Viewpoints: The Medicaid expansion 'dilemma;' Mandate not the only health tax the GOP backed

Jul 6 2012

The New York Times Economix blog: Medicaid Expansion And Jobs
Full-time employment is a major reason that able-bodied adults would have incomes above 133 percent of the federal poverty level. If carried out, this expansion is expected to reduce full-time employment among able-bodied adults, because they would no longer need to be employed full time to obtain health insurance (previously they could pay out of pocket for health insurance when not employed full time, but that is a more expensive way to obtain health insurance) (Casey B. Mulligan, 7/3).

The New York Times: A Gap in Health Coverage
In states that choose not to expand Medicaid, substantial numbers of the very poor could be left out of coverage. The reform law provides tax credits to help people with incomes between 100 percent and 400 percent of the federal poverty level (about $23,000 to $92,000 for a family of four) buy private insurance. But the bill's drafters made no provision to provide subsidies for anyone below the poverty line because they assumed that those people would be covered by expanded Medicaid. But now that the expansion is no longer mandatory, the poorest adults -- those without children and parents with incomes below the poverty line but above Medicaid eligibility (typically well below the poverty line) -- could land in the gap, ineligible for both Medicaid and for tax credits to buy private insurance (7/4).

Los Angeles Times: Republican Governors Vow To Fight Medicaid Expansion, But Will They?
After the election, the ideological passion over the health care law could subside. Right now, public opinion on the law divides almost entirely along partisan lines. That won't change before the election. But political parties seize on different issues at different times, and if Obama wins reelection, the political focus could move to other issues. Moreover, refusing to expand Medicaid could be politically difficult for Republican governors and lawmakers (David Lauter, 7/3).

CNN: Why Medicaid Expansion Is Key Part Of Health Reform
The biggest misperception is that Medicaid is a universal health care program for all poor people. That's just not true. Many people with little to no income do not qualify for Medicaid. Yes, all children up to 100 percent of the poverty line, and children under 6 up to 133 percent of poverty line, are covered. Pregnant women up to 133 percent of the poverty line are covered as well. So are elderly and disabled Americans who qualify for Social Security's Supplemental Security Income. But there's where things start to break down (Aaron Carroll, 7/5).

Kansas City Star: Missouri, Kansas Face Medicaid Expansion Dilemma
Kansas would have to kick in an extra $156 million from 2014-2019 in order to get $3.9 billion from Washington, according to a recent study by the Kaiser Family Foundation. Missouri could get $9.5 billion in extra Medicaid funds over those six years -- but only if it ponies up $385 million of its own. So far, several states led by Republican governors have said "no thanks." You can hear similar noises from legislative leaders in Kansas and Missouri (Dave Helling, 7/3).

Bloomberg: Mandate Not The Only Health Tax Republicans Backed
Long-term, however, the largest increase -- and certainly the most important one for the future of the health-care system -- will be the excise tax on high-value health insurance plans, which begins in 2018. … This is actually an attempt to address a core Republican concern: The tax break for employer-provided health insurance, which Republicans believe encourages employers to spend too much on health care while also making it impossible for a health-care system not based on employers to emerge….So when Republicans call the Affordable Care Act "the largest tax increase in the history of the world," they're not only wrongly supersizing the tax, they're also attacking a reform that they've long supported themselves, in somewhat different configurations (Ezra Klein, 7/4).

The New York Times: Too Quiet, Again, on Health Care
Democrats and the Obama campaign have been amazingly reluctant to speak up for the president's biggest accomplishment ... the debate isn't going to stop. Republicans are happy to continue it with obvious propaganda like "Obamacare is the largest tax increase in U.S. history." Countering this attack and, more important, building a foundation of support for a vastly important social change, will require the president and other Democrats to spend more time and more money explaining the law's benefits, and pointing out that Republicans have no useful ideas to replace it (7/3).

The Los Angeles Times: The Young Don't Buy Into Propaganda Of War Between Generations
There's good news from the front in one of our internecine economic and political battles: the war between the generations. The news is that the younger generation is beginning to see through the propaganda. For years now, efforts to set young against old have been linchpins in campaigns to cut Social Security and Medicare benefits and turn those programs over to the private sector (Michael Hiltzik, 7/4).

Los Angeles Times: A Fourth of July Debate: How Much Power To The People?
Delegates to the Second Continental Congress signed the Declaration of Independence 236 years ago today, accusing King George III of trying to establish "an absolute Tyranny over these States." The republic they went on to establish, however, continues to struggle with the tension between individual liberty and shared responsibility, and between the freedom of the governed and the obligations imposed by the government. ... [C]oncern about the reach and scope of the federal government is likely to be a central issue in this year's elections, in part because of the Supreme Court ruling on President Obama's health care law that, oddly enough, placed new limits on Congress' power (7/4).

