America's poorest still fall through the cracks with Obamacare.

[bunnies]

So... I popped over to healthcare.gov and plugged in my information to see what kind of options will be available to me. But instead of learning about what plans I could chose from, I learned that I may not get any coverage at all. You see, I am currently out of work due to a medical condition which means my income is $0.00. And since my state has not yet decided to expand its medicaid coverage, this is what I get:

If your state isn’t expanding Medicaid for January 1, 2014

Some states aren’t expanding their Medicaid programs effective January 1, 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.

If your income is more than 100% of the federal poverty level -- about $11,500 a year as a single person or about $23,500 for a family of 4 -- you will be able to buy a private health insurance plan in the Marketplace and may get lower costs based on your household size and income.

If you make less than about $11,500 a year as a single person or about $23,500 for a family of 4, you may not qualify for lower costs for private insurance based on your income. However, you may be eligible for Medicaid, even without the expansion, based on your state’s existing rules.

Why this coverage gap exists

When the health care law was passed, it required states to provide Medicaid coverage for adults between ages 18 and 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.

It also provides tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Marketplace.

Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.

The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states are not expanding their Medicaid programs as of January 1, 2014.

Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state’s current rules. But their incomes are too low to qualify for help buying coverage in the Marketplace.[/b

I have already applied for medicaid under my state existing rules and have been waiting since May to know the decision. But as a childless adult under the age of 65, I have to rely on the state deciding whether or not they feel Im disabled. The Social Security Administration has already informed me that I am not injured enough to qualify for SSDI. And since its the same damn determination service that decides for the state, its not looking to good for me at this point.

But lets think "best case scenario" and assume NH will expand medicaid. Which is actually what I think will happen. Problem solved, right? Not so fast. Theres this:

Insurance officials point out possible flaw if NH decides to expand Medicaid

(snip)

Jennifer Patterson, health care legal counsel for the Insurance Department, said the federal Affordable Care Act would not permit anyone in the target low-income population to buy coverage through a federally run exchange or marketplace in New Hampshire next year.

That’s because the Affordable Care Act requires that anyone who earns up to 138 percent of the federal poverty level, or $16,000 a year, and buys health coverage in the exchange must have a choice of at least two “qualified health plans,” she said.

(snip)

“There has to be a choice of qualified health plans, and that presents a problem, with New Hampshire only having one health plan,” Patterson said. “There could be a concern if we tried to go in 2014.”

Sen. Andy Sanborn, R-Bedford, said he doesn’t understand why the Obama administration would refuse to give New Hampshire a waiver or exemption from this two-plan mandate since Anthem is offering 11 different benefit plan options to individuals who will buy coverage in the exchange.

(more) http://www.nashuatelegraph.com/news/1016818-469/insurance-officials-point-out-possible-flaw-if.html

OK. So maybe this two choice issue is unique to NH. I'd be surprised it thats true but I'll concede its a possibility for this posts sake. That aside: If you're among the poorest of the poor and your state doesnt expand medicaid, you get a big fat nothing. I know this wasn't the intent of the law as it was originally written. It is however, the sad reality for millions of Americans. The cracks are still big enough for America's neediest to fall through. Republicans rejoice!

States not expanding medicaid as of today:
Alabama
Alaska
Florida
Georgia
Idaho
Indiana
Kansas
Louisiana
Maine
Mississippi
Missouri
Montana
Nebraska
New Hampshire
North Carolina
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Wisconsin
Wyoming

And I'd like to give a special shout out to the Supreme Court for allowing the above states to fuck their poorest citizens. Thank you SO MUCH for giving the bureaucrats with their government health care the choice to take our choices away. Ya really done America proud on this one.

[grasswire]

1. very clearly stated

What a mess.

[bunnies]

3. It was a very disheartening revelation.

To say the least.

[pnwmom]

104. Here's an article someone else passed to me today that addresses your situation.

I hope there might be something in here that helps you.

http://www.webmd.com/health-insurance/20130808/how-poor-might-qualify-for-obamacare-subsidies-in-states-that-dont-expand-medicaid

[bunnies]

106. If I can ever get my joint replaced so that I can work again...

I will definitely keep this in mind. Im still looking for that position that only requires the use of one arm. Turns out... there arent that many. Hey... maybe I should run for congress! I can sit around doing nothing with the best of them!

[pnwmom]

109. With regard to disability, I've heard that they almost always turn down the first request.

But they're more likely to say yes on the second time around. I hope you're appealing.

[bunnies]

112. I am. And Im getting a lawyer.

It wont get me healthcare, but at least it'll be something to help with the bills. Its crazy how hard you have to fight to get help when you need it. If youre a childless adult... tptb dont really care.

[pnwmom]

2. This IS a serious problem and you're right that the Supreme Court and the red state governors

are responsible for it. People in your state should be shouting to the heavens that they don't want free Medicaid expansion funds -- that their federal tax dollars are helping to pay for -- going to other states and not their own.

[bunnies]

5. Our Governor is a Democrat.

The state legislators, however... I think instead of "Live Free or Die" they'd be perfectly happy to change the state motto to just "Die".

[pnwmom]

29. I'm guessing you're in another state with a gerrymandered legislature. n/t

[bunnies]

31. Can you believe our state has 400 house members?

400! Lets see... we have a Dem Governor, voted for Obama twice, all Dem US House reps, one Dem us Senator, but a Republican majority state legislature. hmmm.

Gerrymandering? What gerrymandering?

http://www.huffingtonpost.com/2011/11/21/new-hampshire-redistricting_n_1105950.html

[Nuclear Unicorn]

4. This is rather unsettling. How does the mandate effect you?

[bunnies]

7. I suppose I will be exempt...

Since there won't be any options provided me. If Im expected to pay for a full-price plan? With what? I guess I'll just have to wait and see.

