GUEST POST: One of the True Failures of the ACA

(This is a guest post by Moorcat, who blogs at The Road Less Traveled.

While everyone is talking about Senator Cruz’s political meltdown yesterday (Really, Green Eggs and Ham?), what people are missing is one of the huge, glaring problems with the ACA that is going to bite over 14% of Montanans squarely in the ass come Oct 1, 2013.

You see, the ACA does have real problems that no one seems interested in talking about or even recognizing. Everyone is so focused on the brainless drive to repeal/defund it because it is “evil” or to defend it because it is politically sound to do so. So few really understand it, though, and it becomes obvious every time it is debated.

One of the key failures of this law is that the framers never really took into consideration just how strongly the vocal minority would react to it. It was never built to be “idiot” proof. A very good example of that is going to happen on Oct 1st of this year.

Under the ACA, the States are required to set up insurance exchanges by Oct 1st of this year. Monica Lindeen, our Commissioner of Securities and Insurance, and her office has done a great job of setting up these exchanges for us here in Montana. Her office has also worked tirelessly to make the information about these exchanges available to anyone that wants to know about it. Moreover, she has gone above and beyond the call of duty to try to negotiate reasonable rates for those using the exchanges from the Insurance Companies that stand to make an obscene amount of profit off the people of Montana. What she can’t do, though, is change the ACA itself and that is where the real problem lies.

Last year, our “Batshit Crazy” legislature thought it would be a great idea to deny the expansion of Medicaid in Montana laid out in the ACA. Their reasoning was convoluted at best, but it basically boiled down to “The ACA is bad, m’kay”. What they failed to realize is that the ACA was designed specifically for that expansion to occur. Until the Supreme Court gave the state’s the perceived ability to “opt out” of the Medicaid expansion, the framers had no reason to built in a contingency for that to occur.

Under the ACA, almost anyone can buy into private insurance from the State Exchanges. Further, those people with an income between 100% of poverty and 400% of poverty line will qualify for subsidies based on their income to help pay for that insurance. Anyone failing to get insurance (either though Medicaid, employer provided insurance or the exchanges) will be “fined” starting April 1, 2014, with some exceptions.

The real effects of that failure will felt by everyone in Montana with an income level below 138% of poverty. According to income census information that is approximately between 14.2% – 15.6% of Montanans. In real numbers, that is about 140,000 – 150,000 Montanans, in case you were wondering.

See, under the ACA, as written, those people could take advantage of the Medicaid buy-in. Since the Montana Legislature denied that part of the ACA in a fit of “righteous indignation”, those people are denied that. Moreover, since the ACA was never designed with that idea in mind, there is nothing in the ACA to address those people. They do not qualify for the subsidies given to those in the income range of 100% – 400% of poverty and no provisions have been passed by Congress to address the situation. In short, those people have been effectively thrown under the bus. They still have to purchase insurance, but they don’t have the benefit of getting subsidies for it.

The Executive Branch of the Federal Government has reacted to this situation in the only way they can – they have suspended the fines for those in that income range in States that have denied the Medicaid buy-in. This simply means that these people aren’t going to be penalized for not having insurance. The real issue is that these people don’t have insurance, though. 14%+ of Montanan’s will not have health insurance because of the actions of our Legislature. 140,000+ people in Montana were royally screwed by the batshit crazy people sent to Helena last year. Wrap your minds around this for second.

Not withstanding the morally reprehensible aspect of this situation, even the budgetary impact of this will felt by everyone. Since emergency care (on an average) costs the taxpayers 37% more than Medicaid does, this situation will have a serious financial impact on every Montanan. Ask anyone in Dillon what happens when thousands of uninsured individuals receive care at the local hospital. We are still waiting to feel the tax impact of this last summer on our next tax bill. Now multiply that by 140,000 people in Montana being effectively denied health insurance by the very legislation meant to correct the issue.

Thirteen states have denied the expanded Medicaid and 11 states have either failed to vote on the issue or have demanded changes to the Medicaid option and those changes haven’t been approved yet. That means that almost half the states in the US are in the same boat we are – with the working poor being seriously thrown under the bus.

Yes, the ACA has REAL issues and until we stop screaming at each other over whether it should be repealed/defunded and start talking about how to fix it, we are all going to see very real financial and moral repercussions. Make no mistake, as Senator Cruz found out yesterday, the ACA is not going anywhere, no matter how many times the Congressional Republicans force repeal votes. It is time to stop talking about what CAN’T be done and start talking about what MUST be done to fix it.

[Note: A previous version of this guest post indicated that people who earn between 133-138% of the federal poverty level (FPL) could buy a plan on the marketplace and qualify for subsidies.  In fact, almost anyone can buy a plan at the marketplace–and pay full price – meanwhile, people who earn between 100-400% FPL will qualify for a price break.  The post has been updated to reflect this and provide a source.  I’m confident that the author will approve of these updates. Even though he and I often disagree, he’s proven to be someone who thinks accuracy and details are important.  -Cowgirl]


110 Comments on "GUEST POST: One of the True Failures of the ACA"

  1. There are some factual corrections that need to be made to that article (I wrote it late last night while arguing online with some real dipshits about the ACA and the effects we will see as the exchanges go “live”).

    1) The lower cutoff for the subsidies to kick in is actually 138% of poverty. Further, to qualify for Medicaid as it stands now, your family actually has to be less than 100% of poverty. That means that even more people will be denied access to affordable health insurance and even bigger drain on our emergency medical facilities.

    2) The actual “fines” for not having insurance go into effect on April 1rst as you have to list what your health care insurance is on your tax returns. The open enrollment period is between Oct 1 2013 and March 31 2014. January 1rst is when your exchange health insurance goes active.

    It should also be pointed out that 13 states have denied the expanded Medicaid and 11 states have either failed to vote on the issue or have demanded changes to the Medicaid option and those changes haven’t been approved yet. That means that almost half the states in the US are in the same boat we are – with the working poor being seriously thrown under the bus.

