DPing on the poor

Missouri State of Mind passes along a very interesting policy brief concerning the fate of Medicaid expansion in Kansas:

I commend to all of you Jagadeesh Gokhale’s policy brief “Should Kansas Expand Medicaid Under the Affordable Care Act? A Perspective on Weighing the Costs and Benefits.”  The most interesting part of his paper is where he compares current and projected Kansas adult Medicaid enrollment for what he calls old-law eligibles and the newly eligible.  Along the way, he notes that “[e]stimates for the number of currently eligible but not Medicaid-enrolled individuals range from 20,000 to 162,000 [citations omitted]” — a number that could actually exceed the estimates for potential new Kansas Medicaid enrollment from Medicaid expansion.  

The astonishing fact is that  currently Medicaid eligible adults in Kansas have a take up rate of roughly 50-60 percent. Once you compare that with Medicaid take up rates that exceed 70 or 80 percent in a state like Massachusetts,

Most of the states that expanded Medicaid without gnashing of their teeth and rending of garmets had reasonably high proportion of adults who were eligible for old Medicaid enrolled.  Most of the states that have turned down free federal money had relatively low proportion of residents who were eligible enrolled in old Medicaid. Furthermore, the non-expansion states tend to have tighter restrictions on old Medicaid eligibility in general. 

Everyone is anticipating that old-law enrollment percentages will go up because more people are aware of the law and are shocked when they are told that they are poor and qualify for assistance.  However the states that are not expanding are counting on fewere people in general hitting healthcare.gov for the Exchange plans, and they are definately not doing any outreach.  So they get to fuck over the extraordinarily destitute who were eligible but not enrolled in old Medicaid as well as the working poor who would otherwise be eligible for Expanded Medicaid.

Fuck you very much Chief Justice Roberts et al.

17 replies
  1. 1
    Frankensteinbeck says:

    From completely anecdotal experience, a lot of folks assume that no matter how desperately in need they are, some loophole will screw them out of qualifying. Expanded Medicaid levels that playing field. It may make more difference than anything else in the ACA. Of course, the states with the ugliest loopholes are the ones refusing expanded Medicaid.

  2. 2
    danimal says:

    I have this fantasy that poor, employable and mobile residents of Obamacare-resisting states start to vote with their feet and move to states that provide health security. After a few years of this winnowing process, the resistant rump states would feel compelled to accept the Medicare expansion in order to avoid an economic death spiral.

    Since in a few years, the blah man will be out of the White House, maybe they will judge the politics of accepting the (almost) free cash differently around 2016-17.

    Yeah, I know it’s just a fantasy…

  3. 3
    Davis X. Machina says:

    @danimal: They’d have to vote with their feet. The clapped-out shitboxes they’re driving, and can’t afford to replace, never mind repair, would never survive the journey. And if they could drop a new tranny* in the beater/hooptie, they still wouldn’t have first-and-last-month’s rent for a new place to sleep, while they look for jobs that aren’t there.

    Poor people except for the handful of places with real public transport are as tied to the land where they were born as any 12th c. serf.

    *New season of RuPaul’s Drag Race!!

  4. 4
    Waynski says:

    Nice Robert Duvall movie quote at the end of the post, Richard. Can’t remember the name of the movie. I think Michael Douglas was involved, as a defense contract worker who loses his job and cracks. Off topic I guess, but I couldn’t help but notice.

  5. 5
    David in NY says:

    My understanding is that New York has for years encouraged (via medicaid managed care groups) people to get signed up for medicaid — I gather so that they are not a total drag on the health care budget, but are subsidized to some degree by federal money. But of course, we don’t just shove the suffering poor out into the road to die, here, we provide them care, which has gotta be paid for somehow. And managed care cuts costs.

  6. 6
    Belafon says:

    @danimal: Poor in the south tends to preclude mobile.

  7. 7
    Tone in DC says:

    They’d have to vote with their feet. The clapped-out shitboxes they’re driving, and can’t afford to replace, never mind repair, would never survive the journey. And if they could drop a new tranny* in the beater/hooptie, they still wouldn’t have first-and-last-month’s rent for a new place to sleep, while they look for jobs that aren’t there.

    I disagree. If someone truly wants to get the fuck out of these rump states, they’ll drive their 1978 Mazda B2000 with its rusty bed, cracked wind shield and 67 horsepower on the highway, maybe even with a certain Springsteen song from 1975 playing on the truck’s Clarion tape deck. The deck with two working preset buttons, and three with bad springs.

  8. 8
    Chickamin Slam says:

    @Waynski: Falling Down was the name of the movie.


    Tone in DC writes about people leaving the South if they really want to leave. The people a block from me did just that. Originally from Mississippi, their car broke down in West Texas. They had to work a few jobs for a bit to fix the wreck to be able to finally make it to the West coast.

  9. 9
    Tone in DC says:

    @Chickamin Slam:

    At work, we have a guy from KasichLand (aka Ohio) who just started. People will come to where the jobs are. And where the health care is. If they are truly sick of being DPed, and have any way at all of getting there.

    And as for the aforementioned song… if these folks in their B2000s are driving down 95, or Route 1, the track might be an AC/DC song from 1979.

  10. 10
    Waynski says:

    @Chickamin Slam: Thanks! Not remembering the name of that movie was driving me crazy.

  11. 11
    dollared says:

    Chief Justice Roberts doesn’t understand your objection. He is certain that the surviving members of the families he denied Medicaid will thank a Federalist Society member some day for freeing them from a life of government dependency.

    Besides, he says, he was just applying Natural Law as interpreted and delivered by his North Star, the Chamber of Commerce.

  12. 12
    boatboy_srq says:

    @Chickamin Slam: Count me as another escapee. Gulf Coast FL for nine years starving to death. I moved there from SFO for family reasons, and found I couldn’t stand it – even when I could survive it. Bailed out and headed north as soon as I could: DC is the new (temporary) home, with much better pay and better climate. There’s a better grade of Teahadist here, too.

  13. 13
    les says:

    @Davis X. Machina:
    Hey, it’s happened to the south before–southern blacks, far more poor and with far fewer resources, and with the white power structure trying to prevent them, moved out to the tune of something like 60% of their population. Current conservatives, stupid and arrogant as they are, won’t fight a new migration–“let the moochers run”; and the neo-confederacy will go down again.

  14. 14
    aimai says:

    @Tone in DC: But the very people who need to move often have enormous, crushing, burdens in terms of family and elder care–or are elderly themselves. The only thing than being poor and elderly without health care is poor and elderly and homeless in a strange place.

    Long term–yes, people will vote with their feet. They will tell their children to move and stay put in states with good health care and good jobs. But there is going to be a decayed and decaying population of poor in some of these red states for the forseeable future.

  15. 15
    boatboy_srq says:

    @aimai: If that’s anything like the decayed and decaying population of poor in those red states for the documented past, then the only thing about to change is the labor migration into those states – provided that the word gets out that the sh!t-for-salaries there won’t buy a single-wide and a Pinto.

  16. 16
    RaflW says:

    The question I have is, will enough people in the red, non-expansion states notice they’re being left in the dust?

    Who is going to help tell them? We need us some left-wing Koch/AFP analog to fund some healthcare advertising.

  17. 17
    evodevo says:

    Whoa! At first I read that as “rending of garnets” – couldn’t fathom how bashing gemstones was related to the corporate whores…

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