Virginians Skeptical of Medicaid Expansion

A big swing in the pendulum. Image: Science Museum of Virginia.

A big swing in the pendulum. Image: Science Museum of Virginia.

by James A. Bacon

The biggest story in Virginia right now (even bigger than the U.S. 460 fiasco) is Medicaid expansion, and the latest wrinkle is that Republican skeptics are winning the debate. Frankly, I am amazed. I thought that the siren call of recouping billions of dollars in federal money that Virginians were  paying already in Obamacare taxes, along with the prospect of providing some measure of health care for thousands of the uninsured, would win the day.

The Republican argument, which I embrace — that the state should extract reforms to the way Medicaid is administered before agreeing to expand the program — always struck me as a bit esoteric. That core message, I thought, was lost amidst a welter of reasons for resisting expansion, and the media never framed the debate in the way that Republicans wanted. How many articles have we seen, for instance, illuminating what kind of Medicaid reforms Republicans propose?

Yet, as Quentin Kidd, director of the Wason Center for Public Policy, said in a statement accompanying the poll results: “Democrats are losing the debate on expanding Medicaid in Virginia. This is mostly because they are not convincing Independents that it will work. Voters seem to be moved by Republican skepticism.”

What explains the marked shift in public opinion since a February poll? Norm Leahy and Paul Goldman, Virginia’s bipartisan blogging duo, each have hit upon part of the explanation. Goldman argues that Virginia’s middle class is feeling increasingly squeezed, which I agree with. What he didn’t mention is that many are feeling squeezed by Obamacare. While the Affordable Care Act has expanded access to health care for lower-income Virginians, it has done so at the expense of many in the middle class who are losing their old insurance plans, losing their doctors, and finding that the Obamacare health-exchange alternatives are costing them a lot of money.

The other part of the story, as Leahy has argued, is that Governor Terry McAuliffe has failed to personalize the Medicaid story. There is no denying that tens of thousands of Virginians are living on the razor’s edge of financial solvency, and the lack of insurance makes their lives even more perilous. Where are the heart-rending stories about families who sold their cars, lost their homes or otherwise been forced into destitution by the lack of insurance? We haven’t seen them.

The battle is far from over. McAuliffe has threatened to continue operating the state without budget authorization (not shut to down state government, as I erroneously stated earlier), an extraordinary assertion of executive authority that may have to be resolved by the Virginia Supreme Court.

Kidd’s poll found that most Virginians hope the governor and the legislature resolve the budget stand-off by means of compromise. If the Rs play their cards right, that sentiment should play to their benefit. They need to make the case that their proposal — we’ll accept Medicaid expansion if McAuliffe and the Obama administration reform the program to make it more financially sustainable over the long run — is the compromise proposal. If they can pull that off, they can win the debate, thousands of uninsured Virginians can get Medicaid coverage, and the state can safeguard its fiscal integrity going forward.

But perhaps McAuliffe is banking on the state Supreme Court, dominated by Democratic appointees, will back him up. This will be the big show of the next two months.

Update: The Commonwealth Institute critiques the Wason Center’s survey methodology here.

33 Responses to Virginians Skeptical of Medicaid Expansion

  1. The Kidd poll interesting ands Paul Goldman may be right but to put the blame on the middle class backlash against Obamacare is a tad ridiculous.

    The middle class has been squeezed on a lot more than the ACA, namely the lack of recovery form the 2008 bust, the sluggish recovery of housing values, the continued phantom unemployed, the lack of hope and, most of all, the enormous and growing spectacle of income and wealth inequality.

    Saying it’s all Obamacare really misses the point.

    • Jim argued that the middle class is feeling squeezed by Obamacare and is thus skeptical about Medicaid expansion. This is well- supported by public opinion polling ever since the dumpster fire that is Obamacare was rolled out last fall.

      He didn’t say that Obamacare was the only reason the middle class is feeling squeezed, only that it is a significant one.

      I think he is right.

  2. The most interesting statistic in the poll is that 70% plus want the two parties in the General Assembly to compromise. Also the disdain is mostly felt for the General Assembly. I think anyone who’s attentive will blame the R’s for that.

    So far as Medicaid I don’t think your average Virginian would care one way or the other except of course for the families who would get it if it is adopted and the hospitals who won’t get paid if it’s not. The message that the voters haven’t gotten yet is that Medicaid expansion is a cheaper and more controlled way of providing services to the working poor/middle class as opposed to the current “charitable” approach which is uncontrolled and simply pushes the costs on to the insured.

    Also you’ve made a few gratuitous unsupported comments about people losing their insurance and doctors and rising costs – that’s simply partisan propaganda and I’m surprised you repeat it. People complaining about the cost of insurance and insurance companies has gone on forever.

  3. Wrong, Jim — the Governor is not threatening to shut down the state government, he is threatening to continue to operate after July 1 with no Appropriations Act in place. Which may be an even bigger threat to the General Assembly and the way all of us thought state government in Virginia operated. That is something the Assembly cannot let stand uncontested, or why do we need them at all?