  2. Updated – thanks for this – great info.

  3. First, subsidies and tax credits are available to anyone at 100 % of FPL or above, not 138 %.

    Second, hindsight is 20/20. There were of very smart lawyers that did not see the 7-2 majority on the Supreme Court rewriting the Medicaid expansion. The law provides billions of dollars in incentives to comply with the law, which, given the constraints of federalism, is the biggest carrot the federal government has to offer.

    Personally, the failure of the ACA lies not with its authors but with the interest groups in Montana and the 23 other states that have yet to convince their state legislators to expand Medicaid over the last 3 years.

  4. Thank you very much for making this clear. I hope our “batshit crazy” legislators catch an earful for this! Unforgivably stupid, turning down billions of dollars for our healthcare system.

    • In the interest of full disclosure, I have to say that this matter is somewhat personal to me as well as having been a concern for a while. Recently, my wife and I moved our daughter, her husband and their four kids out of the shithole called Tennessee. We are attempting to help them get on their feet and one of their major concerns is health care. They have a special needs child and with a family of six, health care is always an important thing. They both work now but they fall in that grey area – they make too much to get Medicaid, but they make too little to qualify for subsidies. We are working hard trying to figure out the best way to get them healthcare but they have been royally screwed by the last legislature. This is a situation that HAS to be addressed.

      • This is TOO TYPICAL. Unfortunately, you’ll have some saying nonsensical thongs like, “We didn’t have health insurance when our kids were little and things turned out OK. Them was the good ol’ days.” I still wish we’d just gone single -payer so no one would be left out or confused.

  5. That’s just it.. Republicans DON’T WANT TO FIX IT….!! They could care less about the American people.

  6. Because the state denied marketplace and Obamacare, All requests for medical insurance will be run through the government not Montana.

    Monica Lindeen’s hands are tied by the state legislature and she can do actually nothing with marketplace it is a federal government run agency at this point. when I signed up 2 months ago it said I will get my healthcare through the feds Marketplace… and reading it right now it still says the same thing 5 days out….

    Anyone else here in Montana can read the same thing upon enrollment you can start at

    • Yes, and no. It is still her job to ensure that the people of Montana are adequately covered under the federal exchange program. She has put together an advisory group to monitor and report on the exchanges set up for Montana. She is also still working with the political machinery of Montana to set up a Montana based exchange system.

      It should also be pointed out that a number of enterprising crooks have/are attempting to use the implementation of the ACA as a jump off point for scamming Montanans. I highly recommend you read the warnings on the State Auditor site about these scams.

      • ObamaCare doesn’t replace Medicare. Medicare isn’t part of your I did read it and she points back to my federal link.!

        We have no State exchange marketplace. please read your link before post Moorcat. Only State’s that took up Obamacare will have health insurance marketplace (sometimes called an exchanges). they only have Application helpers paid by the US government in their offices.

        So if you have Medicare keep it. You will still get all the new benefits, rights and protections ObamaCare offers on your current Medicare plan.

        ObamaCare Medicare reform improves and expands Medicare for seniors. The ObamaCare Medicare cuts are estimated at $716 billion. Those cuts are reinvested into Medicare and ObamaCare to improve care for seniors and close the Medicare Part D ” donut hole” among other things.

        Under the Affordable Care Act, Medicaid eligibility will be extended to all individuals with incomes up to 133 percent of the federal poverty level beginning in 2014. However, this will depend on what state you live because the Supreme Court ruled that the states would not have to participate in the expansion to continue to receive federal funding.

        Attention Montana republicans of our state house, not one democrat who voted mistakenly did that to our montana poor. Neither did the federal government forget them! Mark would like to point out one dem in our legislature, not the others who are party affiliated to republicans, and voted no to place the blame…… And the man wasn’t allowed to change the vote because the house Leadership( GOP) wouldn’t allow it, even though it was in the rules to do so.

        So yes Mark you are as wrong as rain again!

        This medicaid expansion will particularly benefit childless adults, who in more than 40 states cannot currently qualify for Medicaid regardless of their income level. It will also benefit low income parents, who in more than 30 states don’t currently qualify even if their children do. this of course is part of the federal Obamacare bridge, that Moorcat seemed unable to point out.

        So guess what, looks like the majority of the poor that republicans didn’t care about in the first place( and I still cant see why GOP are crying now about it since they vote against poor Americans every chance they get…. would feign a callout for the poor now), well be able to get at least medicaid

        • first sentence Replace with:

          ObamaCare doesn’t replace Medicare. Medicare wont be touched I did read monica lindeen link before it and she points back to my federal link for the federal Marketplace and exchange!

  7. You can get help in the application process for the ACA at the following places:

    Montana Primary Care Association (MPCA)
    1805 Euclid Avenue Helena MT 59601
    Phone: 406-442-2750 (main)
    Office Hours: 8 a.m. to 5 p.m., M-F
    Helps With: Small Business/SHOP
    Application Assistance


    Montana Department of Public Health and Human Services, Human and Community Services Division
    Po Box 202925 Helena MT 59620
    Phone: 1 888-706-1535 (toll free)
    1 406-444-2590 (TTY)
    Office Hours:
    Monday -Friday 8-5

  8. Almost left the most important on out for us regular folk:

    Planned Parenthood of Montana (PPMT)
    1500 Cannon St Helena MT 59601 (map it)
    Phone: 406-443-7676 (main)
    1800230PLAN (toll free)
    Office Hours: M: 8AM-5:30PM

    Helps With:
    Language Support, Small Business/SHOP, Application Assistance, Additional Languages:
    All languages covered by LanguageLine

  9. “Public opinion on Obamacare is complicated but generally consistent. The law is unpopular. But a solid majority wants the Republican sabotage to end.

    A poll this month from the Pew Research Center for the People & the Press found that 69 percent of Americans, including many who disapprove of the law, want Congress to “make the law work as well as possible.” Only 23 percent of Americans say Congress should try to “make the law fail.” ”

  10. That’s a good summary, and thanks for the effort, MC. As a political wonk, I expected that when the bill got to the final nine that anything good would be taken out and anything bad left in, as they are corporatists. Sure enough, the private mandate survived as a “tax,” utter nonsense, while Medicaid expansion was taken down due to states rights, utter nonsense. But that was predictable – if I saw it coming, the insurance companies and their employees, Baucus and Obama, surely did as well.

