Screw Medicaid Expansion:

[Sun Devil 92]

Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage

The article shows that having insurance improves outcomes. Private insurance.

**********************************************************************

As you may know if you’re a regular reader of The Apothecary, the left has systematically ignored the mountains of clinical evidence showing that the Medicaid program doesn’t actually make people healthier. Given that Obamacare is designed to achieve half of its coverage expansion via Medicaid, you can understand why: if Medicaid doesn’t make people healthier, a significant chunk of Obamacare is wasted money. But the other chunk of Obamacare—the one that expands coverage using subsidized private-sector coverage—could indeed have an impact on health outcomes. An important new study, following the health outcomes of Romneycare in Massachusetts, shows us how.

^^^^^^^^^^

The usual Obamacare cheerleaders on the left are arguing that the AIM study is one more reason to expand Medicaid. But the opposite is true. The study gives us no evidence that Medicaid improved health outcomes, because Romneycare expanded coverage primarily through private insurance.

And it turns out that the number of people with private coverage actually goes up if you don’t expand Medicaid in your state.

There are two reasons for this. The first is that eligibility for Obamacare’s exchanges expands if you don’t expand Medicaid. In states that do expand Medicaid, exchange subsidies are available for people whose incomes are between 138 and 400 percent of the federal poverty level. In states that don’t expand Medicaid, people with incomes between 100-138 percent of FPL also become eligible for the exchanges.

In addition, a good chunk of those who are uninsured and would qualify for Medicaid under an expansion already have access to coverage through their employers. For example, a study of Medicaid expansion in New Hampshire by the Lewin Group found that, of the state population eligible for the Medicaid expansion, three-fifths would gain private coverage through either their employers or the exchanges if the state didn’t expand Medicaid.

 

[Fenton Lum]

The private insurance industry

Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage

The article shows that having insurance improves outcomes. Private insurance.

**********************************************************************

As you may know if you’re a regular reader of The Apothecary, the left has systematically ignored the mountains of clinical evidence showing that the Medicaid program doesn’t actually make people healthier. Given that Obamacare is designed to achieve half of its coverage expansion via Medicaid, you can understand why: if Medicaid doesn’t make people healthier, a significant chunk of Obamacare is wasted money. But the other chunk of Obamacare—the one that expands coverage using subsidized private-sector coverage—could indeed have an impact on health outcomes. An important new study, following the health outcomes of Romneycare in Massachusetts, shows us how.

^^^^^^^^^^

The usual Obamacare cheerleaders on the left are arguing that the AIM study is one more reason to expand Medicaid. But the opposite is true. The study gives us no evidence that Medicaid improved health outcomes, because Romneycare expanded coverage primarily through private insurance.

And it turns out that the number of people with private coverage actually goes up if you don’t expand Medicaid in your state.

There are two reasons for this. The first is that eligibility for Obamacare’s exchanges expands if you don’t expand Medicaid. In states that do expand Medicaid, exchange subsidies are available for people whose incomes are between 138 and 400 percent of the federal poverty level. In states that don’t expand Medicaid, people with incomes between 100-138 percent of FPL also become eligible for the exchanges.

In addition, a good chunk of those who are uninsured and would qualify for Medicaid under an expansion already have access to coverage through their employers. For example, a study of Medicaid expansion in New Hampshire by the Lewin Group found that, of the state population eligible for the Medicaid expansion, three-fifths would gain private coverage through either their employers or the exchanges if the state didn’t expand Medicaid.

The private insurance industry provides Wall Street returns for the private insurance industry. That is it's purpose. Same for your private prison industry and your private war/military occupation industry.

 

[usmbguest5318]

Medicaid program doesn’t actually make people healthier... [...] no evidence that Medicaid improved health outcomes...

On being healthier:
Very few things make people healthier. Lots of medical treatment procedures and regimens keep people from becoming less healthy. The two are not the same things. Are you sure Medicaid aims to make people healthier? It's not clear to me that's at all what Medicaid (or Medicare, for that matter) aims to achieve.

