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Obamacare Battle Taken to the States

A reasonably balanced piece in the New York Times today explains why, despite the drama of the shutdown, the most serious Obamacare battleground may be the states.

As many of you know, a chunk of the Obamacare law is little more than a raw expansion of existing welfare programs – that is, dropping millions of people into Medicaid. And for proponents of the law, that could be a problem, because Medicaid is run by the states. And Republicans run some of those places.

The Supreme Court ruling that allowed Obamacare to stand, as the New York Times makes clear, also provided it with an Achilles Heel:

But in June 2012, the Supreme Court ruled that states could opt out of Medicaid expansion. The ruling opened the door for conservative opponents of the law. Americans for Prosperity, with paid staff members in 34 states, walked through it. So did another group, Tea Party Patriots, which recently gave $20,000 to organizers of a referendum drive to put the question of Medicaid expansion on the Arizona ballot.

This is trench warfare. But Obamacare opponents don’t have to take every trench to win, because remember, health care providers need bodies to treat in order to earn enough to make the system work:

Expanding Medicaid, a joint federal-state program for the poor, is critical to the law’s goal of covering the nation’s 48 million uninsured. Hospitals and insurers were also counting on more Medicaid patients to make the economics of the law work.

This work is not as glamorous as a 21-hour filibuster. But, unless Republicans soon gain control over all three branches of government, it may be more relevant to the question of whether Obamacare will survive.

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11 Responses to Obamacare Battle Taken to the States

  1. If the Repubs gain control of Congress in 2014, they might try to repeal Obamacare, butt only if they see a majority of the public wants it done.
    What’s more than likely to happen is that they tweak, refine, and eliminate some of the more unlikeable aspects of the law. They’ll keep the basic form to pacify the liberal Dem votes they’ll need for the changes to pass and become real. Everybody in Congress will win something, but it won’t survive in it’s present form.
    This is a cash cow for the government, a sneaky tax increase that the elected officials will accept as long as more is coming in than going out.

    The Medicare/Welfare system will collapse the different state’s budgets to the point that severe restrictions will have to be placed on eligibility or coverage . When, not if, that happens, the Feds will get involved into the healthcare mess again, but not in the all-in manner that it is now.

    • Medicare expansion was not accepted by my great State of Georgia. Therefore, our General Assembly is not beholden to the Feds and will not cause our budget to explode.

      Even in Georgia’s case, the premise that the Feds would otherwise step in is a complete non-starter, legally, because case law at SCOTUS and the federal judiciary support (and have for quite some time) the concept that States are sovereign and cannot be “coerced” (actual legal term used) into doing anything outside of the federal constitution. Only in the case where, say, a State accepts federal monies can the Feds then have proverbial strings attached.

  2. The Oregonian and others have been bragging about how many people have signed up for Obamacare already–56,000! But these are, as you suggest, people who will be under Medicare or are already. I have no idea how many economically viable people have signed up for the other insurance for which they will have to pay. I imagine it is a negligible number, and as you can figure out, Oregon has a Democratic legislature and governor.

    • People who claim to know these things are saying exactly what you’ve outlined; that poorer people who didn’t qualify for Medicaid before, now are jumping on the site.
      They also suspect that those other “applicants” are desperate to enroll because of existing medical conditions that have kept them out of the insurance market or have been too expensive for them to carry before.
      If so, these are the undesirable enrollees that might sink Obamacare if the young&fit or the upper-middle class don’t enroll.
      Some experts (?) are calling this a ‘death spiral’ for Obamacare, the insurance industry, and for our current healthcare system.

      • I suspect poorer people going to the ER will be “signed” onto Medicaid–they do that now–this is all about being paid, not being cured. Those hosps make sure someone pays them. Zip, zip, sign here, no website, no nothing.

  3. What will this do EMTALA does not already do? I get some alarming reports from some cases from an ER in which I have a highly reliable resource. Every day it seems there is a new report about somebody’s insurance rate going through the roof. The polls, if you can trust them, indicate an extremely high percentage of Americans dissatisfied with the ACA.
    I guess all that time in civics class was wasted. What we have is not what I was taught the Constitution means.