We’re in this together, whether they like it or not

Unsurprising, really (pdf):

The Affordable Care Act (ACA) seeks to fill the longstanding gap in Medicaid coverage for low-income adults by expanding eligibility to a minimum floor of 138% of the federal poverty level (FPL), or $24,344 for a family of 3 in 2012. However, the Supreme Court ruling on the ACA effectively made implementation of the Medicaid expansion a state choice. If a state does not expand Medicaid, poor uninsured adults in that state will not gain access to a new affordable coverage option and will likely remain uninsured. To provide insight into the potential impacts of expanding Medicaid, this report highlights the experiences of adults in California, Connecticut, Minnesota, and the District of Columbia, which all have already expanded Medicaid to adults. Based on focus groups and interviews with previously uninsured adults who recently gained Medicaid coverage in these states, it examines the personal impacts gaining coverage had on individuals’ health, finances, employment, and overall wellbeing.

Obtaining Medicaid coverage enabled participants to access care for unmet needs and preventive care, which had positive impacts on their health and other areas of their lives. Gaining Medicaid coverage provided a significant sense of relief to participants. They used words like “secure” and “grateful” to describe what it feels like to have Medicaid coverage. Many noted that obtaining coverage enabled them to get medications and needed care they had gone without while uninsured. In addition, many obtained a physical after enrolling in coverage and are hoping to follow up with other preventive services, such as colonoscopies and well-woman exams. For some participants, physicals led to the diagnosis of conditions such as diabetes, asthma, and anemia, for which they are now receiving care. Participants also noted that having Medicaid enables them to seek care from a physician early rather than waiting until conditions worsen or using the emergency room. Many participants have established a relationship with a primary care provider and say they appreciate having a doctor who can get to know them and coordinate their care. Participants also emphasized that, by enabling them to get their health needs met, obtaining Medicaid coverage facilitated their ability to take charge of their lives and focus on other goals and priorities, such as employment.

I know none of you are surprised that access to health care had a “positive impact” on….health, but conservatives are in a persistent state of denial on this, so I thought it was worthwhile to present “findings” taken from actual people.

In order to justify his continued refusal to expand his state’s Medicaid program — which would extend health coverage to an additional 200,000 low-income Mississippians — the governor explained that poor people don’t need a “massive new program” when they can simply visit an emergency room to receive care:
BRYANT: There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room.

During the presidential election, GOP candidate Mitt Romney claimed that “we do provide care for people who don’t have insurance” by picking them up in ambulance and taking them to the hospital.

And here’s Bush:

“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America,” he said. “After all, you just go to an emergency room.”

I have a larger question, though. Republicans and media insist on discussing the health care law in discrete chunks. The poor. Medicare. Large business. Small business. But that isn’t how it works, and that isn’t how people will experience it. The goal is universal coverage. It’s a system. For every libertarian CEO who owns a large business and bitches about the health care law, there will be three small business owners who benefit from the health care law. Some of them may even be able to compete with the large business owner. We really do live in communities. Really. Whole Foods isn’t out there on an island.

How do GOP governors justify this, for example?

If a state does not expand Medicaid, poor uninsured adults in that state will not gain access to a new affordable coverage option and will likely remain uninsured.

If one adult makes 150% of poverty level they receive a federal subsidy and have health insurance, but if another makes 120% of poverty they are completely shut out? Even for conservatives with their cavalier tossing off of “send them to the emergency room!” this seems cruel and unfair.

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70 replies
  1. 1
    Jim Pharo says:

    Your bug, their feature. Causing pain and suffering is why sadists get out of bed in the morning.

    Say one thing: BHO may not be a liberal hero, but he’s doing an effective job of exposing the GOP as a bunch of sadistic thugs. I’ll take it, and leave free cable tv for all to President Warren.

  2. 2
    butler says:

    Whole Foods isn’t out there on an island.

    Yet. We’ve yet to see how far they’re willing to go in order to avoid paying an insignificant cost in order to make their employees healthier and happier.

  3. 3
    Wag says:

    Cruel and unfair, but not surprising.

  4. 4
    butler says:

    Also, that link must be broken. More than 50% of the people pictured on that Medicaid report are white. As we all know, the ACA only benefits non-white moochers.