[Yo_Mama]

8. There's no tax for not having insurance if you earn too little to file a return n/t

[grahamhgreen]

6. "why this coverage gap exists" - because we should all be being issued medicare cards, not this crap

[Puzzledtraveller]

10. ^^this^^

[bunnies]

11. Damn right we should.

And Republicans would be for it if they were smart. What they dont seem to understand is that for people in my situation, lack of healthcare keeps us out of the work force. Want fewer "takers"? Let us get healed so we can go back to work!

[Liberal_Stalwart71]

15. You should still be able to use the federal exchanges if your state hasn't

established its own exchanges.

http://obamacarefacts.com/obamacare-health-insurance-exchange.php

[bunnies]

22. And how shall I pay for that with zero income?

This is what it tells me about the federal exchanges:

3 ways to save on health care coverage

You can save money in the Health Insurance Marketplace 3 ways. All of them depend on your income and family size.

You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan. These plans all cover essential health benefits and pre-existing conditions.

You may qualify for lower out-of-pocket costs for copayments, coinsurance, and deductibles.

You or your child may get free or low-cost coverage through Medicaid or the Children's Health Insurance Program CHIP. Some states will be expanding Medicaid eligibility in 2014, so you may qualify even if you have been turned down for Medicaid in the past.

When you fill out your Health Insurance Marketplace application as soon as October 1, you'll find out what plans and premiums are available to you and see how much you will save. Most people who apply will qualify for lower costs of some kind. Coverage can begin as soon as January 1, 2014.

Medicaid is my only option. And having zero income, I do not qualify for rate reductions in the insurance marketplace.

From your link:
Those making between 133% (139% in State's that have expanded Medicaid) and 400% of the Federal Poverty Level can apply for tax credits that can lower the cost of their insurance premiums considerably, resulting in those Americans getting "affordable" health insurance.

I do not qualify.

[lark]

41. It won't help my son either

He made some stupid choices and has a record so can't get a good job, so works as a waiter. In reeling FL, he's barely able to cover rent for a room in a house with 6 other people. He doesn't have any extra money at all after eating, paying rent and buying gas for his 1996 vehicle. He doesn't have any money to pay for insurance - none. FL didn't expand Medicaid and he doesn't qualify. FL actually made it a lot tougher to get Medicaid, essentially ending the medically needy program for non-disabled adults like him. If the penalties were still hapening, this would be a huge problem as he couldn't afford to pay that either. I think it's so terrible that red states can fuck their $ challenged resident. Scott (Volemort) won't even let the Navigators in the state do their jobs. I've seen figures from a number of other states as to the rates available in the exchanges, but not one thing for FL because it hasn't been done, far as I know. I'd like to be able to buy coverage for him, but our income is so far down, don't knw if that's possible since we have no idea about the rates. I'm sure they'll be sky-high since Scott is doing everythign humanly possible to make sure this fails and actually hurts the poor in our state.

Damn, this sucks so bad!

[bunnies]

56. Scott made it TOUGHER to get medicaid?

Holy hell! I literally dont know how that man looks in the mirror each morning. I read stories like this and it only pisses me off even more. See... this is where the federal government really screwed up. They need to give non-state options to people whose state has screwed them over. Like oh, I dont know, Medicare? Whats so damn difficult?

Any chance that asshole wont win reelection?

[grahamhgreen]

87. Just imagine, our Medicare cards arrive in the mail. You never have to do another thing, except

Show up at the doctors office and give them your card.

No hunting through plans. No researching databases. No checks to mail out.

Just take your card to the doctors.

Medicare for all.

[Liberal_Stalwart71]

88. I agree. But in the meantime, you should be able to use access the

federal exchanges. Not a perfect solution but better than what we currently have.

[bunnies]

95. Thats a great solution for people with bags of money laying around.

Do you really think that people who make too little to qualify for subsidies can pay MORE for a plan than someone making 30k a year? Its all well and good in theory. But the reality of the situation is very, very different.

[Liberal_Stalwart71]

97. I actually agree with you. So now, let's talk about solutions.

I notice you do a lot of complaining, and I get it. You're angry that we don't have a single payer system. O.K., we don't have single payer. So, what do we do in the meantime? Is there anything we can do? Are there any viable solutions available out there?

A story I found from my state of Maryland:

http://articles.baltimoresun.com/2012-06-30/news/bs-md-rodricks-0701-20120630_1_individual-mandate-health-insurance-health-care

[bunnies]

100. I think its really very simple.

Give the people who fall through the cracks medicare cards. Im glad there is a safety net in MD. But there should be one for everyone, regardless of how fucked up their state is. Ya know?

I really dont mean to be running around complaining. It just gets tiring trying to explain why things are the way they are. Ive actually had people tell me that no one falls through the cracks. Sometimes I just want to cry.

[dkf]

102. Medicare still has copays. 20% right? And it has premiums.

Nope you need single payer and no expenses if you have zero income.

[bunnies]

103. *sigh*

I guess youre right then. Bunnies-mr is already working 65 hours a week to bring home enough to pay all our bills. We dont have car payments, or a mortgage, we're just scraping week to week.

What really sucks is that all I want to do is be able to go back to work. I just want to get fixed so that I can get a job. The pukes want fewer "takers" but they wont help me get the care I need to go back to work. It really doesnt make any sense!!!!

[dkf]

108. I saw an analysis of Medicare and the out of pocket expenses over the lifetime is in excess of $100k

It might even have been 200k. All I remember is thinking...wow.

