No, reducing medical bankruptcy was an explicit goal of expanding access to insurance.
Here's text from the legislation:
Half of all personal bankruptcies are caused in part by medical expenses. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will improve financial security for families.
Which is just another hidden cost of not having universal healthcare -- when a hospital can't recover $250,000 in cancer treatment costs due to a bankrupty, they have to make it up somewhere else, so we end up paying $17 for a 10 cent ibuprofen pill in the hospital.
Uncompensated care (including bad debt and costs they choose to forgive) is a measurable portion of costs for most hospitals but it isn't that extreme.
I doubt hospitals have cost accounting systems sophisticated enough for them to have any idea what the cancer treatment costs, just as Verizon doesn't know how much it costs for you to talk on the phone for fifteen minutes. Just because they billed $250,000 doesn't mean that's what it cost or even that they ever expected to actually receive $250,000.
Besides, apparently the goal of universal healthcare was to allow everybody to still receive the "$250,000" cancer treatment that they were getting before universal healthcare. This suggests that both with and without universal healthcare, the cancer treatment was being provided, so not having universal healthcare did not actually create another cost.
This isn't trivial nitpicking: the ACA was sold as something that would reduce costs. This was mostly false. The real aim of the ACA was to raid the pockets of more people. Before, there was a "$250,000 cancer treatment" and the insured paid for it with a "$17 ibuprofen." The true objective of the ACA was to keep the "$250,000 cancer treatment" but instead pay for it by raiding the pockets of young, healthy people who previously did not have insurance.
It turns out that raiding the pockets of young, healthy people is not so politically popular. They didn't have insurance for a reason--it's expensive! Their unemployment and student debt is already high, and they already have to pay for old people through Social Security and Medicare tax. Yet the ACA wanted to use those young people, who would pay premiums, use little health care, and thus help pay for more "$250,000 cancer treatments".
Now this political dishonesty is blowing back, as the insurance markets are under strain because the young healthies still aren't getting insurance to help pay for the cancer treatments that others get.
I don't think your raiding pockets of kids goes with reality. Why then did ACA let kids stay on parents insurance to 26 even if married? Millions of kids got free insurance by hopping on their parents plan. Millions of kids got better medical treatment for no money out of their pocket.
ACA isn't perfect but it's way better than we had before.
I'm sorry, but in what reality is this "political dishonesty" "blowing back"? The ACA has overwhelming support in most US populations by a wide margin.
So everyone has to pay into insurance including people who don't use it normally.
This is an interesting story, but correlation is not causation. The article even admits this, stating "The truth is that it’s not that easy to determine how many bankruptcies are caused by medical debt. Examining the paperwork doesn’t always offer insight because debtors often juggle their indebtedness, for example, using a credit card to pay an outstanding medical bill while leaving other debts unpaid."
Yeah I'm surprised that the just picked a single year (2010) instead of the 10 year average prior to 2012, the year ACA took effect.
Agree that the housing crash likely elevated bankruptcies. A number of states have laws where even if the bank takes your house in a short sale, they can go after you personally for the remainder of the loan.
It's also well known that study considered any bankruptcy with the slightest smidgen of medical debt to be a medical bankruptcy. Edit: or expenses. Over $1000 in expenses over 2 years and you're in that category.
Or bankruptcies started coming back down again after the 2008 crash. Note that their graph/data start in 2009 - if you include years before that, this "result" no longer makes any sense.
Does everyone here understand that the ACA much promoted "twenty-seven million people now have insurance" is a complete farce? The number keeps expanding, of course, and it is a tragedy of almost unimaginable proportions.
OK, with great claims one must offer solid evidence. No problem, I accept this responsibility. Thankfully this is a rather easy task.
The great majority of these 27 million people are on what's known as Medicaid.
Is Medicaid health insurance?
No, it is not. Medicaid is a loan.
What?
Medicaid is a loan from the government. It is, if one wishes to interpret it this way, no different from taking out a home equity line of credit.
In other words, you must repay what you spent.
Yes, care you receive under Medicaid must --BY LAW-- be repaid. And, when your lender is the government the realities of dealing with the worst possible kind of loan shark --one with overwhelming power-- can and do easily surface.
Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:
Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan.
And here's where it gets ugly: The State, again, by law, is obligated to seek repayment for services offered and can --and does-- attach your property in the process of doing so.
Medicaid is a program that has convinced people they have medical insurance when, in reality, they have a loan. And this loan can and does cost them their estate as the State automatically becomes the first lien holder once you are on Medicaid.
Please don't take my word for it. Here it is from the horse's mouth:
Here's another source with a revelation that should terrify anyone:
"if the property is sold while the Medicaid beneficiary is living, not only will the beneficiary cease to be eligible for Medicaid due to the cash from the sale, but the beneficiary would have to satisfy the lien by paying back the state for its coverage of care to date"
They should have added "refinanced" to that statement.
For the most part, people getting Medicaid under Medicaid expansion don't have any assets to speak of and won't owe the government anything for services they receive under Medicaid (they are the "working poor").
It certainly is the case that the nursing home care paid for by Medicaid is intended to be a last resort, after other resources are exhausted. So of course it examines other resources.
Here are a few examples of people under the age of 26 who are on Medicaid:
California, 57%
Colorado, 69%
Idaho, 73%
Wyoming, 75%
etc.
The only way your assertion is true is if these are worthless and will never make anything out of their lives. Which, of course, isn't true at all.
And so, a young person is shoved into Medicaid and convinced they have medical insurance when, in reality, they are accumulating debt with the government.
And, yes, as life goes on they see some success perhaps buy a house and have an investment or two and never realize the hook that got sunk and set into them when they were younger.
In California alone well over six million people under 27 years of age are walking around thinking they have medical insurance.
Even if this wasn't the case, let's turn things around a bit.
Say an insurance company, Nefarious Unlimited, was issuing medical insurance policies --real insurance-- with a hidden clause in them. The minute the insurance buyer signs on the dotted line Nefarious Unlimited is given the right to recover 100% of their costs from the persons estate. As little or as much as they might have.
Of course, Nefarious Unlimited does not inform their customers that the product they are buying is actually a loan rather than real medical insurance. They even go on TV to advertise it and tout the millions of "satisfied customers" they have.
Nefarious Unlimited would be brought-up on fraud charges so fast your head would spin. The entire board and management would probably --and rightly so-- end-up in jail. Nobody would argue with this outcome.
You see, whether or not a person has a large estate this is wrong, fraudulent and immoral. That is the point you are missing in addition to the above.
This is our government engaged in fraud of the worst kind. This should not be OK with anyone.
This isn't about political lines. This is about basic human decency and exists at the most basic levels of right and wrong.
There's no recovery mechanism for younger people, they get services and that's it. There's income and asset tests that happen before services are delivered.
You need to carefully reexamine who the asset recovery provisions actually apply to. Among other things, it'd save you time writing lengthy comments about your mistaken conclusion.
I have read all of it and then some. I have even spent money to consult with three different attorneys on the subject as my family became concerned about how this mechanism would affect our parent's estate.
You can find various corner cases where Medicaid estate recovery isn't an issues. Yes. Yet this is NOT reality for the vast majority of those being shoved into the program by the tens of millions.
