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  • Morning Bell: States Should Wait Before Accepting Obamacare

    The Supreme Court upheld Obamacare’s individual mandate to purchase health insurance, but it also struck down part of the law. That part—forcing states to expand their Medicaid programs—offers governors some much-needed relief.

    Expanding Medicaid, the government health insurance program for the poor and disabled, was one of President Obama’s main ways to increase the number of insured people through Obamacare. This was no magic solution for the uninsured, especially since Medicaid is in need of reform, not expansion.

    States’ share of the cost of Medicaid is already crushing state budgets. “In the past decade, Medicaid spending has increased at nearly twice the rate of states’ tax revenue,” according to a new report.

    The only ways to expand Medicaid are to raise taxes, cut other state programs, or slash health care providers’ reimbursements in Medicaid even more. And so far, the majority of America’s governors have not committed to making the expansion.*

    Governor Bob McDonnell (R–VA) sent a letter to President Obama on behalf of the Republican Governors Association: “Before making any final policy decisions,” he explained, “governors must carefully consider the short and long-term implications of an expanded entitlement program and the consequences of significantly increasing the size of government to manage these programs.” The question of a Medicaid expansion faces every state, including Democratic governors who are still on the fence.

    Governor Phil Bryant (R–MS), who has declared that his state will not expand Medicaid, explains the necessary trade-off between state priorities: “I would resist any expansion of Medicaid that could result in significant tax increases or dramatic cuts to education, public safety and job creation.”

    Obamacare’s unconstitutional mandate on the states was an all-or-nothing proposition: States would have been required to expand their Medicaid programs to cover all individuals up to 138 percent of the federal poverty level or risk losing all of their federal Medicaid funds.

    As Heritage’s Nina Owcharenko noted,

    Long before the Supreme Court’s decision to strike down the Medicaid mandate on the states as unconstitutionally coercive, opponents of the health care law argued that it would be financially unsustainable and administratively unworkable. The Court’s decision likely puts the law on a faster pace to collapse.

    The Court’s decision definitely exposes President Obama’s promise to reduce the number of uninsured in the country—half of the reduction in uninsured promised under the law was based on mandating that states expand Medicaid.

    And that isn’t the only broken promise. It may also lead to health care costs increases. The law stipulates that only individuals who are not eligible for Medicaid can qualify for Obamacare’s new federal subsidy. With the Court’s decision, many of those who would be Medicaid-eligible under an expansion—specifically those above 100 percent of the FPL—will now qualify for the federal subsidy. Heritage estimates that there are between 3.5 million and 6.2 million people who will now qualify for the subsidies, raising the cost of the subsidies between $35 billion and $63 billion over 10 years. (These figures are based on either 26 states opting out or all 50 states opting out of the expansion, respectively.)

    There’s really no way to pay for this—by state or federal taxpayers. Between now and the election, states should not entangle themselves in implementing the law, in particular with regard to committing to a Medicaid expansion or even pursuing the Obamacare exchanges. Owcharenko writes that “Even if President Obama is reelected and full repeal fails, the law will undoubtedly have to be reopened. States could push for reopening and use their power to reverse and restructure key provisions in the law.”

    What Medicaid needs is reform, not expansion. In President Obama’s words, “it is not sufficient for us to simply add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform.… Another way of putting it is we can’t simply put more people into a broken system that doesn’t work.”

    Read Nina Owcharenko’s report: “The Supreme Court’s Medicaid Decision: The Obamacare Mess Just Got Messier

    *An earlier version of this post incorrectly stated that a majority of governors had said they would not make the expansion.

    Quick Hits:

    Posted in Obamacare [slideshow_deploy]

    39 Responses to Morning Bell: States Should Wait Before Accepting Obamacare

    1. Johncdavidson says:

      States should be wary that once they start-up a new group, funding usually is never provided by Feds to support it.

    2. RG Schmidt says:

      It would be interesting to see some information, and I mean hard facts, not speculation, no matter how qualified the speculator(s), on how much money is wasted on Medicare/Medicaid fraud. I don't know how the figures could be obtained, but I'm sure more clever researchers than I could dig them up. It would also be nice to see both the feds and the states get serious about cracking down on it. I recently saw a figure for fraudulent medicaid payments going to Cuba that was absolutely staggering, if accurate.

      • Bobbie says:

        everyone involved with running this government of no American need, is corrupting all systems. They're at all levels of authority, government authority and lower. hand in hand, destroying the country..

