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Wednesday, October 26, 2016

by Charles Ornstein, ProPublica.

Many people have asked when we’ll know if the Affordable Care Act is a success or failure.

Was it October 1, the date of the federal health insurance marketplace’s problem-filled launch? Or will it be the end of November, when is supposed to be fixed?

Is it December 15, the last day consumers can enroll for coverage that begins on January 1? Or March 31, when the enrollment period for buying insurance for 2014 closes?

In my mind, there is a different date that will have far more bearing on the number of people covered under the law. It’s June 28, 2012, the date the U.S. Supreme Court ruled on the act’s constitutionality.

What most people remember about the high court’s decision is that it upheld the core of the law: an individual mandate that requires practically everyone to buy health insurance or pay a penalty.

But the most consequential part of the ruling, which got less attention at the time, gave states discretion over whether to expand their Medicaid programs for the poor.

The law originally called for each state to expand Medicaid to people making less than 138 percent of the federal poverty level (now $15,856 for a household of one or $32,499 for a household of four). But the court said states could refuse to go along and not risk losing the federal government’s contribution to their Medicaid programs.

Why is this so important? Because about half the states have refused the expansion (or haven’t approved it yet), putting Medicaid out of reach for millions of their residents. Those states include Texas, Florida and almost all of the south. Here’s a map of what each state is doing.

Medicaid Map
Via: The Advisory Board Company

We’re seeing Medicaid’s importance play out as consumers sign up for health coverage through the health insurance marketplaces. In fact, far more are enrolling in Medicaid than in private health plans. Consider this report Monday from The Wall Street Journal:

In Washington state, one of the states that operates its own exchange, 87% of the 35,528 people who had enrolled in new insurance plans from Oct. 1 to Oct. 21 were joining Medicaid plans, according to state figures. By Thursday, 21,342 Kentuckians had newly enrolled in Medicaid, or 82% of total enrollees. In New York, about 64% of the 37,030 people who have finished enrolling were in Medicaid.

Some states like Maryland, Washington and California are using aggressive outreach to get people into Medicaid, including contacting those who are already on other programs such as food stamps, said Matt Salo, executive director of the National Association of Medicaid Directors.

“When you actively go out and aggressively target people, they sign up,” he said.

It’s easy to understand why. Medicaid is free; private health plans may not be (depending on the subsidy a person qualifies for). Medicaid is relatively easy to sign up for; the private plans, not so much.

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  • lana ward

    OHitlercare is a failure but it will accomplish what OHitler wanted it to , Socialized medicine, a one payer system. Do you fools now see what a communist this fraud in the WH is??? He PROMISED we could keep our health insurance policies-we can’t, he PROMISED we could keep our DRs.-we can’t. He has transformed America as he said he would, that’s the only promise he’s ever kept. He is a dirty rotten lying America hating nig*er. HEIL OHITLER DICTATOR!!!!

    • stcroixcarp

      Sign up for Obamacare, Lana, it will fund your meds

    • Brooke

      Lana,you are ignorant of the facts and very disrespectful of the overwhelmingly elected President. You must have been raised by equally ignorant people. it’s the gift that keeps on giving. You are pathetic.

      • lana ward

        People now wish they hadn’t voted for the America hating bas*ard!! Had he been honest he wouldn’t have been selected in the first place. He gives no respect, he gets none!!

        • WhutHeSaid

          Oh my, Satan will have a wonderful time with you! Can you see it now? He must be just beaming with pride. And sharpening his pitchfork. Be ready!

          • lana ward

            Where have you been?? Trying to sign up for OHitlercare on a site that doesn’t work??? Had he gone with American Companies instead of Canadian, for political reasons, the site would be running!!!

        • Brooke

          He has my respect and the respect everyone I know who voted for him. He lied about nothing. this is all going on in your head fed by fox news. I and nobody I know regrets voting for him.

          • lana ward

            That proves you and those you know are NO information voters. All the monkey does is lie

          • WhutHeSaid

            Have you managed to find that pair of asbestos bloomers yet? You’ll be happy to have them when the day comes for sure.

