Why Not Just Pass MedicAid Expansion?

Chris Bowers argues that MedicAid expansion is the key provision in the health insurance premium assistance bill for progressives:

The largest public option in the health care bills is, and has always been, Medicaid. In terms of the number of people it covers, it dwarfs any other public option currently on the table in either bill. In terms of the type of people it covers, compared to the other public option expansions it includes a much higher percentage of Americans who are currently uninsured and a much higher percentage of Americans who are currently in poverty. [. . .] Providing 15 million low-income, uninsured Americans with public health insurance is also why so few House Progressives carried through on their earlier threat to sink any health care bill without a new public option program tied to Medicare rates. After all, House Progressives both want to help people in poverty, and they disproportionately represent districts that would have been impacted by the new Medicaid coverage.

So, why not just pass MedicAid expansion then? Hell, throw in the subsidies to purchase private insurance too if you want. Use the House funding mechanism (the very popular "tax the rich" approach) and voila - we have a good progressive bill. Are there not 60 votes in the Senate for that? No problem. As was contemplated in 1997 for S-Chip, pass it through reconciliation:

[T]he bill had to comply with the existing balanced budget agreement between Congress and the White House, something that Lott said it did not. The Clinton administration had a deal with the Republican leadership in Congress that forbade the administration from backing any amendments to the budget resolution.

Guess what? The Democrats control the Congress now. Medicaid expansion (and the financing mechanisms) can simply be added to one of the budget bills. Since budget bills are not subject to filibuster, you pass MedicAid expansion and declare victory.

If I was in the Progressive Block, that is what I would hold as my final line in the sand if the Senate keeps fiddling.

What? No exchanges? No Mandates? No Excise Tax? No Stupak Amendment? Well, I guess we would just have to live with that, wouldn't we?

Speaking for me only

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    I thought (none / 0) (#1)
    by Steve M on Thu Dec 10, 2009 at 05:21:01 PM EST
    that the states couldn't afford their end of the proposed Medicaid expansion.

    Then they can turn it down (none / 0) (#2)
    by Big Tent Democrat on Thu Dec 10, 2009 at 05:23:25 PM EST
    Well sure (5.00 / 1) (#14)
    by Steve M on Thu Dec 10, 2009 at 06:27:02 PM EST
    but that's not really helping anyone.

    I'm not talking about some kind of ideological "we don't want any federal stimulus money" thing, I'm talking about a legitimate state budget crisis, which is the case in a lot of places that need help most.


    I think no one will turn it down (none / 0) (#16)
    by Big Tent Democrat on Thu Dec 10, 2009 at 06:50:56 PM EST
    Where will they get the money? (5.00 / 1) (#23)
    by Steve M on Thu Dec 10, 2009 at 08:10:40 PM EST
    I agree, Steve, that this (none / 0) (#18)
    by Cream City on Thu Dec 10, 2009 at 07:34:48 PM EST
    is not such an easily dismissed point -- that is, if Dems want to win in those states in 2010, win the White House again in 2012, etc.

    Speaking not just for me only in what now is ranked as the fourth hardest-hit state in this economy.


    Just an unfunded mandate (none / 0) (#26)
    by diogenes on Thu Dec 10, 2009 at 08:32:56 PM EST
    If you want to expand medicaid to everyone then the feds should pay 100%.  

    I'm all in favor (none / 0) (#27)
    by Steve M on Thu Dec 10, 2009 at 09:15:35 PM EST
    wouldn't really be Medicaid then.  But I'll pay whatever tax rate is required to make it a reality!

    So many unfunded mandates (none / 0) (#28)
    by Cream City on Thu Dec 10, 2009 at 09:17:04 PM EST
    already, so little revenue in our states.

    Yes, fund it federally, as any federal program ought to be funded.  


    Better yet, more state aid. (none / 0) (#4)
    by andgarden on Thu Dec 10, 2009 at 05:25:18 PM EST
    Or that (none / 0) (#5)
    by Big Tent Democrat on Thu Dec 10, 2009 at 05:26:43 PM EST
    You realize that (none / 0) (#32)
    by gyrfalcon on Thu Dec 10, 2009 at 11:40:22 PM EST
    only 21 states as of this moment offer any Medicaid coverage at all to childless adults?  No way, no how are most of these states suddenly going to change their minds and pay for a significant Medicaid expansion when many of them already are refusing to pay for even children at more than 120 percent of the poverty level, and in some cases even less than 100 percent (which is currently at something like $10,000 annual income for an individual, not sure where it is for families).

    You think the resistance to the public option was stiff?  Hah.