I am very well informed on this front, having sought the advice of top attorneys in this domain. This is very real. You can choose to study the links I provided and educate yourself or reject it while armed with imperfect information.
In the end reality isn't modified. We'll probably start seeing the effects of this during the next twenty years. Maybe then people will wake up.
Older people mostly get health benefits from Medicare.
Medicaid is intended to be a further benefit for people that have low incomes.
It's only surprising that it examines an estate if you don't understand that it isn't designed to be anything more than a benefit of last resort.
Sure, you can't have Medicaid pay for your parents care and also keep their estate. But this isn't mind blowing information, it's the way the law was designed to work and something anyone involved in estate planning would know off hand.
You really need to do a bunch of research and reading.
Here's a tid-bit:
Quote:
"Does Medicare Pay For Long Term Care?
NO. After a 3 day hospital stay, Medicare pays 100% of the cost, but only for the first 20 days of skilled nursing care. For days 21 through 100, you are responsible for a co-payment. As of this date, the daily co-pay rate is $148 per day.
But it gets worse: After 100 days of care in a nursing home, Medicare stops paying altogether, and you are responsible for all future costs, unless there is a new 3 day qualifying hospital stay (which then re-sets the 100 day clock).
You also need to be aware that Medicare does not pay for “custodial care.” If you or a loved one are in need of custodial care, it must be paid for either by writing a check, by private long-term care insurance, or by Medi-Cal."
I am not going to bother providing you with links because you are obviously not reading anything. If you are truly interested in understanding the issues you need to spend half a day googling around to build a better image of what reality looks like.
Also, my wife is a doctor. She, among other things, has dealt with precisely the segment "served" by all of these programs for at least ten years. She has left that practice. And so have tons of doctors. This is the other side of the equation.
These programs work for some but, on the aggregate, they are a disaster. It is impossible for doctors to provide good care. Patients are getting screwed right and left. My wife would easily see a dozen patients a week for free because there was no possible way to justify doing it under these programs.
The vast majority of people are extremely ignorant of the realities in US health care.
The issue here isn't that you are claiming that Medicaid is means tested (it is), the issue is that you are mixing up the rules for one group of people with the rules for another.
It's a fine thing if you want to argue that Medicaid should more generously protect the assets of the elderly, go ahead. Just don't make shit up out of whole cloth about how a young mother is going into debt to the government when she and her child have bills paid through Medicaid. That's just flat out not true. Maybe ask your doctor wife about that.
I do understand that Medicare doesn't do much for long term care. But long term care isn't a big source of the million dollar medical events you are ranting about, absent the need for further medical care, it generates a reasonably predictable monthly bill.
I believe you are reading the chart wrong. This is a break down of the distribution of Medicaid by age. 57% of Medicaid recipients in California are under the age of 26.
No, I got it right. You can click on a radio button and get a head count instead of the percentage. Both pieces of information are useful. What it does say is that the overwhelming majority of people on Medicaid are what I would term as "young", say, somewhere around 50 or younger.
And, before you say 50 is old. I know plenty of people who have started businesses and entire new careers in their 40's and 50's. This ain't the 1920's.
You keep pushing on this. I guess I have to spell it out for you.
To be precise, Medicaid is obligated to recover cost of services provided at or after 55 years of age.
OK. Fine.
So CA enrolls twelve million people. Some young some older.
Do these people not age?
Of course they do. So, presumably, they are going to be on Medicaid for a very long time. Maybe their entire lives.
OK. That's established. People age. They think they have health insurance. Yet, they actually don't.
Out of those 12 million roughly 2.2 million were 45+ years old. One million were 65+.
So that 55+ event horizon, we could say, is very close for millions of people being shoved into Medicaid.
In fact, nationwide, about 14.5 million people 45+ were enrolled. Out of those, about 6.4 million were 65+.
These are not insignificant numbers. Source [1]
BTW, these numbers are for FY2011 when we had about 32 million people enrolled in Medicaid. Due to Obamacare and other factors we now have over 74 million and are well on our way to the 100 million mark. Finding current data seems to require a lot of work. You are welcome to do it if you want to be accurate. For now...let's double the numbers above:
45+ 28 million.
65+ 13 million.
So we are looking at roughly 41 million people at or past the threshold for estate recovery. And, of course, millions more that will eventually get there if they don't pop out of Medicaid or if they are shifted back into it because health insurance becomes too expensive.
41 million and counting. All subject to estate recovery or within a few years of it.
I, quite literally, don't understand what you are arguing about.
This is a real problem. People age and live well beyond 55 years of age. My Dad is 90. He had cancer when he was 70. That was 20 years ago. And, like him, millions of people. And most of them don't have a clue that Medicaid is debt they accumulate with the government, not health insurance.
There's another reality: Older people have greater healthcare needs. I read a report showing that the average need for a healthy older adult is around $10K per year. That being true, had my father not had a serious condition --had he been of average health-- he would have racked-up somewhere around $350,000 in medical debt to the government while on Medicaid. The actual number is closer to a million bucks.
A million dollars of debt to the government. And we call this insurance?
Let's see you face that reality and see how you react.
I'm getting sick of saying this. All of this bullshit still misses the greater point:
-------------------
We should not have a program that is falsely promoted as "health insurance" that actually has the government sink it's hooks into people's estates.
-------------------
That is immoral. It is objectively wrong. It is also fraudulent. Obamacare reports taut "27 million insured". No. It's a lie. You have millions of people shoved into Medicaid, which is not insurance. It is debt. Maybe not for all today. Certainly for millions today, maybe 30+ million. And certainly for millions of others who think they have insurance yet, as they approach the estate recovery threshold are unlikely to realize what "insurance" they actually don't have.
It's really sobering to receive a letter from the government demanding payment of $900K in medical care.
Our son was diagnosed with cancer at the age of three. Medicaid served as secondary insurance, and thankfully so, as the bills from the first month exceeded $300,000. This went on for nine months.
It's now been eight years since he passed, with no mention from any agency about recovery.
Besides, it seems you left a few things out of your diatribe. From the medicaid.gov link:
> For individuals age 55 or older, ... recovery of payments
> from the individual's estate for [specifically enumerated things,
> which does not appear to include doctor visits].
Also:
> States may not recover from the estate of a deceased Medicaid
> enrollee who is survived by a spouse, child under age 21, or
> blind or disabled child of any age. States are also required to
> establish procedures for waiving estate recovery when recovery
> would cause an undue hardship.
So, at best a fear-mongering half-truth. Maybe we can agree Medicaid is for people with no money. The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.
First and most importantly, sorry for your loss. That is truly terrible and unimaginable.
This isn't a diatribe, fear mongering or half-truths. The links I provided are real and from government agencies.
If you wish to refute the reality I am presenting you need to do better than your situation because yours is atypical.
Yes, in your case you fell outside the domain of estate recovery.
Of the projected 100 million people who will be on Medicaid, how many do you think will have three year old kids with Cancer?
Your kid's life was invaluable. I would have spent my last dime had I been in your situation and I am sure you likely did. That goes without saying.
You are also wrong in this statement:
> The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.
