The Soapbox

Joined: 09/29/2013 Posts: 60652
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FWIW, and I'm not saying I necessarily agree with the states that didn't

expand, but I don't think you can so easily apply that solely to partisan politics, as convenient and politically beneficial as that may be. I think states have a valid concern about the impact expansion would have on their budgets, and ability to provide other services, once Fed reimbursements start scaling back. And dangerously idealistic to assume those Fed payout rates won't scale back even further than ACA originally promised. (If the Feds pass a budget that says Medicaid reimbursements for expansion will go to regular Medicaid reimbursements going forward, WTF are you going to do as a state? Besides be in a world of hurt. I'm not saying it's likely, at least not that drastic, but to not even consider the possibility is anything but fiscally prudent by states IMO)

Combine that with the poor state of our Medicaid system, and I'm sorry, but there are many reasons to hesitate expanding beyond just "hating Obama and dem Socialists".

(In response to this post by WahooRQ)

Posted: 07/16/2017 at 2:31PM

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Wasn't this one of the major selling points for ACA? That we would save -- Hoodafan 07/16/2017 12:15PM

Michigan Study: Drop in unpaid hospital bills -- DanTheFan 07/16/2017 8:38PM

Thanks Dan. That is good news about the drop vs pre-ACA even though -- Hoodafan 07/17/2017 10:28AM

The answer is the same answer its always been. Unless everyone is covered -- 111Balz 07/16/2017 2:31PM

And everyone will need to pay something into the system -- KCHoo 07/16/2017 2:57PM

How exactly are you going to get residents of, let's say, Norton -- Faz d. Hoo 07/16/2017 11:13PM

Yep ** -- 111Balz 07/16/2017 4:40PM

Which, wrt not having enough young and healthy folks begs the obvious ` -- Hoodafan 07/16/2017 3:14PM

Maybe the 3x cap should be re-calibrated. I agree that the key -- 111Balz 07/16/2017 4:46PM

The 3X cap was nice in theory in that you pay more when young and healthy -- Hoodafan 07/16/2017 5:08PM

Whether 3x or 5x the key is that the upper end MUST be affordable -- 111Balz 07/16/2017 8:39PM

The upper end will never be affordable. That isn't how health care works. -- Faz d. Hoo 07/16/2017 11:32PM

That proviso was built to counteract the stereotype of the recent graduate -- HowieT3 07/16/2017 7:22PM

The first of the baby boomer surge are entering their seventh decade...with -- Tuckahokie 07/16/2017 3:50PM

This is all because the GOP sabotaged the program ** -- Tuckahokie 07/16/2017 12:20PM

It might have something to do with the GA refusing to expand Medicaid, no? ** -- southdenverhoo 07/16/2017 12:36PM

Yes, and from a provider perspective, Medicaid covers less cost -- 111Balz 07/16/2017 2:32PM

Not to mention states that refuse to run their own ACA exchanges. ** -- WahooRQ 07/16/2017 12:55PM

You've made that comment many times so please educate me. Why does that -- Hoodafan 07/16/2017 1:09PM

A bit dated now, but a Pew study on the subject. -- WahooRQ 07/16/2017 1:20PM

A bit more current -- WahooRQ 07/16/2017 1:24PM

Thanks for both of those. And BTW I would not use the "it's dated" method -- Hoodafan 07/16/2017 2:06PM

I wouldn't count on RQ to understand much -- dajoka004 07/16/2017 1:14PM

You may be a doctor, but you are policy and politically illiterate. ** -- WahooRQ 07/16/2017 1:22PM

To answer your post below -- dajoka004 07/16/2017 1:52PM

Thanks, but that doesn't really answer the question. -- WahooRQ 07/16/2017 2:00PM

FWIW, and I'm not saying I necessarily agree with the states that didn't -- Hoodafan 07/16/2017 2:31PM

Refusing to start down an unsustainable path is not an argument that -- Hokie5150 07/16/2017 2:12PM

