PJ Media

Two More Reasons Why 'Obamacare Delenda Est!'

Obamacare’s increasingly desperate apologists have touted increased Medicaid enrollment as one of the supposed high points of the disastrous HealthCare.gov rollout.

On November 13, Kathleen Sebelius’s Department of Health and Human Services announced that through November 2, “396,261 have been determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP).”

That figure is almost four times larger than the number of Americans — 106,185 — who at that point had selected Affordable Care Act plans. It remains to be seen how many in that ACA group will actually pay premiums when they come due in several weeks.

It also remains to be seen how many, especially among those who are eligible for tax subsidies, will pay more than the first month’s premium. As Tori Richards at Reason.com reported earlier this month, the horrifically misnamed “Affordable Care Act” allows tax subsidy benficiaries a three-month “grace period” which, thank to a Sebelius regulation, kicks in after just one premium payment. Previous industry practices generally allowed just one month’s grace, with the health insurance carrier absorbing the risk. Under Obamacare, “doctors and hospitals are left to collect unpaid bills” for the second and third month of the newly extended grace period.

A doctor I know has told me in an email that some surgeons are considering “paying the patient’s premium for them in order to get the surgical reimbursement.” Then they’ll “only” have to try to collect the premium(s) they advanced. How crazy is that?

Texas Congressman Louie Gohmert told Richards he is concerned that the extended grace period “will break the system” and “bankupt the people involved.” Bioethicist Wesley Smith went further: “The government wants people to be irresponsible and apparently they want the whole system to descend into chaos.” Perhaps the entire Obamacare enterprise really is, as its harshest critics have long alleged, a gigantic Cloward-Piven maneuver designed to create chaos and ultimately impose a single-payer system (i.e., total government control) on all of us.

Even if it’s not, what Obamacare has done to Medicaid is a case study in greedy authoritarianism gone wild.

It says something about how hard-up the left is when the best news about its history-making “accomplishment” is how many Americans have been added to the medical welfare rolls. Wait until you see how they’re roping people in.

The Affordable Care Act vastly expands a practice which began in the food-stamp program during the recession. That is, you can qualify for government handouts if you’re pretty well-off financially as long as your household income is below the program’s eligibility thresholds.

Most states have eliminated the food-stamp program’s previous asset test. In 2009, this contrived loophole enabled an Ohio couple with “over $80,000 in (the) bank, a 2001 Toyota and 2006 Mercedes Benz, and a $311,000 home that is paid for” to qualify for benefits; most of the benefits were “expedited.” Apparently, the idea of having to dig into your own pockets to provide for your basic needs in times of temporary financial stress has become passé.

The Affordable Care Act eliminates Medicaid’s asset test, and creates the roach motel of government welfare programs. Medicaid is no longer an “entitlement” you can choose to access. Instead, as Nicole Hopkins’ mother found out earlier this month, if you qualify under its new, lenient rules, HealthCare.gov forces your enrollment:

We checked and double-checked the information, but the only option still appeared to be Medicaid. She suggested clicking on “Apply for Coverage,” thinking that other options might appear.

Instead, almost mockingly, her “Eligibility Results” came back: “Congratulations, we received and reviewed your application and determined [you] will receive the health care coverage listed below: Washington Apple Health (the state of Washington’s version of Medicaid).”

* * * * * *

The page lacked a cancel button or any way to opt out of Medicaid. It was done; she was enrolled, and there was nothing to do but click “Next” and then to sign out.

So Medicaid is now mandatory for those who apply at HealthCare.gov and qualify — and as long as your income remains sufficiently low, you can never leave. Never mind if you believe, as Ms. Hopkins does, that “other people should (not) have to pay for my care, whether it be through taxes or otherwise.”

Beyond that, with the asset test gone, the web site forces even well-off households into the program, as long as their “Modified Adjusted Gross Income” is at or below 100 percent of the poverty level in states which have chosen not to take federal bribes to expand the program, and 138 percent in states which have.

This has led to the following “you can’t make up something this stupid” situation:

The father owns a $5 million house – entirely paid for. His kids attend expensive private schools. He owns three cars, but because he has earned his fortune and has stopped working, and his wife’s new start-up business has yet to produce an income stream, he is considered by the HealthCare.gov website to have no income.

The website put him on Medicaid.

There are no other options. This — not President Barack Obama’s “if you like your plan-doctor-provider, you can keep your plan-doctor-provider” — is how HealthCare.gov has been designed to work.

If you really think this is entirely the result of government incompetence, and that this man’s family can enjoy Uncle Sam’s largesse without financial worry, you haven’t heard of Medicaid’s Estate Recovery Act, a measure which requires states to claw back money spent by Medicaid from available assets in deceased beneficiaries’ estates.

Many people believe that this act only relates to nursing home and long-term care expenses, but that isn’t necessarily so. States “have the option of recovering the costs of all Medicaid services paid on the recipient’s behalf.” My tentative research indicates that roughly half of all states pursue recovery of all costs. Thus, it appears that a person’s estate will be liable for all Medicaid costs incurred while he or she and all other family members were enrolled in the program.

There’s more. Some states pay managed-care providers in some or all of their Medicaid programs on a “capitated” basis, i.e., a flat dollar amount per person per month. It appears that the estates of Medicaid beneficiaries in certain states are required to reimburse the government for capitated payments made — even if no medical services were rendered.

Over the long-term, the well-off are in effect really self-insured while they receive their “free” Medicaid.

This issue never really mattered before the asset test was dropped, because Medicaid beneficiaries have almost all been relatively poor. It matters now, because many won’t be, especially in states which have bought into Medicaid expansion.

I’m sorry, I’m not done yet. Even with the asset test gone, states will apparently continue to require Medicaid beneficiaries to complete annual asset disclosre forms. Even if they can’t do so now, am I really supposed to believe that cash-strapped states won’t work on pursuing reimbursement of Medicaid costs from the asset-rich but income-poor while they’re still alive through court action or new legislation?

So now we have another “unintended” (oh sure) consequence of Obamacare. The well-off are going to have to show enough income on their tax returns to ensure that the Medicaid leviathan doesn’t eventually capture part or perhaps even all of their wealth.

Thus, we can add yet another pair to an already extensive list of reasons why Obamacare must be repealed — or, as Bill Kristol wrote last week, “Obamcare deleda est!” It puts medical providers on the hook for their deadbeat patients, and it forces some of the well-off to enroll in a welfare program which recaptures both its real and imaginary costs upon death.

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