Context in Arkansas Medicaid

Last night in the open thread, Rikyrah asked about what was going in Arkansas’s Medicaid program. It looks bad, but what is happening?

The governor’s proposal would lower the income requirement for Medicaid eligibility from 138 percent of the federal poverty level to 100 percent. That change would reduce the income cutoff for an individual from $16,643 to $12,060, and reduce the income cutoff for a family of four from $33,948 to $24,600.

If Hutchison’s amendments are approved by the federal government, around 60,000 Arkansas residents enrolled in Medicaid would no longer be eligible for the program.

Details matter here. This is fundamentally a state budgetary cost shifting. If an individual is on Medicaid Expansion , the state of Arkansas is on the hook for 5% of the cost of their care in 2017 and 6% of the cost in 2018. Eventually the state would be responsible for 10% of the cost of care. The Federal government pays the 90% to 95% of the cost of care for Medicaid Expansion. If an individual is on Exchange, the Feds pick up the entire subsidization costs.

Individuals who make more than 100% of the Federal Poverty line and are not eligible for Medicaid receive cost sharing and premium assistance subsidies. The Feds pay all of those costs. The individual is no worse off in Arkansas as the 1115 waiver for Medicaid expansion treated the individuals who made more than 100% FPL as if they were on Exchange for premium and cost sharing obligations. Individuals who make between 100% FPL and 138% FPL will see no difference in Arkansas. The biggest change may be a new ID card where the group or corporate policy number changes. That change will be meaningless to anyone who is not employed by an insurer or the ID card vendor.

This is an extremely low priority change to fight. It is merely an aggressive cost shifting from state budgets to federal budgets with no beneficiaries made worse off. On a scale of 1 (acknowledge)-10 (massive civil disobediance), this is a 1 on the fight scale.

Now if other states that did not have a private option 1115 waiver tried to do this, the situation would be different as beneficiaries who make more than 100% FPL would be made worse off with higher premiums and higher deductibles. But given the situation in Arkansas, this is a nothingburger.






82 replies
  1. 1
    satby says:

    Thanks for explaining that.

  2. 2
    Baud says:

    What @satby said.

  3. 3
    satby says:

    @Baud: wow, for a second I felt like digby back in the day.
    Where is everyone?

  4. 4
    Baud says:

    @satby: Don’t know. It’s eerily quiet.

  5. 5
    OzarkHillbilly says:

    @Baud: That’s because I didn’t get much sleep last night.

  6. 6
    Baud says:

    @OzarkHillbilly: I didn’t sleep well either.

  7. 7
    OzarkHillbilly says:

    @Baud: When I work, 3-4 days a week, I don’t sleep much. Pouring concrete today. Gonna be a vic0din night for sure.

  8. 8
    OzarkHillbilly says:

    Apparently there was one hell of a game in Barcelona last night. Sometimes I wish I had satellite.

  9. 9
    satby says:

    @OzarkHillbilly: saw that news. Bet the city went nuts, would have been fun to be there.

  10. 10
    Baud says:

    @OzarkHillbilly: Ouch. At least I’m relatively pain free.

  11. 11
    WereBear says:

    I suspect most everyone is more prone to exhaustion, these days.

    Yesterday I stayed home and rested and did not work. At long last, a protest I can participate in to the max!

  12. 12
    rikyrah says:

    Thanks for the explanation Mayhew

  13. 13
    greennotGreen says:

    I just watched Ezra Klein at Vox talk about the Republican replace bill and how it’s a worse version of Obamacare. He said he didn’t understand what they were trying to accomplish. It’s simple, really. They want to take the onerous taxes off the pitiful, aggrieved rich people, you know the taxes that pay for the subsidies that allow poor people to purchase coverage. Oh, and send some more profit to their insurance company benefactors. Of course, it’s Brownbackian economics based on ideology, not reality, and it will blow up the insurance markets while putting lives at stake (not to mention probably driving some hospitals out of business.) Typical Republican governance!

  14. 14
    satby says:

    @WereBear: Me too, though I wore red and my MomSense made puzzyhat when I was out with the dogs or putzing around the yard.

  15. 15
    satby says:

    @rikyrah: Good morning rikyrah!