    A couple of notes – in the Bozeman Chronicle this week was a long article on the exchanges opening up, and there was not a word about coverages – only premiums. This is sad, as people are not going to find out about “under-insurance” until they need coverage and find out it is not there. The thrust of ACA is to use poor and working poor as a conduit for subsidies to the insurance industry – maximum premiums for minimum coverages is the game. ACA only mandates certain preventive coverages such as physicals and mammograms without follow through – that is, if your annual physical uncovers a condition that needs treatment, you’re going to be out-of-pocket for treatment, so not much has changed. People who premium shop will discover that they cannot afford treatment. Back to square one. Medical costs will continue to be the number one cause of bankruptcy.

    And it is interesting to note that the framers of the bill wrote language into it that limits the ability of the IRS to collect the penalties. That’s odd. The normal collection procedures – liens and seizures and all of that – are set aside. IRS is given one option only – to offset refunds. So if you are not due a refund, IRS cannot legally collect the penalty. Keep that in mind when you prepare your return – don’t overpay your tax and you can legally avoid the penalty.

    For myself, I had good coverage under Cover Colorado, a government-run insurance system. It is going out of business now and I’ll be forced into Humana or United health or some other crappy rentier-driven private fiefdom. Thanks Obama. For nothing.

  11. Advanceable tax credits (subsidies) are available to households earning between 100-400% of FPL. The qualifying income marker was lowered to 100% in Montana specifically to address the refusal by our state of federally-provided Medicaid expansion funds. Please see the following link (website run by the Montana Commissioner of Securities and Insurance) for verification:

    Note that Montanans have entered into a partnership agreement with the feds concerning “our” health insurance marketplace – which means our state has a voice in how the exchange is managed and run in Montana.

    We still have the Medicaid donut hole in our state, but it applies to people who earn BELOW 100% of FPL, and who earn too much to qualify for Medicaid. It is a travesty, and an incredibile illustration of the idiocy of our state legislature.

    • Do I recall correctly that the whole Medicaid debate in Montana turned on the committee vote of one Democrat who “accidentally” pushed the wrong button? I have a bridge for sale if anyone is interested, by the way.

        • A move by Democrats to bring the measure to the floor failed by a single vote, with one Democrat later admitting he voted the wrong way. A later effort to undo the first vote failed by three votes

          Having a sale on bridges! Do I really have to explain politics to you, Lynn? That is how it is done – no matter all the sound and fury, the bill went down.; Democrats were free to grandstand, as they knew in the end it would not matter.

          • Attention Mark double trolling as two separate commentors, in2it and Intodeepinsanity will get you banned again for the forth time.

            This is exactly why jerks like you need to leave! so far everything you have written under both personas is a lie!

          • Norma Doofy strikes again. Pretty soon everyone but Doofy will be banned and the comment section will be solely comprised of her deranged nonsensical rants. Although we are nearly to that point already. In the name of improving this blog I vote that Doofy be the one banned. Guaranteed the participation and quality within the comments section would improve noticeably within a week and soon approach the levels this blog used to reach. You did the right thing by shitcanning Larry now go the full distance and flush Doofy too.

            • I can expect a troll to love a double troll….. Mark?

            • Seconded, Abe.

            • Abe, I hate to point out the obvious but we all don’t get a vote on who goes and who stays. Blogs are not a Democracy. If anything they are the best defense of Democracy because they are proof of the system’s flaws.

              • Seems people have been voting by not commenting or frequenting this blog as much as in the past. Seems safe to assume that Larry Craig Environmental Ranger was banned for the same obnoxious behavior that’s driving away posters and making the comment section unreadable. Not to much to ask I believe to request the same treatment be given to Doofy. The only votes that matter may be those of the cowgirls but the brand is suffering. Save Cowgirl and ban Duffy!

                • You have an argument, Abe. The website needs to remove those who discourage readership. I agree.

                  It is interesting to me as a student of blogging, and I would appreciate your feedback, as to why you think eyeballs as evidenced by comments are the gauge of a blog’s viability. Should a blogger be concerned with the quality of their posts? Or the quality of their commenters?

                  Notice please, we’re having this discussion under a post that was not Cowgirl’s, but rather someone who often disagrees with the blog proprietor, and yet the Cowgirl(s) saw fit to post his input.

            • Thirded Abe. Norma, what business is it of yours who posts here or not?

              • Well, DUH! It’s her ‘bidness’ because if she can’t be right here, then SHE CAN’T BE RIGHT HERE!

                For the honest record, it seemed to be the business of everyone else that Larry Kralj be 86ed. It seems to be Abe’s business that Norma take a walk. You thirded him on that, so apparently it’s your business “who posts here”.

                You will never, ever, find me defending Norma (though you will find me defending her arguments when they are worth defending.) Simply suggested, shine her on. Don’t expect the blog proprietor to make your visiting experience more pleasant. I’m not trying to be combative, here. I just try to help when I can.

                • Be honest Rob you are no diplomat, Im marking you down as a vote to flush the Duffy.

                  • Ohh ~heh~ I’ve never in my life pretended to be a diplomat.

                  • I’ll be honest. Abe please put me down as a vote to flush Duffy. She has infected the comments section of this blog and is spreading to other blogs at a rapid pace, like a highly contagious virus.

                    • Poor little reds, can stand free speech when its honest. Wow your argument, when someone like MARK is trolling under multiple names is blame the person who found them out????? Bwahahahahaha what pathetic little beings!

                  • As a commenter and as the person that submitted this article, I am rapidly coming to the point that I will begin avoiding this site as well because of Stormin Norma. She makes it difficult to want to participate in any kind of discussion here.

                    • If eveyone would IGNORE Trolls,just Stay on Topic

                    • Shorter Moorcat; “Mommy mommy Norma doesn’t like my post. ”

                      Such whining from men, unwilling to be heros anywhere else but by posting garbage on the internet, then expecting educated women to just swallow it???

                      Please stop making me laugh!