  5. 5
    Kay says:

    @butler:

    Right, but what I’d like to see is coverage that presents Whole Foods, and then presents (for example) the effect on a small business who may want to compete with Whole Foods. I hate the health care “debate” because it freezes people into these categories; “Whole Foods employees”, “Medicare recipients”. “The poor”. People move in and out of these categories. The whole point of the health care law was the guarantee. The fact is that MOST people move in and out of categories, it’s inevitable, for one thing, time passes :)

  6. 6
    Bill in Section 147 says:

    Republicans and media insist on discussing the health care law in discrete chunks. The poor. Medicare. Large business. Small business.

    If they don’t fragment the discussion they cannot win the argument. A collection of facts are not the truth even if each of the facts alone is true. If it walks like a duck and talks like a duck and looks like a duck and acts like a duck it can be a man in a duck suit.

  7. 7
    Kay says:

    @Bill in Section 147:

    Well, in terms of media I’m willing to give them the benefit of the doubt and believe they aren’t doing this deliberately. I think they approach “health care” as they’ve always approached it, “haves” and “have nots”. They haven’t had to discuss it as a system, because it wasn’t a system. They’re lacking the universal frame.

  8. 8
    c u n d gulag says:

    Uhm…

    Isn’t “cruel and unfair” their whole position on everything?

    As somone above pointed out – it’s a feature, not a bug.

  9. 9
    BC says:

    One of the most ignorant ads that Romney ran in this election is the one where he says the man with a heart attack would receive health care by going to emergency room. A person with a heart attack may start by going to emergency room even with health insurance, but the important thing is what happens next. If caused by blockage, there may be a stent to keep a vital blood vessel open or bypass surgery. These are not available for the uninsured. So Romney’s ad was ignorant and people who voted for him (who were likely to have suffered a heart attack and had the after care) knew it was ignorant.

  10. 10
    japa21 says:

    One of the many things that bothered me about the woefully inadequate selling of ACA is the impact on the general health of the nation. By getting more people treatment, specially preventative care, you are having an impact on, among other things, communicable diseases.
    That person next to you at work, or in the grocery store or at the mall who didn’t have insurance and couldn’t afford treatment, may well be passing something on to you which they wouldn’t be doing if they received care.
    One of the big reasons for pushing flu vaccinations is not the health of the individual but the health of the society.

  11. 11
    Kay says:

    @BC:

    It’s bullshit on so many levels. People pay for emergency room care. If they can’t pay for it, and they’re working, the provider gets a judgment and their wages are garnished. I have no idea where Republicans got this idea that people just sashay into emergency rooms and walk out, free and easy. Jesus Christ. They’re billed for the ambulance! They pay and pay and pay, and that’s money they can’t spend on something else, like food or housing or a car.

  12. 12
    Forum Transmitted Disease says:

    So Romney’s ad was ignorant and people who voted for him (who were likely to have suffered a heart attack and had the after care) knew it was ignorant.

    Not so much. Sit down with one and ask them, kindly, one on one, why they voted for Romney knowing his position on ACA.

    They’ll tell you.

    They don’t want to pay the taxes to keep poor people from dying. I’ve had three Romney voters say that to my face. They’d rather let people die then pay a few bucks. Even people they know.

  13. 13
    Trakker says:

    There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room.

    Then we must encourage everyone without health care in Mississippi to go to the emergency room when they or someone in their family is sick, and screw the bill if you can’t pay it. Overwhelm the system, create a fckin’ health care crisis in the state and make sure the hospital knows who sent them, their governor. These assh0les on the right have got to begin paying the price for their ignorance!

  14. 14
    Patricia Kayden says:

    I would like to know how going to an emergency room constitutes access to healthcare. You don’t get routine check ups/medical treatment in emergency rooms.

    Sigh.

  15. 15
    Lee says:

    I read in this mornings paper about how in Texas poor immigrants (legal) will have cheaper health insurance than poor native Texans since Perry is going to opt out of the medicaid expansion.

    I would provide a link but the dallas morning news website is a complete mess when trying to find a specific article.

  16. 16
    Trakker says:

    @Forum Transmitted Disease:

    They’d rather let people die then pay a few bucks. Even people they know.

