Our Common Good

Although the Supreme Court upheld the bulk of the landmark health reform law last summer, Obamacare’s proposed Medicaid expansion was scaled back when the court ruled that states should be able to decide whether or not to expand their programs. Since then, GOP governors have been digging in their heels against reform, refusing to expand their states’ Medicaid pools to extend affordable insurance to millions of low-income Americans. That’s led lawmakers in several GOP-run states, such as Texas and Louisiana, to toy with the idea of partially expanding Medicaid in individual counties as a way of overcoming their governors’ continued obstruction.

But Sebelius has confirmed that pursuing that option will make states ineligible for the matching funds that the federal government will offer to the states that choose to fully expand Medicaid:

[W]e explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes. We clarify in our new guidance that states have the flexibility in Medicaid and the Children’s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt “bridge plans” that offer coverage through both Medicaid and Exchanges – keeping individuals and families together when they cross the line between Exchanges and Medicaid. And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, “Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.”


Walmart, the nation’s largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.

Under the policy, slated to take effect in January, Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours — something that happens with regularity and at the direction of company managers.

Walmart declined to disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy. In an emailed statement, company spokesman David Tovar said Walmart had “made a business decision” not to respond to questions from The Huffington Post and accused the publication of unfair coverage.

Labor and health care experts portrayed Walmart’s decision to exclude workers from its medical plans as an attempt to limit costs while taking advantage of the national health care reform known as Obamacare. Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.

“Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured,” said Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley.

For Walmart, this latest policy represents a step back in time. Almost seven years ago, as Walmart confronted public criticism that its employees couldn’t afford its benefits, the company announced with much fanfare that it would expand health coverage for part-time workers.

But last year, the company eliminated coverage for some part-time workers — those new hires working 24 hours a week or less. Now, Walmart is going further.

(Read More)


At over $446 billion per year, Walmart is the third highest revenue grossing corporation in the world. Walmart earns over $15 billion per year in pure profit and pays its executives handsomely.

Wal-Mart’s poverty wages force employees to rely on $2.66 billion in government help every year, or about $420,000 per store. In state after state, Wal-Mart employees are the top recipients of Medicaid. As many as 80 percent of workers in Wal-Mart stores use food stamps.

…In effect, Wal-Mart is shifting part of its labor costs onto the public.

-DailyKos Diary - Oct 10, 2012

Scott has said that he opposes expanding Medicaid in his state because — even though the federal government will pay for 100 percent of the expansion during the first three years, and at least 90 percent of the expansion’s costs after 2020 — he worries that it will be too expensive after 2020. But Georgetown researchers predict that since the expansion will actually strengthen the health care safety net in Florida, the reduced strain on other social programs will more than offset the costs of covering more low-income Floridians.

As the authors of the report put it, “Extending Medicaid coverage to Florida citizens should have positive effects in terms of lower mortality, less illness, improved economic stability and a higher quality of life for those gaining coverage. In turn, improved health may well lead to lower overall health costs for both these individuals and the state.”

Other researchers have also documented the potential cost-saving effects of expanding Medicaid in Arizona, Nebraska, Oklahoma, and Arkansas. And public opinion is on their side, since nearly two-thirds of white Southerners support expanding Medicaid. Nevertheless, Republican governors like Scott continue to stand in the way, ultimately sabotaging their low-income residents and their states’ own bottom lines.

Lt. Gov. Mary Taylor said Ohio plans to let the federal government run the new health insurance exchange required to be up and running in 2014.

Following a speech Tuesday to the Columbus Association of Health Underwriters, Taylor said state officials will send a letter Friday telling the federal government that it can run the exchange, but the state wants to retain its traditional regulatory authority.

For example, the state would still decide who is eligible for Medicaid in Ohio.

Health care markets, called exchanges, would help people and small businesses find affordable health care coverage. The exchanges would be used to help low-income Ohioans enroll in Medicaid as well as set rules for premiums and provide consumer protection guidelines.

Ohio officials would have until mid-February to submit a more detailed outline of what functions they want to retain as the feds step in to run the exchange in 2014, under the Affordable Care Act.