This is not true. If a Medicaid member owns a home and sells it or takes out a second mortgage or comes into money (inheritance, etc.) the government takes a bite right there and then AND kicks the person out of Medicaid because now they have money.
I hope you take the time to read the various links I provided and come to understand your situation isn't typical and that it is true that Medicaid is not medical insurance.
If an insurance company had estate recovery clauses in their insurance policies they would be brought up on fraud charges instantly and most of their management would end-up in jail. Why do we demand less from our government?
Sorry for your loss. I cannot imagine having to go through that.
And I am 100% certain that most people who get shoved into Medicaid either have no idea or have no choice but to sign on the dotted line. That's the tragedy here. Our government is making people sign onto something almost out of desperation.
Let me make my position 100% clear, because those down-voting my post and attacking it might not have understood this. Actually, no, I failed to communicate it.
Medicaid Estate Recovery is an abomination.
It should NOT be a part of the program.
It should NOT exist.
We should provide medical care to the needy without ANY recovery requirements whatsoever.
If someone needs a million dollars in medical care they should receive it.
They should not have to worry about being on the hook to repay it in any way.
That is what a decent and compassionate society does and how it behaves.
If this estate recovery business were done by a private insurance company they would be destroyed by both public opinion and brought-up on fraud charges. We should demand better from our government. We should demand that estate recovery be completely removed from Medicaid.
> That is what a decent and compassionate society does and how it behaves.
Capitalism, especially in the USA, is not an economic system that concerns itself with or encourages a compassionate society. Medicine is one of the most obvious ways that capitalism is literally killing people.
I believe that with the right leadership and a conversation with the nation we could converge on a system that was fair, took care of the needy and got government and insurance companies as we know them to day out of the system to the necessary degree.
I don't, for a moment, believe that we can get both government and insurance companies entirely out of the system in the US. In the first instance, government, you would not want to. Oversight and rules are important. In the second instance, insurance companies, there could be an argument of their need in absorbing some of the risk. Admittedly, not an easy problem.
What we have today, this hodge-podge of laws, agencies and programs is a complete disaster. This should be obvious and evident to anyone who takes the time to take a full dive into the absolute mess healthcare is in the US. The ACA did not fix anything, it made it worst, because it isn't a real solution.
I won't claim to have the solution. As I alluded above, this requires leadership that can bring forth a national-level conversation that, over a year or four, can converge on something that can deal with all issues equitably.
One angle is what I might term a to be a moral obligation: We have the moral obligation to take care of each other. What follows, then, is that we all contribute to a fund or a national health insurance policy of some sort that covers absolutely everyone with, perhaps, reasonable co-pay's to take some of the edge off. If one of us needs a million dollars of medical care he or she should be able to get it.
This should also come with some obligations. I think there's nothing wrong with the idea of requiring regular checkups of some sort. This is where it gets complicated. What do we do about people who destroy themselves through substance abuse. I don't know how we deal with that and other matters.
Anyhow, I think we can all agree that we ought to be able to do far, far better than this mess created by our politicians in playing sick partisan games with one of our most basic needs. And this has been true over at least the last 50 years, no political party is devoid of blood (almost literally) on their hands.
We truly need to take this up to a much higher intellectual level in order to converge on a good solution.
It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid. The reaction is evidence of the political polarization out there and the disconnect that exists with what politicians have done to our healthcare system. It's a mess and what we have isn't getting any better.
It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid.
The analysis in your heavily downvoted comment is blatantly wrong!
Is Medicaid means tested? Absolutely.
Is Medicaid for elderly patients heavily means tested? Absolutely.
Is what you said: Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:
Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan. true? Nope, only people over 55 who have remaining assets are subject to estate recovery.
Everything I said is accurate. Yet, you insist in missing my greater point:
This issue shouldn't even exist.
We, as a society, should revolt at having such clauses in a medical program that is supposed to help people.
The US healthcare system should take care of every single US resident. Period. Rich, poor, healthy and ill. And it should do this without the kind of thing I have highlighted regarding Medicaid.
It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.
It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.
The stuff you are complaining about only applies to people that are over the age of 55.
A 10 year old and their mother that get primary care through Medicaid, they don't ever have to pay anything back (except if they later access Medicaid after age 55, but the asset test would apply to the care received after age 55, not before 55).
So, you don't think it is immoral to have this estate recovery thing?
I don't know why you are focusing on this age business. It does affect a large number of people. And it is objectively wrong.
It is wrong because it is immoral and fraudulent to present it as insurance when it is not.
It is wrong because it is immoral and fraudulent to deceive people.
It is wrong for a country like the US to have a law that results in the government sinking it's hooks into a large percentage of the people on that program.
We should not have such provisions in any healthcare program at all. Period.
You are missing that one point. The most important of all.
Again.
We should not have such provisions in any healthcare program at all.
We should have programs that help people and provide healthcare for all with no such conditions or stipulations.
We should help the poor without having them give up whatever property they have or may have for the sake of having health care.
We need to be a better society and we can't claim to be that when we have a law that allows government to place a lien on someone's property because they had the misfortune of needing medical care.
As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.
It turns out to be that a lot of fixed income older couples who own homes of significant value can easily fall under this FPL requirement. Hence, again, the over ten million people shoved into the program last year in CA alone.
You are sadly misinformed. I urge you to read the links I've provided in this thread so you can get a real picture of what's going on and how things work. I get the sense that you've had exactly zero contact with this system from any imaginable angle. I and my family have, from both the professional angle --my wife being a Doctor-- and the patient angle, with my parents and her parents.
"This has become more of a problem since the ACA’s Medicaid expansion took effect in 2014, as people are now funneled into the Medi-Cal system in much greater numbers than they used to be. Covered California enrollees with income up to 138 percent of the poverty level are directed to Medi-Cal, regardless of the value of their assets (there’s no asset test for subsidy eligibility or Medicaid coverage under the ACA).
As a result, some families have been receiving bills from Medi-Cal after their loved ones pass away, including bills to cover the cost of payments that the state makes to managed care plans, even if the deceased didn’t use any medical services."
Let that last line sink in: "EVEN IF THE DECEASED DIDN'T USE ANY MEDICAL SERVICES"
The famous line from The Matrix applies here:
"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes."
I've shown you where the rabbit hole goes, yet you continue to believe whatever you want to believe despite overwhelming factual evidence. I can't fix that. Enjoy that steak.
As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.
Checking income is a means test.
As for why I keep bringing up the age thing, it's because you keep making incorrect claims where it is a relevant factor and statements implying that receiving Medicaid benefits has grave financial consequences for all recipients (receiving the benefit doesn't even have grave financial consequences for the elderly; it just isn't very generous).
"means testing" refers to something very specific which includes asset valuation.
Obamacare/ACA/Medicaid no longer include means testing. It's a simple income test against FPL.
Where did I say that Medicaid has grave financial results for all recipients?
Again, you continue to ignore the point:
The fact that these hooks exist in Medicaid is objectively wrong. Very wrong.
They (the hooks) are also very real and, yes, they affect millions of people. So real that there are myriad attorneys specializing in complicated asset protection schemes intended to shield people from them.
The trouble is this is only available if you have the money to afford some very expensive and complicated legal work.