    I’m not sure it’s the money, because these same people will get a tear in their eye when they see the glass jar for donations to help a neighbor pay for an operation, and toss a buck or two in. I think they just don’t want the government to do anything good for people. They hate the government with a white hot passion and they would rather see people die than see the government do anything helpful.

  17. 17
    MomSense says:

    I think there are about 9 Governors who have “caved” so far including Jan Brewer. They will get a lot of pressure from providers and hospital associations to expand Medicaid because they stand to gain from the expansion. Medicaid reimbursement rates are better than higher rates of uncompensated care.

    I also think there is a lot of room to sway those who are currently insured. They probably don’t know that they pay about $1,200 (1,800 in Texas) in higher insurance premiums to subsidize uncompensated care and expanding Medicaid would lower their rates and result in better outcomes.

    Right now we pay top dollar and don’t get good value for our money. Expanding Medicaid isn’t just the right thing to do, it’s the smart thing to do.

  18. 18
    Mr. Longform says:

    @Forum Transmitted Disease:

    I think that is such a salient point in this discussion. One often hears it expressed as “a lack of empathy”, but that is so squishy sounding, it’s easy to forget just what that means. I remember back in the ACA town meeting days when the tea baggers first appeared screaming at congressmen that there was a feature in the NYT about an angry white guy who had never been politically active before but who was now going to these town halls and getting all worked up. And the reasons seem to mostly boil down to some idea that some poor person (and by that I think he meant some black person) was getting something for nothing. Imagine never getting interested in anything to do with the systems we have for distributing power goods and services until you perceive that someone is getting something without deserving it (whatever that means.) Not a banker screwing over the whole economy and not some petroleum executive taking subsidies, but some poor guy who might get a little medicine. That’s what gets you going? I don’t know how to relate to such thinking.

  19. 19
    Ohmmade says:

    The GOP alternative of just going to th emergency room is crazily more expensive to the state than having actual medical insurance. I do understand that “fiscal conservative” is a horseshit lie, but it astounds me that this fact isn’t pushed back into the faces of people like this.

    Major points to whomever gets this ball rolling and crushes this talking point. My guess is Tweety will be the first.

  20. 20
    NCSteve says:

    I was a poll monitor for the Obama campaign in the 2008 primary and for the Democratic Party in the 2008 and 2012 general elections. In all three elections, I was sent to precincts in predominantly African American neighborhoods. But in 2012, the neighborhood was particularly tough. The other two times, the neighborhoods were poor and clearly had their share of problems, but they were very much communities.

    The last time, in 2012, however, the neighborhood was very clearly a neighborhood of transients–a neighborhood full of people who’d mostly landed there recently after having lost jobs or their house or their family. A neighborhood full of people who’d always had it rough and had it rougher still because times got hard.

    And the thing that struck me, that hit me hard upside my insular fat white head, was how very many of the people, especially the middle aged men, who came to vote that day had something very wrong with their gait. People showing signs of broken bones or chronic conditions that had never been treated. Even rickets, for God’s sake.

    And that’s when I opened my eyes and really looked at the folks coming in and saw how huge the toll of a world without primary care was. That’s when I really, truly realized, at a visceral rather than statistical or policy level, how desperately needed the health care reform act was, how huge the need was, how critical it was to win that election, and how utterly banal all of the arguments between people on the internet who already had health insurance about the importance of the public option had been.

    That day was when I realized that if we accomplish nothing else other than keeping the plutocrats from crushing out the ACA over the next four years, that would be a Big Fucking Deal.

    That’s what I think of every time another Republican governor decides to score Tea Party Bonus Points by taking a shit on the people whose need is most urgent. It is, and I use the word advisedly and without hyperbole, simply evil.

  21. 21
    John M. Burt says:

    Republicans and media insist on discussing the health care law in discrete chunks.

    I am reminded of the person who said being in an abusive relationship* is like being in a cage where people insist that you describe only one bar at a time.

    *Insert here reference to the need for our dear friend America to get that party out of her life….

  22. 22
    Roger Moore says:

    Even for conservatives with their cavalier tossing off of “send them to the emergency room!” this seems cruel and unfair.

    Cruel and unfair? Yeah, I think the Conservatives can get on board with that, especially if the people it’s cruel and unfair to are brown the Devil’s poor.

