Saturday, June 1, 2013

31 Million Uninsured Under the PPACA (Obamacare) and Rethugs Laugh Loudly As They Stop Medicaid Expansion in States (Lou Reed Recovering!)

(If throwing a contribution Pottersville2's way won't break your budget in these difficult financial times, I really need it, and would wholeheartedly appreciate it. Anything you can afford will make a huge difference in this blog's lifetime.)

The Velvet Underground

John Cale, Lou Reed and Nico

Lou Reed Recovering After Liver Transplant

The ultimate New York band — and, arguably, the most influential of all the proto-punk groups — the Velvet Underground were unique among Sixties rockers in their intentional crudity, in their sense of beauty in ugliness, and in their dark and risqué lyrics. During the age of flower power, the Velvets spoke in no uncertain terms of social alienation, sexual deviancy, drug addiction, violence, and hopelessness, evoking the exhilaration and destructiveness of modern urban life. The group's music and attitude shaped the work of David Bowie, the New York Dolls, Patti Smith, Mott the Hoople, Roxy Music, the Sex Pistols, R.E.M., Sonic Youth, the Jesus and Mary Chain, and literally thousands of other bands.

In 1964 John Cale met Lou Reed in New York City. Both had been classically trained — Cale as a violist and theorist, and Reed as a pianist. By the time of their first meeting, Cale was engaging in avant-garde experimentation with La Monte Young and Reed was writing poems about down-and-out street life. Cale, Reed, Sterling Morrison, and Angus MacLise (the percussionist in Young's ensemble) formed a group that played under various names — the Warlocks, the Primitives, the Falling Spikes — in galleries and at poetry readings around lower Manhattan. As the Primitives, they recorded a series of singles on Pickwick Records, for which Reed had once worked as house songwriter.

In 1965 the quartet became known as the Velvet Underground.

Good luck to Lou and Laurie. Hope he has good insurance, and having just finished reading Who I Am, A Memoir, the autobiography of Pete Townsend, I'm left hoping that Pete's health won't be the topic of the next headline (or mine, for that matter).

From our friends at The Angry Bear we finally get the (some of the anyway) inside info on exactly who is being covered and who is not under the PPACA (known affectionately on both sides as Obamacare). It looks to be pretty much the exact bad deal I had feared originally as a result of the purposive negotiating with the non-negotiating-and-proud-of-it Rethugs (by the way - Thanks, Obama,for pursuing this meaningless gift to insurance interests instead of the Medicare-for-All real national health plan, which at least would have had a public airing before its defeat), being among the long-term benefitless unemployed and not covered by my state's rules on Medicaid eligibility.

No, North Carolina will not be covering anybody as a part of the extended Medicaid provision (relied upon by the plan for coverage of all the left-out poor people - see details below) now that the Koch-elected state legislature has turned down the federal Medicaid expansion coverage.

31 Million Uninsured Under the PPACA . . .

run75441 | May 29, 2013

Over at “Economists View,” Anne and Muses are having a discussion over why some 30-something million will be uninsured under the PPACA (Paul Krugman: The Obamacare Shock). The conversation goes back and forth citing references without giving any real explanation of what the 31 million is composed of and why they will not be covered. For some reason today, I can not log-in and add to the conversation with an explanation of the 31 million.

Perhaps it is a little known fact; but states today can, if they so choose to do so, qualify Medicaid coverage for everyone. States can also cover beyond 100% of FPL which some states do. The majority of states do not cover certain single adults as determined by each state’s rules for Medicaid coverage.

“Currently, few states cover non-disabled, non-pregnant parents up to 138 percent of FPL in Medicaid, and even fewer states cover such adults without dependent children.
At present, only 18 states provide comprehensive Medicaid coverage to parents at or above 100 percent of FPL ($18,530 for a family of three in 2011), and the median state covers working and non-working parents up to only 63 and 37 percent of FPL, respectively. The majority of states do not cover non-disabled, non-pregnant adults without dependent children at any income level, and many low-income women only qualify for Medicaid coverage when they are pregnant. As has been noted, ‘it’s a very common misconception that Medicaid covers all poor people, but that’s far from the truth.’”

“Nationally, just over half (53 percent) of the uninsured who would be newly eligible for Medicaid are male. This is not surprising, since, as indicated above, Medicaid has historically had much broader eligibility for parents than for adults without dependent children, and a high proportion of these parents have been single mothers. ‘Overall, 47 percent of the uninsured who would be made newly eligible for Medicaid under the ACA are women'.” (Opting into the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?)

The expansion of Medicaid to 138% of FPL under the PPACA would have mandated state coverage for single adults not qualifying for the PPACA and its subsidies.
The SCOTUS decision to allow states to back out of the expanded Medicaid coverage up to 138% FPL was previously mandatory under the PPACA with the threat of the removal of Medicaid subsidies. States not expanding Medicaid coverage will maintain the status quo and many who would have been covered under Medicaid may now go uninsured as they will not qualify for the PPACA. The state exclusions for which many blogs, politicians, and conservative think tanks such as Cato blame the PPACA as causing is the result of states not expanding Medicaid and accounts for 15.1 million uninsured of the potential 31 million.

Another estimated 11.2 million are considered to be illegal residents of the US who will not be covered by the PPACA (Treatment of Non-Citizens under the PPACA), and do not have healthcare insurance. The balance of the uninsured is made up of those exempt from being insured, those opting out and paying the penalty, those who may not understand how to apply for Medicaid, etc.

Without a doubt, Republicans hope the constituency will not understand the issues and blame the PPACA for the lack of coverage of single adults by using the 31 million as a political numeric. It is also doubtful whether there is a real concern by politicians for the coverage of illegal residents. I also believe it to be ironic when Republican-led states are concerned a Republican-controlled House may pull the carpet out from under them by negating funding for the expansion of Medicaid in the future.

Many Millions of the Poorest Will Remain Uninsured

May 28, 2013

The poorest of the poor, those living below the federal poverty level, are ineligible for subsidies for the exchange plans, and they will not be able to enroll in Medicaid in those states that have refused to expand eligibility beyond those who are already qualified. *

For those living in poverty, the Affordable Care Act (ACA) could have provided plans through the state exchanges with subsidies for 100 percent of the premiums and 100 percent of the out-of-pocket costs. Instead, it was decided to cover those in poverty with Medicaid, while limiting the income-indexed exchange subsidies to those living above 100 percent of the federal poverty level.

That was before the Supreme Court ruled that state participation in the Medicaid expansion could not be made mandatory. Since so many states opted out, millions of the very poor will not be eligible for Medicaid nor for the exchange plan subsidies. They will simply remain uninsured.

Because of the obstructionists in Congress, no legislative remedy is possible at this time. Too many members of Congress want to prove that ACA won't work. Of course, they do not advance any program that will.

Even if all glitches were eliminated, the fundamental structure of ACA is irreparably flawed.
It will leave 31 million uninsured, establish under-insurance as the new standard, and fail to control costs. So let's replace it with a system that covers not only the poorest of the poor, but covers all of us - an improved Medicare for all.
* States Policies on Health Care Exclude Poorest

-- Don McCanne, MD

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