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SCOTUS on health reform – the bloggers respond – Part Two

The blogosphere’s view of the Supreme Court decision is nuanced, insightful, and often surprising. Following up on our late Thursday night report on initial reactions to the decision, this is a quick tour of “the best of” posts over the weekend.
We start off with views on the Supreme’s ruling that the Feds can’t cut off all Medicaid funding to states that don’t increase Medicaid coverage. Anthony Wright trenchantly observes:
“For the first three years, the federal government would pick up the cost of 100% of the newly eligible. In 2017-18, then the federal government picks up 95% of the tab, and then down to 90%, into the future. Even in the out years, the federal government is providing a 9:1 match.
In terms of investments in health care, or in terms of economic stimulus, there’s no place that can get you the bang-for-your-buck of a 9:1 match. Why would any Governor or Legislature reject this?
Over a dozen years ago, Congress created the SCHIP program, and allowed states to do a child health expansion voluntarily, with no tie to Medicaid funding. The SCHIP program provides a 2:1 match. And ultimately, 50 states took advantage of his benefit.”
Good take; I’d note the political winds have changed pretty dramatically over the last decade, and I would not be surprised to see some conservative govs stand on “principle” and refuse free money even if it gets their poorest citizens health care.
Bob Laszewski notes the 29 governors who’ve expressed outrage/concern/anger over the Feds attempt to require them to expand Medicaid coverage now are in the driver’s seat:
“Whether or not their state gets a Medicaid expansion is now entirely up to them. It’s put up or shut up time for conservative governors and state legislators who said the ACA was an onerous expansion of federal powers over their states.
If some states do reject the Medicaid expansion, consumers between 100% of poverty and 133% of poverty would become eligible for the private federally subsidized insurance in the exchanges since the subsidies start at 100% of poverty.”
Nathan Cortez at Health Reform Watch took the dissenting Justices to task; “What disappoints me about the joint dissent (by Alito, Kennedy, Scalia, and Thomas) is that it doesn’t seem to appreciate why health insurance is a unique problem of unique scale that requires unique solutions like mandates. How do you pretend that the uninsured are pre-commerce? How do you pretend a $2.5 trillion industry doesn’t exist?”
Neil Versel is still surprised about Chief Justice John Roberts’ support of ACA; he also notes that ACA is no panacea, and health care in the US is still, well, in need of improvement. Lots of improvement.
I’ve been reading a history of the New Deal; much of the legal footing for the dramatic expansion of governmental programs was based on the Constitutionally-established ability of the Federal government to tax. One book does not a scholar make, but the precedence is well-established and rock-solid.
I posted Friday about the impact of the decision on workers comp; overall, it is good news indeed – healthier claimants with more coverage = lower work comp costs, although access to primary (and some specialty) providers is going to be tight indeed for several years to come.
Finally, Jaan Sidorov has been tracking goings-on here whilst on vacation in Sweden; he thinks reform is here to stay, and we better get used to it.

One thought on “SCOTUS on health reform – the bloggers respond – Part Two”

  1. If ACA is so odious to Republicans, then how do they propose to alleviate the national health care problem? If private initiative is so far more effective a solution for grave, gnawing societal issues, how is it that we cannot seem to extricate ourselves from this dilemma? If taxes are unacceptable no matter their source or magnitude, then what is the role of government, if any? Should we be content with politicians, and lobbyists, that continue to ignore reality?

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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