  23. 23
    Kay says:

    @NCSteve:

    Great comment. I don’t know if this is true across the board, or is just something I notice, but if you go into a poorer area and look at the selection in the drug store, I have observed you will see a LOT more OTC remedies in poor areas, particularly for dental pain. It upsets me. They’ll be three or four dental numbing potions and such and I don’t see that over in my neighborhood.

  24. 24

    @Forum Transmitted Disease:

    They don’t want to pay the taxes to keep poor people from dying. I’ve had three Romney voters say that to my face. They’d rather let people die then pay a few bucks. Even people they know.

    Let me guess… most (if not all) of them call themselves “Christian”. And if they’re the sort to go to church every week, they sing louder than anybody else.

    (Just guessing, of course. But I know similar people).

  25. 25
    Steeplejack says:

    Emergency-room treatment is “health care” in the same sense that having your car towed after an accident is “transportation.”

  26. 26
    Xecky Gilchrist says:

    @Patricia Kayden: I would like to know how going to an emergency room constitutes access to healthcare. You don’t get routine check ups/medical treatment in emergency rooms.

    This.

    It might be fun to make an O’Keefe-style (only non-dishonest) vid where the crew goes to an emergency room and attempts just that.

    If it weren’t, you know, a waste of the ER people’s time.

  27. 27

    this seems cruel and unfair.

    Abusive mentality, Kay. They like to hurt people, and they like to feel righteous. It’s quite easy to do both by blaming the victim. Thus ‘takers’ and Brokaw’s speeches about how people need to learn to live with a little less. The overall theme used to be ‘removing the safety net will help the poor by Building Character’, the classic abuser’s excuse. This was always a basic part of the Republican Party, but they went insane when Obama became elected and can’t pretty it up anymore.

    EDIT – Note, racism combines beautifully with this. Being a mean, unempathetic asshole makes it easy to hate anyone different, and being scared of The Other makes it easy to think they don’t deserve help.

  28. 28
    nemesis says:

    Here’s the dealio: it seems rwingers advocate for poor and uninsured citizens using the emergency room. Frankly, Im aghast gopers dont simply advocate that the poor and uninsured go without healthcare completely. Galt demands it!

    So, if cons support emergency room visits for the poor and uninsured, thats good. Now lets examine the costs.

    It doesnt take a rocket surgeon to understand that a routine visit to the ER is expensive. Care is performed exclusively by nurses and physicians. They gonna get real paid.

    Now, lets look at that same routine doctors visit being handled by a Primary Care Physician or a Specialist. Vital signs, height weight, etc are performed by Medical Assistants and care could be performed by a Physicians Assistant for basic office visits. The cost savings is huge when comparing the two scenarios.

    Arent the cons all about cutting gummit spending? Well, using the ER exponentially increases gummit healthcare spending.

  29. 29
    Joel says:

    @Kay: I actually wonder if the competition angle is why Mackey is so opposed to ACA. Health care benefits is one of the major advantages Whole Foods seems to enjoy in the employment market against its competitors.

  30. 30
    Kay says:

    @Frankensteinbeck:

    ‘removing the safety net will help the poor by Building Character’,

    Right, but I still think it’s a problem for them. It’s one thing to say “there are 40 million uninsured” blah, blah, blah, ‘the poor’, compassion, mumble, mumble”

    It’s another thing entirely to say “everyone is insured except the poorest adults”. It starts to get personal and specific.

  31. 31
    Jim, Foolish Literalist says:

    @Ohmmade: Major points to whomever gets this ball rolling and crushes this talking point. My guess is Tweety will be the first.

    Say what you want about him, and over the years I’ve said it all, but he was all over Romney’s “we don’t just let him die in his apartment”. Charlie Pierce said it was old school Irish working-class resentment of the uptown swells who made his old man tip his cap, and I think that’s right. But in this case, I’d put my money on Schultz. He may be the least wonky of the MSNBC prime time line up, including Tweety, but his heart is in the health care fight, like his coverage of groups hosting health fairs around the country

  32. 32
    Kay says:

    @Joel:

    It’s pure loss to large employers. They had a competitive advantage in terms of competing for employees over small business, and the lowest wage employers (so not Whole Foods) could free-ride on our crappy public safety net system. Now they have to put up (insurance) or pay the federal government to take care of their employees. I think it’s perfectly predictable that chain restaurants are screaming the loudest. They had a free ride. Now they don’t.