Medicare is expensive medicine too. The rest of the developed world spends 12% or less of GDP while we pay over 17% and we don't even cover everyone.

It's the costs that make it impossible to cover all our people. That's why we need single payer to bring down costs and bring it in line with other countries.

Until we do that it's not economically feasible.

[bunnies]

111. 200k?

Omg. How in the world do people do it? Seniors pay that much? How do they EAT?! And I bet it doesnt even take that long to rack up. The MRI I had on my arm? The bill was over $8500.00. Then there was the $900.00 splint I got from physical therapy. In fact, I managed almost $20k in bills just to get diagnosed. Ill already be paying those for the rest of my life.

This is so damn depressing.

[dkf]

113. This is why people get medigap plans in addition to Medicare to pay those extra out of pocket costs.

I am lucky my parents are double covered through Medicare and their old employer, the state. But they don't give the great packages my parents got anymore.

On edit: this was an illustration of the out of pocket of a married couple who lived decently long lives. So it included the premiums plus the medigap premiums plus any out of pocket expenses. The surprising thing was that the husband who died of cancer earlier had less expenses than the wife who lived longer and landed up in a care home at an old age. But it didn't even include the nursing home costs which they estimated another 100k+ at future prices. Suffice it to say it was quite eye opening. It was an exercise in estimating how much you need to retire with.

[bunnies]

115. Well...

Im 40 now and have about $350.00 in the bank and several thousand dollars in medical debt. Doesnt exactly seem Im on the path to success. Maybe I should call an investment adviser. Do I or ... . I guess Im doing both at this point.

I dont think I ever really knew how messed up healthcare in this country is. Im just thankful my issue isnt life threatening. My God. What would I do then? Scary.

[dkf]

116. That's why I support single payer Canada style because I've looked at the numbers.

Medicare isn't going to cut it. It's really the only hope normal people will have unless there is some big improvement due to who knows what in the private market. I don't see it.

[bunnies]

117. The private market has one function.

Charge the most money for the least care. It should be criminal, really, especially in a country that guarantees "life, liberty, and the pursuit of happiness". Whoever devised the idea of maximum-profit heathcare holds a special place of scorn in my heart. And those claiming to be "Patriots" while wishing suffering on other Americans? They're in that scorny place too.

I am really, really, grateful that Obamacare will help so many people with their needs. But youre absolutely right. Anything short of single payer and we're all still hostage to the insurance industry. Im not really sure, but I think I might be turning into a Socialist. Its not conscionable to allow the many to suffer at the hands of the few.

[dkf]

118. Something is wrong in the numbers. I still haven't figured out why its so expensive...

Yet hospitals are struggling even with staggering billing. Is it insurance? Maybe but I am not sure.

I also don't understand why college tuitions are so outrageous.

[bunnies]

120. And theres another thing that should be free.

Higher education. Oh, dont get me started.

[leftstreet]

12. +1

[adirondacker]

68. We'll catch up with the rest of the world by the end of the century at the rate this country is

going. Be Patient!

[Puzzledtraveller]

9. k&r

[Liberal_Stalwart71]

13. What do all those states have in common? They all have Republican governors.

They're not going to expand Medicaid, though there are some Republican governors who would like to, but haven't due to pressure from the Teabaggers in their state. For instance, in Georgia, Nathan Deal has gone on record suggesting that he would like to expand the Medicaid system, but the state legislature is now nominated by extreme Teabagger Republicans who have obstructed his efforts to do so. This is really sad.

You can't blame Obamacare for that. You should be blaming the Republicans for it.

Also, I think you can still go through the federal exchanges if the state exchanges haven't been implemented. I think you should be able to apply for federal subsidies that will provide some assistance there.

Obamacare isn't a perfect law. Far from it. But it is a start. The Republicans want it to fail, and they want YOU to blame Obama for it. So if they can deliberately put up roadblocks to subverts its implementation, they'll do so. They know that the law can be confusing, and through confusion, you'll blame Obama for it--not them.

Let's get wise, here.

Learn all you can about Obamacare and how your state plan works. Armed with knowledge, let's not let the Republicans get away with their shenanigans.

[bunnies]

17. Our Governor is a Democrat.

And as I stated in my OP - there will be no option for me under the Government exchange. Also, nowhere in my OP did I blame Obama for anything. Im simply stating the reality for me and millions of others.

[Liberal_Stalwart71]

23. I don't think you're blaming Obama. And are you sure your state hasn't instituted

the exchanges?

[bunnies]

24. Yes. Unfortunately.

That Nashua Telegraph article I linked to is only a few days old. I do think that our state will expand Medicaid, but because we will only have one choice of plans, it will not be acceptable under the ACA unless the President gives NH a waiver. Maybe he will.

[enlightenment]

28. You're very patient, bunnies.

Kudos.

[bornskeptic]

85. Three states not expanding Medicaid have Democratic governors.

New Hampshire, Missouri, and Montana. As far as I know, it's the legislature that's blocking it in all cases.

[Liberal_Stalwart71]

99. Well then that makes more sense. If the legislature is blocking it.

Hell, even in GA with Nathan Deal--a Republican governor who wants to expand Medicaid--it's his Teabagger Republicans in the legislature that are putting pressure on him not to.

[cali]

14. that is problematic

as you know, I live across the river. I'm also an adult under 65 and I had no problem here getting Medicaid. got it the same day I applied.

Is it a possibility that you could move to vermont?

[bunnies]

19. You got it the same day you applied?!

Wow. Yet another way VT is a seriously impressive state. I lived in VT for a couple of years about 20 years ago and loved it. We've been considering moving there on and off for a while. But now that I know this, its time to look into it seriously. wow. Thank you so much for telling me that! Thats amazing.

