(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]