  33. 33

    @Kay:
    They’ll just cut hours to make sure the free ride continues.

  34. 34
    Jim, Foolish Literalist says:

    @Joel: I think he’s just a mildly loony “I built this” glibertarian

  35. 35
    Kay says:

    @Chuck Butcher:

    If you look at the IRS rule that goes along with the law, it’s tough to get around. I guess they can work it, but it’s not going to be easy or (necessarily) profitable. They don’t have “extra” employees. They’ll have to keep all those part time hires going, and each employee adds costs apart from health care. That’s besides the problem of keeping good people when you offer only 20 hours a week.
    It reminds me of how they always threaten to fire their employees every time the minimum wage goes up. Do you know any business owners who pay spare employees to hang around? They’re all at bare minimum staffing.

  36. 36
    Cassidy says:

    I’m not sure if it’s been said, but we’re past the point of “plutocrats” and “money republicans”. We are dealing with true believers now. These people really think that poor is something that happens to morally degenerate people and that giving something away for free is an abomination. There is no reasoning with these folks.

  37. 37
    Bulworth says:

    I know none of you are surprised that access to health care had a “positive impact” on….health,

    No doubt a severe case of skewed reality. /

  38. 38

    @Kay:

    Right, but I still think it’s a problem for them.

    A problem in one way? Politically? Absolutely. They avoided saying this stuff out loud for decades for a reason. Emotionally? Yes, and no. The abuser does not have to think through the details like that. He can pick exactly the phrasing that makes him feel like he’s the mature self-sacrificing adult while he hurts people with his two year old tantrums. It’s not hard. Hell, it’s the opposite of hard. It’s what our brains are designed to do.

    In fact, because it’s easy is exactly why they’re doing it much more than they did before Obama was elected. When you’re scared or angry or otherwise under heavy stress you revert to instinct rather than reason. People who used to be able to overcome these urges now can’t. They’re too afraid of the Kenyan Marxist Usurper Who Will Take Away Our Guns And Kill Gramma.

  39. 39
    Kay says:

    @Frankensteinbeck:

    I think a big part of being a conservative is their idea that they are morally superior to liberals. It’s a huge part of why they got so angry with the Newtown tragedy. You could hear it in their voices. They ARE NOT, EVER irresponsible! They DO TOO care about children!

    So if I think they have a problem if we have two identically situated working people, where one makes a little more than the other, and the slightly better-off worker gets a state subsidy for health insurance, while the other does not. Remember, these very low-income adults will be the only people who are cut out of the system. It starts to look like conservatives have it in for them :)

  40. 40

    @Kay:
    So you do mean ‘politically’, an image problem seen by everyone in the nation who hasn’t gone into a screaming panic that the US isn’t Leave It To Beaver anymore. Sure. The 2012 election showed that quite well. That is not going to enter into the conservative decision making process, except to egg them on just a touch more. That is the point of saying they’ve gone crazy. They’re acting on a similar playbook, but now they’re taking it so far that they don’t care if they hurt themselves in the process. It’s pathological, self-destructive. That’s how you medically define crazy as opposed to weird.

  41. 41
    RepubAnon says:

    Let’s start calling the “emergency room option” what it is: the Republican Doctor Tax. If the emergency rooms treat the indigent, guess when they get paid? (Answer: never.) It’s a tax, which is passed on to the rest of us in the form of higher hospital charges due to the extra overhead.

    Medicare for all means lower overall health care costs, as expensive emergency room visits are replaced by low-cost clinic visits.

    My personal suspicion is that the Republicans are using this as a form of gerrymandering by forcing poor people to move to states with better safety nets. The fewer poor people, the fewer votes against the Ayn Rand fans.

  42. 42
    kc says:

    Surely no one here is surprised that red state governors are refusing to expand Medicaid.

  43. 43
    Kay says:

    @Frankensteinbeck:

    I think there are a lot of conservatives who won’t want to identify with, or claim membership in, a “mean” Party. They have a lot invested in the idea that they are “good people”. I’m not talking about the media celebrities or the leaders, I mean the ordinary voters they count on to produce the 47% (or whatever). Cutting poor adults out of the herd like this is different than before, where they were able to slough it off as “the uninsured” (which no one really gave a shit about, it’s so vague, it’s millions, etc). Everyone BUT these folks will be insured in these states. I think that changes the politics.