    3. Carol, AZ says:

      Along with 26 other Governor, AZ has stated, they will not enjoin Obama care.
      Along the road to perdition for the crushing of State's Rights, what 26 States see clearly, is the continuation of force feed one disastrous program after another control from D.C on all States.
      What we know here, IS, what we can afford, and what will certainly crush us fiscally.
      By now we all know having a Federal budget to adhere to, is a new age idea by the Federal Govt.
      We do have a budget that we adhere to which has kept us from certain bankrupting our State.
      Yes difficult decisions were made; The results are very positive. We have a vastly improved job market compared to three years ago and experiencing growth in all aspect for Buss.
      I would also recommend the book, "Aftershock " to others here.

    4. Ray W. Hinkle says:

      I am concerned about Governor Snyder of Michigan's effort to set up the exchange in Michigan. This indicates to me an acceptance of Obama Care by this Republican Governor.

      • southrngirl77 says:

        I think Gov Snyder of Michigan is proving himself to be a solid RINO. Not only does it seem he will go along with Obamacare, I also noticed that he has vetoed severa conservativel Legislative attempts including putting Voter ID in place. TN is having the same problem with Gov Bill Haslam.

    5. stephen says:

      Why can't people just buy a health policy from medicaid or medicare, especially since some states don't have many choices for health insurance, but every state has medicare and medicaid?

      • glynnda says:

        I wouldn't wish either of those services on my worst enemy…….

      • timpclimber says:

        Wow! You must have been sipping cool aid a long time. When you cut out the free market and competition the service and product gets shoddy very quickly. My East German friends have told me how much better everything became when they reunited with West Germany. There is no perfect system but the free market is much better than socialism.

      • Bobbie says:

        why would any conscious mind want to add the cost of non health entity government control bureaucracy you call medicare and medicaid, over a private health insurance plan? Choices are minimal because abuse of government authority is regulating all insurances the same according to the interests of those people in government, contrary to the right of the insurance to conduct their business freely and in a matter or manner of consumer interests!!!!

    6. Laura says:

      The best way to for people to obtain health insurance it to have a job. Obamacare will only kill jobs and raise our health care premiums. If they are self-employed, like I am, then purchase it on your own. I've been self-employed for 7 years and have always purchased my health insurance.

    7. Anne says:

      SO…what do you propose ppl like me do? I am 61, unemployed, needing medical care and yet here in Fla while I am eligible for food stamps I am NOT eligible for Medicaid due to the state laws. I cannot get Medicare until I am 65. Here is what I had little choice to do.. I had pneumonia, I went to an ER and when I was done the bill was $8,000. Which YOU the taxpayer will pay. I sure as hel don't have it, and now what little bit of crappy credit I have is toast, yet again. I have been job hunting for a very long time, my age and lack of skills are against me.. What do you propose I do lady? We have to do something to bring basic care to those like me who have little choice about the situation in..

      YOU want to rant …try this on for size.. As an Expat IF I come back into the US more than 5 days a yr, I am rquired to purchase health insurnace that I cannot use living in another country. IF I live outside the US, but keep a US address I am required to purchase healthcare that I cannot use…

      Next.. despite the fact that I am unemployed, by the terms of ACA, I am required to purchase healthcare with money I do not have to get a subsidy on the backside.. how about whining about that…

      Your time would be better spent in railing about the outrageous salaries and healthcare package of Congress.

      • glynnda says:

        Hi Anne, I see your point, about the requirements of being an expat, however you are talking about requirements……..who do you think put them into place? Another point, you made it yourself. Health care is available to ANYONE who needs it in this country. All you had to do was walk into an emergency room and you were cared for……you won't be paying and we all know it. If you need the help no one is against helping you, but the solution IS NOT putting the government in charge….under any circumstances!!! As you so well pointed out, they are not only mismanaging the money we send to them, they are misusing it intentionally, we have so many examples of mismanagement from government officials who are never elected and will never be held accountable….can we say Freddie and Fannie and GSA?

        I feel your pain, but giving more of our money and control to the government is most definitely NOT the answer!

      • timpclimber says:

        When I found myself in similar circumstances I searched for an M.D. and traded services. I tutored his kids in math and science in return for health care for my family until I found a job.

      • Jeff says:

        If you were on Medicaid wouldn't we be paying anyway?

      • muskegonlibertarian says:

        Without prescription laws the cost of taking care of your health would be far less than it is today. In effect the federal government has given doctors a monopoly over access to medical drugs. Which is one reason why they can earn so much today. Same idea applies to the rest of the "licensed professions". That professional license is really a license to seek payment in return for granting your "permission" to do something. If there was a true free market in health care, there would be no prescription laws. No more than having to pay someone for "permission" to buy a computer at Walmart. Of course a person would have to take the responsibility of following directions with the medicine as such, just as you have to take responsibility driving a car, using power tools, or anything else.