[cali]

42. yes. I got food stamps at the same time.

and I've never been treated with anything but kindness and respect by those working for the agency.

[bunnies]

53. heh.

Whereas Ive been treated like a low-life POS by virtually every state agency Ive gone to. In fact, they're more than a month late on my medicaid decision. This is how much NH cares about its citizens. Live Free or Die with the emphasis on DIE. Pretty much the opposite of VT in that way.

Bunnies-Mr's Dad had cancer & lived in VT. He was on medicaid and got the best treatment possible. They really spared no expense trying to save his life and did everything they could to make him comfortable at the end. And the people in the Hospital in St. Johnsbury were some of the nicest, most caring people Ive ever encountered in my life. They never treated him as "less-than" due to his financial situation. It was truly impressive.

[cali]

59. Yeah, they're pretty good at NVRH

(it's now part of Dartmouth Hitchcock)

My primary care doc/practice is as well and they are fantastic. My doc spent 40 minutes with me yesterday just talking and exploring further options for my Reflex Sympathetic dystrophy pain. She's also open to alternative medicines.

c'mon bunnies, if you can, make the move. Social Services and medical folks don't make you feel like shit here because you're poor. It makes a world of difference.

[bunnies]

64. And yet another difference.

My Doctor put a nasty note in my medical records about having to spend time "consoling" me on a day I went in hysterical because I didnt think I could take the pain anymore. She also charged me extra for taking up so much of her valuable time. And she literally laughed in my face when I asked her if she thought alt. medicines might help me. Needless to say, that was the last time I saw her.

When bunnies-mr. gets home tonight I'll sit him down and have the talk. I think you might be right. Time to move. Health care is pretty much the most important thing to both of us right now and we both love VT. It just makes sense.

[cali]

74. I'm so sorry. That's just a horrid thing for your doc to do.

pm me if you want any information that I might be able to provide.

[bunnies]

77. Thanks Cali.

Cant tell you how much I appreciate all your help.

[Sissyk]

79. bunnies and cali!

You two are making me cry. Even with all each of you are going through, you show us what DU is all about.

Good luck to you both!

[bunnies]

86. awww!

Thanks for the luck, Sissy. DU is great like that, isnt it.

[cali]

89. you're so nice to say that!

thank you, Sissyk

[leftstreet]

16. Pelosi: We have to pass it to find out what's in it!

DURec

[ellenrr]

18. this really sucks! I hope you get something.

I made it to 65 and medicare. I had no insurance for some 30 years before I turned 65. Lucky and healthy so didn't suffer much.

But nobody should be without access to health care.
I wish you well.

[bunnies]

20. Thanks Ellen.

[Pretzel_Warrior]

21. Very good write up summarizing your dilemma and

The difficulties millions of Americans will face because their states choose not to expand Medicaid.

My only hope is that as the law's impact is felt when it is implemented, we'll see a chastened Republican party work with Dems and the administration to find fixes for some of the issues being brought up.

[bunnies]

25. Republicans will probably explode with glee...

once they figure this out. Unless, of course, the poor in the red states start putting blame where it belongs. I'd be shocked if that happened though. Voting against their best interest seems to be an ingrained Republican trait.

[Hydra]

26. Keep trying with SSDI

They tell you no so that you'll go away, not because you don't have a case. Be polite and persistent and offer to get whatever extra docs they need.

I can only say this because I got it for my disabled relative, and they insisted over and over that her issues were not bad enough to warrant disability, but they eventually ruled in her favor.

[awoke_in_2003]

30. And get a lawyer involved...

yeah, he got 20% of the initial payout (they denied my wife for two years) but 80% of something is better than 100% of nothing.

[bunnies]

36. I just filed my appeal the other day.

Theyre "decision" was so bizarre. It referenced things that didnt even pertain to me such as "avoiding heights". WTF? Where the hell they got that from I have no idea. I need a joint replaced, I dont have vertigo! Then they went on to say that I should be able to find gainful employment. Uhhhm. I have use of only one arm. What the hell can I do? I think they should HAVE to tell you what work they think youre qualified for. The process has been such a joke. ugh.

[Hydra]

54. Trying to get any help is a joke

It makes me so angry when I see DUers parroting RW talking points about how much safety net fraud and abuse there is by the people on the programs.

Where I HAVE seen fraud/waste and abuse on a huge scale is by the providers of services...and whenever we report it, we're told they can't do anything about it and other providers are the same.

GL, keep the pressure on and call them on the inaccuracies. The don't make it easy(or even possible) but keep trying anyway.

[bunnies]

57. Speaking of fraud and abuse...

youve got it exactly right. Get this: While I was in physical therapy they made me a splint to wear at night. It was some sort of foam that they put in hot water, molded to my arm, and it turned to plastic as it cooled. Its maybe 4" wide and 12" long. To keep my arm from bending while I sleep. They put some velcro on it and gave me two strips of fabric to strap it on. Want to take a guess at how much that cost? $754.00. I thought it was a typo. Nope!

Thanks for the luck. Ill take all I can get. This system is rigged to screw us all.

[Wounded Bear]

27. Tough situation, and I take no joy that you must suffer because of geography, so to speak...

But I am glad I live in a state (WA) where the Exchange will open on schedule, though as it works out, I may not need it. I have finally found work with a real employer, no longer at a temp agency. I hope something can be worked out in your situation.

I hate to bash states, in general, but there is a lot of things to not like in what is being done in many "red" states these days in the name of some falses sense of 'freedom.'