    The situation will be unprecedented and his legal foundation may be shaky, but clearly the 2012 Appropriations Act can be honored for several more months if no replacement act is signed. And there is an argument that the functions of government dictated by the Virginia Constitution can be funded and move forward. But what other powers does he have? We may be about to find out. The State Supreme Court is likely to have to decide.

    Since the beginning of the year the Americans for Prosperity Group and others have pounded the Medicaid proposal as “expanding Obamacare” and I’d say the opponents have won the PR skirmish. Not too surprising that the opinions have shifted but the shift is not huge. And who wouldn’t tell a pollster the Assembly should compromise? That was a question that answered itself.

    This appears to be locked up tight. There will be no budget coming out of the House that gives the Governor even a fig leaf, and the Senate and the Governor seem just as unlikely to accept defeat and pass a budget without some elements of Medicaid expansion. Who gets the blame? Who cares. Who pays the price? We all do.

    • Thanks for the correction on a fundamental point — no government shut-down is threatened. I will make the correction in the original post ASAP.

      • re: govt shutdown.

        same issue with the Fed and Obama and the biggest debt in the history of the US – _under_ Obama – who cannot spent a penny that Congress does not approve.

        all that “biggest” debt in the history of the US came from – continuing resolutions…

  4. what is wrong with making the stipulated reforms the price for compromise?

    why can’t we have- written in law, approved by the GA – the reforms they want and vote on them in the same vote for expansion?

    why is this – “we can’t do the expansion until we do reform”?

    this sounds a lot like Repeal and Replace with no specification for Replace.

    the GOP has lost all principle in these issues. they have no alternatives and they refuse to put forth alternatives while at the same time demanding no other actions either.

    the truth is that the GOP does not want healthcare – period. they have lip service so they don’t sound like hipocrites.. but at the end of the day – they have no counter-proposals – because they fundamentally disagree with the concept of govt sanctioned health care.

    be honest. tell the truth here. as bad as the truth might be – it’s better than the lie they now promote.

    • No, Larry, the truth is that many in the GOP do not want to see a massive transfer program — pure redistribution of income – grow even larger. That is what Medicaid is — a transfer program that taxes some to provide benefits to others (and in this case, the beneficiaries include the health providers, hardly impoverished). Healthcare, SNAP, TANF, public housing – the people who call themselves the Tea Party have had enough and they are ready to throw it all into the bay. Do you share those principles? Clearly not. They trouble me, as well — but I 100 percent get where they are coming from. If they are consistent I think it is a highly principled stance. If they are consistent.

      In fact, that is the beef with the whole ACA — at its heart it is a system to redistribute income coupled with a set of federal mandates on how the health care industry must provide its services. Again, plenty of principled reasons to oppose both.

      • Breckinridge – if the GOP were HONEST – they’d ADMIT we ALREADY have massive transfers in totally inequitable ways – like the tax-free employer health care while others who don’t have it cannot get a tax credit for it.

        They’d also admit that we do not turn people away from the ER and you and I will pay ER prices to treat a child’s cold symptoms because we refuse to admit that we prefer this to providing that child with a primary care physician.

        we also would admit that we provide guaranteed health insurance to seniors who make 85K in retirement income for 100.00 a month. Tell me who can get that deal in the open market.

        we are hypocrites when it comes to not wanting a massive transfer.

        we already have it and we have it for twice what it should cost because we want to pretend otherwise.

        let’s be honest. we have given a great number of people “massive transfers” and now refuse to do the same for others.

        that’s wrong and it’s unprincipled and it’s hypocritical to base one’s objections on a lie and then refuse to reform it – for all of us.

        • Larry, if expanding Medicaid will cut costs by reducing ER expenses, why did both Oregon and Washington experience an increase in ER use by people covered by Medicaid? If expanding Medicaid will reduce taxpayer and premium payer costs, why not mandate the cost savings be passed through? I’ve asked several Democratic senators this question and they dodge it. They won’t require savings to be passed along. That tells me they don’t think there will be savings. If there are no savings, the premise that Medicaid expansion will reduce costs is a LIE. Yet, it’s still being made.

          I asked Senator Favola how we can prevent an Oregon-Washington result. She said managed care will fix this. That is not right unless the PCP must provide a referral to use an ER. I don’t believe that’s part of the proposal. And if one needs a referral, why not just go see the PCP? Evidence from Oregon and Washington suggests the newly covered will go to the ER for the cold or the stomach ache.

          The Democrats want an expansion of government programs in order to expand government programs and get more people, including the health care industry, to be dependent on tax money. That’s why Virginians are skeptical of expanding Medicaid. They don’t trust the Democrats’ promises.

          As I challenged several Democratic senators, calculate the savings from Medicaid expansion and take those dollars out of the health care budget (after paying for expanded Medicaid costs) and also require a dollar-for-dollar offset to insurance premiums. All they do is mumble? Why?