From CMS' strategy statement, their goal is "to leverage our internal resources and external partnerships to fulfill our mission – as an effective steward of public funds, CMS is committed to strengthening and modernizing the nation’s health care system to provide access to high quality care and improved health at lower cost." CMS also says, that it has a goal of "prevention and health" -- a profoundly vague and ambiguously stated goal to say the least -- which CMS ostensibly (presumably?) seems to assert will in turn result from their achieving the stated goal above. It is important to note that whereas doctors are concerned with doing what they can with regard to individuals' health, CMS takes a macro view and approach. They are concerned with enabling the citizenry on the whole accessing the care that will benefit their health status, but boosting/maintaining individuals' health status (healthiness) remains exclusively the goal of healthcare providers, not CMS and not private sector institutional payers.

Unless and until one recognizes that insurance companies/payers are not tasked with boosting health, one will surely conflate outcomes sought and achieved by insurers -- public and private -- with those pursued and reached by providers and recipients of healthcare. Politically, that happens often enough by one's merely

Examples of things that make people healthier (as opposed to preventing or slowing health deterioration):

• Losing weight, if one is obese
• Smoking cessation, provided one smokes
• Not using drugs recreationally
• Consuming only a small amount of alcohol
• Eating a balanced diet, if one doesn't already have one
• Consuming certain foods that are known to reduce one's risk of getting various maladies

The health outcome of doing/not doing the things above is that one becomes more or less healthy.

Most procedures and treatments don't alter one's health status and risks, i.e., make one healthier, but many of them fix what's already "broken," whereby "broken" refers to a malady's being either chronic or acute.

• For instance, with regard to, say, cancer, one's health status/risk is what it is, and one either will or will not develop cancerous cells in one or another part of one's body as a consequence of their health status, their healthiness. Cancer treatments can attenuate the growth and/or spread of cancer, but as far as one's health status, susceptibility to getting cancer, well, that's not changing. One already got cancer, whereas a healthier person would not get it in the first place. One cannot "un-get" cancer. Even if the treatment removes the cancer, the only way one isn't going to again get that particular form of cancer is to have removed the types of cells that became cancerous, but one's getting that form of cancer has no bearing on one's risk for a different form of cancer. It's a dubious proposition to argue that one is healthier without a body part with which one is born.
  • Understanding Your Risk of Developing Secondary Cancers
    
  • Second Cancers After Breast Cancer
    
  • How does chemotherapy affect the risk of second cancers? | American Cancer Society
    
  • Risk Factors
• When it comes to acute, rather than chronic, maladies, things are slightly different. A person with a broken limb, for instance, is less able than they are without a broken limb, but they aren't more or less healthy. If one has a heart attack, staving off the worst consequense(s) of the cardiac arrest does not make one healthier beyond one's being alive, thus the term "healthy" at least relevant to some degree, instead of dead, which is neither more or less healthy insofar as "dead" is the absence of health, not a qualitative/existential state of health. One's heart disease is not gone because one survives the heart attack. Bypass surgery does not eliminate heart disease; it provides an alternative modality by which the heart can function adequately while remaining diseased.
• When it comes to medical treatments, some of them improve one's health. For instance, an antibiotic that works improves one's health. It kills the harmful bacterium that infests one's body, and once the bacterium is gone, one is indeed healthier than one was with the bug. Other medical treatment regimens improve health too provided the side effects don't, on net, worsen it -- some examples may include cholesterol and blood pressure reducers, aspirin to thin the blood and reduce the risk of clotting, etc.
• There are also some procedures that sort of improve one's health. When a doctor runs a "scrub brush" through one's arteries/veins and drags out the cholesterol, yes, one is healthier after the procedure. Whether one's health is indeed improved depends on whether the conditions/behaviors that caused the vessels to clog with fat remain after the "cleaning." The same concepts apply with certain other procedures such as a clot removal and not with others like a bypass or chemotherapy.

In short, one is healthier when an action reduces below "standard" one's risk of getting a malady. Once one has acquired a given malady, one's risk for getting it is 100%. Only revisionist history will alter that, but modern medicine and its techniques may be able to lower one's future risk, assuming one survive the ailment.

Having written the above, don't think I don't realize that in laymen's terms, in laymen's minds, "better than before" is much the same as "healthier." That understanding of the matter is perfectly fine when discussing one's own or another's health among friends and in a casual context. In the context by which public and private organizations like CMS, health insurers, and healthcare providers deliver the various health-related goods and services they do, one must realize they don't apply nearly so blasse a meaning to their goals, methods, tools' efficacy/effectiveness, etc.

