Sunday, June 23, 2013

ObamaCare for Mississippians II

But how do we all get health coverage?

Most Americans and Mississippians have health coverage. Most get it through their employers, seniors have Medicare, many of the very poor have Medicaid, and veterans have the VA. Some buy it themselves at outrageous prices.
However, more than a third of Mississippians under 65 are uninsured. Almost half of African Americans are uninsured. Contrary to what you might think, almost three fourths of the uninsured are employed. These numbers are a few years old and are probably worse now.
So what will ObamaCare do for these Mississippians? Unfortunately, Mississippians will not have the same benefits other Americans will have, because our Republican Governor and State Legislature have fought ObamaCare every step of the way. But let's look at how ObamaCare is supposed to work, and then how it will be in Mississippi.
Health care in America is very complicated. ObamaCare was not the easiest or best solution, but it was what could be passed by Congress. It kept the employer based system that we've had for many years and tried to correct its drawbacks. There are several layers to these corrections, and we'll look at them one at a time. 

The Working Poor

There are working people who don't qualify for Medicaid, either because they have no children or they earn too much. But they don't earn enough to afford to buy insurance. Under ObamaCare,  Medicaid would be expanded to cover ALL people with incomes at or below 135% of the poverty level. In Mississippi, this would give health coverage to around 300,000 Mississippians who have none now. The Federal government would pay 100% for the first 3 years, gradually decreasing to 90% by 2020.
The Supreme Court decision last year that upheld ObamaCare did say that states could not be required to expand Medicaid. To no one's surprise, our Republican Governor immediately said Mississippi would not expand Medicaid - before he had even studied it or looked at the numbers. The Republican leadership in the State Legislature was on board.
Only one problem: Democrats demanded that the expansion be brought to a vote before funding the current program. Democrats are NOT saying they won't vote for the current Medicaid program. All they want is for the expansion to be debated and voted on. If it loses, they'll vote for the current program. Republicans refuse to even debate or vote on it. Why? Who knows? Maybe they don't have the votes to kill it. Maybe some Republicans don't want to go on the record as opposed to a bill that will bring $1 billion to Mississippi, create 9,000 jobs, provide 300,000 Mississippians health care, and save many small, rural hospitals*.
As of right now, the entire Medicaid program is set to end on June 30th. Although the Republicans have a majority in the State Legislature, they need Democratic votes to pass funding bills, which require more than a majority. Since the Legislature is not in session, the Governor must call them into special session next week.
If the Republicans get their way, there will be 300,000 working Mississippians who will NOT have health coverage, whereas Americans in states that expand Medicaid will have coverage. Guess Mississippi Republicans just don't care about those families. There will also be several small hospitals that will be forced to close. Guess Republicans don't care about those communities.
We'll know in a week, and I'll post an update here.
*Hospitals will be adversely affected if Medicaid is not expanded because of a federal funding formula that is beyond the scope of this post. Consequently, Mississippi hospitals are very supportive of expansion.
Coming next: ObamaCare for Mississippians III: What about those uninsured middle class families that don't qualify for Medicaid?

Saturday, June 22, 2013

ObamaCare for Mississippians I

What exactly is ObamaCare 
and how will it affect us in Mississippi?

ObamaCare (more formally known as the Affordable Care Act) had one very simple goal: provide affordable health care to all Americans. However, achieving that goal was anything but simple.

ObamaCare became law March 2010. It was upheld (with some exceptions) by the Supreme Court a year ago. A few months later, President Obama was reelected. So ObamaCare is here to stay for the foreseeable future.

ObamaCare is being phased in over several years, with the most significant changes coming next year. However, several provisions have already gone into effect, and Mississippians are already benefiting from them.
  • Mississippians covered by private insurance companies and Medicare* are receiving preventative care at no cost. Even though extra federal funds are available to states that provide no cost preventative care to Medicaid** recipients, Mississippi and most other states have not yet taken advantage of it. (The Supreme Court ruling allows states to opt out of Medicaid** provisions.) Preventative care is defined by the US Preventative Task Force
  • Insurance companies can no longer refuse to cover children because of preexisting conditions. This protection will be extended to adults next year. Lifetime limits are prohibited, and annual limits are being phased out.
  • Insurance companies must spend 80% of premium dollars on health care - or provide rebates to their policy holders. Last year, 12.8 million insured people received $1.2 billion in rebates. This provision has already led to lower premiums.
  • Young adults without insurance through their work can stay on their parents' policies until age 26. 3.1 million more people have insurance because of this provision.
  • Medicare's* prescription drug coverage has a huge gap in coverage called the "doughnut hole". Increased savings are provided until 2020 when the gap will be closed. Seniors have already saved over $6 billion since 2010.

* Medicare is the health program for people 65 and over and is paid for by a payroll tax.
** Medicaid is the health program for people with limited incomes. It is run by the States, who determine who is eligible. The Federal Government provides matching funds depending on the poverty level of the state. Of course, Mississippi gets the highest percent (75+%). The lowest match is 50%, and several states qualify - Virginia is the only southern state.

Coming next: ObamaCare for Mississippians II: But how do we all get health coverage?