  44. 44
    Tim in SF says:

    “If one adult makes 150% of poverty level they receive a federal subsidy and have health insurance, but if another makes 120% of poverty they are completely shut out? ”

    I don’t understand this sentence.

  45. 45
    Mnemosyne says:

    My friend’s sister lives in Mississippi (I know, but people do stupid things for love sometimes). She also has a serious seizure disorder and suffers grand mal seizures if she doesn’t have her medication on a regular basis (and, unfortunately, has had “breakthrough” seizures even when on medication).

    And the idiot governor of the state she lives in thinks a serious seizure disorder can be treated at the emergency room? All she has to do is be brought to the ER every time she’s found unconscious after a seizure and that’s all the healthcare she needs?

  46. 46
    gene108 says:

    I can’t blame Republican governors for denying Medicaid expansion.

    The underlying basis of Republican thought for the past 30+ years has been “government is not the solution, government is the problem.”

    By expanding Medicaid they will demonstrate “government is the solution” and lose a major basis of whatever passes for political thought on the Right, other than pushing the Culture Wars.

  47. 47

    @Kay:
    If there were, Kay, they lost every single one of them during the Romney election. Your best hope there is that now that they know Obama has well and truly beaten them, despair will make some start panicking and they’ll regain enough reason to notice the freakshow surrounding them on all sides.

  48. 48
    kc says:

    I’m wondering what’s going to happen to Democrats politically when millions of people start getting penalized by the govt because they still can’t afford insurance? At least Obama won’t have to worry about it

  49. 49
    Mnemosyne says:

    @Tim in SF:

    As far as I can tell, this is how it’s going to work in some states:

    If your wages are 120% of the poverty level, you can get Medicaid. If your wages are 150% of the poverty level, you can buy insurance from the federal exchanges and get a subsidy to do it. If you fall in between, you get nothing.

    There was supposed to be an increase in Medicaid funding by the states that would let people making less than 150% of the poverty level be enrolled, but the Supreme Court decided that the federal government could not dictate that to the states. So now there’s a situation in some states where people who make between 121% and 149% of the poverty level have no options — they make too much to get Medicaid and too little to get an insurance subsidy, so they’re hosed.

  50. 50
    Jim Pharo says:

    @Mr. Longform: Let me help: it comes from a sense of victimhood. These folks think, “No one helped me when I was down, and I suffered but I got by. Why should that other guy get a hand when I didn’t.” I think forcing basic medical care down their throats will actually help relieve some of this lack of empathy by cutting down on the sense that “I didn’t get help, why should you,” when in fact “you” did get help.

    I think it’s called “progress”…

  51. 51
    gene108 says:

    @kc:

    I’m wondering what’s going to happen to Democrats politically when millions of people start getting penalized by the govt because they still can’t afford insurance?

    From what I gather the enforcement provisions are pretty minimal, with regards to the government being able to collect a penalty.

    I’m not sure, if people will be any more adversely impacted due to the law.

  52. 52
    brantl says:

    Even for conservatives with their cavalier tossing off of “send them to the emergency room!” this seems cruel and unfair.

    What part of standard operating procedure don’t you understand?

  53. 53
    MomSense says:

    @Kay:

    If the total cost of wages goes above a certain amount (regardless of the number of hours each employee works) they have to either provide health insurance or contribute for every employee that goes to the exchange for their health insurance.

  54. 54
    Anna in PDX says:

    @Patricia Kayden: Yes, it seems that these politicians have never been to an emergency room and don’t understand how it works.

  55. 55
    brantl says:

    The uninsured also pay about double what is paid for the insured, as well, if the institution can wring it out of them.

  56. 56
    brantl says:

    The uninsured also pay about double what is paid for the insured, as well, if the institution can wring it out of them.

  57. 57
    quannlace says:

    Sure. And right now in the NE, the emergency rooms are slammed with flu patients due to a really bad flu season. But I’m sure they’ve got plenty of time to see all these uninsured patients as well

  58. 58
    FormerSwingVoter says:

    If one adult makes 150% of poverty level they receive a federal subsidy and have health insurance, but if another makes 120% of poverty they are completely shut out? Even for conservatives with their cavalier tossing off of “send them to the emergency room!” this seems cruel and unfair.