In other words, the poor and lower middle class are totally screwed and can't defend against this. This is horrible.
We should not do this to our people.
--
1- Are you saying it is OK for Medicaid to have estate recovery rules?
--
2- Are you saying estate recovery isn't real?
--
Please clarify because I truly don't understand where you are coming from.
Means testing has a broad and non specific meaning. Wikipedia of course isn't authoritative, but it discusses it in broad terms: https://en.wikipedia.org/wiki/Means_test
As an example, due to the pension my father left her, my mom will never qualify for any Medicaid assistance. This is a means test, she has resources above what Medicaid would provide.
The poor don't have assets to scheme to protect, so they don't really get screwed by asset tests.
The resources for elder care have to come from somewhere. Having the people receiving the care be the first payers makes a lot of sense to me. So the asset tests don't really bother me much.
Should society step in and help people who can't afford to pay? Of course. Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
Hmm. OK. You probably haven't spoken to an attorney since Obamacare. I have.
Even so. We are dicing and slicing words here and the whole thing is irrelevant.
> Should society step in and help people who can't afford to pay? Of course.
> Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
OK, it sounds like we might be coming to an understanding here. Please answer the questions I asked, because everything else is irrelevant.
Here they are again, slightly restated:
-----------------
1- Is estate recovery real?
Can we agree on that point?
Forget age thresholds. Is it real?
-----------------
2- Is this OK?
Should a nation like the US have a healthcare system with programs that place citizens past a certain age --the age where medical needs increase significantly-- in a debtor relationship with the government?
-----------------
I am willing to bet your answers will be:
1: Yes, it's real.
2: No, we should not have a healthcare program that turns medical care recipients into debtors
-----------------
If these are your answers we, then, are 100% in agreement and this back and forth has largely been irrelevant because these two questions are the meat of the objections I have raised.
We need a healthcare system that takes care of everyone, rich and poor. There should be no distinction when you walk into the doctor's office or hospital. And it should certainly not turn you into a debtor to the government. That's immoral and wrong.
As for the philosophical question of the wealthy passing assets to their children, that's an entirely different discussion. As an advanced and "civilized" nation we should not use the healthcare system as a battering ram to deal with such issues. Healthcare should be about just that, healthcare. Everyone should have access to it and it should not bankrupt anyone or turn them into debtors to the government. We need to achieve that. The issue of inheritance, etc. is a matter for a different kind of legislation and it should be kept separate from medical care. I hope you'll agree to that as well.
-----------------
I'm pretty sick of what politicians have been doing with our healthcare system over the past 20 to 50 years. It is an absolute mess. And I fear it will get worst before it gets better.
What we need is leadership that is able to have an adult conversation with the nation to explain how we need to work together for the greater good. Instead we have politicians in various political camps playing fucking games with our healthcare for political gain, not our benefit.
The right kind of leader would be able to unite the citizenry in understanding that the ONLY way we are going to end-up with a better system is if we accept that we all have the obligation to contribute --obviously based on financial ability-- in order to create a system where anyone, rich or poor, can walk into a hospital and not worry one iota about costs. What we have today is a horrible mess. And Trump, despite what many might think, is very far from the leader we need on this matter. I think we can agree on this as well.
I've never argued that estate recovery doesn't happen. Maybe you could admit that the 3/4 of people on Medicaid that aren't elderly aren't subject to it in any way, the primary thing that has lead me to pushing back on your comments. It's a pretty big deal that it doesn't apply, because that's where you started, fear mongering about how evil Medicaid is for everyone.
And I think I was clear enough in my previous comment. It's fine if the resources for elder care come from the assets of the people receiving the care. Dealing with it through estate recovery is a detail; the other way to do it would be to force disposal of the assets before providing any benefit (pretty much the situation faced today by people who don't own homes).
I think a different health care system could cost a lot less and be better for everyone. In the healthcare system we have, where funding for Medicaid is quite limited, I'm fine with it kicking in as a last resort.
I am not going to slice and dice numbers because that's irrelevant. The data I've seen indicates the number of afflicted is far greater than the 25% you are alluding to due to Medicaid expansion.
Yet, let's leave it at that. Let's concede it is only 25% of the folks on Medicaid. We are at 75 million people enrolled right now and firmly headed towards 100 million if nothing changes.
And so, per your number, that means 19 to 25 million people are in debt with the government for their medical care.
You keep calling it "fear mongering". All I did is provide links to source information where the way the program works is clearly laid out. And everything is factually correct.
Here's the part you don't seem to want to concede: If someone is put into Medicaid when they are, say, 40 because they don't qualify for subsidies and can't afford anything else, they are likely to stay there for a long time. And I'd be willing to bet money, they have no clue what's coming.
So, 15 years later they are still on Medicaid only now they shift over to becoming a debtor to the government for aspects of their medical care. And it so happens that after 50 to 55 years of age most people start having greater needs.
Our population is living far longer now, with 90+ not being uncommon. Which means that the 100 million or more that will be on Medicaid over the next decade or two will have a greater component of 55 or older folks. And every single one of them will owe money to the government for health care.
This isn't fear mongering, this is a mathematical reality.
> It's fine if the resources for elder care come from the assets of the people receiving the care.
Ah. OK. Now we understand each other.
I do not agree with this. Not at all. And mostly because most people have no clue they are accumulating debt.
If we did NOT call it medical insurance. If we classified it clearly for what it is. And if we made certain everyone knew what they were walking into it might be a different matter.
I know you are going to say it's right there in the forms. Nobody reads the fucking things. They want healthcare and they are placed between a rock and a hard place. They sign on the dotted line and move on.
-------------------
The fundamental disagreement here is that I am not OK with there being a program that turns people 55 and older into debtors to the government for their medical care.
You don't have a problem with the idea.
That, I think, is the bottom line. Everything else is slicing and dicing numbers. This, to me, is a question about the morality of the thing, not about statistics.
The OP may be over the top and on the fear-mongering side of things, but there are some very difficult situations monetarily especially for elderly recipients. While there is some policy to not completely bankrupt surviving spouses, the reality of a long term care spouse utilizing medicaid is that the surviving spouse must reduce assets to below $2500 with few exceptions or shelters. That policy will almost guarantee that the surviving spouse if not a homeowner, will be strongly below the poverty line for the rest of their life. The primary cause of that scenario is the huge gap between enough money to be retired(50k-150k), and the amount of money required to be retired without assistance(350k-500k). Full time skilled care like a retirement home, can easily cost $7k a month on the low end, with averages around 28months.
The OP may be able to make a more widely accepted argument, by more empathetically communicating that medicaid is at best emergency support for crisis, and not a vehicle for long term or widespread medical care. He is correct that using Medicaid as a primary vehicle for ACA coverage expansion ensures a very large group of people will have huge negative motivations to exit poverty, even more so than were previously. I would guess that the OP has first hand experience with Medicaid policy completely eliminating a family member's entire life's monetary worth, which is a hard pill to swallow when someone has paid into Medicaid for decades.
In the US it is extremely easy to rack-up hundreds of thousands of dollars in medical bills. A single operation can cost $200K. Be ill for an extended period of time and the idea of millions of dollars in medical care isn't out of the realm of the possible.
