Under ACA some middle class folks may find themselves stuck in Medicaid

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by tap4154, Dec 12, 2012.

  1. tap4154

    tap4154 VIP Member

    Dec 8, 2012
    Thanks Received:
    Trophy Points:
    Surf City USA
    Up to 30% of businesses say that may drop employee coverage and pay the less expensive penalty/tax, which will dump many folks into the exchange. Also middle and lower income self-employed sub-contractors, small businesses, family farms and others will have their high deductible HC plans taken away, and either be forced to buy a more expensive comprehensive plan (I believe $2K is the max deductible under the ACA), or go into the exchange.

    Since in the exchange they will be assessed for subsidies via adjusted gross income, and not means-tested as far as assets, many who are having a few bad years economically (very low AGI, but have assets or savings to get by on) may end up being dumped into Medicaid, or have to go outside the exchange and pay much higher premiums for the lower deductible plan MANDATED by the ACA.

    So much for "if you like your coverage, you can keep it". HDHPs are a great alternative, and have been very popular, and can be linked to HSAs, but Obama is ripping that option away from us.

    Damn this is a MESS!


    Brandon Clark and Jim Frogue, co-founders of the government relations and consulting firm FrogueClark, told CBS Charlotte that a potential series of ramifications could be set in motion by the PPACA’s Medicaid expansion affecting those applying for coverage through their state’s health insurance exchange.

    “A lot of middle class individuals are going to apply for a state exchange… thinking they’re going to get a Blue Cross Blue Shield plan, or a United Plan, like they had before,” Clark said. “[But t]hey will find out they’re not on private health insurance, but rather, a state Medicaid program.”

    He specifically referenced Section 1311(d)(4)(F) of the PPACA, which states that “if through screening of the application by the Exchange, the Exchange determines that such individuals are eligible for [Medicaid, State Children’s Health Insurance Program (CHIP), or] any such program, [the Exchange shall] enroll such individuals in such program.”

    “A large number of families with family farms or small … businesses are going to go into their state health insurance exchange expecting to enroll in a traditional, commercial health insurance plan and end up on their state’s Medicaid program…” Clark said. “Because the law mandates the use of modified adjusted gross income, which includes numerous deductions, to determine eligibility, you could easily have a family of four or five making well over $50,000 per year ending up on Medicaid.”

    Frogue said that the climate created from a dwindling number of families on Blue Cross Blue Shield and United would lead to dangerous results.

    “The rates of families on Blue Cross Blue Shield or United will decline, and it’s unlikely doctors will want to continue seeing those people [on Medicaid] – it will create a ripple effect,” Frogue told CBS Charlotte. “There’s a physician shortage to begin with, and it’s just going to get worse.

    He added: “The Medicaid program pays far less for services, from a routine check-up to a certain procedure. Where the Blue Cross Blue Shield plan would pay hundreds, Medicaid would only pay $55 or $65.”

    Matt Salo, executive director of the National Association of Medicaid Directors, told CBS Charlotte that Medicaid has traditionally not paid providers well, resulting in weaker rated than Medicare or private providers.

    Could Enforcing Obamacare Result In A Negative Medicaid ‘Ripple Effect’? « CBS Charlotte
    Last edited: Dec 12, 2012

Share This Page