Saturday, November 23, 2013

ACA - Healthcare's Dynamic Expansion by Nicole Huberfeld :: SSRN

Let's get this straight.  Newspaper reporters and TV reporters are windvanes.  They reflect the momentary shifts - and they often make their own wind.  Website glitches will not sink the Affordable Care Act.  The question about what has come to be called Obamacare is: will it expand the number of people who have health care available to them?  The answer to that is Yes.  
First - the expansion of Medicaid is practically irresistible for Republican Governors.  How can you say no to accepting 100% federal coverage of the extension of Medicaid to a substantial number of citizens?  Nicole Huberfeld documents that trend .
Second 'Obamacare' private insurance policies will be substantially subsidized by government.  And the coverage will be better than that available before.  (no preexisting conditions, no lifetime cap, lower deductibles, contraceptive coverage, keep kids covered to 26, etc.)  People will buy that insurance even without the push of the tax penalty.
Third - the ACA is already cutting growth in health insurance costs.  Price controls on insurance reduce medical costs.  Sellers tend to cut their prices to meet the money available to their customers.  And they now have a lot more paying customers.  Hospitals will have many fewer patients who must be provided free care.  - GWC Dynamic Expansion by Nicole Huberfeld :: SSRN:

Dynamic Expansion

Nicole Huberfeld 

University of Kentucky College of Law
November 22, 2013


In the run up to the ACA’s effective date of January 1, 2014, the sleeper issue has been the Medicaid expansion, even though Medicaid stands to cover nearly a quarter of the United States citizenry. While the national press has portrayed a bleak picture that only half of the states will participate, the Medicaid expansion is progressing apace. Though this thesis may sound wildly optimistic, it is more than predictive; it is empirically based. I have gathered data on the implementation of the Medicaid expansion during the crucial months leading up to the operation of the insurance provisions of the ACA, and it is clear that most states are moving toward expansion, even if they are currently classified by the media as “not participating” or “leaning toward not participating.” The data thus far reveals counterintuitive trends, for example that many Republican governors are leading their states toward implementation, even in the face of reticent legislatures and a national party’s hostility toward the law. Further, the data demonstrates dynamic negotiations occurring within states and between the federal and state governments, which indicates that the vision of state sovereignty projected by the Court in NFIB v. Sebelius was incorrect and unnecessary.
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