And so, imagine selling the family home to try to pay medical bills or provide more favorable circumstances only to get a knock on the door by the Medicaid estate recovery folks who have first dibs on the proceeds of the sale.
Not only that, the sale also means the patient is now kicked off Medicaid because they have money.
I'll repeat it because the shift in perspective is important:
If a private insurance company had exactly the same clauses in their policies people would be up in arms, they would be brought up on charges and some of their management would land in jail. Yet we are willing to accept this from our government? And enroll people by the tens of millions?
This should not be. We should provide care to the needy without any such preconditions. Our government should not sink hooks into them at all.
Readers seem to be confusing passion for fear mongering. This is real and, as far as I am concerned, it is seriously immoral. We should not be in the business of doing this to our own citizens. This isn't health insurance. Not sure what it is, but I know what it is not.
This is the point that is being missed in my exposure of this issue: This is an abomination. The US should not have a program fraudulently presented as insurance that takes people's property at all. Even if the net effect was that this only affected ten people, it would be wrong.
We should take care of those who need care and not set hooks into them or their estate.
I'm not sure I care for this topic on HN, but I believe one of the biggest problems in healthcare is the 'collaboration' among the hospitals and insurance companies on billing through the National Uniform Billing Committee[0], which ultimately results in people not knowing how much stuff costs (i.e. how much is an MRI). Without this knowledge, people can't make proper decisions because it's completely opaque.
48 comments
[ 3.2 ms ] story [ 12.9 ms ] threadHere's text from the legislation:
Half of all personal bankruptcies are caused in part by medical expenses. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will improve financial security for families.
http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf
~5-6%.
Besides, apparently the goal of universal healthcare was to allow everybody to still receive the "$250,000" cancer treatment that they were getting before universal healthcare. This suggests that both with and without universal healthcare, the cancer treatment was being provided, so not having universal healthcare did not actually create another cost.
This isn't trivial nitpicking: the ACA was sold as something that would reduce costs. This was mostly false. The real aim of the ACA was to raid the pockets of more people. Before, there was a "$250,000 cancer treatment" and the insured paid for it with a "$17 ibuprofen." The true objective of the ACA was to keep the "$250,000 cancer treatment" but instead pay for it by raiding the pockets of young, healthy people who previously did not have insurance.
It turns out that raiding the pockets of young, healthy people is not so politically popular. They didn't have insurance for a reason--it's expensive! Their unemployment and student debt is already high, and they already have to pay for old people through Social Security and Medicare tax. Yet the ACA wanted to use those young people, who would pay premiums, use little health care, and thus help pay for more "$250,000 cancer treatments".
Now this political dishonesty is blowing back, as the insurance markets are under strain because the young healthies still aren't getting insurance to help pay for the cancer treatments that others get.
ACA isn't perfect but it's way better than we had before.
So everyone has to pay into insurance including people who don't use it normally.
That's. The. Point.
The bankruptcy code itself changed tremendously in 2005: http://www.nolo.com/legal-encyclopedia/new-bankruptcy-law-ch...
The housing market bubble mostly likely had a tremendous effect on bankruptcies as well: https://en.wikipedia.org/wiki/United_States_housing_bubble
Agree that the housing crash likely elevated bankruptcies. A number of states have laws where even if the bank takes your house in a short sale, they can go after you personally for the remainder of the loan.
http://www.cnbc.com/id/100840148
http://www.npr.org/sections/health-shots/2016/03/08/46889248...
If you're slightly interested in this topic, 2 milliseconds on Google will reveal a wealth of information.
http://www.tradingeconomics.com/united-states/bankruptcies (hit the "max" button)
Pretty clearly shows that the ACA came at the trailing end of the huge spike in bankruptcies from the real estate bubble bursting.
Correlation does not imply causation, however much one wants to sell a particular story. I expect better from consumer reports.
http://www.bankruptcyaction.com/USbankstats.htm
OK, with great claims one must offer solid evidence. No problem, I accept this responsibility. Thankfully this is a rather easy task.
The great majority of these 27 million people are on what's known as Medicaid.
Is Medicaid health insurance?
No, it is not. Medicaid is a loan.
What?
Medicaid is a loan from the government. It is, if one wishes to interpret it this way, no different from taking out a home equity line of credit.
In other words, you must repay what you spent.
Yes, care you receive under Medicaid must --BY LAW-- be repaid. And, when your lender is the government the realities of dealing with the worst possible kind of loan shark --one with overwhelming power-- can and do easily surface.
Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:
https://www.statista.com/statistics/245347/total-medicaid-en...
Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan.
And here's where it gets ugly: The State, again, by law, is obligated to seek repayment for services offered and can --and does-- attach your property in the process of doing so.
Medicaid is a program that has convinced people they have medical insurance when, in reality, they have a loan. And this loan can and does cost them their estate as the State automatically becomes the first lien holder once you are on Medicaid.
Please don't take my word for it. Here it is from the horse's mouth:
https://www.medicaid.gov/medicaid/eligibility/estate-recover...
Here's another source with a revelation that should terrify anyone:
"if the property is sold while the Medicaid beneficiary is living, not only will the beneficiary cease to be eligible for Medicaid due to the cash from the sale, but the beneficiary would have to satisfy the lien by paying back the state for its coverage of care to date"
They should have added "refinanced" to that statement.
http://www.elderlawanswers.com/medicaids-power-to-recoup-ben...
Medi-Cal has similar provisions:
http://www.dhcs.ca.gov/services/Pages/TPLRD_ER_cont.aspx
Another reputable source:
http://www.nolo.com/legal-encyclopedia/how-medicaid-recovers...
You might have to pay your parent's Medicaid bill:
https://www.agingcare.com/articles/medicaid-repayment-of-nur...
More detail from HHS:
https://aspe.hhs.gov/basic-report/medicaid-estate-recovery
https://aspe.hhs.gov/basic-report/medicaid-liens
To be clear, estate recovery was not imposed by ACA. N...
It certainly is the case that the nursing home care paid for by Medicaid is intended to be a last resort, after other resources are exhausted. So of course it examines other resources.
http://kff.org/medicaid/state-indicator/medicaid-enrollment-...
Here are a few examples of people under the age of 26 who are on Medicaid:
California, 57% Colorado, 69% Idaho, 73% Wyoming, 75% etc.
The only way your assertion is true is if these are worthless and will never make anything out of their lives. Which, of course, isn't true at all.
And so, a young person is shoved into Medicaid and convinced they have medical insurance when, in reality, they are accumulating debt with the government.
And, yes, as life goes on they see some success perhaps buy a house and have an investment or two and never realize the hook that got sunk and set into them when they were younger.
In California alone well over six million people under 27 years of age are walking around thinking they have medical insurance.
Even if this wasn't the case, let's turn things around a bit.
Say an insurance company, Nefarious Unlimited, was issuing medical insurance policies --real insurance-- with a hidden clause in them. The minute the insurance buyer signs on the dotted line Nefarious Unlimited is given the right to recover 100% of their costs from the persons estate. As little or as much as they might have.