    Heck, why not (none / 0) (#3)
    by Zorba on Thu Dec 10, 2009 at 05:25:17 PM EST
    just go for single payer, which is what the Dems should have been fighting for from the beginning?  I guess we'll just have to live with whatever watered-down, insurance-industry-friendly piece of merde they come up with.  

    This is a myth that some want to believe. There are not 20 House members or 5 Senators who would vote for it.

    Honestly, I wish they would put it up for a vote once and for all so that folks would understand this.


    I agree (5.00 / 1) (#11)
    by Zorba on Thu Dec 10, 2009 at 05:59:49 PM EST
    that they have not been fighting for single-payer.  The whole health "care" reform has been a total..... I can't say it on this site, but you know what I mean.  We are the only Western country that does not have some form of single-payer, and we also have worse health-care results than other Western countries do.  I wish we would do the math- we're not getting what we could be getting in terms of health care.

    Would've thought (none / 0) (#29)
    by Socraticsilence on Thu Dec 10, 2009 at 09:47:06 PM EST
    people got the message when HR 676 got shut down for the upteenth straight year in January- I mean don't get me wrong god on Conyers for Sponsoring it but c'mon.  

    I'm beginning to think (none / 0) (#7)
    by lilburro on Thu Dec 10, 2009 at 05:36:54 PM EST
    it's sort of a shame that Obama has 60 Senators.  If he only had 55, he would have to talk and think about reconciliation a lot more.  And the bills might be better off for it.

    He doesn't have 60 senators. He has (5.00 / 1) (#9)
    by steviez314 on Thu Dec 10, 2009 at 05:39:21 PM EST
    55 senators and 5 morons.  That's not actually the word I wanted to use, btw.

    I came to that conclusion a while ago (none / 0) (#8)
    by Big Tent Democrat on Thu Dec 10, 2009 at 05:38:40 PM EST
    Heheh (5.00 / 2) (#10)
    by lilburro on Thu Dec 10, 2009 at 05:58:31 PM EST
    read this post:

    But the 2004 Dean proposal, which I've been talking about lately, offers a good example of the sort of bill you could pass [through reconciliation]. Dean basically folds the Children's Health Insurance Program and Medicaid into one program called the Families and Children Health Insurance Program and makes everyone up to 185 percent of the poverty line eligible for it. He also allows people between the ages of 55 and 65 to buy into Medicare. He creates a tax credit for people in the middle.

    Those changes alone would be a lot less than what we're looking at in health-care reform. They would cover, and help, many millions fewer than the House bill. But they would nevertheless help a lot of people.

    We're trying to get 60 votes for LESS than this.


    I don't (none / 0) (#12)
    by Ga6thDem on Thu Dec 10, 2009 at 06:13:09 PM EST
    know why the bozos didnt just take Deans plan and go with it. It's tons better than what they've spent MONTHS doing.

    Because Dean was dumped (5.00 / 1) (#19)
    by Cream City on Thu Dec 10, 2009 at 07:37:04 PM EST
    formally this year but actually last year . . . and we know by whom, when he wasn't even kept in the loop in the campaign.  He seems to be a voice in the wilderness by now, when he ought to be heard and put to use with his credentials on the issue and his credibility with a lot of progressives, still.

    Howard Dean has (none / 0) (#31)
    by gyrfalcon on Thu Dec 10, 2009 at 11:18:40 PM EST
    been so far ahead of the pack on so many issues, from the war in Iraq (hard to remember now how scandalous and shocking it was considered when he took a stand against it in the campaign), on same-sex marriage and on health care.

    The guy gets no respect, I think, because he turns out to be right too often for comfort.

    I wouldn't mind seeing him make another run in 2012 just for the sake of giving the whole Overtown window another big shove to the left.  Actually, I'd still like to see him become president, I admit, but there's no chance of that.


    Because it was Dean's plan (none / 0) (#20)
    by BackFromOhio on Thu Dec 10, 2009 at 07:38:20 PM EST
    I don't agreee, but I'm not part of that village.

    You and Bowers have it wrong (none / 0) (#13)
    by s5 on Thu Dec 10, 2009 at 06:14:15 PM EST
    The Medicaid expansion is indeed a must-have, but there are other "key" provisions in there, like the ban on rescission and guaranteed pre-existing condition coverage.

    Medicaid will never help me, nor will it help most of the country. But even those of us who are insured and middle class are one health insurance bureaucrat away from being ruined in medical bankruptcy following an illness or an accident.