Baltimore Sun: Health Care Reform Is Good For The Kids
My generation is going to slide safely into Medicare soon, if some of us have not already done so. In any case, many of us have worked for a single employer for 20, 30 or 40 years, and our health care has been assured during our working life. It isn't going to be that way for our children. And I worry. A recent issue of the libertarian magazine Reason featured a cover story on "Generational Warfare" and made the case my nephew regularly makes to me. That is, Social Security and Medicare are funded by taxes on the meager wages of his generation, and those same benefits will not be there for them when they retire (Susan Reimer, 7/4).

Philadelphia Inquirer: Romney's Vow To Repeal Obamacare Is Misguided
Regardless of who wins the presidency in the fall, the route to long-term improvement of health care in this country is not another major shift in the direction taken by the Affordable Care Act. The law has already provided a road map for change, and we stand to learn much from the innovative efforts it prescribes. Despite the current campaign rhetoric, Mitt Romney well knows the advantages of the act's approach from his experience initiating Massachusetts' health-care reform, which was the model for the Affordable Care Act (Ralph Muller, 7/4).

Philadelphia Inquirer: Supreme Court Rulings We've Survived
There was bound to be a gnashing of teeth and an overuse of death metaphors no matter what the Supreme Court decided on the Affordable Care Act. Liberals and Democrats were spared the hand-wringing only because a slim majority of justices upheld the Obama administration's signature health-care program. But a vital truth has been lost in the Twitter- and cable-fueled frenzy: The country has experienced its share of presumably earth-shattering decisions without catastrophic consequences (Eva Rodriguez, 7/5).

Richmond Times-Dispatch: Supreme Court: The Ideologues
This liberal praise for a conservative is nice, and some of it even seems sincere -- though it is the sort of sincerity you used to hear from supposedly high-minded white people who said the occasional black person was "a credit to his race." It was racist and condescending and highly offensive … but they meant it in the nicest way. Roberts, say liberals now, is not like the rest of his useless kind (7/5).

Detroit Free Press: Ruling Upholding Health Care Act Deals A Setback To The Language Of Law
Besides being enormously significant, the ruling contained several surprises -- and may further blur the precision of our legal language. Chief among the surprises was Chief Justice John Roberts' upholding the individual mandate not based on Congress' power to regulate interstate commerce, but on Congress' power to lay and collect taxes. Of the nine federal courts that had reviewed the act, none had ever taken this position (Anthony Dillof, 7/5).

Detroit Free Press: Detroit's Aging Population On Collision Course With Nursing Home Shortage
Detroit, a city that once had 50 nursing homes, has lost 20 -- 16 of them in the past 13 years. And many are struggling to remain open. Nineteen Detroit nursing homes must upgrade or install sprinkler systems by next summer to be certified and continue to receive the government funding they need to stay open. The new elderly and the looming nursing home crisis are documented in a Detroit Area Agency on Aging report that was released Monday. Based on a three-year study of illness and death rates in Detroit, Highland Park, Hamtramck and the Grosse Pointes, the report shows that in addition to accelerated aging, the elderly in the Detroit study area die at a rate 131 percent higher than their peers around Michigan (Rochelle Riley, 7/5).

The Houston Chronicle: How About A Patriotic Fix For Health Care?
What voters deserve from candidates of both parties as the 2012 campaign season revs up is a common-sense discussion of what workable health care coverage looks like in its specifics -- regardless of which party claims credit. Such a debate would be in the "Spirit of '76" -- the thoughtful, enlightened patriotism that the Founders envisioned would guide this nation when they created the Declaration of Independence, the document we honor today (7/3).

Minneapolis Star Tribune: Health Care Debate: Two Views Of Liberty
Governments do many things poorly that private institutions can do better. But the essential role of government has always been to manage precisely the kinds of social challenges that require resources and coordination on a massive scale. When governments succeed in these tasks, they promote freedom through interventions that facilitate real choices for citizens (Michael Fuerstein, 7/3).

Chicago Tribune: Illinois and Obamacare
The federal law envisioned that most states would run their own exchanges. But many states, including Illinois, have been waiting to see what the U.S. Supreme Courtwould decide. Gov. Pat Quinn says Illinois likely will partner with the federal government to set up an exchange by 2014. That runs the risk of inviting more rules and regulations from the feds. Illinois would be wise to flesh out the rules for a state-run health insurance exchange on its own, one best tailored to serve Illinois customers (7/5).