[bunnies]

38. If I lived in a red state, Id have expected it.

*sigh*. On a better note... congrats on finding a permanent job! Must be a lot of stress of your shoulders. I loved my job. Wish I still had it. Hopefully my Dem Governor will start twisting arms and Ill get some help. Fingers crossed.

[Wounded Bear]

45. I'm not sure NH classifies as "blue" though...

Sorry, don't mean to joke at your expense, but NH is pretty conservative in what I've read about it. Especially since the neighboring states have gone so blue, hasn't there been an influx of "reds" to NH? I know there's a strong influence of, for lack of a better term, libertarian leaning in NH, no?

[bunnies]

51. Libertarians? Oh yes.

We're infested with them. I think we should tent the whole state and smoke them out.

But we have a Dem Governor, both house reps are Dems and one Senator is a Dem. Sadly though, our state is gerrymandered so that our Legislature is majority Rs. So... we're blue on a federal level I guess. Ya gotta give me something! Wont be surprised if Rand Paul wins the R primary here in '16 though.

[awoke_in_2003]

32. Since most puke politicians are Christians...

I say " what you do onto the least of my brothers you do onto me". of course, they never remember those parts of their holy book.

[frazzled]

33. This is a problem of the states (and the Supreme Court), not Obamacare

That's all I have to say.

[bunnies]

40. It has to do with all three.

As I said in my OP.

[Recursion]

34. Side note: there are a ton of lawyers whose entire practice consists of getting people on SSI/SSDI

They're good at it, and in a lot of cases the states are happy to help because it means the Federal government is paying instead of them. Might be worth looking into.

[bunnies]

39. Yep.

Ive gotta get one. Filed my appeal the other day and was thinking of going it alone. Ive smartened up though. Fight fire with fire and all that.

[Wounded Bear]

47. Good plan...

It's sad to say, but because once an appeal is won, and it often is, you'll get a lump sum payment including back pay to the date of the original claim. The lawyer will want a chunk of that. That's what they're after. I've know a few people that went through it.

[bunnies]

49. Yeah. I think they get 20%.

But I guess 80% of something is better than 100% of nothing. They shouldnt make it so damn hard to get our money back when we need it. Its really kind of a slap in the face.

[Nay]

80. Frankly, bunnies, I agree with the poster above who suggested moving

to VT -- so much easier and less stressful, I would think. And it's not like you would be moving cross-country. NH sounds like a hellhole!

[bunnies]

81. Im going to give it serious consideration.

It makes good sense at this point. I didnt use to think NH was so bad... until I needed help. It been quite an eye-opener, sadly.

[ProSense]

35. Blame the SCOTUS, but also think about this:

How long will these states hold out?

Mooching Off Medicaid

By PAUL KRUGMAN

Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible...When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — namely, that it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid.

Some background: Medicaid, which provides health insurance to lower-income Americans, is a highly successful program that’s about to get bigger, because an expansion of Medicaid is one key piece of the Affordable Care Act, a k a Obamacare.

There is, however, a catch. Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured.

Now, in the end most states will probably go along with the expansion because of the huge financial incentives: the federal government will pay the full cost of the expansion for the first three years, and the additional spending will benefit hospitals and doctors as well as patients. Still, some of the states grudgingly allowing the federal government to help their neediest citizens are placing a condition on this aid, insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want.

- more -

http://www.nytimes.com/2013/03/04/opinion/krugman-mooching-off-medicare.html

After Medicaid was intiated, one state held out for 15 years.

<...>

Over time, however, the lure of federal dollars proved strong enough to win over resistant states. Eleven joined the program in 1967. Another wave of eight, largely Southern states came on board in 1970. Arizona proved the last holdout, not joining Medicaid until 1982.

- more -

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/09/six-governors-say-they-will-opt-out-of-medicaid-how-long-will-they-hold-out/

Similarly, SCHIP was implemented in 1997. Yet only 87 percent of eligible children are covered.

As Krugman points out, the incentive to comply is there. These are different times, and the exchanges (in most of the OP states the federal government is running the exchanges), multi-state plans and other factors will make a lengthy holdout unlikely.

[bunnies]

43. I do think NH will expand it. Eventually.

But if the President doesnt give NH a waiver for the 2 plan minimum, It may not matter. The Supreme Court never should have given the states the power to opt out of the expansion. They are certainly to blame. It would be nice though, if the ACA offered options for those whose states have opted out. Instead, there is just no coverage available. Its unfortunate.

[DissidentVoice]

37. I've said it before and I'll say it again...

The ACA is a big step up from the status quo, but it cannot and must not be thought of as an endpoint.

The only thing that won't have people falling through the cracks is single-payer.

I think President Obama was well-intentioned but naive in leaving the insurance industry in charge...he probably thought Republicans would at least get on board in some fashion. He should have paid attention to history. The Clinton 1994 plan was not single-payer, and we know what happened to that.

Of course, President Clinton rolling over and letting the GOP kick him didn't help either.

President Obama came close to that with Max Baucus.

The standard response is "there's not the political will" for single-payer.

I am so bloody sick and tired of hearing that I could scream. All that says is that the Democratic politicians in Congress are either too scared, too enamoured of Third Way/DLC crap or in the pockets of the insurance/pharmaceutical industry themselves to stand and fight for it.

Single-payer wasn't initially well-received in Canada either...but they had someone with the backbone of Tommy Douglas PC CC SOM to stand and fight. Now he was named as "The Greatest Canadian" in a CBC survey...AND he was from the largely-rural Province of Saskatchewan, not Toronto, Montreal, Vancouver or one of the other urban centres.