                    • Hey if you’re willing to post a story, and can’t take the heat because your story was incomplete, and not factually checked. its not my fault your feelings are hurt because I ask the tough questions Moorcat.

                      Deliberation is not a kumbaya moment… I believe you guys know if you cant stand the fire get out of the kitchen

                    • Flush Duffy please. Hopefully a plunger won’t be needed.

    • I have found the same information, KM, but there still exists some issues with that. Looking at the state budget, I can’t find where that money is suppose to come from. Moreover, if the state is looking for Federal backing for that “100% – !38%” area, they won’t get it because there is no federal money for it.

      Let’s assume just for a second that the money does become available for those subsidies. That still leaves the 50,000 – 70,000 people in this state that are below the 100% level but no eligible for Medicaid to cover. That “doughnut hole” is still very real and very large.

    • I went to lindeens information tour last night in Bozeman- great information. People are in the coverage gap if they earn less than 100% fpl, if they earn more, yes they would have been able up to 138% to get mediaid, but now they can get subsidies if they can afford to pay the balance

      There are 50,000 people who are in the coverage gap-these are the people who the legislature screwed. 10,000 of them are native Americans.

      By the way, word on the street is that Chuck Hunter went to republican leadership and told them it was okay to let the expansion bill die- saying he didn’t want the political flack and that he wanted the bill to be his own. I hope that isn’t true.

      • Thanks, Ed. I am glad they found the money to at least cover the people in the 100% – 138% bracket. It still leaves 50,000 people uncovered but it does help. Now we need to reverse the legislation’s screwup.

      • On further research, it appears that the states that have denied Medicaid expansion are split on the issue. Some have (like Montana did) enacted some kind of state funded “solution” to the 100% – 138% of poverty market. Some simply forgot about it. This has added to the confusion when attempting to find a solution to the problem.

        As far as the specific situation I have dealt with – The local office designated by the website Norma keeps posting told her that she should apply for Medicaid (she has already done that and been denied). She contacted the Butte office listed on the website and spoke to three agents. One had the temerity to suggest that she or her husband go part time so that they would qualify for Medicaid. None of the three individuals had a straight answer for her. We are now attempting to work through Lindeen’s office to find a solution.

        The point here, is that while the information is pretty straight forward for people like Norma, people who are NOT straight forward are getting a large run around because no one really seems to know what to do with the people that don’t qualify for Medicaid and don’t meet the 100% poverty line requirements for subsidies. This situation MUST be addressed. Screw the political angle here.. the moral obligation for our society is to fix the situation.

  12. This whole article is again fraught with bullpucky, about what people again dont know about Obamacare because they are to lazy to read… kinda like the author of this post. Further confusing people about the ACA.

    Montana doesn’t have anything to do with this exchange. The reason articles are written inside the Montana government is because the majority of officials elected to public office were Democrats. People who knew ACA would be good for the state. People who care enough to explain the right path. Monica Lindeen did infact fight very hard for ACA, but she is paid to only work on what the legislature pays her to do. Her montana information page, therefore points you to the federal sitepage to know more about ACA from a trusted government source. Plus it is her job to tell you of scams, but I personally have talked to her at some length…. she and her office cannot investigate any federal claims, she can only take on the details and pass it on to the federal government.

    Only Montana based insurance scams… can she investigate which are outside the ACA enforcement purview.

    Get smart folks and discover what you need for yourself!

    The same can not be said of the house and senate of our state, the majority which is republican voted against it, and pulled off multiple shenanigans to keep it that way.

    Stop reading the pundits, and start reading and enroll. you can ask questions in their online chat, the phone numbers I gave above are to application experts who can help you through the enrollment process……

    As Individuals no one is the same regarding the health care you need for you and your family, plus the price you are willing to pay.

    Two things I can tell you personally from me signing up it this:

    1. my insurance plan went down from 300 a month, which I could hardly afford to looks to be about 80 dollars,

    2. Co-payments plans look to be cheaper than coinage plans.

    3 Marketplace catastrophic plans are available.

    • Thanks, Norma, for once again showing just how out of touch you really are. The article is NOT “bullhucky” and it has started a discussion about fixing a major problem with the current system. I am glad your experience with the ACA has been a good one, but for many people – including my daughter’s family – it hasn’t been. The site you reference does NOT contain all the information and a lot of the information available IS contradictory.

      You are not doing yourself (or Democrats) any favors by continually acting all “better than thou”. Instead of being part of the problem, how about you do something new for a change and be part of the solution…


        I made up a mythical Family of 3, one women 2 children, making 15,000 a year, 77% of Poverty rate, No Subsidy was available, insurance would cost $261.00 a month $3132.00 a year. said to apply for Medicaid………

      • Listen how you read my comments, aren’t based on any real science just your own opinion here as well as the meatheads who cant post under their own name.

        Its okay for you to shoot down commenters, when you haven’t produced any substantive facts to back your just opinion? but I am not allowed too call it into question? Really?

        Your only link to back what you said in your post here was Ted cruz’s green egg and ham speech, a lot of the rest of your post was just, tired argument already passed through the meat grinder of media and right wing punditry since Obama was elected … and basically your information is confusing and at best wrong.

        If the tea party is in such a hurry to grow up I suggest they also learn to read as well on the healthcare site…. while we are not sure how each mechanism of the bill well help in January, it has helped fabulously so far in returning premiums to people who have overpaid, protected children who have pre existing conditions, and kept young adults insured under their parents plan. Not to mention dropping insurance pricing because of out right competition.

        There are some hiccups but they will be smoothed out before subsidies drop in January. What you people are arguing is akin to your new car getting a flat tire before you buy it. All Supposition at best!

        • Norma, for the record, the link to green eggs and ham was actually Cowgirl’s, not mine. The link I used was the following –

          The fact is, you are behaving like every politician in Washington. You waxed poetic about how you got your insurance and how easy it was to do so, therefore it must be easy for everyone, right? Like most other politicians, you have no idea what you are talking about. The situation is very real and the conflicting laws just make it even more confusing for those caught in this mess. Even Lindeen’s office has posted that they are encouraging Montanans to contact the Governor to call a special session. It is the only way to fix the situation for working poor Montanans. We might not be able to fix the situation nationally for the reasons posted by multiple people, but we might be able to influence the legislators here in Montana to fix it if (and only if) we work together to show them that the working poor in Montana need them to fix it. You are not helping and, in fact, are being part of the problem. Get off your high horse and help the rest of us fix this easily fixable situation. That would show some actual legislative ability.