Tell Congress: No Benefit Cuts to Social Security, Medicare and Medicaid (by AFLCIONow)

The states least likely to join in the Medicaid expansion also happen to be among those whose residents are in the greatest need. The poor and uninsured in these parts of the U.S. will likely continue to go without unless their political leaders have changes of heart. Texas had the highest rate of uninsurance in the nation last year: 24 percent, according to census data compiled by the Henry J. Kaiser Family Foundation. In Florida, Georgia, South Carolina and Louisiana, it was 20 percent. Nineteen percent of Mississippians were uninsured in 2011. Nationally, 16 percent of people had no health insurance last year. In Massachusetts, which enacted a comprehensive health care reform program in 2006, only 4 percent of residents are uninsured. States that refuse to cover more poor people will do so despite the fact that Uncle Sam will pick up most of the tab. From 2014 to 2016, the federal government will pay 100 percent of the cost of covering newly eligible people, after which the share will gradually go down to 90 percent in 2022 and later years.

As Politico points out, whether or not the health reform law is able to operate as it was intended — and expand coverage to about 30 million previously uninsured Americans — largely depends on the extent that governors agree to cooperate in their states. But some Republican governors have already made it clear that they don’t plan on playing nice during Obama’s second term

Paul Krugman:

There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.

But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.

So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.

For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.

So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.


So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.

How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.

And the gap has been widening over time: Medicaid costs have consistently risen a bit less rapidly than Medicare costs, and much less rapidly than premiums on private insurance.

How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers. It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.

Also, Medicaid is much more effective at bargaining with the medical-industrial complex.

In 1959, 22.1 percent of Americans lived below the poverty line.

In 1969, 13.7 percent of Americans lived below the poverty line.

The poverty level has varied since 1969. It has gone as high as 15 percent. But it has never again gotten anywhere near where it was in 1959.

What changed during the 1960s to dramatically decrease poverty?

“Centralized, bureaucratic, top-down anti-poverty programs” like Medicare (1965), Medicare (1965), the initiatives launched with the Food Stamp Act of 1964 and Economic Opportunity Act of 1964 programs such as the Jobs Corps (1964) and Head Start (1965).

Those programs worked.

States Refusing To Expand Medicaid Will Cost Hospitals Over 50 Billion Dollars

According to new findings by the National Association of Public Hospitals and Health Systems (NAPH), by 2019, safety net hospitals’ uncompensated care costs will be $53 billion higher than originally estimated if states don’t opt into the voluntary expansion of the Medicaid program under Obamacare.

Safety net hospitals serve areas where, on average, 14.9 percent of the population is uninsured and 32.5 percent of the population relies on government-provided health coverage such as Medicaid. Current Medicaid reimbursements often fall short of the full cost of care, so programs such as federal DSH funding help make up the difference. Obamacare cuts DSH funding in half by 2019 in an effort to reduce national hospital payments — but only because the cuts to safety net hospitals were intended be offset by the vastly expanded pool of newly insured low-income Americans. But Republican governors across the country are digging in their heels and refusing to expand the Medicaid programs in their states.

As a consequence, safety net hospitals that care for America’s most vulnerable could face significant financial burdens by 2019, and millions of low-income and disabled Americans may lose access to the medical services they need.

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While most Americans have been watching the elections, dozens of wealthy CEOs have put together a $30 million lobbying effort to cut Medicare, Social Security and Medicaid before this Congress goes home for the holidays. They’re already visiting offices on Capitol Hill and plan a huge television ad blitz right after the election.

Why?  Because they’d rather cut services for the elderly, sick and poor Americans than make the top 2% pay one cent more in taxes.

We have champions in Congress fighting hard to keep this from happening. They will hold the line on Medicare, Social Security and Medicaid, but they can’t do it alone.

They’re being relentlessly attacked by unaccountable front groups spreading lies and misinformation about the programs that provide healthcare and economic security for seniors, veterans, people with disabilities and children whose parents can’t afford insurance.

We can stop them. We’ve stopped them before.  We can beat back greedy CEO’s and shady corporate front groups, if we work together with progressives in Congress.

Stand up to oppose cuts to Medicare, Medicaid, and Social Security by adding your name right now.

A federal judge blocked Arizona on Friday from applying a new law that bars Planned Parenthood clinics from receiving money through the state to provide medical care because the women’s health organization also performs abortions.