          • re: Oregon and why … give it a while TMT… people who are used to going to the ER will continue to do so unless they are encouraged to see a primary care … just the nature of folks..

            and this demonstrates just how potent a “massive wealth transfer” is…when you offer anyone, anytime, free medical care at the ER courtesy of you and I… why should they change?

            re: the Dems and health care expansion.

            it’s not the Dems who expanded Medicare Part D.

            it’s not just the Dems who give SOME people tax-free health insurance while denying that same benefit to those who have to pay for their own health insurance with their already-taxed dollars.

            you want to blame someone TMT but you refuse to admit the system right now is biased and unfair and benefits some while penalizing others.. for no rational reason other than happenstance.

            you take aware tax-free health insurance and see how many people start complaining about massive wealth transfers… there will be more pig squealing than in Deliverance.

            we are hypocrites for standing by and allowing totally arbitrary benefits for some while whining about similar benefits for others.

            it’s all about “I’ve got mine, screw you” and as a people – as a society – we should be ashamed.

            I’m not necessarily advocating a universal healthcare approach but what I am saying is that we do not have a level playing field that applies to everyone equally.

            take away tax-free health insurance and Medicare and see how many folks start complaining about also denying a MedicAid expansion.

            if we wanted to be honest and righteous – we’d get rid of tax benefits for health insurance, we’d let seniors go out into the market and get their own insurance just like the folks you want to deny MedicAid to and we’d give the military folks vouchers for them and their families to also, likewise go out into the free market and find their own insurance.

            how can we be so hypocritical as to support enormous carve-outs for health care for some people and at the same time just callously deny the same type of benefits to others?

          • Larry, stop giving the Democrats cover. A Democratic president and Congress made employer-payment of health insurance tax free. And the Democrats have held Congress for more time than the Republicans ever since. But you expect the GOP to step up and fight to remove the tax-exemption. Let Obama and Reid do the dirty work. Let them propose making employer-provided benefits taxable and see what happens in 2014 & 2016.

          • re: ” Larry, stop giving the Democrats cover. A Democratic president and Congress made employer-payment of health insurance tax free.”

            How many GOP POTUS and Congress have we had since then that could have repealed it ? tax-free employer provided healthcare costs the US Treasury 131 billion dollars a year. That’s a subsidy.

            ” And the Democrats have held Congress for more time than the Republicans ever since. But you expect the GOP to step up and fight to remove the tax-exemption. Let Obama and Reid do the dirty work. Let them propose making employer-provided benefits taxable and see what happens in 2014 & 2016.”

            I expect the GOP to take action on what they say they support instead of making threats to repeal and then excuses why they won’t and then adding Medicare Part D to Medicare which they say is govt single-payer healthcare – and it is.

            the GOP are hypocrites.

            they basically lie about healthcare and lack the backbone to take actions consistent with their avowed beliefs.

            we have a system that subsidies people on healthcare at the same time we penalize others on healthcare – with no rhyme or reason why.

            If you work for a company that provides tax-free health insurance, you’re good. If you don’t – tough luck.

            if you are over 65, you get guaranteed health insurance for 100.00 a month.

            if you are in the armed services – you get health care instead of a voucher to go buy your own.

            and if you are working at a job for 40 hours a week and can’t get guaranteed health insurance for 100.00 a month like seniors – it’s tough luck.

            it’s a bad system that you support TMT and no apologies…either..other than supporting the status quo – ….because…

            why?

            what’s your justification for selling health insurance to one group of people for 100.00 a month and denying that same choice to others?

  5. Larry, I would be fine with taxing health care benefits for employees the same as other forms of monetary compensation. But when you start whining about Medicare benefits for those who earned them, who paid into the tax pot for forty or more years, then you hack me off. There is a cap on how much income is taxed for social security but I’ve been paying Medicare taxes on my entire earned income all my working life. I may live to be 90 and I may kick off at 70, but I’ve paid premiums into that system. Libs like you want to steal that money back with a “means test” and I can tell you, knowing that is the liberal goal is one more reason you’ve lost middle class support for ACA and all the rest of the welfare system.

    • Breckinridge – People did NOT.. _earn_ Medicare Part B. It’s totally voluntary and it costs 100.00 for anyone who make 85K a year (or less) in retirement income. It costs the taxpayers of the US $400 million a year.

      what you’re paying for is Medicare Part A – Hospitalization.

      how well would you do in retirement if there was no Medicare PartB?

      would you be able to buy market-based health insurance?

      Do you really understand that Medicare Part B is not something you “earn”?

      How many seniors who are guaranteed health insurance for 100.00 a month do you think could get health insurance if not for Medicare?

      If this is a “lib” thing, I would say the “conservative” here does not have the facts.

      • I suspect it costs the government $400 BILLION a year. You have me, I do not know the details and if you say FICA doesn’t pay for Part B, fine. But it sounds like truly wealthy retirees do pay more and your problem is the cut off ($85K) is too high and should be lower. Sounds like it is means tested. You want it more highly means tested. If my FICA taxes didn’t pay for this, well, I’ve paid plenty of income tax, excise tax, etc.

        Yes, we have built a system where many are subsidized (including the well-off elderly) and many are not, and the situation we have now in Virginia is unfair. There is a coverage gap created by the passage of ACA coupled with Virginia’s refusal to participate in the Medicaid expansion. I said I was troubled by the Tea Party argument, but I do understand it. And the House of Delegates is unlikely to budge.

        • 400 billion – my bad.