    8. glynnda says:

      I am surprised by the comment Obama made (quoted at the end of the article). He actually made sense! Did he mean it? I don't think so. The Obamacare problem is what true "trickle down economics" entails. We have heard the left screaming about this concept since the Reagan administration and no one really ever explained what it meant. Well….here is your explanation……the Federal government mandates something and someone at a lower level pays for it…..the only entity that practices such economics is the one in Washington DC…….we have several examples I can think of immediately.

      The first one that comes to mind is the 100,000 new police officers Mr Clinton promised to put on the streets of America if he got elected. Well, he put them there alright, but what he failed to mention is the states and local governments had to take over paying for those police officers after two years…….Obama is doing the same thing, very short term things just to get elected and later when we can't "unelect" him we end up paying…..just another lib tactic/distraction for people who think they can get a free lunch

    9. Barbara Sbrogna says:

      It is simply astonishing to me that anyone, governors, individuals, members of Congress and especially The Heritage Foundation, are discussing whether or not to "accept" or not accept certain provisions of Obamacare. Understood that you are reporting what's being talked about. However, ALL discussions should immediately turn to how do we completely repeal this monster. If parts of it are retained, it is just a matter of time and complacency and it will grow to the size of its original intent. The public at large needs to hear a constant drumbeat of why this is bad for them and bad for America, period. And the RNC should start with an ad that simply lists all of the onerous fees and taxes (how about 3.8% tax on home sales), most of which have nothing at all to do with health care. This is critically important to the future of this country and we're all talking about tinkering around the edges! Depressing.

      • Annie says:

        Barbara – I think the states have to make a decision on whether or not to opt out of Obamacare, since right now it IS law, and soon will have to be implemented. Like it or not, they have to deal with the here and now. And unless we can elect Romney, keep our majority in the House and regain the majority in the Senate, Obamacare is here to stay. What can the House do except what they've done – pass a bill to repeal Obamacare, only to be knocked down in the Senate. And no one, except for conservative organizations, will discuss the bad aspects of this bill. I DO agree that the RNC should list all the fees and taxes in Obamacare that will hit us – sooner than later. And it needs to be repeated over and over. Since most people won't take the time to, or care to read the outrageous bill, those who have the ability to understand exactly what is going on should shout it from the rooftops!

    10. Cindy says:

      I think that the Governor of the State of Minnesota may have been hasty in deciding to have Minesotans be a psart of "Obamacare.

    11. toledofan says:

      One thing is crystal clear once you develop a new government agency or department, that entity just grows until it becomes bigger than life. There are so many holes in Obamacare and I think so many questions that still have to be answered, I'd hold off on implementing anything until everyone knew exactly what the heck is required. I'm sure Pelosi still hasn't read it enough to tell us what she thinks it means and maybe she won't because, if I remember correctly, it won't affect her.

    12. Bill says:

      I note several high profile arrests by the Obama Administration against Medicare fraud recently. They need to not only keep going, but also do not accept any plea bargains. When you start sending the cheaters to jail, things will change.

      Maybe Medicare/Medicaid wouldn't cost as much if the DOJ were to go after those who cheat the system. I knew of one man who had lots of Docs who scheduled him alot. All the Doc did was to come in. sign the requisite form (the PA did the exam) and leave. So, there are good Docs and bad ones. Also, the working poor make too much for Medicaid (in places like Texas), but can't afford health insurance as they don't make enough.

      One thought I had was a Govt defined plan (basic and expanded) that was EXACTLY the same in all 50 states. Any qualified Ins Co could offer the plan(s) in any state. They would have to compete with each other, but as they are competing against each other for the exact same plan, one can easily compare them for the best price.

      Finally, ACA, does try to get costs under control. To say otherwise is to lie. Is it the best? Probably not, but remember, many of the provisions are from Republican/conservatives. But the Republicans were only interested in one thing and that was NOT with the welfare of the Country or its citizens, rather it was making Obama a one term President. Shame on them.

      Its a good bet that many who do not care about the poor and their problems also claim to be Christian. It's a good bet most Christians do not know much about Christ.

      • Bobbie says:

        I don't agree with you, Bill. You can't expect a country of self reliant people to give up their dignity because a president doesn't want to abide his oath of office! Where government didn't exist, your fellow Americans did and if the ACA is tied with government to usurp inalienable rights as the government is clearly doing through their insurance plan then that is not Christianity. Christians believe in self worth in all and inalienable rights sacred to each individual human life. People in today's government believes in control over all even the beliefs of Christians as government members use the teachings of Christianity to manipulate the minds of many when government isn't suppose to act as any religion. The more unconstitutional government control the less ability to do God's will with sincerity!

        Obviously the role of America's government or they wouldn't have interfered abusively and needlessly!