  13. Now we have all of these brain trust people coming out and trying to explain ACA and what is wrong with it. My question is, where were you when the law was being proposed? Probably smothered by the lawyers, accountants, actuaries, etc., that carved out their niches at our expense. A single payer system with EVERYBODY

    • Exactly who are your railing against, Richard? I seriously doubt that you missed the simple choice at the time. It was not an either/or between single payer and the ACA. Baucus, and in fact the entire Senate (Democrats and Republicans alike) made certain that the choice was between the ACA and the status quo of 2009. You most surely cannot still believe that single payer stood any chance at all in a 3-way race for reform at that time, can you?

      As Moorcat adequately and accurately points out here, the ACA is the law and will not be repealed. We cannot and will not return to the status quo of 2009. Those who seek that by costing us all more money will simply rain political woe and hell on themselves. That’s all to the good. The dynamic of choice has changed. Now, as opposed to then, there is a realistic opportunity to look at the either/or of single payer as a fix to a broken law. Put simply, I think you should be all-in with the naysayers, Richard, as opposed to blaming them for not supporting your view when it wouldn’t have mattered at all.

    • The catch 22 here is that, to fix the system, you have to amend the actual law. The law won’t be amended while the hard right is busy trying to defund/repeal/push it back.

      Like Rob pointed out, it was not politically feasible to pass a single payer system (I am not as sure about that as Rob is, but I bow to his superior knowledge of politics on this one). The choice will eventually become a single payer system and the ACA but that choice isn’t upon us yet (for the record, I have supported a single payer system from the beginning because it is the only financially viable solution to the out of control health care costs extant in the US today). What is before us is a very easy to fix problem with the ACA that would take a simple amendment to fix. The sad part is that, to fix the problem, you have firsts get the morons and hardliners to stop trying to sabotage it first.

  14. Right now the poor need Help
    “People on Montana’s seven reservations die younger than many others around the country. They’re getting diabetes at an alarming rate. They have less money to live on, and the dollar has to go further at the grocery store or gas station. That means the processed foods at the Albertsons in Harlem make up a good portion of diets on this reservation.”

    Sign the Petition for Emergency Session this Fall

  15. “Politically feasible” needs to be fleshed out a bit. In terms of public support, push polls aside, it was a slam dunk. It was in 2004 too, but was not even discussed by Kerry, who said it was not “politically feasible.”

    So the term does not mean what it appears to mean. It’s a euphemism, and I think it means “insurance companies won’t allow it.” So we should be clear about that. We should also be clear that Baucus did what he did because the entire debate had been scripted to lead to passage of this bill, which was the bill that the insurance companies wanted. He had to do that – he had to crush our expectations, otherwise good things might have happened.

    I fear it is a very bad bill in terms of providing actual health care. In terms of providing insurance, it’s what the insurance companies wanted. So the question now is what kind of access to health care the insurance companies will allow. All I hear and read is talk of premiums, but I fear that those premiums will buy very poor health care.

    • “Progressive economists like Dean Baker have written [11] that Obamacare is better than most people think, even if it contains elements that bother progressives, such as not creating a non-profit, public system like many Western democracies, or imposing cost controls.”

      “Looking ahead, it prohibits insurers from not covering people if they have a pre-existing condition. Because nearly everyone gets sick with something serious by the time they are middle-aged, that industry practice prevented most people who lost their jobs from getting new coverage. Instead, they had to pay 112 percent of the premium cost paid by their ex-employer through a program known as COBRA to keep their healthcare.”

      • Again, he’s talking about access to insurance and not access to health care. We know now that we can get insurance, but after co-pays, deductibles, out-of-pocket maxes AND premiums (not to mention things that are simply not covered, like office visits here in Colorado), can we also afford to pay for the actual care we need and pay the insurance companies too?

        That’s why single payer is really the only solution, and before someone reminds me, yes, I know it is not politically feasible. What that really means is that access to quality health care for everyone is also not politically feasible.

        • It’s a start in the right direction toward Single payor

          But the Issue right NOW is getting Medicaid Expanded in Montana

        • Single payer may not be politically feasible now, but as the flaws in the Affordable Care Act become more of a burden, the advantages of an everyone covered for everything federal single payer system will become increasingly manifest, and in time I believe that ACA will prove a bridge to single payer. In the meantime, we would do well not to keep saying that single payer is politically impossible lest that pessimism become a self-fulfilling prophecy. The political reality is that Obamacare is a foot in the door to single payer and we should treat it as such. Meanwhile, it will help some people.

          • I suspect that ACA was meant to be the final nail in the health care system. After all, it was passed when your party had a sixty vote senate, house and presidency. With all of that, if this is the best we could do, what can we do when your people are smaller in number?

            Keep in mind that we all knew that the system was broken, people were suffering, 45,000 a year dying for lack of care due to lack of access to the system. I find it hard to imagine this is a bridge. It is more like an impediment, which is why many of us thought doing nothing was a preferable alternative, holding out for a real fix to a broken system.

            • We need to start somewhere and James is right. I believe single payer is around the corner. if we can keep the GOP from trying to defund ACA, because it is the same natural conclusion found out by England and France with their single payer plans. And trust me Private insurers didn’t disappear from the scene in those countries they still sell health care.

              Infact a lot of it is to the government!

              What are the naysayers Factual arguments about ACA? there is none that are true at this time.

              There is no proof so far, that ACA will change private insurance for the worst or cost more…. not even anecdotal information exists at this time, because the biggest part of the insurance hasn’t started yet and will not until January.

              WHat we do know is insurance prices in the U.S. have gone down, and children are being saved already, by what has already been implemented.

              I saw this crap when medicare and medicaid became law. I watched Ronnie Reagan rail against it in the beginning and when he became president I watched him do everything he could to protect it. I see no difference with the nasty opposition to this bill.