          PART A – hospitalization is paid for through your FICA taxes
          PART B – medical providers is not paid for by you through your FICA
          but instead after you retire through monthly premiums.

          re: I already pay taxes – no Breckinridge – you KNOW BETTER guy.

          you don’t get everything you want or need because – “I already pay taxes” – I thought you were a Conservative.. where do you get that logic ? sounds liberal to me! ;-)

          re: troubled but do understand. Not me. we have a grotesque, arbitrary and capricious system that totally destroys the fundamental premise of equal opportunity – not what this country stands for yet we pretend otherwise when we “understand” the opponents misguided view of the ACA and MedicAid expansion.

          All I ask , is 1. – that we deal with the facts on the existing benefits that government DOES provide – to millions of people

          2. – that we acknowledge the totally wrong and unfair approach we currently have where we arbitrarily favor – wealthy retired seniors – over the working poor without insurance.

          how can we do this and believe we are fair minded while we adopt the utter total hypocrisy of those who oppose the MedicAid Expansion – for working poor?

          Of all demographic groups, people who work 40 hours a week would seem to be at least – as deserving – as seniors who make 85K a year and pay 100.00 a month for guaranteed health insurance. this is perverted.

          why can’t we adopt a truly principled position on this instead of latching on to the totally corrupt and dishonest view of the opponents?

        • Breckinridge – you advocated means testing for Medicare. We agree.

          but were you aware that the MedicAid expansion also is means-tested?

          were you aware that some of the funding from the MedicAid expansion – that the govt promises to fund – comes by trimming the subsidies for Medicare Part C which is government subsidized supplemental Medicare gap coverage?

          In other words – they funded the MedicAid expansion by transferring some of the Medicare Subsidies – via means testing.

          What is dismaying to me – is the ignorance of people who have taken positions and do not understand the facts – including some of the legislators who themselves do not understand but are willing to assume an unprincipled partisan position…

          why do we – as voters – allow ourselves to be victimized by those who know we are ignorant and promote propaganda and misinformation – that we believe instead?

  6. The facts with regard to Medicare – Part A and Part B are apparently not known by many people – both liberal and conservative. And liberals will believe, as Conservatives that both are “earned” entitlements.

    but the truth is that Medicare PartB is not “earned”, not paid for through your FICA taxes.

    Medicare PartB is guaranteed, government provided single-payer insurance that is totally voluntary. You have to sign up for it and you have to pay for it. It’s ridiculously priced – though – heavily subsidized by taxpayers – because you can have up to 85K in retirement income and get guaranteed insurance no matter your pre-conditions for 100.00 a month.

    it’s nothing you earned and nothing you particularly “deserve’ or not (as compared to other segments of society) – Seniors are essentially a demographic like the “poor” who cannot afford insurance in that most people that are 65 or older could not afford market-priced insurance and great numbers of them would become destitute and die early if it were not for Medicare.

    We do not allow that to happen to seniors but we justify it for would-be MedicAid recipients because as has been claimed by many including folks here – it would be a “massive” government intrusion into healthcare.

    All I ask is that folks be honest about Medicare Part B and tax-free employer provided insurance when they talk about how wrong it is for the government to be involved in healthcare.

    If folks are honest about this – they would admit that we already have about 60% of people “covered” by massive government involvement in healthcare and if we are serious that government should not be – then as principled opponents we were not only be opposed to the ACA and the MedicAid expansion but also Medicare Part B, tax-free employer-provided insurance and EMALA – the law that guarantees free treatment at any ER for anyone who wants it.

    My contention is that the opponents of MedicAid expansion are not principled in their opposition. They have totally double standards where they support the status quo where millions and millions receive government–sponsored healthcare benefits and yet they oppose similar benefits for the folks not similarly covered by govt programs.

    Now that we’ve got millions of people “covered” by government-sponsored health care benefits, we want to play the “massive involvement of govt” card – which is just gross hypocrisy in my view.

    Let’s do it one way – or the other. Either no one gets govt-sponsored health care benefits or everyone does and let’s stop this really corrupt charade that we are all pretending about.

    We demonize government as the argument – like government was not voted by people to institute these programs that we now pretend do not exist and that we’ll be dammed if we’re going to allow to government to create – more like them.

  7. re: ” stop giving the Democrats cover.”

    it’s pretty simple – the Dems believe in everyone having access to health care. they support a number of different ways to accomplish it but you won’t find the Dems denying that they want everyone to have access.

    that’s a totally consistent and honorable position even if non-Dems disagree.

    but what is the consistent and principled position of the GOP on access to health care?

    do they support the concept of everyone having some level of access to it or not?

    or do they support it for those who have “good” jobs and it’s tough cookies for those who do not have good jobs – even if they work 40-50 hours a week at those jobs?

    what is the principled position of those who oppose the Dems vision of health care?

    I find it to be totally hypocritical. They basically support the status quo for the ones who have employer-provided or Medicare but oppose it “officially” for those who are not economically secure – but won’t advocate getting rid of the high-priced version – charity ER care.

    I could respect a consistent principled opposition even if I disagreed with it but I cannot respect the current GOP approach which says it’s against the government being involved – but won’t propose legislation that gets the government out of health care – just deny it to the folks that were never fortunate enough to have employer-provided or Medicare.

