forcing them to take every deadbeat with a hangnail and provide them with intensive care. When I was younger back in the very early 70’s, I was dirt poor. But I lived in the best city in the world for medical care: Cleveland, OH. There were outpatient clinics that charged a sliding fee, based on ability to pay, at every hospital in town. If I became suddenly ill, I went to the clinic. If I were in an accident, I’d be taken to whichever hospital had me at their outpatient clinics. I had OB care, Cardiology, etc. and paid whatever I was charged as a working poor person. The hospitals needed me (to have patients for interns and residents to work on) and I needed them. There was a real relationship of giver and grateful recipient. I think every state should dump Medicaid. It’s a failed program about to get a lot worse. You can’t force a doctor to accept Medicaid patients!

    1. Yes you can, actually. You make it a condition of state licensure. They’re already talking about this in Massachusetts I’ve been told.

      1. And they think they have a shortage of docs now…

        It is obvious to any thinking person that this can only result in a first smaller and later less able pool of doctors available to treat people. Smaller because some (perhaps many) of the docs will go to another state to practice, and when that avenue is closed to them some potential docs will pick another career.

        Once that happens, we’ll get to the “less able” part, ’cause the government will respond by offering “incentives” to people to choose the profession and to med-schools to make sure they graduate. And most of the school will do their best to hold the line, but…the fact is that sooner or later you’re going to get a surgeon who passed through school on the Gentleman’s A-.

        And seeing that happen to everyone in favor of socializing medicine wouldn’t bother in the slightest, except that I’ll be facing the same fate as will my SO and out hypothetical crochfruit.

        For Glod’s sake, people! Finding Doctors who are both analytical and knowledgeable is pretty damn hard even now.

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