The Likely Impacts on Health Care

An academic panel discusses the consequences of he Affordable Care Act. Although some time – especially at the start is squandered discussing the politics and legalities, the Q & A session is generally worth a listen. Cue to these segments for discussion of the prospective impact of the ACA on U.S. healthcare:

  •  24:00: What is the liklihood that states will embrace Medicaid expansion?
  • 33:00: Who are the principle beneficiaries of Medicaid expansion?
  • 36:30: How will the ACA impact quality of care?
  • 40:00: Who will pay Mandate penalties?
  • 41:45: Do deductibles and copay lower costs or discourage participation?
  • 44:00: Will there be physician and nurse shortages?
  • 48:00: Who won’t be covered under the ACA?
  • 53:00: What would be the repercussions if the states do not embrace Medicaid expansion?

Key Takeaways

  • After November elections, there will be huge pressure on state governors to adopt the expanded eligibility standards for Medicaid.
  • The principle beneficiaries of the Medicaid expansion are the ones that most oppose it on partisan ideological grounds, particularly Texas, Louisiana and Florida.
  • The Mandate Penalty is not a tax. It is a nonenforceable tax penalty, and in Massachusetts has impacted about 1% of citizens.
  • High deductible plans are coupled with savings accounts that cover preventive care.
  • The ACA has numerous subsidies to create a structure to expand coverage availability.
  • Massachusetts has the nation’s highest number of physicians per capita.
  • After 2016, the CBO suggests that there will still be 24 million uncovered. either because they
    •  opt out,
    • are undocumented aliens (33%)
    • are eligible for medicaid but don’t enroll – but are entitled to on-the- spot enrollment(25%)
    •  have no affordable coverage available due to their employment (25%)
  • The vision of Medicaid as an integrated national program has been dealt a slight setback by the Court decision, but it’s too early to know how the individual states respond.

Beyond the Politics: Red States Need Medicaid Expansion Most

Many wavering politicians represented districts that had much to gain from the new lawNPR’s Peter Overby noted that 53 of the 100 congressional districts with the highest uninsurance rates were represented “either by Republican lawmakers who are fighting the overhaul, or by conservative Blue Dog Democrats who have slowed down and diluted the overhaul proposals.”

Many red-state governors and representatives rail against the evils of Medicaid and other programs while quietly accepting billions of dollars in subsidies to their districts and states. If Mitt Romney does not ascend to the presidency and enact “repeal and replace,” conservative politicians will face some genuine  pressure to “put-up or shut-up.”

Thousands of Texas and Mississippi hospitals, nursing homes, and physicians need the money to care for literally millions of people. Other local constituents need this money, too, particularly during our current period of economic distress. Between 2014 and 2019, Texas is slated to receive more than $50 billion in additional federal funds for ACA’s Medicaid expansion, with the federal government picking up more than 95% of total costs.

Although states can turn down the money, judging by this chart, the ideological activists will likely lose out to a much larger group of service providers, low-income, elderly, and disabled citizens.

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