    So we have a GOP position that supports giving some period full health care insurance for 100.00 a month but then turn around and oppose that same price for others for no rational or understandable reason other than in their view the folks who don’t have it – don’t deserve it.

    we certainly don’t want Granny dying on the steps of the ER – no way – but Granny’s son who works 40 hours in a 7-11 can die … once the ER tells him he should have seen a doctor months ago and now he’s terminal.

    this is the kind of system we have. The Dems want one where everyone has somewhat equal access; the GOP – who knows what they support.. you only know what they oppose…

    • Larry, BS. Obama and Warner, among others said many, many times that giving everyone access to health insurance would not require people to give up their existing coverage unless they wanted a change. We all know this is one of the biggest lies in American history. This is principled? If so, Al Capone was principled too.

      And why won’t Democratic state senators agree to flow through cost savings from expanding Medicaid to taxpayers and policy premium payers?

      Health care reform is fraud plain and simple.

      • re: ” Larry, BS. Obama and Warner, among others said many, many times that giving everyone access to health insurance would not require people to give up their existing coverage unless they wanted a change. We all know this is one of the biggest lies in American history. This is principled? If so, Al Capone was principled too.”

        The Dems have a principled and consistent position on access to health care. It’s clear and unambiguous not dishonest and hypocritical.

        they made a bad mistake in promising I agree but Medicare has changed a dozen times since it was first enacted – to fix flaws and this one will also.

        “And why won’t Democratic state senators agree to flow through cost savings from expanding Medicaid to taxpayers and policy premium payers?”

        they are. they are cutting the disproportionate share subsidies to hospitals for ER charity care..

        but why would support letting some people have insurance for 100.00 a month and not others getting the same deal – in the first place?

        how principled is that?

        “Health care reform is fraud plain and simple.”

        well no. what is a fraud of the GOP’s position on health care. It’s dishonest and unprincipled.

        If they had a real position – it would provide a real alternative to “reform” – one that would give those who don’t like Obamacare something to support instead of just being opposed to giving the working poor the same 100.00 a month access to health care that seniors with 85K in income get.

        you have to be FOR something TMT. Opposition without a real alternative is feckless and just plain hypocritical in my view.

        the OTHER principled position would be – to be opposed to ALL govt support of health care of any kind – and make that proposal as part of the repeal of ObamaCare – to prove to everyone that they do have a principled position on the government’s role in health care.

        instead – we have hypocrisy.

        • Back up the truck! The ACA barely passed the Democratic-controlled House and likely did because Obama promised Americans that, if they liked their existing policy, they could keep it. If they liked their doctor, they could keep him/her. No qualifications. No read the fine print. Just a flat-out promise that was not true.

          Health care reform would cut the cost of insurance and reduce tax expenditures. But many people find substantially higher deductibles and premiums. Just a flat-out promise that was not true.

          This conduct meets the definition of fraud. It’s not principled. It’s criminal conduct. It meets the standard of the Washington Post editorial board – the ends justify the means.

          And “no,” I don’t think I have an obligation to even out health care any more than I have an obligation to even out housing costs or income or savings.

          There is no natural right to free health care. We could create one, but only at great cost to many. If Obama or Mark Warner want to do this, they should do it openly. Tell people that many of them will need to accept less and pay more to subsidize access for 0thers. That’s principled, but it’s not what the Democrats do.

          • “Back up the truck! The ACA barely passed the Democratic-controlled House and likely did because Obama promised Americans that, if they liked their existing policy, they could keep it. If they liked their doctor, they could keep him/her. No qualifications. No read the fine print. Just a flat-out promise that was not true.”

            this is total blather TMT and you know it. How many insurance plans before Obamacare ever saw the light of day – changed their doctor networks? how many refused to renew after one year and someone got a “pre-existing” condition? If you changed insurance plans, the network would often change. This is typical for the entire industry.

            “Health care reform would cut the cost of insurance and reduce tax expenditures. But many people find substantially higher deductibles and premiums. Just a flat-out promise that was not true.”

            how long would it take to do it? did you really think overnight or is that just more of your opposition rhetoric?

            “This conduct meets the definition of fraud. It’s not principled. It’s criminal conduct. It meets the standard of the Washington Post editorial board – the ends justify the means.”

            do you think when your employer-provided insurance changes doctor networks that it’s “fraud”? Whats “fraud” here is the double standard you’re using.

            “And “no,” I don’t think I have an obligation to even out health care any more than I have an obligation to even out housing costs or income or savings.”

            you may not think so – but when there is inequity – changes are going to happen to try to correct it. you can object.. but opposition without offering alternatives leaves you basically as an opponent and defender of the status quo. Besides, you are ALREADY paying for the uninsured!

            “There is no natural right to free health care. We could create one, but only at great cost to many. If Obama or Mark Warner want to do this, they should do it openly. Tell people that many of them will need to accept less and pay more to subsidize access for 0thers. That’s principled, but it’s not what the Democrats do.”

            if there is no “natural right”, then let’s get the govt out of ALL OF IT so that we do have an equitable approach for everyone.

            you’re defending special interests… and don’t care about others.

            that’s fine – that’s your right – but don’t expect to not be impacted when changes are made. You either lead, follow or get out of the way.

            you’re clinging to special incentives for yourself – and that’s not going to stay that way.