  16. 16
    WereBear says:

    @greennotGreen: I explain their principles in one word:

    Theft.

  17. 17
    WereBear says:

    Here’s a new wrinkle in diabetes care:

    Diabetes Reversal Program

    Which focuses on causes and should save a staggering amount of money.

  18. 18
    JMG says:

    @greennotGreen: Ezra wondered why they just didn’t pass a big tax cut and leave it at that. He fails to understand how important the suffering of others is to Republicans. If money equals virtue, as they believe, then those without money are bad and should be punished in this world for their sins.

  19. 19
    WereBear says:

    As always, the irony of them pining for the Fifties, when we Ruled the World; and had tax rates up to 90%.

  20. 20
    rikyrah says:

    @JMG:
    He hasn’t accepted that they are sociopaths. The entire lot of them.

  21. 21
    OzarkHillbilly says:

    @satby: Yeah, more often I wish I was in Spain.

  22. 22
    WereBear says:

    @rikyrah: If he did, that would upend his world, where there are two parties equally bad and equally good.

    I think that notion is starting to crumble with some of them. Is Trump a force which cannot be rationalized?

  23. 23
    OzarkHillbilly says:

    @JMG: And they still call themselves Christian. There are times I really hope I am wrong about Jesus not being Christ.

  24. 24
    WereBear says:

    @OzarkHillbilly: Hybridizing fundamentalist Christianity with retrograde conservatism creates a creature who cannot live for long; let’s hope.

    It can also take down both parents.

  25. 25
    Kay says:

    The American Medical Association and American Hospital Association criticized the health bill, saying it would harm vulnerable patient populations.
    But House committees forged ahead with support from groups and industries whose taxes would be cut.

    A lot of our elites are terrible people who will literally kill other people for a tax cut. Trump’s voters may be flawed in their thinking too but this problem starts at the top.

    It’s not like the situation before there was Obamacare. Then there was some doubt. Now there’s no doubt. They’re kicking people out of an existing plan for a tax cut and some of those people will die as a result. We’ll be able to count how many were sacrificed for this tax cut.

  26. 26
    Baud says:

    @OzarkHillbilly: If hell didn’t exist, I would have to invent it.

  27. 27
    Baud says:

    @Kay: The dead don’t vote, Kay, despite what the GOP thinks.

  28. 28
    MomSense says:

    So tired this morning.

  29. 29
    Baud says:

    @MomSense: Weariness must be going around.

  30. 30
    Davebo says:

    @OzarkHillbilly:

    My girlfriend bought tickets to the match for her brother and nephew for Christmas and they got to see it live! They’re pretty hyped.

  31. 31
    Kay says:

    @Baud:

    The NYTimes has, in big letters, that only 3% of premiums went up under Obamacare. The entire country believes that ALL premiums went up because media so flogged that 3% one would think it was 93%.

    It’s too late for them to cover the health care law properly. They failed and it’s too late to fix it. One would have had to literally knock every door in the country and speak to each voter individually to counter the wave of bullshit they created.

  32. 32
    MomSense says:

    @Baud:

    Another consequence of this presidency is the reverse aging effect. We watched previous presidents go gray and turn haggard before our eyes from the stress and demands. This time it’s the rest of us.

  33. 33
    Baud says:

    @Kay: I wish there a word in the English language adequate enough to describe the NYT.

  34. 34
    OzarkHillbilly says:

    @Davebo: I’m available for adoption.

  35. 35
    MomSense says:

    @Kay:

    In some cases the increases were just one plan out of a whole band. Of course they also neglected to talk about how Rubio killing the risk corridors caused the problems.

  36. 36
    MomSense says:

    @Baud:

    How ’bout three. Rotting fish bait.

  37. 37
    Baud says:

    @MomSense: To be honest, part of me appreciates the moral clarity of our brave new world.

  38. 38
    Davebo says:

    @OzarkHillbilly: I was pretty surprised by what Premier League tickets cost on the secondary market even in the nosebleed seats.

    Still, a few days in Barcelona and a great match is a nice way to break up the week.