Where in the hell is our Tommy Douglas?!

[bunnies]

46. Couldnt have said it better myself.

Damn.

[Myrina]

52. ^^ This x10 ^^

n/t

[IronLionZion]

44. Virginia will expand medicaid when Terry McAuliffe wins election next month

We need Dems at the state and local level.

[bunnies]

48. The local level is where NH is screwn.

Looking good for Terry in VA? Great news!

[IronLionZion]

50. It's a nasty mudslinging race, but it looks good for a Dem pickup if we can turn out the vote. nt

[SheilaT]

55. I used to work for an attorney who did

SSDI appeals cases. She only took those she knew would probably win. The 20% that the attorney collects on the entire retroactive amount has some sort of cap, which I can't recall. But it is well worth it.

Most original appeals are turned down for a variety of reasons. If you have the good fortune to go blind, you'll be automatically accepted. Most other things, not.

You also need boatloads of records, and not just medical. You'll need an assessment of how you perform day-to-day living tasks. Some of that, as I recall, is self-assessment.

Simply being out of work at the present for a medical condition may not make the cut. What will matter is if you can never perform substantially in your previous work, your age (being over 50 helps because of the assumption it's harder to re-train and find new work at that point), what kind of work you realistically can do and whether or not there are any jobs like that. If they think your medical condition will come to an end (and trust me, I'm making no assumptions here) the thinking is that it will end, you'll go back to work. If there are jobs you can do, even if they're on the other side of the state, you might get turned down.

Talk to an attorney who handles these cases. If that attorney won't take your case, talk to one or two others. If none of them are willing to take your case, then you need to resign yourself to the fact that your situation simply isn't going to result in a determination of disability and SSDI.

I've never lived in NH, but I used to have friends there and visited several times. It struck me as essentially a conservative state, which seems to be reflected in having a Republican dominated legislature. The Governor being a Democrat isn't as important. Just my opinion.

I live in New Mexico. We currently have a Republican governor, but a strongly Democratic legislature. This state is both expanding Medicaid and setting up exchanges, and according to this morning's newspaper will have one of the lowest costs for the new plans under ACA. This is also a fairly poor state, with an abysmal high school graduation rate, not terribly good high schools (except in Los Alamos, surprise surprise), a relatively large population of non English speakers or English learners in the schools. I have a friend, a retired elementary school teacher who tutors 1st and 2nd graders, and she's shocked at how in the last two years kids are coming into the school system with zero reading skills that don't get very better. In the middle of the school year a lot of them still cannot recognize all letters of the alphabet, nor the first ten numbers. Scary.

[bunnies]

61. Thank you for all the advice.

Luckily Ive kept copies of all the paperwork and assessments Ive filled out for SS. There have been a ton of them. The situation (generally) is that I have severe degenerative osteoarthritis in my right shoulder, wrist and elbow with the elbow needing to be replaced. The forearm tendons in that arm are also completely destroyed, along with my bicep tendon. So basically, I have no meaningful use of that arm. Some days I have to ice/heat for more than an hour before it will move at all. And with a work history of mostly physical jobs... Im not sure what I could do. At this point, Ive been out of work for nearly a year and the degeneration just continues.

All I really want is the chance to get the surgery and a little help in the meanwhile. I cant tell you how much I really want to get back to work. I HATE this situation. And I dont have many years before I'll be in this situation with other joints... so I need to get a job and healthcare before that happens.

Youre correct about our state legislature. We have a large libertarian population and heavily gerrymandered districts. I dont think Dems have controlled the State Congress in a hundred years or so. It really sucks. Doesnt help that our House has 400 members in it. Try to get them to agree on anything. The only good thing theyve done is pass a very liberal Medical Marijuana bill, but then our Dem Gov gutted the thing. I dont know what the hell happened to her once she became Gov. She took a hard lurch to the right. Very disappointing.

Im totally blown away by what you said about the kids in middle school not recognizing letters in the alphabet. I remember already knowing how to read and write before I hit the 1st grade. Its horrifying that kids can make it that far without the most basic of skills. How in the world do they even do their schoolwork? That is a serious problem indeed.

[SheilaT]

75. Not middle school. Kindergarten and first grade.

But still. Most of these kids come from homes where the parents speak little or no English, and may not even be literate in Spanish, their native language. Even if they are, my friend tells me, it's clear the parents rarely if ever read to the kids. So it's more like they're unaware of the existence of literacy. I'm not sure what happens to these kids at fourth grade or so. Hopefully by then they are at least reading, even if not yet at grade level.

[bunnies]

83. ooooh. Phew!

I see now that I misread. Scared the bejeezus out of me for a minute there.

I can imagine it must be tough for the kids with little to no English at home. I cant imagine the pressure and stress it puts on the teachers. Not to mention the blame Im sure they take. Thats really sad.

[sunwyn]

60. I am in the same boat as you...I will be unlikely to get healthcare and

having lyme since 1996, I haven't seen a doc in 11 years

[bunnies]

67. 11 years with no treatment for lyme?

omg. I have a friend that has lyme. Its horrible. Im so, so sorry. That just not right. Its just NOT RIGHT!!!

[sunwyn]

91. No it's not and the Federal government does not consider it chronic.

I have learned to manage with herbs, supplements and diet over the years but I have bad days. And some days are wrse than others.

[JCMach1]

62. However, I believe ACA changes Medicaid eligibility formulas/methods in those states who rejected

the additional Medicaid funds.

For example in Florida, under current rules, if you have 2K in 'assets' you cannot qualify.

I believe rules like that are changing to a formula solely based on income.

Consequently, I think, people who might not qualify now, may under the new regime.