Here, we're discussing the CMS' goals; thus an accurate and precise understanding of what CMS says it's trying to do, rather than what citizens may wish CMS aims to do, must be applied for it's the only way to soundly analyze the matter and CMS's performance. When one asserts one aims to accomplish, regardless of what another's normative stance on one's aims, the only fair basis for evaluating one's achievement is based on what one said one wants to accomplish.


Considering the Manhattan Institute study cited:
The Manhattan Institute's study is what it is, but there are plenty of countervailing studies that show that Medicaid facilitates not only positive health outcomes, but also positive non-health-related outcomes.

• The Oregon Health Insurance Experiment
  
• Childhood Medicaid Coverage and Later Life Health Care Utilization
  
• THE EFFECT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT MEDICAID EXPANSIONS ON FINANCIAL WELL-BEING
  
• MEDICAID AS AN INVESTMENT IN CHILDREN: WHAT IS THE LONG-TERM IMPACT ON TAX RECEIPTS?
  
• Medicaid Expansion Producing State Savings and Connecting Vulnerable Groups to Care

And all that's before one considers that the Manhattan Institute is an organization that, in essence, defines its conclusions prior to performing its studies. It's not that they don't present facts; they do, but they "load" and "color" them rather than presenting them objectively so the facts can speak for themselves.

Romneycare vs. Obamacare:

(See also: Obamacare vs Romneycare - Difference and Comparison | Diffen)​

In comparing and contrasting R-care and O-care, there's a 10 ton elephant in the room: there aren't any fundamental differences between them, but there are minor ones. In the words of Jon Gruber, the key architect of both policies, "They're the same f*cking bill." As for the details, see the link listed below the chart above or click on the chart itself.

Here's the thing, however, if the Medicare expansion doesn't work in O-care, it works neither better nor worse in R-care. Yet the Forbes article cited asserts that O-care's Medicaid expansion merits being opposed, yet doesn't make the same claim about the same expansion in Massachusetts. The Medicaid expansion didn't get better or worse merely because Democrats implemented it.

 

[Moonglow]

They would need to amend the interstate commerce clause and I don't think Congress wants to work that hard....They get special treatment by corporations to keep it stuck up our asses as deep as they can go on cost...

 

[Sun Devil 92]

The private insurance industry

Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage

The article shows that having insurance improves outcomes. Private insurance.

**********************************************************************

As you may know if you’re a regular reader of The Apothecary, the left has systematically ignored the mountains of clinical evidence showing that the Medicaid program doesn’t actually make people healthier. Given that Obamacare is designed to achieve half of its coverage expansion via Medicaid, you can understand why: if Medicaid doesn’t make people healthier, a significant chunk of Obamacare is wasted money. But the other chunk of Obamacare—the one that expands coverage using subsidized private-sector coverage—could indeed have an impact on health outcomes. An important new study, following the health outcomes of Romneycare in Massachusetts, shows us how.

^^^^^^^^^^

The usual Obamacare cheerleaders on the left are arguing that the AIM study is one more reason to expand Medicaid. But the opposite is true. The study gives us no evidence that Medicaid improved health outcomes, because Romneycare expanded coverage primarily through private insurance.

And it turns out that the number of people with private coverage actually goes up if you don’t expand Medicaid in your state.

There are two reasons for this. The first is that eligibility for Obamacare’s exchanges expands if you don’t expand Medicaid. In states that do expand Medicaid, exchange subsidies are available for people whose incomes are between 138 and 400 percent of the federal poverty level. In states that don’t expand Medicaid, people with incomes between 100-138 percent of FPL also become eligible for the exchanges.

In addition, a good chunk of those who are uninsured and would qualify for Medicaid under an expansion already have access to coverage through their employers. For example, a study of Medicaid expansion in New Hampshire by the Lewin Group found that, of the state population eligible for the Medicaid expansion, three-fifths would gain private coverage through either their employers or the exchanges if the state didn’t expand Medicaid.

The private insurance industry provides Wall Street returns for the private insurance industry. That is it's purpose. Same for your private prison industry and your private war/military occupation industry.

Except this study shows that outcomes improve with private insurance.

Not so with Medicaid.

Can't help that.

 

[Conservative65]

Medicaid program doesn’t actually make people healthier... [...] no evidence that Medicaid improved health outcomes...

On being healthier:
Very few things make people healthier. Lots of medical treatment procedures and regimens keep people from becoming less healthy. The two are not the same things. Are you sure Medicaid aims to make people healthier? It's not clear to me that's at all what Medicaid (or Medicare, for that matter) aims to achieve.