              Whine all you want Obama will not dismember this ACA bill in anyway, except to make it better. And the republicans wont be able to touch it by election time 2014 or 2016.

              • There is really only one way that SP will arrive, and that is the Canadian way. It will not be done in DC, as the corporate lobbies own the city, most in Congress, the Supreme Court and the White House in total.

                In Canada, Tommy Douglas (Kiefer Sutherland’s grandfather) was premier of Saskatchewan in the 1960’s and they instituted SP in that province. It was so successful that by 1971 the private insurers had to pack their bags, and the whole of Canada was aboard. they call their program “Medicare,” which is where our program for seniors got its name.

                If one American state can break free of the insurers, it might start a rush, Canadian style. California had already passed it but Schwarzenegger vetoed it in 06 and 08.

                I think one of the urgencies that brought ACA about were the rumblings in the land that SP was on the rise and that the walls would eventually cave. ACA came about to stop SP, and will surely not lead that way. That’s the worst part of the bill, taking all of that good energy for reform, and trashing it. ACA may have set SP back a couple of decades, if not permanently.

                • Saskatchewan still has private health providers who are not hurting for money. the fact that you guys keep saying insurance companies will go away is a fallacy. they will bundle services to the people who want it and the government as well. there methods of retaining customers will change but it will still be a force within single payer.

                  the only difference we have here is the insurance companies were addicted to caps and being able to kick off the pre- existing condition customers.

                  the more i have read about other nations single payor the more I am convince that insurance companies are not only still there, but still making money!

  16. We need a special Session

    “State officials can choose to join in Medicaid Expansion at any time. The federal government will pay for 100% of the cost of the expansion in a state for the first two years of the program. However, funding levels reduce after that point. Funding levels available to the State will be determined by the year the State joins the expansion.”

    • If Bullock can cut a deal to expand Medicaid, then I’m all for calling a special session to ratify the deal. But I have no reason to believe that the same legislators who shot down Medicaid expansion will have a change of heart and do in a special session what they refused to do in the regular session. And I have no reason to think that Montana’s voters will throw these bums out come November, 2014.


        “Senator Ed Buttrey (R- Great Falls) says he voted for the expansion bill because he wanted to keep at least one bill alive which could expand Medicaid and dramatically reform the system.

        “We have to have a solution. We don’t want to come out of this session with no solution as to what we do for medical coverage moving forward,” Buttrey explained. “I don’t support the full expansion of Medicaid. But there are a limited number of bills now that have titles that will support reforming Medicaid and implementing a new Montana made solution.”

        Before the Senate began debating the bill, Republican leadership urged their caucus to stick together and vote no on Medicaid expansion. However, it was evident not everyone in their caucus was on board.”

        “Senator Llew Jones (R- Conrad) voted for the bill saying his constituents were asking him why he hadn’t been involved in bringing Medicaid expansion up for a vote earlier.”

        We need people to get involved and sway enough members to vote for Medicaid Expansion we need 12 Brave republicans to change their minds in the House and 5 in the Senate.

        • According to the ACA: As an American Indian or Alaska Native, you can continue to get health care through the IHS or through your tribal facilities. In fact, the health care law makes IHS benefits more secure. First, the law makes sure the comprehensive health services available through the IHS are here to stay. Second, more people who use IHS will have health coverage, which in turn helps make funding for the IHS more secure.

          Also, tribes that are also employers can buy coverage for their employees through the same plan that members of Congress and other federal employees use, making it easier to buy good coverage at lower cost.

          I believe our native brethren haven’t done any more research on the new inroads on IHS at this time as non natives have done for Obamacare… kind of stuck in the same quagmire of confusion about ACA and IHS as well .

          I know with our Montana tribes the biggest problems in the past have been new health facilities, doctors who will stay, and some embezzlement of health care funds which is being looked into… They are far from perfect but , I believe they are on the right path also. plus they will be able to use the marketplace if they wish, and still opt to use medicaid and IHS as well!

          • “Waiting times in the state’s IHS clinics are high. There aren’t enough doctors or nurses to provide prompt care. The doctors who come don’t stay long. They don’t want to live anywhere near this rural reservation, says tribal councilwoman Patty Quisno. They’ll come fresh from school and stay for a few years before moving on. They come because working for IHS forgives $20,000 per year in student loans for up to two years of service at the clinics.

            In mid-April, there were 103 openings at IHS clinics throughout Montana. Another 10 were open in Wyoming. Jobs pay well, much more than the average wages made by the 20-30 percent who are employed on Fort Belknap.

            A doctor came a few years ago from New York and another from West Virginia. Plumage liked the doctor from West Virginia, and the doctor liked it here. His wife didn’t. So they moved back east, and the IHS facility here had an open position again. Today, it has open positions for medical officers, nurses, lab technicians and pharmacists.

            Plumage says the facilities around here aren’t hospitals. Hospitals birth babies and treat cancer patients and perform surgeries and typically have more patients than administrators. These facilities are clinics; Armories, as Plumage calls them.
            An anonymous grave site at a cemetery off Highway 2 on the Fort Belknap reservation makes death seem a little closer here than elsewhere. The average life expectancy for American Indians living on Montana reservations is 67 — markedly lower than the United States average of 77.

            An anonymous grave site at a cemetery off Highway 2 on the Fort Belknap reservation makes death seem a little closer here than elsewhere. The average life expectancy for American Indians living on Montana reservations is 67 — markedly lower than the United States average of 77.

            “Indian Health used to be, not saying it isn’t today, but it used to be a lot better in my opinion,” Plumage said. “A lot better staffed, they had an ambulance crew.””


            “A Medicaid expansion in Montana would add up to 19,547 American Indians into that funding pool, money that would stay at local service units, clinics.”


            • I know when I went back to Dc in 2011, I went back there for the SEIU, and Occupy Wall Street and spent an extra day working with my Indian brethren talking about these very problems with Tester’s staff and Bacus Staff, not to mention the Staff of North Dakota. The very thing Plumage was talking about in this news article.