  39. 39
    MomSense says:

    BTW Lyin’ Ted Cruz posted a photo of his daughters in the Oval standing next to 45 while he sat with his hands folded on top of the desk. My first thought was that instead of saying “cheese” Heidi probably shouted “keep your hands where I can see them”.

    I’m turning into a horrible person.

  40. 40
    Kay says:

    @MomSense:

    “Across state lines!” OMFG how many supposedly smart people fell for THAT. We have low quality elites. Quality has slipped and this must be addressed. The fish rots from the head down.

  41. 41
    Baud says:

    Did anyone see the Perez/Ellison live video about their plans for rebuilding the party? Haven’t seen much reporting on it.

  42. 42
    Baud says:

    @Kay: I’m not sure the elites fell for that. Maybe the average voter did. The elites understood what it means.

  43. 43
    MomSense says:

    @Kay:

    I said yesterday that we had a brief experiment with across state lines in Maine in 2011. People sent their money across state lines to pay their premiums and the company didn’t pay for their medical services on this side of the state line. It’s a total sham. Basically we will let states with the fewest regulations and oversight sell junk plans here. The premiums will be lower but the coverage will be non existent and the consumer will have no recourse.

  44. 44
    Baud says:

    @MomSense:

    the consumer will have no recourse.

    Not true. They will blame Obama.

  45. 45
    MomSense says:

    @Kay:

    Back when this mess started I predicted that the Republicans would grind out a bullshit plan that cut all the patient protections and gave us the old catastrophic plans, HSAs, shopping across state lines, and high risk pools. The only thing I haven’t seen yet is the tort reform. The Republicans love them some tort reform.

  46. 46
    FlipYrWhig says:

    @Baud: Something “neoliberal,” no doubt. :P

  47. 47
    Baud says:

    @MomSense: I don’t think tort reform can be passed via reconciliation.

  48. 48
    Baud says:

    @FlipYrWhig: Those two seem to be playing nice. It’s interesting how the DNC leadership seems to have become less relevant now that there is no internecine warfare associated with it.

  49. 49
    MomSense says:

    @Baud:

    Yup.

  50. 50
    OzarkHillbilly says:

    @Baud: No, it can’t. Along with a # of other GOP *healthcare* priorities.

    (*healthcare* in asterisks because the only health they care about is the tax refund checks for the rich)

  51. 51
    satby says:

    @Kay: And speaking to each voter individually wouldn’t work after they’ve been so thoroughly propagandized anyway. Most wouldn’t believe you. I’ve been doing that for years with the crime statistics, and people just flat out don’t believe the truth because they’ve heard otherwise for so long.

  52. 52
    Weaselone says:

    @Kay:

    Did anyone ever fall for that, besides the media? Everyone knows there’s a Mississippi and Mississippi knows there’s an Arkansas and that purchasing insurance from there sounds like a bad idea.

  53. 53
    Ruviana says:

    @WereBear: Sounds dubious. Even though the poster’s an M.D. he prolly ought to brush up on his science.

  54. 54
    Baud says:

    @satby: People don’t believe the truth because they don’t want to believe the truth. The lie gives them something the truth won’t.

  55. 55
    satby says:

    @Baud: Well, with crime statistics it’s fear, and I’m not so sure what’s so attractive about that.
    Edited to add: I think some people would love to feel like things are safer than what they’ve been told, but they’re only hearing it from the hippie rescue lady, not the media.

  56. 56
    MomSense says:

    @satby:

    I was talking to a woman who has Medicare and she was angrily complaining to me about how Obama slashed the Medicare budget. So I tried to explain to her how they cut the money going to Medicare advantage insurance companies who didn’t pass the savings to the patients and instead added a bunch of services to basic Medicare. She didn’t believe me. So I asked her which services she personally had cut. She couldn’t think of a single cut in services and even agreed with me that she didn’t have to pay for her bone density exam. And still she was mad that Obama cut her Medicare. WTF. I just excused myself but honestly I wanted to ask her if she just couldn’t accept that she was being helped by a black president.

  57. 57
    FlipYrWhig says:

    @MomSense: People seem to think Obama did all kinds of terrible things to other people somewhere out there. Never to the complainer directly, but to unlucky people the complainer imagine as being just like them.

