Tha MA Mandate And The Medicaid Buy-In

DemfromCt discusses how the Massachusetts mandate works:

[U]sing MA as an example to compare to the Senate version of health care reform (HCR) is tricky. MA uses Medicaid/SCHIP as a "public option" of sorts, the Senate does not.

(Emphasis supplied.) Again, offering a Medicaid buy in to all mandated person is the solution to a lot of problems here. Not incidentally, it can solve the Nelson/Stupak problem.

< Ben Nelson Will Filibuster Without Stupak | "This Is Not A Great Bill" >
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    Well now... (5.00 / 1) (#14)
    by DancingOpossum on Thu Dec 17, 2009 at 04:26:31 PM EST
    There will always be some portion of the population who can't afford the care they need.

    Not in countries that have national health care.

    That's not true (none / 0) (#16)
    by CST on Thu Dec 17, 2009 at 04:38:21 PM EST
    they get emergency care covered, but they don't necessarily get everything else covered.

    My point was, this poll didn't define "need".

    For example, in England, they don't cover mammograms for people under 50.  But they have national health care.

    There is always a trade-off.


    There's also the whole (none / 0) (#1)
    by Socraticsilence on Thu Dec 17, 2009 at 01:39:43 PM EST
    massive cost overruns bit.

    not because of medicaid (none / 0) (#2)
    by Big Tent Democrat on Thu Dec 17, 2009 at 01:42:32 PM EST
    Massachusetts begs to differ (none / 0) (#9)
    by vicndabx on Thu Dec 17, 2009 at 02:17:48 PM EST
    Commission members said they will urge Governor Deval Patrick and the Legislature to replace the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit, with a set payment for each patient that covers all that person's care for an entire year.

    Massachusetts would be the first state to broadly adopt such a system, which would essentially put doctors and hospitals on a budget in an effort to restrain health spending.


    What's interesting is once again, private insurers are already doing this:

    The state's Blues plan introduced a limited wave of capitation last year with its "alternative quality contract," which several large physician-hospital organizations signed onto this year. But the special commission is set to push for per-member payments to replace fee for service for all payers -- including Medicare and Medicaid -- within five years.



    That;s not disagreeing at all (none / 0) (#12)
    by Big Tent Democrat on Thu Dec 17, 2009 at 03:32:20 PM EST
    due to underpayment (none / 0) (#19)
    by diogenes on Thu Dec 17, 2009 at 10:04:16 PM EST
    Medicaid massively underpays; many doctors don't accept it or take few medicaid patients and hospitals and nursing homes only stay afloat because of access to private pay and insurance patients who pay better.  The government might as well also control the deficit by decreeing that it will only pay oil companies 60 cents a gallon for gasoline.

    I know in MA (none / 0) (#3)
    by CST on Thu Dec 17, 2009 at 01:49:03 PM EST
    there are also pretty high minimum coverage standards.

    Are these included in the federal bill?

    For example, if you can't afford insurance that meets the minimum coverage standard, than you are exempt from the mandate or qualify for a subsidy.

    it prevents insurers from offering junk insurance.

    And yes, the premiums for the rest of us are higher than anywhere else.

    Also - I really want to know if people in MA who aren't covered will be fined twice... and what the state plans on doing about that, because that's pretty messed up...

    There are a lot of people who claim (none / 0) (#4)
    by inclusiveheart on Thu Dec 17, 2009 at 01:51:11 PM EST
    that junk insurance is still a problem in Massachusetts.  I don't know for sure, but I've heard that claim made on more than a few occasions.

    probably depends on your definition of (none / 0) (#5)
    by CST on Thu Dec 17, 2009 at 01:55:31 PM EST

    Like anything else.

    But at least there is SOME measure of control.  A lot of which Romney tried like hell to strip out, but his vetoes were all overruled.  Does anything like this exist in the senate package?

    Also, although it is fairly weak (a small fine), there is an employer mandate as well for employers with more than 11 employees.


    It's still (none / 0) (#6)
    by TeresaInSnow2 on Thu Dec 17, 2009 at 01:58:55 PM EST
    a problem according to some articles KOS quotes


    [T]he affordability of health care remains a barrier to receiving care for some residents. Of the total population, 21 percent went without needed care in the previous year because of cost.

    And (5.00 / 2) (#7)
    by TeresaInSnow2 on Thu Dec 17, 2009 at 02:11:39 PM EST
    BTW, my definition of junk insurance is when you've been forced to buy health insurance, but you still can't afford health CARE.  

