Vox asked a bunch of experts what they thought about Senator Schatz (D-HI) Medicaid buy-in plan. Five of them made good points. I am not sure what this one guy was talking about:
David Anderson, Duke University
I need to see the details. There are so many different ways this could spin.
What does the plan design look like? Is it a silver plan [70 percent actuarial value], or is it 97 percent? On costs, that’s gonna be tough. The number of states that can take on a significant new [Medicaid] obligation long term is not high.
Big questions: How do states pay for this, and how does the benefit design integrate into the ACA?
I think the big divide within the Democratic Party is not if we need to have everyone covered, but how to do so. How much disruption is plausibly tolerable in each iteration of reform?
The details of the plan matter. Right now we are seeing that Senator Schatz wants to bump up Medicaid rates to Medicare rates with the Federal government taking on 100% of the increment like the Feds did with the 2013-2014 PCP bump. The option would be available on a state by state basis. I think the rating cells would be based on the above 133% total buy-in population and it would play by ACA rules on risk adjustment and benchmarks.
I am still thinking this one through and the details are really going to matter.
dr. bloor
Should have known the name of the one you omitted from the “good points” group without looking. Roy is such an intellectually dishonest, fur-encrusted dingleberry.
Kelly
Good on Schatz for bringing it up. Can’t happen until Dems have control but this gives time for the details to be worked on.
Off Topic: What was it like in middle school to have a last name so close Shat?
Alex in NYC
It is so frustrating to hear about all of the middle class people who can’t afford “Obamacare.” 1) Dems think the subsidies should be higher (higher income levels covered, as well as higher subsidies at all levels); 2) These same people could only buy crap or got no subsidies before Obamacare; 3) Those who once had employer-funded care have no concept that that system is a relic of World War 2 wage caps, and lowered their cash compensation; and 4) Dems would love to go to a system that covers more of people’s healthcare, but were forced to go with a Republican Rube Goldberg contraption (and thanks, Joe Lieberman!). So, we’re left defending a system that is better for most people, and one that we want to make better for those who are feeling the squeeze, but we are made out as the assholes.
dmsilev
@dr. bloor: He didn’t even try to address the question, but just gave a knee-jerk content-free response.
TenguPhule
My Senator makes us proud.
WaterGirl
@dr. bloor: Yeah, but he clearly read his talking points! Oops, make that singular – he apparently only had one talking point, and he went with it.
Jumbo76
Duke sucks.
Someone had to say it.
jl
I’m interested in what David thinks of Bruenig’s idea that the employer market be included. Seems like that would create possibility of more risk sharing, if cost sharing was compatible with competition for mix of low premiums and wider provider networks that I think would be needed to survive in employer markets.
jl
@Jumbo76: I guess David had to abandon the Dick Mayhew name, otherwise we could call him ‘Dukey Dick’ Which would impolite and unfitting for an almost top 10,000 premier mommy, pet-poop, and cat-walking aficionado blog.
The Dangerman
@Jumbo76:
Duke is cool.
Now, Christian Laettner….
Major Major Major Major
@Alex in NYC: the ACA might be a Rube Goldberg contraption but it’s certainly not a republican one. That myth needs to die already.
Laura
100% agree that Medicare buy in would make more sense if for no other reason than the constraints on state budgets and the almost universal satisfaction with Medicare by the public.
At the most recent joint labor management benefits committee meeting a novel plan was floated -if you have another source for medical coverage (spouse or partner),and would agree to waive county offered benefits, you could enroll in a plan that would reimburse 100% of all out of pocket costs related to that other coverage:co-pays, perscriptions, premium contribution etc., and would not be limited to costs in a single plan year, but would adjust to maintain cost coverage. It’s cost/risk shifting and would possibly reduce utilization, but no guess on the impact to the remaining premium costs.
I’d be interested in your thoughts on this semi-off topic issue.
Alex in NYC
@Major Major Major Major: Well, not any more. But its DNA is Heritage/RomneyCare. I love the ACA — didn’t mean to imply otherwise. It’s done so much good (when you look at the mortality and bankruptcy numbers, etc.). The scenes of citizens in our country waiting for days to get free dental care are horrifying and something we would expect to see in a 3rd world country. My point was that we’re defending something that many of us want to make better, but are stymied by Republicans. Much like how Obama was criticized from the right for not closing Guantanamo (as a campaign failure/even as a “lie”), when those doing the criticizing were the ones stopping it, and didn’t want him to close it themselves. These awful people shouldn’t have any platform from which to complain.
MomSense
@Laura:
Medicare buy in makes sense for some people but doesn’t Medicaid have a higher actuarial value? There are a lot of out of pocket and supplemental insurance costs with Medicare.
David Anderson
@Alex in NYC: not really….Medicaid was expanded in the ACA not in Heritage.
Actuarial value is high in the ACA not in Heritage
Regulation was moved towards federal/national regulation in the ACA not in Heritage.
Romneycare was passed by a veto proof Democratic super majority in Massachusetts… This is what could get the votes
Laura
@MomSense: hi Momsense! I’m not sure about the actuarial value between the two -and will defer to my betters.
MediCal was a godsend to me when my mother’s dementia progressed beyond our ability to provide adequate care, and California is a huge market for Medicaid services.
I was solely focused on the federal government as a funding source vs. a state’s balanced budget constraints, block granting and the like.
Fair Economist
“Romneycare” was a democratic plan shoved down Romney’s throat by veto-proof majorities. The need for those majorities is why it borrows from the heritage plan.
p.a.
The Health-Care Legacy of the Great Society byPaul Starr
Paul Starr is a Pulitzer Prize-winning professor of sociology and public affairs at Princeton University. He is also the co-editor and co-founder of The American Prospect.
pdf, not too long, not too wonky.