              These issues is little known among the regular white American population of how hard our Native Indians, still have to search for better healthcare and a hand up.

              • Believe it or not it is well known… thanks to Tester and Baucus opposing the measure to allow tribal Indians to seek healthcare off the reservation back in 2008. They were stuck then and continue to be stuck now in a failed reservation healthcare system.,d.aWM

                Summary: Coburn amendment 4034 empowers tribal members to choose for themselves how they get their health care.
                Tribal members receiving care in the Indian Health Service system are condemned to a system that rations health care services on a “life or limb” basis. Long wait times for services exacerbate patients’ conditions. The IHS is an inefficient bureaucracy that has underperformed for decades, insulated from any competition because tribal members have no other choice. The underlying bill being debated only compounds the current problem by adding more of the same.
                Coburn amendment 4034 creates a new option in the IHS that allows tribal members to choose from various health care coverage options. If a tribal member has to wait months before they see a doctor, the tribal member can demand that IHS give them a risk-adjusted amount to purchase private health insurance like every other American can do. Not only will this compel the IHS bureaucracy to start delivering results, this will allow tribal members to decide if health care choice can improve quality, outcome, satisfaction, and affordability. The Congressional Budget Office has said this amendment’s score is zero.
                Congress has a moral obligation to fix the broken IHS system.
                This amendment gives tribal members some of the same choices in health care coverage that members of Congress and their staff enjoy. It is wrong for Washington politicians to force tribal members into a failed government run health care bureaucracy when other options are available that can provide access to affordable quality health care.
                The only way to improve a failed system is to provide an alternative. No one would be forced into a health care plan that they do not want, as they are now under the current system. Rather, this amendment puts patients in control of their own health care by providing tribal members with a choice of health care coverage options…

                • 2007 Craig, you reach back for bullshit that didn’t make it off the table since 2007??????
                  I believe the Ammendment had anti-abortion language in it Craig. the Chipawa and other tribes didn’t want or need that admentment. and therefore it died not because of tester and Baucus but because Colburn wrote a piece of shit bill 6 years ago?

                  Again another jerk muddying the waters!!!!!!

                  • Another thing Craig, Max and Jon have both been lauded numerous times for helping the indian nations…. Colburn not so much!

                    This was one of your worst try’s yet at muddying the waters against Democrats in Montana and an complete failure as usual!

      • I agree with you. A special session won’t do much good if the same legislators are in office. We need a special legislature – one that gives as good as it gets. In Ravalli County, all but one legislator voted against Medicaid expansion. Pat Connell voted in favor, and now he’s fallen out of favor with the rabid wing of his party. Legislators Connell, Ron Ehli and Scott Boulanger all receive taxpayer-subsidized state health insurance; two – Nancy Balance and Ed Greef are on Medicare and collect the state reimbursement in lieu of state health insurance. The remaining legislator, Fred Thomas (sponsor of the infamous energy deregulation bill) is an insurance agent and presumably has his own health insurance, but he also collects the state in-lieu-of reimbursement. Connell is the only honest legislator in the bunch, hence the Rabid Wing challenge in the 2014 primary. No, I don’t think a special session would result in any changes.

        • I think it would depend on how much public pressure is applied on these people. You will never change the minds of people like Fred (I went to school with him, believe me when I tell you that…), but there are a enough non-rabid Republicans in this state that can be pressured. If they can be identified, and pushed, then A) you can get one of them that voted against expanding Medicaid to bring it back up and B) you might be able to use logic and facts to get enough of them to fix the mistake. The worst case is that nothing happens. The best case is that the situation is resolved. There is no downside to trying.

    • I would also suggest writing a letter to our Congress persons – Baucus, Tester and Daines. I have no expectation that Daines will respond (he has almost unilaterally stated that the ACA should be shitcanned) but Tester and Baucus may respond and further, they may push the Governor for a special session. I have already done so and am awaiting a response. Senator Tester has openly asked for feedback on his facebook page so I am hoping for some response from him at least.

  17. The legislature didn’t pass any exchange legislation so these exchanges were set up by the Feds as I understand it.

    • At this point, you are correct, Jeff. Lindeen put together a group of people from insurance, health care industry and citizenry and proposed a bill before our legislature for a Montana state exchange system. This bill never got voted on. Instead, the Montana legislature punted on both Medicaid expansion and on having a state run exchange. There is a push to have Governor Bullock to call a special session to revisit this, but given the makeup of our legislature, I don’t have a lot of hope that anything will be accomplished. Democrats are not being a lot of help either with people like Stormin Norma claiming that there isn’t an issue because the ACA is just so star spangled wonderful. Her tact is that these people not covered by the ACA are just “misinformed”. Again, she isn’t doing Democrats any favors, and as this situation progresses (and it will because despite the efforts of the Congressional Republicans, the ACA is here to stay), Democrats like Norma will unwittingly provide ammunition to the Republicans by ignoring the glaring issues with the ACA.

    • The word “exchange” leads one to think of a marketplace, like a stock exchange. The problem is that what will be offered is the same product in different wrappers. I have learned over many years that all insurance companies offer the same product. They must do so, as competition forces them to restrict what they cover – the exact opposite effect that economists teach us to expect. (If one insurer decides to cover a certain illness while the others don’t, there would be a rush of sick people to that insurer, and it would affect profitability. So all have to use the same play book.) The same with regards to pricing – if one insurer engages in price competition, it would force others to do the same, and the whole industry would suffer. Cartels do not behave that way.

      So the exchange, along with everything else in this bill, is likely a smoke exchange, nothing more.

      • If you honestly believe that all insurance plans are the same, you are an idiot. We have been lucky enough to have a choice of plans (either through my work, or through my wife’s work) and there are certainly NOT the same. The coverage levels are different, the rules for what is covered is different and the choices for care are different. This last comment of yours was completely wrong and unhelpful.

        The Exchanges are a marketplace (whether you want to recognize that or not). Further, it is likely that that marketplace will change over time as people use it – the market will respond to the force of consumers. How that will work remains to be seen and no one seems to know with certainty – not the experts, and certainly not you, Mark.