Of course, Nefarious Unlimited does not inform their customers that the product they are buying is actually a loan rather than real medical insurance. They even go on TV to advertise it and tout the millions of "satisfied customers" they have.
Nefarious Unlimited would be brought-up on fraud charges so fast your head would spin. The entire board and management would probably --and rightly so-- end-up in jail. Nobody would argue with this outcome.
You see, whether or not a person has a large estate this is wrong, fraudulent and immoral. That is the point you are missing in addition to the above.
This is our government engaged in fraud of the worst kind. This should not be OK with anyone.
This isn't about political lines. This is about basic human decency and exists at the most basic levels of right and wrong.
You need to carefully reexamine who the asset recovery provisions actually apply to. Among other things, it'd save you time writing lengthy comments about your mistaken conclusion.
You can find various corner cases where Medicaid estate recovery isn't an issues. Yes. Yet this is NOT reality for the vast majority of those being shoved into the program by the tens of millions.
I am very well informed on this front, having sought the advice of top attorneys in this domain. This is very real. You can choose to study the links I provided and educate yourself or reject it while armed with imperfect information.
In the end reality isn't modified. We'll probably start seeing the effects of this during the next twenty years. Maybe then people will wake up.
Medicaid is intended to be a further benefit for people that have low incomes.
It's only surprising that it examines an estate if you don't understand that it isn't designed to be anything more than a benefit of last resort.
Sure, you can't have Medicaid pay for your parents care and also keep their estate. But this isn't mind blowing information, it's the way the law was designed to work and something anyone involved in estate planning would know off hand.
Here's a tid-bit:
Quote: "Does Medicare Pay For Long Term Care?
NO. After a 3 day hospital stay, Medicare pays 100% of the cost, but only for the first 20 days of skilled nursing care. For days 21 through 100, you are responsible for a co-payment. As of this date, the daily co-pay rate is $148 per day.
But it gets worse: After 100 days of care in a nursing home, Medicare stops paying altogether, and you are responsible for all future costs, unless there is a new 3 day qualifying hospital stay (which then re-sets the 100 day clock).
You also need to be aware that Medicare does not pay for “custodial care.” If you or a loved one are in need of custodial care, it must be paid for either by writing a check, by private long-term care insurance, or by Medi-Cal."
I am not going to bother providing you with links because you are obviously not reading anything. If you are truly interested in understanding the issues you need to spend half a day googling around to build a better image of what reality looks like.
Also, my wife is a doctor. She, among other things, has dealt with precisely the segment "served" by all of these programs for at least ten years. She has left that practice. And so have tons of doctors. This is the other side of the equation.
These programs work for some but, on the aggregate, they are a disaster. It is impossible for doctors to provide good care. Patients are getting screwed right and left. My wife would easily see a dozen patients a week for free because there was no possible way to justify doing it under these programs.
The vast majority of people are extremely ignorant of the realities in US health care.
Anyhow, that's the end of it. Thanks.
It's a fine thing if you want to argue that Medicaid should more generously protect the assets of the elderly, go ahead. Just don't make shit up out of whole cloth about how a young mother is going into debt to the government when she and her child have bills paid through Medicaid. That's just flat out not true. Maybe ask your doctor wife about that.
I do understand that Medicare doesn't do much for long term care. But long term care isn't a big source of the million dollar medical events you are ranting about, absent the need for further medical care, it generates a reasonably predictable monthly bill.
And, before you say 50 is old. I know plenty of people who have started businesses and entire new careers in their 40's and 50's. This ain't the 1920's.
None
To be precise, Medicaid is obligated to recover cost of services provided at or after 55 years of age.
OK. Fine.
So CA enrolls twelve million people. Some young some older.
Do these people not age?
Of course they do. So, presumably, they are going to be on Medicaid for a very long time. Maybe their entire lives.
OK. That's established. People age. They think they have health insurance. Yet, they actually don't.
Out of those 12 million roughly 2.2 million were 45+ years old. One million were 65+.
So that 55+ event horizon, we could say, is very close for millions of people being shoved into Medicaid.
In fact, nationwide, about 14.5 million people 45+ were enrolled. Out of those, about 6.4 million were 65+.
These are not insignificant numbers. Source [1]
BTW, these numbers are for FY2011 when we had about 32 million people enrolled in Medicaid. Due to Obamacare and other factors we now have over 74 million and are well on our way to the 100 million mark. Finding current data seems to require a lot of work. You are welcome to do it if you want to be accurate. For now...let's double the numbers above:
45+ 28 million.
65+ 13 million.
So we are looking at roughly 41 million people at or past the threshold for estate recovery. And, of course, millions more that will eventually get there if they don't pop out of Medicaid or if they are shifted back into it because health insurance becomes too expensive.
41 million and counting. All subject to estate recovery or within a few years of it.
I, quite literally, don't understand what you are arguing about.
This is a real problem. People age and live well beyond 55 years of age. My Dad is 90. He had cancer when he was 70. That was 20 years ago. And, like him, millions of people. And most of them don't have a clue that Medicaid is debt they accumulate with the government, not health insurance.
There's another reality: Older people have greater healthcare needs. I read a report showing that the average need for a healthy older adult is around $10K per year. That being true, had my father not had a serious condition --had he been of average health-- he would have racked-up somewhere around $350,000 in medical debt to the government while on Medicaid. The actual number is closer to a million bucks.
A million dollars of debt to the government. And we call this insurance?
Let's see you face that reality and see how you react.
I'm getting sick of saying this. All of this bullshit still misses the greater point:
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We should not have a program that is falsely promoted as "health insurance" that actually has the government sink it's hooks into people's estates.
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That is immoral. It is objectively wrong. It is also fraudulent. Obamacare reports taut "27 million insured". No. It's a lie. You have millions of people shoved into Medicaid, which is not insurance. It is debt. Maybe not for all today. Certainly for millions today, maybe 30+ million. And certainly for millions of others who think they have insurance yet, as they approach the estate recovery threshold are unlikely to realize what "insurance" they actually don't have.
It's really sobering to receive a letter from the government demanding payment of $900K in medical care.
[1] http://kff.org/medicaid/state-indicator/medicaid-enrollment-...
Go figure out the median estate recovery in a few states and I'll listen.
(Or however you want to present the statistics, but get some numbers.)
Um, ... no. Or, at least not in my case.
Our son was diagnosed with cancer at the age of three. Medicaid served as secondary insurance, and thankfully so, as the bills from the first month exceeded $300,000. This went on for nine months.
It's now been eight years since he passed, with no mention from any agency about recovery.
Besides, it seems you left a few things out of your diatribe. From the medicaid.gov link:
Also: So, at best a fear-mongering half-truth. Maybe we can agree Medicaid is for people with no money. The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.This isn't a diatribe, fear mongering or half-truths. The links I provided are real and from government agencies.
If you wish to refute the reality I am presenting you need to do better than your situation because yours is atypical.
Yes, in your case you fell outside the domain of estate recovery.
Of the projected 100 million people who will be on Medicaid, how many do you think will have three year old kids with Cancer?
Your kid's life was invaluable. I would have spent my last dime had I been in your situation and I am sure you likely did. That goes without saying.
You are also wrong in this statement:
> The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.