            TMT – do you think you are “entitled” to tax-free employer-provided health care or Medicare? what “entitles” to those things? Be honest.

  8. A critique. There is nothing substantive in Massey Whorley’s critique. Were the questions different? Yes, but the first question can also be critiqued as overly simplistic. The second question actually lays out the positions of the two political parties. It’s a better question.

    Larry, Uncle Sam gives tax advantages to employer pension plans. But most people don’t have them. And some employers give generous matches to employee contributions to their 401K plans while others don’t. There is no level playing field. Should these differences be leveled too? One can argue retirement security is equally important as health care.

    Am IU entitled to tax-free employer-provided health care or Medicare. My wife gets our health care insurance as part of her compensation. I reimburse half the premium. Neither of us are eligible for Medicare. What gives people tax advantages? Congress and laws passed by Congress. And I suspect a lot of sitting members would lose their seats if they voted to repeal the tax advantages. Just like a lot of Rs lost their seats in 1986 for being perceived as going after SS and Medicare. Just like Rostenkowski lost his for voting for higher fees. And, hopefully, so will a lot of Ds this fall for lying about health care reform.

    I have no fundamental opposition to insurance reform per se. But be honest about it. Tell the public that many will need to pay more and receive less so that others can get subsidized access. Tell the public that they might need to pay even higher taxes to expand Medicaid and that, if there are any savings, they won’t be returned to the public. Tell them that state aid to K-12 education might be cut as happened in NC. If these disclosures are made and elected officials vote the changes, then so be it. But you know as well as I do, the public is not willing to pay this price. That’ why Obama and the Democrats lied. They knew their reform would not pass if the public knew the truth.

    • “Larry, Uncle Sam gives tax advantages to employer pension plans. But most people don’t have them. And some employers give generous matches to employee contributions to their 401K plans while others don’t. There is no level playing field. Should these differences be leveled too? One can argue retirement security is equally important as health care.”

      not Uncle Sam -TMT – Congress. The same Congress that passed laws giving tax breaks to those with employer-provided insurance and retirement plans, Medicare and EMTALA.

      re: retirement plans – you have no retirement plan if you are 65, have a pre-existing condition and there is no Medicare.

      “Am IU entitled to tax-free employer-provided health care or Medicare. My wife gets our health care insurance as part of her compensation. I reimburse half the premium.”

      you are receiving a subsidy for your health insurance as well as government assistance in keeping it even if you have a pre-existing condition.

      Neither of us are eligible for Medicare.

      what entitles you to Medicare when the time comes?

      “What gives people tax advantages? Congress and laws passed by Congress. And I suspect a lot of sitting members would lose their seats if they voted to repeal the tax advantages. Just like a lot of Rs lost their seats in 1986 for being perceived as going after SS and Medicare. Just like Rostenkowski lost his for voting for higher fees. And, hopefully, so will a lot of Ds this fall for lying about health care reform.”

      I agree.

      “I have no fundamental opposition to insurance reform per se. But be honest about it. Tell the public that many will need to pay more and receive less so that others can get subsidized access. ”

      what the GOP has done very effectively is spread “gullible” and “ignorant”.

      you ALREADY PAY for the poor. The reform is an attempt to reform the system so that people go to doctors instead of ERs. It won’t happen overnight.. it won’t change things overnight but who in the world would be so gullible as to expect such changes – overnight?

      “Tell the public that they might need to pay even higher taxes to expand Medicaid and that, if there are any savings, they won’t be returned to the public. Tell them that state aid to K-12 education might be cut as happened in NC. If these disclosures are made and elected officials vote the changes, then so be it. But you know as well as I do, the public is not willing to pay this price. That’ why Obama and the Democrats lied. They knew their reform would not pass if the public knew the truth.”

      but again, where does the money come from for expanding MedicAid – for people who work for a living? where is that money coming from?

      do you know or care or just swallow the GOP propaganda?

      prove to me that you know where the money comes from… show it .. in your response?

      no excuses.. don’t go running to the GOP propaganda sites.. tell me where the money comes from… prove to me that you know.

  9. FYI –

    The pollsters say they found that Virginians’ support for expansion dropped from 56 percent on February 3 to 41 percent now. What the pollsters do not fully acknowledge, however, is that they asked the question in two markedly different ways, making this a highly misleading, apples-to-oranges finding that doesn’t necessarily show a shift in public opinion:

    On February 3 the question was asked: Medicaid is a health care program for families and individuals with low income that is funded by both federal and state tax dollars. Currently, Virginia is faced with a decision about whether to expand the Medicaid program to cover an additional 400,000 mostly working poor Virginians who are uninsured. In general, do you support Medicaid expansion or oppose it?

    But on April 24 poll the question was asked: In [the Medicaid expansion] debate, the Democrats propose to subsidize private insurance for 400,000 uninsured and low income Virginians by using federal Medicaid money that would otherwise not come to Virginia. Republicans oppose this expansion because they fear the federal Medicaid money will not come as promised, and also say the current Medicaid program has too much waste and abuse and needs reformed before it is expanded.

    which basically calls into question the motives of those who would alter the original question in revisiting the issue.