    Well frankly (none / 0) (#10)
    by CST on Thu Dec 17, 2009 at 02:29:03 PM EST
    We don't know if that's what this number represents.  For all you know, it could be people like me, who have insurance provided by their employer, that's considered "good insurance" under most definitions, but decided to put off some health care expense because of financial constraints this year.

    BTW - I am exactly in the boat I described above, and I would've purchased my employers health insurance regardless of what the law was.

    It's not because I have "junk" insurance, it's because stuff is expensive.

    That doesn't mean I didn't get other needed care this year that I wouldn't have gotten without insurance.


    One last thing (none / 0) (#11)
    by CST on Thu Dec 17, 2009 at 02:57:23 PM EST
    If that's how you really feel, than I don't see how you could support any bill with mandates, even single payer.

    There will always be some portion of the population who can't afford the care they need.

    If that's your real opinion (no mandates in any situation), than fine, that's a perfectly legitimate opinion to have.  But at least admit that's what you're talking about.


    This is completely not true (5.00 / 1) (#18)
    by Militarytracy on Thu Dec 17, 2009 at 09:15:19 PM EST
    I posted a link to a boy a few days ago who receives titanium rib treatment with my son and he comes in from Canada and Canada pays for everything and this kid has no yearly caps in his coverage that he and his parents have to worry about.  His parents don't pay more for his coverage either because he is a medically expensive member of society.

    Single payer (none / 0) (#13)
    by TeresaInSnow2 on Thu Dec 17, 2009 at 04:14:25 PM EST
    Yep, as Bill Clinton would say, don't let the perfect get in the way of the good.  I love the strawman that proponents of this awful bill put out.  People who oppose this bill are not opposing it because it isn't perfect.  We oppose it because it's a giveaway to insurance companies with very little real gain for consumers, and real losses for many.

    I didn't once say any plan would be perfect.  And since you choose to ignore this obvious fact, I will spell out to you that for profit insurance making zillionaires richer is going to be unaffordable for far more people than true single payer insurance, the latter which includes sliding scales and exemptions and true cost controls because it would be government run. Saying that if I don't like this bill I don't like single payer is completely a joke of an argument.  Truly beyond ridiculous, into absurd.

    Stop putting words in my mouth to defend a junk bill that includes junk insurance provisions.  You can't even afford healthcare on your own insurance.  You should be asking yourself if what you have is actually junk.  I would say it is.  You have it, you paid for it (either through direct contributions or as part of your compensation package) but you can't use it.  An insurance company is profiting from it while you're getting no benefit.  Why is that not a good definition of junk?


    you must have missed the part (none / 0) (#15)
    by CST on Thu Dec 17, 2009 at 04:36:11 PM EST
    where I DO use it.  That doesn't mean it pays for everything.  I'm not getting no benefit, I'm getting more benefit than most, I just chose not to get everything because I'm watching my finances like everyone else out there, and I didn't consider it urgent.  Furthermore, like I said originally, I'm not affected by the mandate, because I had this insurance anyway, but I am still in that 21%.

    And you do realize we are not talking about the federal bill here?  I would say you probably have no idea whether the MA bill is "aweful" or not.

    I'm saying if you don't like mandates in any situation where people can't afford all their care, than you don't like single payer, because even that system will mean not everyone can afford all care.  You were the one who put the ultimatum out there, not me.


    Funny you'd mention Bill Clinton (none / 0) (#17)
    by Socraticsilence on Thu Dec 17, 2009 at 07:38:11 PM EST
    What with him coming out in favor of the bill today and all.

    In favor of what bill? (none / 0) (#20)
    by cawaltz on Fri Dec 18, 2009 at 07:39:03 AM EST
    The ever evolving Senate bill or the House bill? I mean last I heard he was in favor of A BILL(as in you nimrods better do SOMETHING)and did not give any sort of committment otherwise to particular versions being floated around.

    Missing (none / 0) (#8)
    by CST on Thu Dec 17, 2009 at 02:12:47 PM EST
    from that are thwo major questions:

    #1 - What was the percentage of that BEFORE the bill was passed?

    #2 - What qualifies as "needed care"

    Here is a pretty good reference if anyone is interested in what's in the law itself.

    The state of MA did not pass a perfect plan, far from it.  I would note however, that it still retains relatively high popular support (although a lot of people want some changes, very few want it repealed), and has not caused any kind of political or economic disaster.

    Yes the state has budget problems, yes some people are struggling, but let's face it, that's true everywhere.  And we are in better shape than a lot of places.


    NHS (none / 0) (#21)
    by tombo101 on Mon Feb 08, 2010 at 10:50:58 AM EST
    People in the UK slate the NHS, but the US need to take note.