    13. Dr. Henry Sinopoli says:

      Obamacare is the law of the land…It will remain the law of the land because politicians don't care…they don't have to participate. Any challenge will be fought by a Justice Department run by Black Panther supporter Holder…
      While the world concentrates on some crazy guy shooting people in a movie, Obama and his tribe continue, with the suppoert of the life-long politicians (Republicans & Democrats), moving us to a socialist mentality…Let's face it…Americans will chase the next news story and forget the importance of freedom. Who cares, 50% pay no or little taxes, enjoy subsidized housing and eat government food…Oops! that's, the Obama family!

    14. Capt. A. says:

      "Will you walk into my parlour?" said the Spider to the Fly…

      Capt. A.
      Principauté de Monaco

    15. KC - NM says:

      States like New Mexico that has a democratic legislature, voted for Obama in 2008, and has 50% of its population standing with hands out waiting for more – will probably agree to use Obamacare. The state cannot afford this and already taxes the heck out of those who have something to tax! Not good!

      • Diana says:

        California is all about Obamacare as well. We are broke, are building a new train we can't afford and signed up for Obamacare. My insurance company is already charging me more for unlimited coverage, having children signed up until they are 26 etc. What happens when a statr goes bankrupt? Guess California will find out. Sac

    16. Ken Jarvis says:

      SOUNDS Good.
      Health and Human Services (HHS) Secretary Kathleen Sebelius
      announced a new opportunity made possible by the
      Affordable Care Act to
      help states design and
      test improvements to
      their health care systems that would
      bolster health care quality and decrease costs.

      Also, don't forget the OVER $1 Billion the Ins Companies are going to Refund.
      That will definitely Stimulate the Economy and bring HCare Cost down.
      So that is GOOD.
      Send me an Email with your Questions, and Objections.
      HF readers have trouble Comprehending GOOD NEW.

      • Joseph McKennan says:

        OVER $1 Billion refund by ins companies is less than 6% of the debt. $2 billion is being added to the debt ON A DAILY basis. I do not see where the measly $1 billion is going to make that much difference

    17. boberic says:

      There is no question that in a wealthy country such as the US there needs to be some way for the very poor such the gentleman who told a desperate story above that there should be some way to have medicle services. THERE is it's called Medicaid. He should apply for benefits. That having been said nothing in any of the Democrat proposals that addresses Tort reform. About 30% of all medical expenses are medico-legal. If you go to your MD and complain of persistant headache here is what will happen. First an Xray, if negative next will be a consult with a neurologist. He will send you for an MRI. If nagative he will send you to a major medical center headache clinic where a battery of blood tests and a repeat MRI and a complete Hospital based neuro work-up will be performed. If negative they will prescribe advil, and set up a return appointment so as to repete all the previous tests. IF negative they will continue the script for advil and send you home with a bill for $25,000. All of this because all the MDs are afraid of being sued if they missed something, even though they knew the chances that you were truly ill was essentially nil. Everyone is afraid of tort reform is because the all the laws are written by lawyers and they don,t want to kill the golden goose!!!

    18. Jeff says:

      Something every governor should demand to see before making their decision is what the "new" Medicaid benefits will be. I suspect that they will be much broader than they are now and this will put an even larger burden on the states. So far the administration seems reluctant to release this informtion.

    19. Elliot says:

      My thoughts on this encroaching communist menace…

    20. Blair Franconia, NH says:

      I agree because Obamacare slashes Medicare, made states dependent on Medicaid, and slashes HSAs and FSAs. There's no such thing as a free contraceptive.

    21. timpclimber says:

      Elliot's nasty rant makes Ken J. sound like the most intelligent guy on the block. Ken I'll read and think about your comments any time..

      • Joseph McKennan says:

        You must have the same kind of glasses I have. They make a gila monster look like bird of paradise

    22. Lynda Deming says:

      “The Supreme Court UPHELD Obamacare’s INDIVIDUAL MANDATE to purchase health insurance, BUT it also STRUCK DOWN PART OF THE LAW.”

      How is that possible? I distinctly remember hearing there was no severability clause written into the “law” – or it had been removed. What that meant was either the entire “law” – including forced purchase of a product – was “constitutional” or the entire “law” needed to be defeated. They were not supposed to be able to uphold some parts while striking down other parts.

      Why is no one talking about that instead of end runs around a new “law” now written by the non-Supremes? Where in the Constitution does it give the non-supreme court the jurisdiction to write laws … especially tax laws? I’m sick of everyone laying down and playing dead while the regime rolls full bore ahead in the destruction of our country.

    23. Tonie says:

      With no information coming out to the states, governors cannot/should not make a decision. When they finally get medicare change information from "o", I am sure it will not bode well for current or future medicare recipiants.

    24. Karen says:

      The best way to improve Medicaid is to eliminate the FRAUD. I know someone who does Medicaid cost auditing and there is sooooo much fraud that even the state can't keep up with it. There are people who truly need Medicaid, but when the principals line their pockets first, the cost is outrageous.

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