    MedicAid Expansion is NOT for unemployed people on welfare. It is for people who work full time jobs but have no employer-provided insurance and do not make enough to buy market-based insurance.

    the whole premise to reject expansion is boneheaded bass ackwards. the very people you should want to help – are those people who work, require less entitlements, and pay taxes.

    it’s partisan and it’s mean spirited .. and supported by people who have their insurance subsidized by the government which is just totally hypocritical.

    we talk about class warfare – this is how it makes the issue worse. Give subsidies to those with employer-provided and those who are 65 but deny a similar benefit to – not the poor – the WORKING poor.

    people should be ashamed.

  10. “Paying for the uninsured.” Larry, you keep ignoring my answer to this. I agree that some of the costs incurred by hospital ERs are passed along to taxpayers and insurance companies and their insured. I also suspect they sometimes eat some costs.

    If Medicaid expansion occurs, the argument goes these unreimbursed costs will decrease. OK, I will accept that statement. Where I go next is: Those cost savings should be returned to taxpayers and insurance companies and their premium payers. Can you agree to that? The equation is: Costs paid by taxpayers less the costs of expanding Medicaid equal savings. (Ditto for insurance companies and the insured). Can you agree to that?

    What I have pushed Democratic elected officials on (and been rebuffed) is put a requirement in the law that these savings must be returned to taxpayers and premium payers. Let’s assume McAuliffe’s study shows taxpayers will save $500 million from lower ER costs after paying for Medicaid expansion and insurance companies will save another $500 million. Then the $500 million should be removed from the appropriation to pay for indigent care and spent on education, public safety, transportation, etc. This would pass along the savings to taxpayers. Can you agree to that? The law should also require the VSCC to reduce health insurance company revenue requirements by $500 million, passing along the savings to the insured. Can agree to this?

    I am willing to ignore the first year as transition time. But either there are cost savings or there are not. If there are cost savings, why won’t the Democrats pass them along? If there are no costs savings (because the newly covered will use more health care services at a cost higher than the cost of unreimbursed ER services passed along to taxpayers and premium payers), the argument that expansion will save the public money is a bald-faced lie.

    It’s no different than a con artist saying “you can increase your gas mileage by 25% if you buy this $25 magnet to be placed on your engine block.” It’s fraud.

    What I suspect is the Democrats know expanding Medicaid coverage will be more costly than the status quo, but know that, if they tell the truth, the public won’t support Medicaid expansion.

    If the Democrats were honest, they would come out and say “I believe everyone has a right to health care and you – the citizens of Virginia and taxpayers – must be willing to pay higher taxes and see funding for other programs cut to deliver that right to the uninsured.”

    I belong to a civic association. We recently debated the FY15 budget and taxes for Fairfax County. Some people got up and argued FCPS needs are not being funded. We need to give the Schools everything they say they need and raise taxes even more. Guess what? They were voted down. The very same thing would happen if the Democrats were honest about their position on Medicaid expansion. It’s going to cost more than the status quo. And the public will need to pay more and accept less. It is the same basic lie as told by Obama to get the ACA passed.

    • ““Paying for the uninsured.” Larry, you keep ignoring my answer to this. I agree that some of the costs incurred by hospital ERs are passed along to taxpayers and insurance companies and their insured. I also suspect they sometimes eat some costs.”

      no they do not ‘eat’ the costs – most are non-profit and will either pass on costs to insured or try to get additional govt funding.

      “If Medicaid expansion occurs, the argument goes these unreimbursed costs will decrease. OK, I will accept that statement. Where I go next is: Those cost savings should be returned to taxpayers and insurance companies and their premium payers. Can you agree to that? The equation is: Costs paid by taxpayers less the costs of expanding Medicaid equal savings. (Ditto for insurance companies and the insured). Can you agree to that?”

      I totally agree but it’s not going to happen tomorrow… it’s going to take time but one change that is already happening is that government funding for charity ER costs is being reduced…

      “What I have pushed Democratic elected officials on (and been rebuffed) is put a requirement in the law that these savings must be returned to taxpayers and premium payers. ”

      already being returned to taxpayers but rate payers? what would you do? would you outlaw cost-shifting? any or all or what?

      “Let’s assume McAuliffe’s study shows taxpayers will save $500 million from lower ER costs after paying for Medicaid expansion and insurance companies will save another $500 million. Then the $500 million should be removed from the appropriation to pay for indigent care and spent on education, public safety, transportation, etc. This would pass along the savings to taxpayers. Can you agree to that? The law should also require the VSCC to reduce health insurance company revenue requirements by $500 million, passing along the savings to the insured. Can agree to this?”

      I would agree to MORE transparency on costs FIRST – i.e. REQUIRING hospitals to provide the cost-shifting data – and then some phased in reduction over the years.

      I would also support a law that requires the ERs to refer non-urgent, non-emergency cases to local community clinic and primary care.