This is not true. If a Medicaid member owns a home and sells it or takes out a second mortgage or comes into money (inheritance, etc.) the government takes a bite right there and then AND kicks the person out of Medicaid because now they have money.
I hope you take the time to read the various links I provided and come to understand your situation isn't typical and that it is true that Medicaid is not medical insurance.
If an insurance company had estate recovery clauses in their insurance policies they would be brought up on fraud charges instantly and most of their management would end-up in jail. Why do we demand less from our government?
Sorry for your loss. I cannot imagine having to go through that.
Look at the things it makes clear and information it asks for.
And I am 100% certain that most people who get shoved into Medicaid either have no idea or have no choice but to sign on the dotted line. That's the tragedy here. Our government is making people sign onto something almost out of desperation.
Let me make my position 100% clear, because those down-voting my post and attacking it might not have understood this. Actually, no, I failed to communicate it.
Medicaid Estate Recovery is an abomination.
It should NOT be a part of the program.
It should NOT exist.
We should provide medical care to the needy without ANY recovery requirements whatsoever.
If someone needs a million dollars in medical care they should receive it.
They should not have to worry about being on the hook to repay it in any way.
That is what a decent and compassionate society does and how it behaves.
If this estate recovery business were done by a private insurance company they would be destroyed by both public opinion and brought-up on fraud charges. We should demand better from our government. We should demand that estate recovery be completely removed from Medicaid.
Hope that clarifies my position.
Capitalism, especially in the USA, is not an economic system that concerns itself with or encourages a compassionate society. Medicine is one of the most obvious ways that capitalism is literally killing people.
I believe that with the right leadership and a conversation with the nation we could converge on a system that was fair, took care of the needy and got government and insurance companies as we know them to day out of the system to the necessary degree.
I don't, for a moment, believe that we can get both government and insurance companies entirely out of the system in the US. In the first instance, government, you would not want to. Oversight and rules are important. In the second instance, insurance companies, there could be an argument of their need in absorbing some of the risk. Admittedly, not an easy problem.
What we have today, this hodge-podge of laws, agencies and programs is a complete disaster. This should be obvious and evident to anyone who takes the time to take a full dive into the absolute mess healthcare is in the US. The ACA did not fix anything, it made it worst, because it isn't a real solution.
I won't claim to have the solution. As I alluded above, this requires leadership that can bring forth a national-level conversation that, over a year or four, can converge on something that can deal with all issues equitably.
One angle is what I might term a to be a moral obligation: We have the moral obligation to take care of each other. What follows, then, is that we all contribute to a fund or a national health insurance policy of some sort that covers absolutely everyone with, perhaps, reasonable co-pay's to take some of the edge off. If one of us needs a million dollars of medical care he or she should be able to get it.
This should also come with some obligations. I think there's nothing wrong with the idea of requiring regular checkups of some sort. This is where it gets complicated. What do we do about people who destroy themselves through substance abuse. I don't know how we deal with that and other matters.
Anyhow, I think we can all agree that we ought to be able to do far, far better than this mess created by our politicians in playing sick partisan games with one of our most basic needs. And this has been true over at least the last 50 years, no political party is devoid of blood (almost literally) on their hands.
We truly need to take this up to a much higher intellectual level in order to converge on a good solution.
It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid. The reaction is evidence of the political polarization out there and the disconnect that exists with what politicians have done to our healthcare system. It's a mess and what we have isn't getting any better.
The analysis in your heavily downvoted comment is blatantly wrong!
Is Medicaid means tested? Absolutely.
Is Medicaid for elderly patients heavily means tested? Absolutely.
Is what you said: Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:
https://www.statista.com/statistics/245347/total-medicaid-en....
Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan. true? Nope, only people over 55 who have remaining assets are subject to estate recovery.
This issue shouldn't even exist.
We, as a society, should revolt at having such clauses in a medical program that is supposed to help people.
The US healthcare system should take care of every single US resident. Period. Rich, poor, healthy and ill. And it should do this without the kind of thing I have highlighted regarding Medicaid.
It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.
Be well.
Aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaagh.
The stuff you are complaining about only applies to people that are over the age of 55.
A 10 year old and their mother that get primary care through Medicaid, they don't ever have to pay anything back (except if they later access Medicaid after age 55, but the asset test would apply to the care received after age 55, not before 55).
So, you don't think it is immoral to have this estate recovery thing?
I don't know why you are focusing on this age business. It does affect a large number of people. And it is objectively wrong.
It is wrong because it is immoral and fraudulent to present it as insurance when it is not.
It is wrong because it is immoral and fraudulent to deceive people.
It is wrong for a country like the US to have a law that results in the government sinking it's hooks into a large percentage of the people on that program.
We should not have such provisions in any healthcare program at all. Period.
You are missing that one point. The most important of all.
Again.
We should not have such provisions in any healthcare program at all.
We should have programs that help people and provide healthcare for all with no such conditions or stipulations.
We should help the poor without having them give up whatever property they have or may have for the sake of having health care.
We need to be a better society and we can't claim to be that when we have a law that allows government to place a lien on someone's property because they had the misfortune of needing medical care.
As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.
It turns out to be that a lot of fixed income older couples who own homes of significant value can easily fall under this FPL requirement. Hence, again, the over ten million people shoved into the program last year in CA alone.
You are sadly misinformed. I urge you to read the links I've provided in this thread so you can get a real picture of what's going on and how things work. I get the sense that you've had exactly zero contact with this system from any imaginable angle. I and my family have, from both the professional angle --my wife being a Doctor-- and the patient angle, with my parents and her parents.
Here's yet another link:
https://www.healthinsurance.org/california-medicaid/
And here's a quote from that article:
"This has become more of a problem since the ACA’s Medicaid expansion took effect in 2014, as people are now funneled into the Medi-Cal system in much greater numbers than they used to be. Covered California enrollees with income up to 138 percent of the poverty level are directed to Medi-Cal, regardless of the value of their assets (there’s no asset test for subsidy eligibility or Medicaid coverage under the ACA).
As a result, some families have been receiving bills from Medi-Cal after their loved ones pass away, including bills to cover the cost of payments that the state makes to managed care plans, even if the deceased didn’t use any medical services."
Let that last line sink in: "EVEN IF THE DECEASED DIDN'T USE ANY MEDICAL SERVICES"
The famous line from The Matrix applies here:
"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes."
I've shown you where the rabbit hole goes, yet you continue to believe whatever you want to believe despite overwhelming factual evidence. I can't fix that. Enjoy that steak.
Checking income is a means test.
As for why I keep bringing up the age thing, it's because you keep making incorrect claims where it is a relevant factor and statements implying that receiving Medicaid benefits has grave financial consequences for all recipients (receiving the benefit doesn't even have grave financial consequences for the elderly; it just isn't very generous).
Obamacare/ACA/Medicaid no longer include means testing. It's a simple income test against FPL.
Where did I say that Medicaid has grave financial results for all recipients?
Again, you continue to ignore the point:
The fact that these hooks exist in Medicaid is objectively wrong. Very wrong.
They (the hooks) are also very real and, yes, they affect millions of people. So real that there are myriad attorneys specializing in complicated asset protection schemes intended to shield people from them.
