Far from bringing us closer to universal health care or coverage, Obamacare, a partnership between insurance companies and the federal government created a tepid, minimal requirement for health insurance policies focused largely on the cheap treats, finite costs of free checkups and preventive services, that left those ill arguably in a worse position than before with larger out of pocket expenses in the form of deductibles, copayments and coinsurance and an out of pocket maximum established by the government itself that could crush an individual or family dealing with illness.
While Democrats will pull all sorts of half-informative "metrics" and stats out to "prove" things are better, Obamacare is only a country success in a fairy-tale portrayal that ignores its rotten roots, the very partnership between government and insurers, allowing both to reduce their spending per capita through a variety of means.
But there was an Obamacare bright spot, the expanded Medicaid program that boomed, with states embracing the federal dollars to provide essentially free health insurance and health care not only to the economically disadvantaged, as the program was designed to help, but to an expanded group of those with income and potentially assets as they offered "eligibility" and coverage for those with income and removed any assets test.
But this false narrative has already Obamacized Medicaid. Medicaid program payments traditionally were shared by the states and federal government to provide health insurance and health care to the poorest, sickest individuals in our country. Under expanded Medicaid, the federal government picks up most of the bill, so it's a win for states. But how about the individuals?
Medicaid was designed as a fallback for those who couldn't obtain health insurance, not as a giveaway, or as a change to our healthcare/health insurance system. Governments have always had the right to come after the estates and potentially other assets of Medicaid recipients to help recoup their losses. So why haven't they?
What stopped an endless steady flow of states suing individuals for the Medicaid payments was that oftentimes this was not a money winner for states. After all, by its very nature Medicaid was available to those who had not enough to afford health insurance. Going after these individuals with limited assets was not lucrative for the states, especially since they had to share the money they got back with the federal government, because remember both state and federal contributed to coverage.
In 1993, the federal government decided to make it MANDATORY for the states to go after the estates of those 55 and over who had received Medicaid in order to recoup some of their money. This mandate was necessary for the very reason stated above, states weren't systematically going after the estates of people who were poor and incurring that administrative clog and expense just to recover money they would have to share with the federal government.
Enter Obamacare, expanding who is eligible for Medicaid, meaning that people with means were now eligible for free health insurance and health care within certain income constraints, though any consideration of their assets was put aside. Technically, this meant that someone who owns millions of dollars in assets can get the free treats from government. But remember, the 1993 law is still in place, so their assets are now subject to Medicaid cost recovery by the states on behalf of the states and the federal government.
There was never a free ride, but Obamacare made things worse for individuals seeking a solution to the outrageous costs of health insurance and health care which were not solved by Obamacare at all as evidenced by the explosion of new Medicaid enrollees.
But expanded Medicaid was just another Obamacare band-aid, designed to provide temporary relief so that the government could brag about all the newly insured AND get its money some other way, and it has.
Long before the idea of requiring those receiving Medicaid to work, which makes perfect sense post-Obamacare since Medicaid was changed into a type of welfare entitlement program rather than a government sponsored health insurance program for the poorest and sickest among us, states like New York expanded their definition of "estate" to have access to recover more assets.
Under Obamacare you can be above the poverty level, you can be working, you can have assets, you can be healthy and still be eligible for the program. Calling it Medicaid is a bit of a stretch and Obamacare designers knew it and therefore left the Medicaid recovery rules of 1993 in place, in addition to room for additional state and federal rulemaking to allow or mandate additional recovery options for governments.
It also made such rulemaking much more likely because the federal government pays for the majority of the costs of Medicaid under expanded Medicaid for these increased numbers of newly eligible people.
The drawbacks of this mislabeling of the expanded Medicaid as Medicaid and all the "celebratory" comments for the state of Virginia in the news this week, are a disappointing turn for Americans. Not only does Medicaid NOT offer free healthcare and health insurance, but in fact creates ongoing liability and potential recovery from government but it prevents real policy change to address the untouched health insurance and health crisis problems in the United States today.
Therefore, demand more from your "sources." Celebrating Medicaid expansion in Virginia is as foolhardy as celebrating the passage of Obamacare was based on false narratives. Medicaid is already a government sponsored program that has the tools for governments to recover their costs and those who choose Medicaid are gambling that neither their state nor the federal government will exercise that right.