From CMS' strategy statement, their goal is "to leverage our internal resources and external partnerships to fulfill our mission – as an effective steward of public funds, CMS is committed to strengthening and modernizing the nation’s health care system to provide access to high quality care and improved health at lower cost." CMS also says, that it has a goal of "prevention and health" -- a profoundly vague and ambiguously stated goal to say the least -- which CMS ostensibly (presumably?) seems to assert will in turn result from their achieving the stated goal above. It is important to note that whereas doctors are concerned with doing what they can with regard to individuals' health, CMS takes a macro view and approach. They are concerned with enabling the citizenry on the whole accessing the care that will benefit their health status, but boosting/maintaining individuals' health status (healthiness) remains exclusively the goal of healthcare providers, not CMS and not private sector institutional payers.

Unless and until one recognizes that insurance companies/payers are not tasked with boosting health, one will surely conflate outcomes sought and achieved by insurers -- public and private -- with those pursued and reached by providers and recipients of healthcare. Politically, that happens often enough by one's merely

Examples of things that make people healthier (as opposed to preventing or slowing health deterioration):

• Losing weight, if one is obese
• Smoking cessation, provided one smokes
• Not using drugs recreationally
• Consuming only a small amount of alcohol
• Eating a balanced diet, if one doesn't already have one
• Consuming certain foods that are known to reduce one's risk of getting various maladies

The health outcome of doing/not doing the things above is that one becomes more or less healthy.

Most procedures and treatments don't alter one's health status and risks, i.e., make one healthier, but many of them fix what's already "broken," whereby "broken" refers to a malady's being either chronic or acute.

• For instance, with regard to, say, cancer, one's health status/risk is what it is, and one either will or will not develop cancerous cells in one or another part of one's body as a consequence of their health status, their healthiness. Cancer treatments can attenuate the growth and/or spread of cancer, but as far as one's health status, susceptibility to getting cancer, well, that's not changing. One already got cancer, whereas a healthier person would not get it in the first place. One cannot "un-get" cancer. Even if the treatment removes the cancer, the only way one isn't going to again get that particular form of cancer is to have removed the types of cells that became cancerous, but one's getting that form of cancer has no bearing on one's risk for a different form of cancer. It's a dubious proposition to argue that one is healthier without a body part with which one is born.
  • Understanding Your Risk of Developing Secondary Cancers
    
  • Second Cancers After Breast Cancer
    
  • How does chemotherapy affect the risk of second cancers? | American Cancer Society
    
  • Risk Factors
• When it comes to acute, rather than chronic, maladies, things are slightly different. A person with a broken limb, for instance, is less able than they are without a broken limb, but they aren't more or less healthy. If one has a heart attack, staving off the worst consequense(s) of the cardiac arrest does not make one healthier beyond one's being alive, thus the term "healthy" at least relevant to some degree, instead of dead, which is neither more or less healthy insofar as "dead" is the absence of health, not a qualitative/existential state of health. One's heart disease is not gone because one survives the heart attack. Bypass surgery does not eliminate heart disease; it provides an alternative modality by which the heart can function adequately while remaining diseased.
• When it comes to medical treatments, some of them improve one's health. For instance, an antibiotic that works improves one's health. It kills the harmful bacterium that infests one's body, and once the bacterium is gone, one is indeed healthier than one was with the bug. Other medical treatment regimens improve health too provided the side effects don't, on net, worsen it -- some examples may include cholesterol and blood pressure reducers, aspirin to thin the blood and reduce the risk of clotting, etc.
• There are also some procedures that sort of improve one's health. When a doctor runs a "scrub brush" through one's arteries/veins and drags out the cholesterol, yes, one is healthier after the procedure. Whether one's health is indeed improved depends on whether the conditions/behaviors that caused the vessels to clog with fat remain after the "cleaning." The same concepts apply with certain other procedures such as a clot removal and not with others like a bypass or chemotherapy.

In short, one is healthier when an action reduces below "standard" one's risk of getting a malady. Once one has acquired a given malady, one's risk for getting it is 100%. Only revisionist history will alter that, but modern medicine and its techniques may be able to lower one's future risk, assuming one survive the ailment.