[winter is coming]

63. I haven't heard of such a clause, although it would certainly be welcome to many. n/t

[bunnies]

66. I havent heard anything about that.

I already qualify based on income & assets though, so it doesnt look like that would help me anyway. It would be nice if it helped some people though. Hope its true.

[JCMach1]

70. Here are some links

http://floridachain.org/the-aca-is-changing-medicaid-eligibility-in-florida-2/

http://floridachain.org/wp-content/uploads/2013/07/The-ACA-Is-Changing-Medicaid-Eligibility-in-Florida.pdf

And yeah, I was right... the FORMULA for eligibility changes under ACA... even if the state rejected funding for 'expanded' medicaid.

[bunnies]

71. I cant find anything like that for my state.

But like I said... it wouldnt make a difference in my situation anyway.

[JCMach1]

73. Yeah, some people are still going to fall through the cracks...

[etherealtruth]

65. "I'd like to give a special shout out to the Supreme Court for allowing the above states ..."

"... to fuck their poorest"

That sums it up.

[BKH70041]

69. Welcome to the DMV!

Last edited Thu Sep 26, 2013, 04:29 PM - Edit history (1)

Please take a number and be seated. We'll be with you when we damn well please.

(Brought to you from those who thought this was a good idea)
(Just wait until we upgrade again)
(Careful what you wish for)

[duffyduff]

72. Somehow these idiots who make the rules think single people with no dependents

can afford to buy lousy health insurance if they make over 11k.

One person can not live any more cheaply than two or more.

That is absolutely NO money.

I won't pay for any crummy health care "plan." I won't.

I have no money left over for anything as it is.

Furthermore, Medicaid isn't real insurance anyway but has strings attached that you have to pay the money back if somehow you ever get back on your feet.

Screw that.

[bunnies]

76. Wait. What?!

You have to pay the money back if you get back on your feet? Are you fucking serious? Jesus Christ! Ive never heard about that. Thats INSANE!

And yeah... the income levels and what you can "afford" are a total joke. They think we all live in places where rent is $400 a month. Even then if you make $11k a year, youre still totally fucked. Id like to see them do it.

[judesedit]

78. Give them a chance to tweek the law. You still could get Medicaid even if it is not expanded.

Just because you don't fall into one of the situations that benefit many of whom are already excited about the new law, doesn't make the law bad. This has been necessary for a long, long time. Medicare has been getting ripped off for ages. It's time to investigate and prosecute the cheaters. Your insurance premiums have gone way up over the years under a GOP controlled Admin and Congress. The Dems keep getting the costs to come down, but as long as idiots vote against their own best interests by letting Repugs control their states and this country, we're going to have a harder time of getting them to govern for the people....not the insurance companies and pharmaceuticals. Soooooo...2014 is almost here! Get ready to vote. Maybe one day we'll have health care coverage for everyone without all of the shenanigans. And hopefully, get the money out of elections, so we can move this country forward for the benefit of most. Not only for the 1%. We have to start somewhere and this is as good a place as any. Wait to hear the results of your application. Keep applying and if you're not happy, call your leaders. Make some noise for the people in the same boat as you are. It seems to me, they are aware of this problem and are working on a solution as we speak. Hang in there.

[upaloopa]

82. It isn't the ACA calling the shots in your case.

You don't now qualify for Medicaid. Because of your state you will still not qualify in 2014 but not because of Obama Care. If you lived in CA you would have Medicaid in 2014.

[bunnies]

84. Except where it is.

As I said, even if the state expands medicaid, it will not be acceptable under the ACA due to NH not having more than 1 plan to chose from. Without a waiver from the President, medicaid expansion will not matter.

[Hestia]

90. Say what y'all want about Ark. but our governor jumped at the chance to go up to DC and meet

with Siebelius (sp?) about coming up with an option the teabaggers could accept. It's a private/public exchange (private insurance who also handles the medicaid end also) and our TB did vote to expand medicaid - it all came down to federal reimbursement for the first 3 years, then the state picks up like 1-10% of the reimbursement - can't remember exactly what our part of the funding will be, but I think it is closer to 3%.

We have way too many poor here in the state to not do it and I really feel for those in the states who thumbed their noses at the change to work with the feds to get insurance to the citizens who need it most. I hope the leadership is voted out in 2014 on because of this. Cut off their noses to spite their faces.

[Jamastiene]

92. I fall in the same category.

I live in NC and would have qualified for the Medicaid Expansion. Because NC opted out of that and I am still required to purchase health insurance AND the health insurance lobby in NC is so strong, I'm going to be paying almost as much for health insurance as I used to pay for my mortgage. I'm just glad I got my mortgage paid off in time for this, because I'm going to be paying a lot for health insurance that doesn't cover all hell too much.

I will certainly be paying about 12 times more (at the very least) for the health insurance than I was for my two doctor visits per year for a checkup and rewrite of my prescriptions. So, I'm going from paying about $140 a year, in cash, out of my own pocket, for my two office visits, to who knows how much I will be paying per month, depending on the plan I end up getting. None of the plans I just looked at come to about $10 or $15 a month, which would be close to what I'm currently paying for my two visits a year. Most of the cheapest plans I looked at were $150+/per month for the most basic coverage. So, I will be paying more than 12 times what I have been paying just to go to the doctor twice a year, because of that new monthly bill that I did not want but will be forced to have now.

