Obamacare

This week's issue of Time magazine contains an article on the Affordable Care Act, also known as Obamacare, that's worth the time and trouble it takes to read it. So, if you don't have a subscription to Time, hie thee to the public library and get ahold of it.

According to Time, there have been significant computer glitches associated with the roll-out of the health care exchanges. Moreover, there is a real concern that many people - particularly healthy young people - will not sign up for insurance and pay the tax surcharge instead. Without a base of younger people, the program will be crippled by insurance coverage for people who are in poor health to begin with, and will make larger claims to the insurance companies than they can pay from the premiums they collect.

Moreover, Time says that 27 states have opted out of the state health exchange part of the Act, and some state officials are doing what they can to sabotage the whole scheme. (I used that word "sabotage" deliberately, and I don't think it's too strong a term for what is happening.) Here's an excerpt from the Time article.

"The day before a federally operated exchange launched in Missouri, the state's lieutenant governor urged residents not to sign up. In Florida, a directive from Governor Rick Scott blocks navigators - consumer-assistance workers paid through the ACA - from working with county health departments. And Georgia's insurance commissioner has said his department will do 'everything in our power to be an obstructionist.' Such efforts guarantee that a federal law may look very different depending on what part of the country you're in."

There is a certain amount of confusion about the Act. Subsidies are available for people who are living in poverty as defined by the government. Also, people who are above the official poverty line but not very far above it can qualify for Medicaid, unless they live in a state that has decided not to expand Medicaid coverage, even thought the federal government will pay the entire cost for three years and ninety percent of the cost in perpetuity. Here's more from Time.

"It is not a coincidence that the marathon speech meant to defund the Affordable Care Act was delivered by a Texas Republican. Senator Ted Cruz's 21 hour sermon on the danger of Obamacare was just the latest broadside against the law from Lone Star State lawmakers. Under Governor Rick Perry and the Republican-controlled state legislature, Texas has opted out of nearly every aspect of the law it is legally allowed to.

In addition to not expanding Medicaid, the state has declined to set up its own insurance coverage, ceding the task to the federal government. The Texas department of insurance says it will not enforce ACA regulations, like those requiring insurers to cover pre-existing conditions. In September, Perry called for a law limiting the role of navigators, and the day enrollment began, he called the ACA ' a criminal act.' Unlike the robust public-service campaigns in some states that support the law, in Texas, ACA information is not even available on the state's official website."

And,

"In Texas, opposition to the ACA is both philosophical and financial. The law is seen as an unwelcome federal intrusion into the affairs of a state that doesn't want any part of a massive new entitlement program. Perry also points out that expanding Medicaid would add costs to a program that already consumes one-quarter of the state's budget. About half of all children in Texas are covered by existing government programs. Medicaid alone pays for more than half of all births in then state. The law is 'a recipe for disaster. . . an asteroid about to enter the atmosphere,' says Representative John Culberson, a Republican who represents southwest Houston in Congress.

But the terms of the Medicaid expansion might seem to cast doubt on such economic reasoning. The federal government would pay 100% of the cost of covering those newly eligible for the program until 2017, phasing down to 90% after 2020. . . A recent report by Texas' former deputy comptroller found that while a Medicaid expansion would increase the cost of the program, much of the extra spending would be offset by savings in other state-funded programs that pay for health care for the poor. According to the U.S. Department of Health and Human Services, Texas will leave $79 billion in federal funds on the table over the next 10 years by not expanding Medicaid."

One thing that bothers me about the opposition to Obamamcare -aside from the apocalyptic rhetoric being used - an asteroid? - is that the opponents never come to grips with why they are so adamantly against a law that would provide - at no cost to the states initially - decent health coverage to people who otherwise would be clogging emergency rooms and often absconding on their bills. I'm honestly curious. Can any reader explain how providing people with insurance is worse than what we've had before the ACA was enacted? I promise to listen and to reprint rational comments on my next blog entry.