          • lana ward

            OHitlers ingenious OHitlercare is leading us to a single payer system, just what the communists (dems) have wanted for years. That piece of black garbage knew from the start it wasn’t going to work–have you gotten through yet, rat?? You haven’t, and you won’t. HEIL OHOMO OHITLER DICTATOR!!!! He is a bigger liar and more smooth than Hitler himself

          • WhutHeSaid

            I don’t need to go on the site because I already have health care insurance. But, let me tell you, you’ll need some pretty good insurance to cover you where you’re going. Not many insurers cover 3rd-degree burns for eternity. I guess you’d better quit wasting your time on The National Memo and get out on that site right away.

          • lana ward

            You better hope you still have your insurance. How will you feel if you lose it because of OHitlercare as millions already have

    • Dominick Vila

      Lana, accusing a U.S. President of acting like Hitler and being a dictator is so ridiculous that it is not even worth discussing it. Regarding the Affordable Care Act, would you care to let us know how it resembles communism? Communism and socialism are about the transfer of property and services from the private to the public sector. A program that uses for-profit hospitals, private practice doctors and other medical professionals, and for-profit insurance companies to administer it is as far apart from the socio-political ideologies proposed by Marx, Engels, Lenin, Stalin and others as we are from the farthest nebulae. You may want to consider other economic systems if you want to give your claims a semblance of credibility, instead of making them comical.

    • Jim Myers

      I sure am glad you aren’t being a racist about all of this.

      Always so supportive of our President, and such a lady, as opposed to all of those who constantly call him names.

      You’re parents must really be proud of you.

      After all, you turned out so well.

      • lana ward

        He’s only getting what all you freaks gave and are still giving President Bush–fun to hear isn’t it!!!!! : ))

  • charleo1

    An article in Polictico today claimed RomneyCare is totally unlike ObamaCare, because for one thing, Obamacare is Bigger. Really? Well, who knew? Then ObamaCare is totally different than RomneyCare, because RomneyCare was
    passed in a very Democratic State, and got lots of support. While ObamaCare
    was passed by a very Democratic Congress, in a Country with Republican
    Governors like Rick Perry of TX. Who could care less if poor people, or people
    that can’t qualify for health insurance, has a doctor. Or is protected from
    financially ruinous medical costs. And the Pope is Catholic. And Perry is a Bible thumping hypocrite. So, ObamaCare will not get cooperation like RomneyCare.
    Not a lot of news in that. The article also said, RomneyCare was created for the unique people of MA. But, what it didn’t say, and what I would be curious to know,
    is what is it about Massachusettians that make their 6.9 million people’s healthcare needs any different than Texans? Where a full 25% of that State’s population is uninsured.

  • elw

    I have watched many government sponsored national health programs implemented during my decades in the Healthcare system. They all have bumps and glitches that need to ironed out, they all start out slow and they continue to grow and the overwhelming number of them end up popular. When President Bush implemented his Drug Program it was a much bigger mess than this, enrollment was postpone several times, the initial enrollment was confusing and slow, but hey it is still here today and it is getting better. BTW millions of Seniors had to change how they got their health then as well, because their old plans no longer met requirements. If our senior can live through that why can’t our younger citizen manage? ACA will not be any different, a year from now no one will even remember what is happening now, except the historians. I also predict that by this time next year most of the State will be participating in the Medicaid expansion, even the red ones.

    • Dominick Vila

      The same is true for every major government program and, for that matter, major private sector deviations from the status quo. I spent 40 years at NASA and if incumbent Presidents or Department heads had been asked to apologize or resign every time changes were needed, we would still be trying to catch up with their apologies.
      The charade that is going on has absolutely nothing to do with unprecedented or devastating problems, this is all about scoring political points and trying to portray the Affordable Care Act as a failure when everything suggests otherwise.
      In any case, time will tell.

      • elw

        I could not agree with you more having spent over 30 years working in the private and public side of healthcare. One would think from the reaction in the news and on cable that a Website glitch has never happened before, it just all so sophomoric and such a waste of time and energy over something they will not be able to stop. I don’t even find it entertaining any more, I just kinds feel sorry for them. I just cannot imagine how horrible it must be to be stuck in such a negative space all the time.

  • mandinka

    Its not an individual mandate its a TAX, that’s what the court said. AS to how many sign up the data is already in 80% of those enrolled are on Medicaid NOT ACA

  • 10acres

    I guess red stands for stupid.