    It has never (5.00 / 3) (#15)
    by Zorba on Thu Dec 10, 2009 at 06:39:09 PM EST
    ceased to amaze me why so many Americans are screaming "But I don't want the government saying what medical procedures I can and can't have!" while they seem to be perfectly comfortable with leaving these decisions in the hands of insurance company drones whose main raison d'être is to deny as much care as they can in order to maximize the profits of the companies they work for.

    Here's the problem: (5.00 / 1) (#17)
    by andgarden on Thu Dec 10, 2009 at 07:22:45 PM EST
    In order to get the benefit of the slim hope that those regulations will be at all effective, we all agree to be bound by law to hand over money to the industry every year, or pay a fine (i.e., the mandate).

    I don't have a problem with the mandate. (none / 0) (#21)
    by s5 on Thu Dec 10, 2009 at 07:54:52 PM EST
    It's $750 per year added to your taxes, and in exchange you get guaranteed coverage. It's waived for those who can't afford it, and it even has the effect of pushing people to sign up for programs (like Medicare) that they already qualify for but don't realize it.

    Sorry, it's good policy. No one likes being mandated to do something but it's beneficial, and it's a fantastic trade for guaranteed coverage. Flame me all you want.


    You did not read what I wrote (5.00 / 2) (#22)
    by andgarden on Thu Dec 10, 2009 at 08:00:21 PM EST
    I actually have no problem with the mandate. What I do not trust, and you have given me no reason to believe otherwise, is that the Insurance companies will comply in substance with the new regulations. That is the point: without a public option available to everyone mandated to buy insurance, we have no alternative but the mercy of the insurance companies. Apparently you believe that our regulatory structure will keep them in line. No one has yet convinced me of that.

    Unless things (5.00 / 1) (#24)
    by TeresaInSnow2 on Thu Dec 10, 2009 at 08:27:06 PM EST
    have changed drastically, the $750 you're speaking of on your tax bill is a FINE.  The only thing it guarantees is that you'll pay more in taxes.  You don't get anything in return.  Essentially they're making it illegal to not have insurance and penalizing you if you don't.

    Mandates without a REAL public option should go down in defeat.  They will ensure that health insurance costs far more for all of us than it ever did.

    If you don't understand that, you're obviously not in the individual insurance market.  I am.  And premiums are exhorbitant.  $750 is more like a monthly rate than a yearly rate.


    Ban on rescission (none / 0) (#25)
    by TeresaInSnow2 on Thu Dec 10, 2009 at 08:29:52 PM EST
    You know, honestly, I don't think you really understand the health care debate.  You should probably read the bills in Congress.

    Medicare expansion (none / 0) (#30)
    by Socraticsilence on Thu Dec 10, 2009 at 09:49:06 PM EST
    is a really great idea you know until you start realizing the AMA is going to fight it.

    karma (none / 0) (#34)
    by jedimom on Fri Dec 11, 2009 at 07:10:32 AM EST
    the AMA, Hospital Association and Pharma will get karmically screwed...all 3 cut a deal with Obama BEHIND CLOSED DOORS!!!! No CSPAN in sight, lol, and all 3 are now on the hot seat. GOOD.
    Mayo Clinic is freaking out noting if Medicare is expanded to 55 and up even THEY will not be able to overcome the losses....
    My mom was excited to until I told her she should expect they will add MEANS TESTING

    I dont want ANYTHING that adds ANY means testing to ANY part of Medicare...but I am GEN X and am waiting for Obama to lower the boom on my SS, I think I am supposed to work til age 80 now as it is...


    medicaid (none / 0) (#33)
    by jedimom on Fri Dec 11, 2009 at 07:08:05 AM EST
    I dont know if BTD has had experience with Medicaid and maybe in PR it is better, but in NYC and in AZ it is horrible horrible
    Sen Alexander R-TN is right when he says it is the ghettoization of insurance

    no doctors , good ones anyway, take it, you wait months and months and months for an appointment, forget about a specialist, and then they dont want to give you treatment or your meds (they have DISincentives)

    SCHIP is getting expanded and IMo that is a far far far better use of the money

    let them do the Federal Employee Benefit Plan for all...

    for all the medicaid complaints (none / 0) (#35)
    by CST on Fri Dec 11, 2009 at 09:16:10 AM EST
    to me it comes down to one basic question - would you rather have this, or nothing at all?

    Is it as good as private insurance?  Probably not.  But for the most part, we're talking about the uninsured here.  And personally, I think it's a whole lot better than nothing.

    That doesn't mean the problems shouldn't be solved.  But the existence of problems does not convince me it shouldn't be expanded to people with no coverage at all.