I just got out of debt only to be saddled with a new monthly bill that is going to be almost as much as my mortgage payments were....or else. That's the part that pisses me off the most, the "or else" part of this mandate. The Medicaid Expansion was a brilliant idea and a great part of the ACA, but the SCOTUS has basically made that part null and void while keeping the mandate. Gee, thanks, assholes. You did exactly the opposite of what most poor people needed done. Meanwhile, the very people who are so "against socialized medicine", as they call it, are benefiting from socialized medicine. What hypocrites. Doesn't everyone in Congress get a form of socialized medicine? Gee, if it is good enough for them, it ought to be good enough for the rest of us too. Instead, they get to benefit from socialized medicine while telling the rest of us it is communism/socialism to allow the rest of the country to have universal health care.

And the worst part of it is, they don't even need the handout. They make oodles of money or they wouldn't have been allowed on the ticket to run for Congress to begin with. Is there any member of Congress worth less than at least $1,000,000. That would be interesting to compare, who is the richest and "poorest" in Congress, with their completely covered health care, telling the rest of us who are at or below the poverty line why we don't deserve universal health care or at least to be allowed to get a subsidy instead of being forced to fall through the cracks and forced to add a new monthly bill that we didn't ask for, did not want, and cannot afford without going broke or starving or both. What next? What are they going to force us to buy next to keep us in debt and always at risk of losing everything we have worked for? Meanwhile, they are sitting pretty with Secret Service protection and the best medical coverage imaginable.

To be honest, I'm at the point where I'm thinking about just taking the tax penalty. It will be cheaper and may buy some time until a new Congress revisits parts of the ACA to fix the loopholes/cracks and maybe we can get a Democrat back in as governor of NC and at least then get the Medicaid Expansion back into the discussion.

[bunnies]

93. See. This is exactly why Im so pissed off about this "gap".

It just doesnt make sense to me that if you make too little to qualify for subsidies, that you should be forced to buy a plan at full price. What the hell is that? It feels like it was done intentionally to hurt people and it should be fixed. Now. How hard would it be to issue medicare cards for people like us that fall through the cracks. Arent WE the ones this law was supposed to help the most? And you just KNOW that republicans are giddy that this law will make some of us miserable. Its disgusting what little regard they have for their fellow Americans. They wrap themselves in the flag and call themselves "patriotic". Right. Wouldnt true patriotism involve wanting to make every citizen of your country stronger?

Oh. But most of them dont need that crappy socialist government healthcare. You know theyve all got spouses with million dollar paychecks and healthcare plans we couldnt even imagine. I read just yesterday that Ted Cruz is on his wifes plan that would cost you or I $40,000.00 a MONTH for just one person. Fourty fucking thousand dollars. Yet he stands up there with his smug damn face and tells everyone what the "American People" want. If I hear one more of them use that phrase I think my head will explode. I suppose we are not part of the "American People" he cares about. I guess that should come as no surprise.

I am so sorry for your situation. You are truly getting the shit end of the stick. If I were to get a job making 10 grand a year Id be in the same damn spot. It infuriates me that people whose heads are barely above water are now expected to breath through a stirring straw. And when peoples lives go to hell over these "loopholes", the pukes will point and laugh. I hate them all.

[Octafish]

94. Look. If you wanted universal coverage you should've voted for a candidate who stood for universal -

...Hey. Wait a minute. Where did that go?

[bunnies]

96. Right?

[Liberal_Stalwart71]

98. So this is really about Hillary Clinton losing to Barack Obama and the 2008

Primaries??? Oh, I get it now. It all makes sense now.

And a reminder: During the primaries, Mrs. Clinton was for an individual mandate. Obama wasn't. He changed his mind as president, which essentially makes BOTH of them equally reprehensible if we're going down that road...

http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html?_r=0

[bunnies]

101. What?

You take me for a Hillary supporter? Good one.

adding: Can I reference this next time someone calls me a hater? Pretty Please? Its the first time this has ever happened. I might even print it out!

[antigop]

105. wow, bunnies. I can't really offer anything but my sympathy and hope things work out

for you.

Maybe someday we will live in a civilized society and this kind of crap doesn't happen to people.

All the best...

[bunnies]

107. Thanks, atigop.

Well wishes from DU are whats keeping me from losing my mind right now. I really thought I was going to be ok come January. Im glad its helping others though. I truly am.

[BlueCheese]

110. The decision to set up a different exchange for each state was terrible.

Not only did it multiply the implementation complexity by a factor of 50 or so, it basically punishes people who live in small states. If part of the ACA's philosophy is to group together a large enough pool of people who need insurance to increase their leverage and average out their risk, why would you want to split that pool into 51 (including DC) pieces?

[bunnies]

114. Yep. You nailed it. Thats maybe the biggest problem for us.

That we will only have one insurance provider participating. And under the ACA, that would not be enough choices. So instead we get nothing? It makes no sense. If not for that and letting the states opt out of medicaid expansion... we might actually have achieved universal healthcare under the ACA.

Imagine the rates we'd get if we we all in the same pool? Or even regional pools for places like New England? Its really sad to think about what might have been. How long NOW till we can go after single payer? Years.

[ProSense]

119. There will be

"Imagine the rates we'd get if we we all in the same pool? Or even regional pools for places like New England? Its really sad to think about what might have been. How long NOW till we can go after single payer? Years."

...multi-state plans, which will include at least one non-profit plan.

Multi-State Plan Program and the New Health Insurance Marketplace
http://www.opm.gov/healthcare-insurance/multi-state-plan-program/#url=Factsheet

New Loan Program Helps Create Customer-Driven Non-Profit Health Insurers
http://www.cms.gov/CCIIO/Resources/Grants/new-loan-program.html

[bunnies]

121. Thats FANTASTIC news!

Thanks Pro! I wasnt aware of that.

[ProSense]

122. You're welcome. n/t