      “I am willing to ignore the first year as transition time. But either there are cost savings or there are not. If there are cost savings, why won’t the Democrats pass them along? If there are no costs savings (because the newly covered will use more health care services at a cost higher than the cost of unreimbursed ER services passed along to taxpayers and premium payers), the argument that expansion will save the public money is a bald-faced lie.”

      you’re assuming something without any real evidence… and using it as opposition before the fact.

      right now – you pay each Medicare recipient about $500 a month in subsidies and yet you do not hold it to the same standard as you do MedicAid. why?

      “It’s no different than a con artist saying “you can increase your gas mileage by 25% if you buy this $25 magnet to be placed on your engine block.” It’s fraud.”

      do you think MediCARE is FRAUD?

      “What I suspect is the Democrats know expanding Medicaid coverage will be more costly than the status quo, but know that, if they tell the truth, the public won’t support Medicaid expansion.”

      what the GOP has done and is wildly successful is propagandize the issue and get people like you to oppose something – not on facts or evidence but beliefs.

      “If the Democrats were honest, they would come out and say “I believe everyone has a right to health care and you – the citizens of Virginia and taxpayers – must be willing to pay higher taxes and see funding for other programs cut to deliver that right to the uninsured.””

      or they could do this. They could REQUIRE retired people who make 85K in income pay $500 a month for insurance and give $200 of the savings to subsidize the working poor.

      what if we share the current subsidies more equitably?

      “I belong to a civic association. We recently debated the FY15 budget and taxes for Fairfax County. Some people got up and argued FCPS needs are not being funded. We need to give the Schools everything they say they need and raise taxes even more. Guess what? They were voted down. The very same thing would happen if the Democrats were honest about their position on Medicaid expansion. It’s going to cost more than the status quo. And the public will need to pay more and accept less. It is the same basic lie as told by Obama to get the ACA passed.”

      TMT – are you aware of Fairfax County’s position on the expansion? are you aware of their dollar reasons why?

  11. Larry, I would be willing to allow a two-year transition period before all cost savings need to passed along, although McAuliffe has already proposed to move $200 M from indigent care.

    I would do exactly what I said. I would require projected tax savings to be moved out from indigent care accounts to other accounts dollar for dollar. I would also require the VSCC in setting premium rates to flow through projected savings dollar for dollar. If the total savings don’t appear, McAuliffe would not have the full amount of money to pay for indigent care and the insurance companies would lose a lot of money. Maybe they’d need to cut back on executive compensation.

    And if the Democrats think the tax subsidies are unfair, let them call for raising Medicare fees on the “wealthy” and transferring them to the “working poor.” Then they can face the voters.

    I don’t believe the Democrats on Medicaid expansion or the ACA in general. They’ve lied and lied, as well as dodged my legitimate questions.

    • “Larry, I would be willing to allow a two-year transition period before all cost savings need to passed along, although McAuliffe has already proposed to move $200 M from indigent care.”

      I do not think the current plan is perfect nor complete and believe that people who rely on the ER right now will have to be encouraged to do otherwise and I support that. We did not get here in 2yrs and likely won’t fix it totally in 2 years but we do need to take action.

      “I would do exactly what I said. I would require projected tax savings to be moved out from indigent care accounts to other accounts dollar for dollar. I would also require the VSCC in setting premium rates to flow through projected savings dollar for dollar. If the total savings don’t appear, McAuliffe would not have the full amount of money to pay for indigent care and the insurance companies would lose a lot of money. Maybe they’d need to cut back on executive compensation.”

      I don’t know how you would know what the costs are in cost-shifting. How would you know what they are and even if you found out – would you then have the govt require insurance companies to lower their premiums ?

      “And if the Democrats think the tax subsidies are unfair, let them call for raising Medicare fees on the “wealthy” and transferring them to the “working poor.” Then they can face the voters.”

      that would be more principled than pretending otherwise. they’re not “raising” fees – they are reducing subsidies. why is it characterized as “raising” fees instead of reducing subsidies for one group of folks and characterized differently for the other folks?

      “I don’t believe the Democrats on Medicaid expansion or the ACA in general. They’ve lied and lied, as well as dodged my legitimate questions.”

      what insurance company has ever “promised” you that you could keep your doctor?

      Obama did a dumb thing… true.. but you never had such a guarantee – ever – to start with.

      you personalize this to Dems… I don’t. I think our current system is effed up.. and has to be reformed. there are lots of thoughts on how to do it – but opposing the only way proposed while offering no ideas of your own is feckless and arguing to keep the status quo – where the government currently subsidizes millions while denying equivalent treatment to the work poor is hypocrisy.

      you cannot support the current system in good conscience… in my view.

      we give seniors $500.00 a month in subsidies and we can’t do even a small part of that for people that are not required and do work? what is wrong with us?

  12. not RETIRED – working poor.

    when someone who works 40 hours a week and gets sick and can’t afford treatment – they go on welfare.., get food stamps, etc…

    why would we not do what we can -to help the working poor – continue to work and not take even more entitlements?

    we’re encouraging the working-poor – to not work.. just get the current MediAid for people who don’t have a job at all.

    it’s dumb.

  13. Pingback: Virginians Skeptical of Medicaid Expansion | The Commonwealth Institute

Leave a Reply