The trouble is this is only available if you have the money to afford some very expensive and complicated legal work.
In other words, the poor and lower middle class are totally screwed and can't defend against this. This is horrible.
We should not do this to our people.
--
1- Are you saying it is OK for Medicaid to have estate recovery rules?
--
2- Are you saying estate recovery isn't real?
--
Please clarify because I truly don't understand where you are coming from.
As an example, due to the pension my father left her, my mom will never qualify for any Medicaid assistance. This is a means test, she has resources above what Medicaid would provide.
The poor don't have assets to scheme to protect, so they don't really get screwed by asset tests.
The resources for elder care have to come from somewhere. Having the people receiving the care be the first payers makes a lot of sense to me. So the asset tests don't really bother me much.
Should society step in and help people who can't afford to pay? Of course. Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
Even so. We are dicing and slicing words here and the whole thing is irrelevant.
> Should society step in and help people who can't afford to pay? Of course.
> Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
OK, it sounds like we might be coming to an understanding here. Please answer the questions I asked, because everything else is irrelevant.
Here they are again, slightly restated:
-----------------
1- Is estate recovery real?
Can we agree on that point?
Forget age thresholds. Is it real?
-----------------
2- Is this OK?
Should a nation like the US have a healthcare system with programs that place citizens past a certain age --the age where medical needs increase significantly-- in a debtor relationship with the government?
-----------------
I am willing to bet your answers will be:
1: Yes, it's real.
2: No, we should not have a healthcare program that turns medical care recipients into debtors
-----------------
If these are your answers we, then, are 100% in agreement and this back and forth has largely been irrelevant because these two questions are the meat of the objections I have raised.
We need a healthcare system that takes care of everyone, rich and poor. There should be no distinction when you walk into the doctor's office or hospital. And it should certainly not turn you into a debtor to the government. That's immoral and wrong.
As for the philosophical question of the wealthy passing assets to their children, that's an entirely different discussion. As an advanced and "civilized" nation we should not use the healthcare system as a battering ram to deal with such issues. Healthcare should be about just that, healthcare. Everyone should have access to it and it should not bankrupt anyone or turn them into debtors to the government. We need to achieve that. The issue of inheritance, etc. is a matter for a different kind of legislation and it should be kept separate from medical care. I hope you'll agree to that as well.
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I'm pretty sick of what politicians have been doing with our healthcare system over the past 20 to 50 years. It is an absolute mess. And I fear it will get worst before it gets better.
What we need is leadership that is able to have an adult conversation with the nation to explain how we need to work together for the greater good. Instead we have politicians in various political camps playing fucking games with our healthcare for political gain, not our benefit.
The right kind of leader would be able to unite the citizenry in understanding that the ONLY way we are going to end-up with a better system is if we accept that we all have the obligation to contribute --obviously based on financial ability-- in order to create a system where anyone, rich or poor, can walk into a hospital and not worry one iota about costs. What we have today is a horrible mess. And Trump, despite what many might think, is very far from the leader we need on this matter. I think we can agree on this as well.
And I think I was clear enough in my previous comment. It's fine if the resources for elder care come from the assets of the people receiving the care. Dealing with it through estate recovery is a detail; the other way to do it would be to force disposal of the assets before providing any benefit (pretty much the situation faced today by people who don't own homes).
I think a different health care system could cost a lot less and be better for everyone. In the healthcare system we have, where funding for Medicaid is quite limited, I'm fine with it kicking in as a last resort.
Yet, let's leave it at that. Let's concede it is only 25% of the folks on Medicaid. We are at 75 million people enrolled right now and firmly headed towards 100 million if nothing changes.
And so, per your number, that means 19 to 25 million people are in debt with the government for their medical care.
You keep calling it "fear mongering". All I did is provide links to source information where the way the program works is clearly laid out. And everything is factually correct.
Here's the part you don't seem to want to concede: If someone is put into Medicaid when they are, say, 40 because they don't qualify for subsidies and can't afford anything else, they are likely to stay there for a long time. And I'd be willing to bet money, they have no clue what's coming.
So, 15 years later they are still on Medicaid only now they shift over to becoming a debtor to the government for aspects of their medical care. And it so happens that after 50 to 55 years of age most people start having greater needs.
Our population is living far longer now, with 90+ not being uncommon. Which means that the 100 million or more that will be on Medicaid over the next decade or two will have a greater component of 55 or older folks. And every single one of them will owe money to the government for health care.
This isn't fear mongering, this is a mathematical reality.
> It's fine if the resources for elder care come from the assets of the people receiving the care.
Ah. OK. Now we understand each other.
I do not agree with this. Not at all. And mostly because most people have no clue they are accumulating debt.
If we did NOT call it medical insurance. If we classified it clearly for what it is. And if we made certain everyone knew what they were walking into it might be a different matter.
I know you are going to say it's right there in the forms. Nobody reads the fucking things. They want healthcare and they are placed between a rock and a hard place. They sign on the dotted line and move on.
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The fundamental disagreement here is that I am not OK with there being a program that turns people 55 and older into debtors to the government for their medical care.
You don't have a problem with the idea.
That, I think, is the bottom line. Everything else is slicing and dicing numbers. This, to me, is a question about the morality of the thing, not about statistics.
The OP may be able to make a more widely accepted argument, by more empathetically communicating that medicaid is at best emergency support for crisis, and not a vehicle for long term or widespread medical care. He is correct that using Medicaid as a primary vehicle for ACA coverage expansion ensures a very large group of people will have huge negative motivations to exit poverty, even more so than were previously. I would guess that the OP has first hand experience with Medicaid policy completely eliminating a family member's entire life's monetary worth, which is a hard pill to swallow when someone has paid into Medicaid for decades.
http://www.longtermcarelink.net/eldercare/nursing_home.htm https://www.ahcancal.org/ncal/facts/Pages/State-Data.aspx
edit: typo medicaid
The income limits for Medicaid expansion are really low, people aren't going to pass on a $10 an hour job + subsidized ACA plan to stay on Medicaid.
And so, imagine selling the family home to try to pay medical bills or provide more favorable circumstances only to get a knock on the door by the Medicaid estate recovery folks who have first dibs on the proceeds of the sale.
Not only that, the sale also means the patient is now kicked off Medicaid because they have money.
I'll repeat it because the shift in perspective is important:
If a private insurance company had exactly the same clauses in their policies people would be up in arms, they would be brought up on charges and some of their management would land in jail. Yet we are willing to accept this from our government? And enroll people by the tens of millions?
This should not be. We should provide care to the needy without any such preconditions. Our government should not sink hooks into them at all.
Readers seem to be confusing passion for fear mongering. This is real and, as far as I am concerned, it is seriously immoral. We should not be in the business of doing this to our own citizens. This isn't health insurance. Not sure what it is, but I know what it is not.
This is the point that is being missed in my exposure of this issue: This is an abomination. The US should not have a program fraudulently presented as insurance that takes people's property at all. Even if the net effect was that this only affected ten people, it would be wrong.
We should take care of those who need care and not set hooks into them or their estate.
[0]https://en.wikipedia.org/wiki/National_Uniform_Billing_Commi...