    As an added bonus, the individual mandate will likely still apply to these people. Republican governors can deny the Medicaid expansion, then when their constituents get hammered they can blame it on health care reform instead of their own seething hatred of all things democratic.

  59. 59
    Kay says:

    @FormerSwingVoter:

    No it won’t. The individual mandate drops out at a set percentage of income/premium cost. It disappears.

  60. 60
    Ruckus says:

    @Kay:
    And they don’t get billed at the insurance company rate either. They get billed full pop plus, IMHO up to 200-300% of full pop. Plus collection fees and penalties.
    They don’t just pay, they keep paying and paying, as well as the care they receive is not as good because it is not and can not be as through.

  61. 61
    Ruckus says:

    @Kay:
    And they don’t get billed at the insurance company rate either. They get billed full pop plus, IMHO up to 200-300% of full pop. Plus collection fees and penalties.
    They don’t just pay, they keep paying and paying, as well as the care they receive is not as good because it is not and can not be as through. And of course if one does need additional care that’s an additional trip to the ER, with all the costs piled on, again.

  62. 62
    Kay says:

    @Ruckus:

    They don’t just pay, they keep paying and paying

    It’s so weird how we talk about this, isn’t it? How did they get away with saying “they just go to the emergency room”? It’s such an incredibly stupid, clueless answer, and this was from a President! No one said “well, yes, Mr. President, but the emergency room costs…money”

  63. 63
    Ruckus says:

    @Trakker:
    Had to go to the ER once, when the receptionist asked who is going to pay I told her to send the bill to bush, after all he is the one that told me to go to the ER. She didn’t see the humor/truth in my statement.

  64. 64
    FormerSwingVoter says:

    @Kay: Good to know, thanks for the correction! That was something I used to know, but had forgotten about.

  65. 65
    Ruckus says:

    @gene108:
    I can’t blame Republican governors for denying Medicaid expansion.

    I sure can. They are the ones denying it. Your point of course being that they can’t change their stripes. But they were elected, in theory to represent all the people in their states. And they are failing at that in a huge way.

    They deserve all the blame.

  66. 66
    julie says:

    Wouldn’t a resident of a state whose governor refused the Medicaid expansion have grounds to sue? I mean if they’re Medicaid-eligible and would get the medical care if they lived in another state, wouldn’t they have a case?

  67. 67
    Joel says:

    @Kay: Imagine if we mandated that the states get rid of the restaurant worker’s minimum of ~$1.50 + tips in some palces.

  68. 68
    Triassic Sands says:

    There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room.

    The stupidity (and/or dishonesty) of people who say this is mind boggling. Emergency rooms provide emergency care, not health care. Preventive care is critical to good health and EMTALA doesn’t require hospitals to provide preventive care; they just have to stabilize the very ill. The kind of continuing care that diabetics, heart and cancer patients, and women of reproductive age require is not available in emergency rooms.

    Whenever this subject comes up, I can’t help but think of the Republican politician who claimed that Medicaid is so bad that its patients would be better off without it. There are undoubtedly areas where Medicaid recipients find it difficult to impossible to locate a doctor willing to see them; something especially true for specialists. That is a problem caused by low Medicaid reimbursements and greedy doctors and none of the patients would be better off if they had no coverage at all.

  69. 69
    splashy says:

    @Kay: Yes, the poor live with pain on a daily basis, if only because of their teeth.

    They do jobs that break their bodies down, so their backs hurt, their knees hurt, their shoulders hurt, their feet hurt – everything hurts.

    Daily pain like that wears you down. Combine that with worrying about your next meal, malnourishment, and wondering about the rent and utilities, and you have people that have a hard time making good decisions and feeling like they can take a chance to better their lives.

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    splashy says:

    One thing that isn’t often mentioned is that this balking about expanding Medicaid is actually another part of the war on women. Far more women are poor, so far more would be on Medicaid.

    About half of the states will not give Medicaid to adults that are child-free at the present time, so these women are between a rock and a hard place. If they don’t have children, they are cut out. If they do, they are treated with disdain for “having children they can’t afford.” It’s a Catch-22.

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