All five of the bills envision a significant expansion of Medicaid. As it stands, the LBJ-era program, which celebrated its 44th birthday on the day before Nancy Pelosi laughed at the progressives, awards benefits according to a jumbled series of state-by-state criteria. Some states, like Vermont, offer Medicaid to citizens whose income is as high as 300 percent of the federal poverty level, while others, like Georgia, only offer Medicaid to those closer to, or below, the poverty level.
The House plan would expand Medicaid eligibility to automatically include every American whose income is 133 percent of the poverty level or less. For those earning somewhat more " up to 400 percent of the poverty level " federal subsidies would help pay for the cost of a public or private plan purchased via the insurance "exchanges." That worries state governments, which currently pay for almost half of Medicaid " and which are already seeing their Medicaid rolls swelled by the economic meltdown. A massive surge in new Medicaid members " as many as 11 million Americans under the current proposals, according to the Congressional Budget Office " might literally render many big states insolvent overnight.
Democrats pointed out that under the House plan, the federal government would pay the costs of any "newly eligible" members of Medicaid. But that phrasing, it turns out, was a semantic trick designed to undersell the cost to the states. When Massachusetts imposed a similar mandate under Romney, thousands of people who were already eligible for Medicaid, but had not enrolled, immediately joined the program in order to avoid the tax penalty for being uninsured. So while the House plan would pay for "newly eligible" patients, it won't cover the "oldly eligible."
Congress in this instance is behaving like corporations in the Enron age, orphaning hidden costs and complications through clever wording and accounting. Another neat trick involves the federal subsidies for low-income people who make up to 400 percent of the poverty level. The Congressional Budget Office projects that under the House bill, the subsidies will cost upwards of $773 billion by 2019. But some aides think that number could end up being much higher. "Without a real public option to drive down costs, the federal support to make sure everyone gets coverage is going to get very expensive very fast," says Behan, the aide to Sen. Sanders.
Here's the other thing. By blowing off single-payer and cutting the heart out of the public option, the Obama administration robbed itself of its biggest argument " that health care reform is going to save a lot of money. That has left the Democrats vulnerable to charges that the plan is going to blow a mile-wide hole in the budget, one we'll be paying debt service on through the year 3000. It also left them scrambling to find other ways to pay for the plan, making it almost inevitable that they would step in political sh*t with seniors everywhere by trying surreptitiously to whittle down Medicare. As a result, the Democrats have become so oversensitive to charges of fiscal irresponsibility that they're taking their frustrations out on people who don't deserve it. Witness Nancy Pelosi's bizarre freakout over the Congressional Budget Office. When the CBO questioned Obama's projected cost savings, Pelosi blasted them for "always giving you the worst-case scenario" " which, of course, is exactly what the budget office is supposed to do!
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