Having written the above, don't think I don't realize that in laymen's terms, in laymen's minds, "better than before" is much the same as "healthier." That understanding of the matter is perfectly fine when discussing one's own or another's health among friends and in a casual context. In the context by which public and private organizations like CMS, health insurers, and healthcare providers deliver the various health-related goods and services they do, one must realize they don't apply nearly so blasse a meaning to their goals, methods, tools' efficacy/effectiveness, etc.

Here, we're discussing the CMS' goals; thus an accurate and precise understanding of what CMS says it's trying to do, rather than what citizens may wish CMS aims to do, must be applied for it's the only way to soundly analyze the matter and CMS's performance. When one asserts one aims to accomplish, regardless of what another's normative stance on one's aims, the only fair basis for evaluating one's achievement is based on what one said one wants to accomplish.


Considering the Manhattan Institute study cited:
The Manhattan Institute's study is what it is, but there are plenty of countervailing studies that show that Medicaid facilitates not only positive health outcomes, but also positive non-health-related outcomes.

• The Oregon Health Insurance Experiment
  
• Childhood Medicaid Coverage and Later Life Health Care Utilization
  
• THE EFFECT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT MEDICAID EXPANSIONS ON FINANCIAL WELL-BEING
  
• MEDICAID AS AN INVESTMENT IN CHILDREN: WHAT IS THE LONG-TERM IMPACT ON TAX RECEIPTS?
  
• Medicaid Expansion Producing State Savings and Connecting Vulnerable Groups to Care

And all that's before one considers that the Manhattan Institute is an organization that, in essence, defines its conclusions prior to performing its studies. It's not that they don't present facts; they do, but they "load" and "color" them rather than presenting them objectively so the facts can speak for themselves.

Romneycare vs. Obamacare:

(See also: Obamacare vs Romneycare - Difference and Comparison | Diffen)​

In comparing and contrasting R-care and O-care, there's a 10 ton elephant in the room: there aren't any fundamental differences between them, but there are minor ones. In the words of Jon Gruber, the key architect of both policies, "They're the same f*cking bill." As for the details, see the link listed below the chart above or click on the chart itself.

Here's the thing, however, if the Medicare expansion doesn't work in O-care, it works neither better nor worse in R-care. Yet the Forbes article cited asserts that O-care's Medicaid expansion merits being opposed, yet doesn't make the same claim about the same expansion in Massachusetts. The Medicaid expansion didn't get better or worse merely because Democrats implemented it.

Let's compare Obamacare and Romney care. However, the comparison won't be on the specific items but the level of government at which each took place. Obamacare was done on the national level despite no specific authority in the Constitution granting the federal government power to regulate healthcare. Romneycare was done at the state level, and despite my opposition to government being involved in the healthcare industry, it was done in accordance with the 10th Amendment of the Constitution. Unless someone that supports Obamacare can show me the word "healthcare" in the delegated powers of Congress, I don't have to agree with it happening in Massachusetts to agree that if a STATE chooses to do it, they have the reserve power to do it in their STATE.

 

[dblack]

Let's compare Obamacare and Romney care. However, the comparison won't be on the specific items but the level of government at which each took place. Obamacare was done on the national level despite no specific authority in the Constitution granting the federal government power to regulate healthcare. Romneycare was done at the state level, and despite my opposition to government being involved in the healthcare industry, it was done in accordance with the 10th Amendment of the Constitution. Unless someone that supports Obamacare can show me the word "healthcare" in the delegated powers of Congress, I don't have to agree with it happening in Massachusetts to agree that if a STATE chooses to do it, they have the reserve power to do it in their STATE.

But socialism doesn't work if people can just move to another state to avoid it.

 

[Sun Devil 92]

Let's compare Obamacare and Romney care. However, the comparison won't be on the specific items but the level of government at which each took place. Obamacare was done on the national level despite no specific authority in the Constitution granting the federal government power to regulate healthcare. Romneycare was done at the state level, and despite my opposition to government being involved in the healthcare industry, it was done in accordance with the 10th Amendment of the Constitution. Unless someone that supports Obamacare can show me the word "healthcare" in the delegated powers of Congress, I don't have to agree with it happening in Massachusetts to agree that if a STATE chooses to do it, they have the reserve power to do it in their STATE.

But socialism doesn't work if people can just move to another state to avoid it.

Isn't the general claim that people will move to that state to benefit from the government goodies.....

Until they see the tax bill.......