  58. 58
    AnonPhenom says:

    @OzarkHillbilly:

    Trump(don’t)Care.

  59. 59
    raven says:

    @OzarkHillbilly: I went to a state championship basketball game that was hosted here in Athens last night. The last time I went to a high school game I was officiating and the last time I went to a state championship game was 1984! They have watered down the high school game by creating six or seven levels but I guess if more kids get to participate it’s for the better. No more Cobden Appleknockers vs The Pekin Chinks.

  60. 60
    satby says:

    @MomSense: at the Dr’s office where I work, we’ve had similar angry patients, and most insurance doesn’t come with vision coverage, you have to add it. But we hear anti-Obamacare stuff all the time. I’m the first to agree there’s a racism factor because it’s sometimes obvious, but it’s more than that too. The news media and the Republican party have actively lied to people for years and most people still rely on MSM for their information. Propaganda works.

  61. 61
    Kay says:

    @satby:

    So funny how Medicaid is now popular with GOP governors. If only they had thought of that, right? Democrats take the political hit and the GOP turns into defenders of the poor.

    All those fucking think tanks events and not a single GOP governor thought “I should expand Medicaid”? Nancy Pelosi had to tell them?

  62. 62
    laura says:

    @MomSense: I wanted to ask her if she just couldn’t accept that she was being helped by a black president.
    Ding Ding DING!

  63. 63
    greennotGreen says:

    @AnonPhenom: I’m so stealing that!

  64. 64
    FlipYrWhig says:

    @satby:

    But we hear anti-Obamacare stuff all the time. I’m the first to agree there’s a racism factor

    I’m telling you, the biggest component of opposition to Obamacare is Republicans who are sure it was a law designed to give shiftless black people and sketchy immigrants free health care, a/k/a “welfare.”

  65. 65
    Spanky says:

    @raven: I had to Google that even though it’s well within the realm of belief that a high school mascot could still be a chink in this day and age, and I found this:

    Finally, in 1980, as times changed and sensitivities grew, the school board changed the name of the team to the “Dragons.”

    But some alumni were outraged and formed a group to change the name back. Pat Hagen, a Pekin High graduate, invoked the name of the town’s most famous native son, Senate Minority Leader Everett McKinley Dirksen. “He was born a Chink,” Hagen said, “he died a Chink; he’s known around the world as a Chink.”

    The Onion wept.

  66. 66
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    In talking about healthcare, it would be helpful to stop using the all-inclusive “poor”. The reality is that people think “not working” when they think “poor”. The reality is that those who are aided by the ACA are low income workers who are struggling to make ends meet while working very hard, often at multiple jobs, and we do them a disservice when we lump them in with those who aren’t working at all.

  67. 67
    MomSense says:

    @Kay:

    I’m in a non expansion state and so we are dealing with the cruel Medicaid gap which our governor is all too happy to blame on Obamacare as if his veto of expansion has nothing to do with the problem.

    The other issue is that poor people don’t have internet at home and they often have limited cell minutes so unless they know where and when a navigator clinic is they don’t call healthcare.gov to get help signing up. We still have a lot of people going without care, showing up in ERs really sick, and trying to get hospitals to give them free care. When I ask people why they didn’t sign up for the ACA they tell me that they heard it was really expensive.

    When what passes for news media fail to inform people of basic things, people make really bad decisions.

  68. 68
    raven says:

    @Spanky: Yep. There are still the Fisher Bunnies and the Freeport Pretzels!

  69. 69
    rikyrah says:

    @Kay:

    It’s not like the situation before there was Obamacare. Then there was some doubt. Now there’s no doubt. They’re kicking people out of an existing plan for a tax cut and some of those people will die as a result. We’ll be able to count how many were sacrificed for this tax cut.

    keep on telling the truth.

  70. 70
    FlipYrWhig says:

    @MomSense: That’s so frustrating to hear.

  71. 71
    satby says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: this is so on point. People with regular jobs and benefits are often shocked when they find out MANY full-time workers don’t have them. They just assume they do because that’s what they get at their (higher paid, corporate) jobs. And they can’t understand why if you’re working in a job with no benefits you wouldn’t just go find one with. They may get that Wal-Mart workers don’t have benefits, and people at fast food joints; but there’s lots of jobs where people work and the only thing they get is their hourly wage.