Chicago Tribune: Supreme Court Hits Reset On Obamacare -- Will The President Fight This Time?
(Democrats) seemed to think their job was done in March 2010, when they eked the law through Congress. Operatives turned their attention to other matters and did little to counter the massive, poisonous GOP campaign against it with loud reminders of the urgency and fundamental decency that animate this landmark legislation and the benefits it will confer. Thursday's ruling -- the real one, I mean -- doesn't guarantee Obama a second term. But it gives him a second chance to fight the battle he lost last time (Eric Zorn, 7/4).

Chicago Tribune: Health Care Problems Persist
I'll get over it. But as Obamacare opponents talk about changing the dreaded law, I'm sure they are hoping that during the election season they can remain curiously vague about what they want to change it to -- or whether they want to change it at all. For example, when Senate Republican Leader Mitch McConnell was asked last weekend how his party would provide coverage to the nation's 30 million uninsured, he sounded as if those folks had nothing to do with the health care debate (Clarence Page, 7/4).

Chicago Tribune: Getting The Old Off The Road
In 2011 Wisconsin congressman Paul Ryan proposed a plan to balance the federal budget over the next two decades. House Republicans adopted a version of the plan as their budget, and it has since been (nervously) endorsed by Republican presidential nominee Mitt Romney. The essence of the plan? A gigantic off-loading of budget pain from old to young. Medicare and Social Security will be protected exactly as they are for Americans now over age 55. Younger Americans, on the other hand, will find Medicare progressively less generous, with the heaviest burden of adjustment falling on the youngest of all (David Frum, 7/5).

The Washington Post: Curbing The Cost Of Health Care
Many liberals believe that the Affordable Care Act -- Obamacare -- is unpopular only because most Americans don't understand it. There is some truth to this: Studies show that the core provisions of the bill are more popular than the bill itself. But there's also a reason, rooted in reality, why many Americans worry about Obamacare -- its cost. Most Americans have health care. What they worry about is the cost of insuring 20 million to 30 million more people. Unless the meteoric rise of health-care costs is slowed, a big expansion of coverage might well remain unpopular, no matter how it is explained (Fareed Zakaria, 7/4).

The Wall Street Journal: Romney's Tax Confusion
Appearing on MSNBC, close Romney adviser Eric Fehrnstrom was asked by host Chuck Todd if Mr. Romney "agrees with the president" and "believes that you shouldn't call the tax penalty a tax, you should call it a penalty or a fee or a fine?" "That's correct," Mr. Fehrnstrom replied. ...  in a July 4 interview (Romney) stated himself that the penalty now is a "tax" after all. But he offered no elaboration, and so the campaign looks confused in addition to being politically dumb. This latest mistake is of a piece with the campaign's insular staff and strategy that are slowly squandering an historic opportunity (7/4).

The Wall Street Journal: ObamaCare's Lost Tribe: Doctors
Back at the at the dawn of ObamaCare in June 2009, speaking to the American Medical Association's annual meeting, President Obama said: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period." But will your doctor be able to keep you? Or will your doctor even want to keep you, rather than quit medicine? (Daniel Henninger, 7/5).

The Wall Street Journal: The Supreme Court Rules, Markets Yawn
Of all the public reactions to last Thursday's surprise ruling from the Supreme Court on the Affordable Care Act, one of the most interesting came from the markets: Nothing happened. That probably disappointed those who spent the past two years saying that the costs from increased regulation and fear of the health plan explain why U.S. companies have not hired faster and have accumulated huge amounts of cash on their balance sheets. If that were so, the court ruling should have had a big impact on expected future profits. Stocks should have tumbled. They didn't, and the markets' collective yawn was the latest piece of evidence refuting the notion that the health plan and other regulations are the main problems facing the economy (Austan Goolsbee, 7/4).

USA Today: Hospitals 'Cash In' Due To High Health Costs
Arthur Rosenberg, a 53-year-old attorney, recently came to see me for a routine physical. I sent a blood sample to Quest Diagnostics for routine lab tests. When Rosenberg received his portion of the bill, $196.93, he also discovered that his health insurance company, Blue Cross/Blue Shield, had paid a whopping $1,060. My patients are increasingly shocked when they find out about the exorbitant charges for many non-emergency procedures. And the charges vary from lab to lab and from hospital to hospital (Dr. Marc Siegel, 7/3).

The Arizona Republic:  Health Care Law Does Good
The Supreme Court's decision on the Affordable Care Act is the latest in a 100-year debate on the American health care system going back to 1912 and Teddy Roosevelt. Proposals about fixing the system have come from every president since FDR and those proposals have come from both parties. The ACA has provided a significant number of positive results for the country and for Arizona (Dr. Leonard Kirschner, 7/5).