Medicaid expansion rejection bites back

The expansion of Medicaid health benefits to people who were too poor to be eligible for the health insurance subsidies was supposed to be an integral part of the Affordable Care Act. But the US Supreme Court ruled that it was an option that states could choose to accept or reject. And of course two-dozen Republican-dominated states chose to reject it even though it seemed like a no-brainer since the federal government would pick up 100% of the costs in the first three years and about 95% after that, because god-forbid that poor people should get health insurance.
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How many will die due to rejecting Medicaid expansion?

We know that some Republican controlled states have refused the Medicaid expansion portion of Affordable Care Act even though the federal government will fully fund it for the first three years and then after that will pay for at least 95% of the cost. By any measure, accepting the expansion should have been a no-brainer for the states and the only reason that it was refused is because those states did not want to do anything that might be construed as supporting Obamacare. As a result, poor people in those states who do not earn enough to qualify for the subsidies in Obamacare are left without any affordable insurance.
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Measuring cost-effectiveness of health care

There is always some rationing involved in providing any service and health care is no exception. In the US, rationing is largely determined by the ability to pay because the limitations are largely set by the for-profit health insurance companies. If you are rich and/or have good employer based health insurance coverage, you get more and better services than if you are poor and do not have an employer who provides it. The Affordable Care Act tried to close that gap by increasing the affordability of health insurance for those with lower incomes.
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People who die due to lack of insurance

charlene dillI have written about the unbelievable cruelty shown by those states that refused to expand Medicaid so that those people who are too poor to be covered by the subsidies offered by the Affordable Care Act could obtain health insurance anyway. As a result, we have the predicable result that some people are now dying because they have no health insurance.

Bill Manes has written an excellent article about such cases, focusing on Charlene Dill, a 32-year old working mother of three small children. In the process, he also describes the complexities of life when one is poor.
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How getting money from the government can be injurious

In order to bring suit against someone in court, the plaintiff has to show that they have ‘standing’, which means that they have suffered a fairly direct injury of some sort that the court can redress. In response to my post on the cases bought against Obamacare because of its use of federal subsidies in the form of tax credits to make health insurance affordable to low income people, reader Mark Dowd posed the good question of how the people who were suing could have standing to do so. How can getting money from the government to purchase health insurance be considered to cause an injury?
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Another legal challenge to Obamacare

One of the key features of the highly complicated Affordable Care Act is the subsidy that is given to lower income people to enable them to afford to purchase health insurance. These subsidies are provided through both the state exchanges for those states that set them up and through the federal exchanges in those states that decided that they wanted to have no part of the ACA or decided to let the federal government set them up. So far, 16 states have set up their own exchanges and 34 exchanges are run by the Department of Health and Human Services. The subsidies come in the form of tax credits provided by the IRS.
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Obamacare enrollment seem to exceed expectations

Despite a major effort at deception that involved outright lying by opponents of the Affordable Care Act that actively sought to dissuade people from getting health insurance that would save them from some catastrophic expenses due to illness, and despite the disastrous rollout that seemed to confirm people’s worst fears, it looks like the enrollment figures will meet their original target of seven million. The final tallies will take some time to be sorted but initial signs are good.
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Oh, those long Canadian wait times

The favorite (if not only) talking point of boosters of the awful American health care system, when confronted with data showing that health outcomes are so much better in single-payer systems like those in Canada, is to point to the wait times for elective treatments in those countries. It is true that for elective procedures, you may have to wait for some time. As a result, those in Canada who can afford it sometimes cross the border to the US and pay for treatment that they could have had for free at home, a fact that is seized upon eagerly to argue that this shows how superior the US system must be.
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These people are swine

Kevin Drum recounts the case of a cancer patient Julie Boonstra who was featured in an anti-Obamacare ad “claiming that her new insurance plan under Obamacare was far more expensive than her old plan and didn’t cover all her medications.” When informed that this was not true and that if she had only bothered to go to the healthcare website and checked she would have found better coverage than what she had that was actually cheaper, she refused to believe it because it went against what she had been repeatedly told by Obamacare opponents, like the Koch brothers funded Americans for Prosperity (AFP) that featured her in the ad.
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