  72. 72
    WereBear says:

    @MomSense: When what passes for news media fail to inform people of basic things, people make really bad decisions.

    They have totally fallen down on that; by design.

  73. 73
    WereBear says:

    @Ruviana: Actually, it’s cutting edge science.

    Which has not yet filtered down. But there are many people impatient with the usual decades it takes for new ideas to be accepted. Which is fine with me.

    It’s others who need to brush up.

  74. 74
    satby says:

    @WereBear:

    They have totally fallen down on that; by design.

    I agree. A misinformed, frightened population is easier to manipulate.

  75. 75
    Ruviana says:

    @WereBear: Given my reading of Science-Based Medicine and Respectful Insolence, individual blogs by doctors who also function as “consultants” for commercial products (as Virta Health is) set off my alarm buttons. But YMMV.

  76. 76
    Ruckus says:

    @MomSense:
    Across state lines was the same thing that happened in the credit business. Companies moved to states that gave them the lowest taxes and allowed the highest interest rates. IOW fuck the customer, we need a way to steal all the money. They don’t want to be in any actual business, which provides a product or service, they want to be the MOB but with legal protections so that no one can put them out of business or arrest them.

  77. 77
    FlipYrWhig says:

    @Ruckus: I think the problem with this comparison is that most people who carry credit cards don’t think that credit card companies are doing anything particularly abusive or predatory. Sure, they screw you, but that’s just business. So if you say “This would make the health insurance business like the credit card business!” they’ll say, “And?”

  78. 78
    Ruckus says:

    @FlipYrWhig:
    That’s a problem of education, not of reality. Of course none of the avenues of education for the greater population is going to even try to educate people about this, because they can benefit from it in some way, or at least think they can. And in the case of credit cards you don’t have to have any. It does/can make life a bit more “interesting” but it can be done. I’m thinking one needs healthcare, I mean you don’t really need it, but the cost of not having it is just a bit more severe than not having any credit cards.

  79. 79
    StringOnAStick says:

    @Ruviana: While that may be true, the science behind carbohydrate restriction for people who have developed metabolic syndrome or have moved past that to type 2 diabetes is pretty firm now; the problem is how long it takes to get these changes out there where people live.

    I had metabolic syndrome. I cut sugar, grains and processed foods out of my diet and I no longer have metabolic syndrome and my blood work looks fantastic. The problem for most people is this is a big dietary change, and temptation is everywhere, plus people telling you “oh, that low carb stuff is bullshit and how can you live without healthy whole grains and all the fiber they provide?” Uh, vegetables provide much more fiber, and “healthy whole grains” is the triumph of marketing over metabolic reality. Eating sugary stuff, breads (same blood sugar response as sugar, only worse) feeds an insulin spike and collapse model, which leads to more eating because of the hunger signals that cycle produces. Get off the blood sugar spike and collapse treadmill, and hunger decreases, blood markers improve significantly. As carbohydrates have become a bigger and bigger part of our diet, diabetes rates have climbed right along with that increase.

    The science is there, period. The problem is that asking people to change their dietary habits is extremely difficult; for some people changing their diet is asking for a huge change in deeply held ideas and psychological needs.

  80. 80
    Ruviana says:

    @StringOnAStick: I’m noy arguing that metabolic syndrome and reduced carbs as a treatment are wrong or “not true.” I’m a type II diabetic and I don’t eat sugar and eat a low carb diet. What bothers me is the platform which struck me as a lone wolf shilling for the benefit of a company he invested in. Those who complain about Big Pharma cite these kinds of conflicts of interest all the time. It’s true on the “other side” (for want of a better term) too.

  81. 81
    WereBear says:

    @Ruviana: Oh, I do not blame you there. But this is no fly-by-night con artist.

    He was part of the Nutrition Science Initiative; but a disastrous personality clash sank their first study. He decided to go a different way.

    I know what you mean about “websites that sell you something” but on the other hand, some very good people operate that way. :)

  82. 82
    Ruviana says:

    @WereBear: Thanks for your clarification, really and truly.

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