Regardless of who wins the election, the candidate who wins should begin his victory speech with the words, “I’m not the other guy.” Imagine the cheers. And then there is the preparation for the infamous Day One…but the “Not the Other Guy –In chief” will be less relevant than the makeup of Congress.
According to knowing predictors of the outcome, the House is likely to remain Republican-dominated and the Senate Democratic, the status quo in which case President Obama’s second term will have its ready-made excuse for inaction, namely the absence of democrats controlling both houses, and Republicans will get back to the work of trying to pass laws approved by the House but rejected by the Senate.
Perhaps this won’t be a bad thing as we get to further experience Affordable Care as its provisions continue to unfold and lumber through our economy.
For instance, this year’s benefits season will help illustrate what the ACA means for American wallets as individuals prepare to pay more in both premiums and out-of-pocket expenses in preparation for the inclusion of preventive care requirements and the removal of lifetime limits and preexisting conditions constraints slated to take effect in 2014.
Even if the makeup of Congress is the same, there will still be decisions to make regarding healthcare, significantly whether states opt into expanding Medicaid coverage and receiving additional Federal support for the expansion beginning in the year 2014.
For states, it’s important to note that leaving things the same is not a choice because of other changes that are occurring pursuant to the ACA, specifically the Disproportionate Share Hospital Payments.
Under section 1203 of the ACA entitled, “Disproportionate Share Hospital Payments,” Medicaid payments to hospitals in specific areas will be reduced. The Act justified these reductions based on the provision for expanded Medicaid which presumed a greater number of patients would be covered by Medicaid thereby reducing the need for the large payments to hospitals under this provision which provides money to hospitals for the expense of treating uninsured, indigent patients.
In the event that a state opts out of expanding Medicaid coverage, it does not simultaneously become eligible for its former Disproportionate Share Hospital Payments from the Federal government. The two provisions do not depend on one another. States that opt out of expanded Medicaid coverage for citizens will still face reduced Disproportionate Share Hospital Payments from the Federal government meaning that even if their uninsured populations remain unchanged, the costs of treating the uninsured will be greater because of the reduction in Disproportionate Share Hospital Payments.
There is an additional incentive for states to adopt expanded Medicaid coverage in the Act. The cost of Medicaid health insurance is essentially picked up by the Feds. Under the Affordable Care Act the Federal government will pick up the entire tab for new Medicaid participants from 2014 to 2016, 95 percent of the tab in 2017, 94 percent of the tab in 2018, 93 percent of the tab in 2019, and 90 percent from 2020 onward. This is an enormous amount of Federal contribution to the cost of Medicaid insurance coverage which usually pays more than half but less than 60 percent of the bill.
Whether your candidate wins or loses, within your own state your healthcare decisions and political participation are vital to helping shape how you and your fellow state citizens will experience healthcare.