        • I beg to differ on that matter, having been exposed and having dealt in the private market now since 1986 and knowing enough about insurance to be able to see through most of what has passed for debate on the matter. In the 1990’s, as the not-for-profits were taken private, the terms for insurance policies were set by the big guns, United Health, CIGNA, WellPoint, Humana – therefore, if one of the big guns decided not to cover a certain condition, say diabetes, the others had to follow suit or they would have all of the diabetics.

          What you are seeing in Montana, at least when I was there, was a market divvied up between BCBS and one other company, something like 80/20. It is true that there would be some turf battles, but the competition was generally over premiums charged, and coverages, unless Montana is different, suffered death by a thousand cuts. Unless the state mandated a coverage, it was not offered. Employee share increased and deductibles and out-of-pockets and co-pays creeped up, and this was all of them. For those outside of large groups, there were like 81 conditions considered “preexisting” and each and every company refused to cover each and every one. The worked in harmony on that, as they had to present a united front against potentially unprofitable clients. They claim otherwise, but please, I’ve got eyes.

          That’s not competition. It can’t be! Competition would put them out of business. A public option would have killed them. So the idea that they are going to go into the exchanges and compete with each other is impossible. Private health insurance cannot work due to perverse incentives. Obamacare has not changed that.

    • Lynn, fee cryin’ out loud, please distinguish between health “insurance” and health “care.” One does not lead to the other. We have a health care crisis, and a whole lot of it is due to health insurers who are now subsidized by Obamacare.

      Two parts of the duckspeak we have to deal with right now: Conflation of care with insurance, and discussion of premiums without coverage. You are doing both. In spades.

      • Coverage has improved, Preexisting conditions are going away. No more Caps on how much the policy will pay. I had been without insurance AND Health Care for 11 years till 2013. At least now if I break my leg etc. I can get help. YOU have obviously always had either insurance or 20,000 dollars in the bank.

        • Health insurance companies are an impediment to access to health care. That’s why most industrial countries do not have them, and those that do regulate them to such a degree that they cannot harm people. We give them free rein.

          Without health insurance companies, if you break your leg you go to an emergency room and get it treated. you show them your ID card. End of story.

          With health insurance companies you must first show that you have insurance, and then fill out paperwork. You are treated, but later the bills start coming in. You must pay the deductible and co-pays, and the insurance companies’ community college dropouts might decide that the doctors or hospital staff did some thing they won’t cover. You’ll be billed directly. If by chance your accident happened on December 31st, your deductible and out-of-pocket limits are reset, so by pure happenstance your costs have doubled if costs overlap the year end. If you do not pay your share of the bills, the hospital and doctors will hunt you down out you through collection, possibly force you into bankruptcy. And worse yet, if you did not have insurance, your costs skyrocketed and the wolves are at your door. The idea that emergency rooms are “free” is only true for the destitute, who are judgement-proof.

          The objective of true reform was to get rid of the insurance companies. Instead, Obama and Baucus kissed their asses and put us all completely under their control.

          I know that because Obama did it that you are going to justify everything as well-intended, just as if it had been done under Bush, you’d oppose it all as mean-spirited and greedy. The job of Democrats in these matters is to get us to expect less and be satisfied with a few spoonfuls of gruel. True reformers would have fought for us. Your leaders had no spirit, no fight in them. You blew it. They screwed us all over. Stop putting lipstick on the pig.

  18. Lack of health care and high costs have been an issue in this country since long before Obama. Hillary Clinton’s attempt to corporatize the system, “Hillarycare” (later called “Romneycare” and now “Obamacare”) took place in 1993. That was a boiling point, meaning the issue was simmering long before. Ergo, the issue could have been raised in any year, 1992 through 2004, but was not. Al Gore refused to touch it in 2000 as did John Kerry in 2004.

    So why 2008? The insurance industry was healthy and happy, so there was no impulse for reform coming from there. Politicians in AHIP pockets were being paid not to act, and were performing admirably. Why suddenly the need for “reform?” Why did The One arrive on the scene to fix things?

    I suspect they took a reading of the lay of the land, and realized they were in trouble. Our largest state, California, in many ways a bellwether, saw its legislature pass single payer legislation twice, in 2006 and 2008, each time vetoed by Governor Schwarzenegger. The wall was going to fall, and like Canada, if single payer passed in one place, would spread to every other state in short order.

    That was the impulse behind Obamacare, in my opinion. It was not the need for reform, but rather the fear of reform. ACA stopped Single Payer in its tracks.

    • Again Mark you conversation is complete and utter bullshit. Anyone who listens to the likes of you are bound to become stupider. This is one of the reasons I cannot abide in whatever you call wisdom.

      Like Moorcat said before you’re stupid about exchanges. Agreeing with you for any reason past that… is looking to get slapped in the face for all the crazy you endorse. you don’t live in Montana anymore, you don’t care about montanas let alone the problems – people in your state are enduring in colorado since the flooding…. and Like I said before I will continue to call you out on your lies.

      • If you are a real person and not an avatar created by “Cowgirl” to keep the site active, you are perhaps as devoid of intellect as anyone I’ve known, keeping the keyboard going, misspelling basic contractions, attacking without reasoning. I don’t know who you are or what you look like, but imagine Java the Hut, unable to move from place to place, computer screen in front of your face, your whole life wrapped up in this this website. I am sorry for you. I beg you leave me alone. If I set human feelings aside, I can hurt feelings. Go away.

        • Sadly, Norma is actually a real person and while she bears some physical resemblance to Jabba the Hut, she exists. She is not an avatar created by Cowgirl (Cowgirl doesn’t need a fake commenter to keep the site alive and, in fact, many people don’t visit this site anymore because of Norma). While she may be an ignorant pain in the ass, she is a living breath eating machine.

  19. Hi! It’s “ME” again. I just heard some new info, regarding the AHA. The States, like ours, who Opted-Out of “Expanded Medicaid” Will only make their “Health Market Place” Rates, HIGHER! Please inform your readers, AND our Governor. I did this morning! Still hoping for it, so I don’t have to “MOVE!”

  20. Everyone – please refrain from attacking other commenters. That’s what happened with Kralj.

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