What joka is calling "unsustainable" was, ironically, a pre-existing -- WahooRQ 07/16/2017 2:22PM

It absolutely was -- dajoka004 07/16/2017 2:35PM

Perhaps, but refusing to expand Medicaid (at 100% federal funding through -- WahooRQ 07/16/2017 2:50PM

The negative is the feasibility -- dajoka004 07/16/2017 3:16PM

There you go again, all persuasive & logical & shit... ** -- southdenverhoo 07/16/2017 1:26PM

All well and good, but when it comes to dealing with trolls -- WahooRQ 07/16/2017 1:34PM

As opposed to dajoka's post? Garbage in, garbage out. ** -- KCHoo 07/16/2017 1:33PM

In this very thread, he appears to be educating you on our system -- HoosGuy 07/16/2017 3:26PM

If more people are being insured because of the ACA than before this -- Tuckahokie 07/16/2017 12:41PM

Correct. And even with expanded Medicaid, that would add to the -- Hoodafan 07/16/2017 1:00PM

Increase is result of change by the hospital. -- DanTheFan 07/16/2017 12:54PM

Hence why I made the comment about fungible. But as I understood it, that -- Hoodafan 07/16/2017 1:05PM

The other two had increase of 1-1.5% -- DanTheFan 07/16/2017 2:56PM

Yet you and others kept telling us we had to pass ACA because we -- Hoodafan 07/16/2017 3:08PM

Has anything happened they promised? Of course not, this is just -- TomKazanski 07/17/2017 10:02AM

You have to have providers to get these people care -- dajoka004 07/16/2017 1:12PM

Absolutely! And one of the biggest problems with ACA (and -- Hoodafan 07/16/2017 1:22PM

Why wouldn't supply and demand principals lead to more supply ** -- KCHoo 07/16/2017 1:48PM

In addition to the medical school / residency bottleneck issues -- BocaHoo91 07/17/2017 07:23AM

Medicaid pays substantially less than Medicare. That's why you don't see -- Hoodafan 07/17/2017 10:45AM

The doctor bottleneck is caused by the professional union but supply of -- KCHoo 07/17/2017 10:19AM

I know it hasn't, at least not anywhere near enough. And that's what I was -- Hoodafan 07/16/2017 2:18PM

Markets don't adjust instantly. Especially when training is required. -- KCHoo 07/16/2017 2:35PM

For Medicaid patients, it's my understanding it is. Or at minimum less -- Hoodafan 07/16/2017 2:50PM

Well that is very different from the statement you made. -- KCHoo 07/16/2017 2:55PM

Not different at all. Supply was not increased dramatically enough to match -- Hoodafan 07/16/2017 3:01PM

Medical school spots have to align with residency positions -- dajoka004 07/16/2017 2:32PM

Thanks! I knew there was a bottleneck in the supply chain even if -- Hoodafan 07/16/2017 2:45PM

What incentive is there for physician supply to increase? -- dajoka004 07/16/2017 1:59PM

More overall available money to be made from increased -- KCHoo 07/16/2017 2:04PM

Why would I want to take on new, complicated patients that pay less? -- dajoka004 07/16/2017 2:24PM

You wouldn't. Which is why the principles of supply and demand should -- KCHoo 07/16/2017 2:32PM

Do you know what physician oversight entails? -- dajoka004 07/16/2017 2:39PM

Yes. And over time the years without treatment issue would -- KCHoo 07/16/2017 2:51PM

Your train of thought may apply to other businesses -- dajoka004 07/16/2017 3:22PM

Why wouldn't it still apply for healthcare? Seems to me it's because we put -- Hoodafan 07/16/2017 3:38PM

The money paid doesn't meet the providers' compensation -- Hokie5150 07/16/2017 2:15PM

Because of governmental interference in the marketplace. ** -- Hokie5150 07/16/2017 1:52PM

How so. ** -- KCHoo 07/16/2017 1:55PM

See my above post ** -- dajoka004 07/16/2017 1:59PM

Exactly. ** -- Hokie5150 07/16/2017 2:13PM