Many of the pitfalls you describe were easily forseen and discussed on this website at the time of passage. The Medicaid expansion, as written, had failure written all over it and it will cause problems even in the states that accept it.

It is hard to believe that the authors of this bill were so naive or short sighted as to not see how problematic implementation would be over the objections of the naysayers. Is there actually a democrat out there that could not forsee Rick Perry throwing up every obstacle within his grasp?

Just the other day, Arizona’s Governor Jan Brewer announced that Arizona would not participate in this expansion to Medicaid and her argument was premised on the eventual increased cost to Arizona’s taxpayers.

Therefore, we, the Progressives should revert to the “single payer” and where the eventual “buy-in” will occur. As such, this effort must be premised on “open access” to Medicare, the VA, and Indian Health Services. And if an employee wants to continue being held hostage to the employer, the employee still has the “right” to hostage himself/herself to the employer.

Unfortunately, Progressives have yet to come full circle for “empowering the Individual” but will be doing so, in the years to come, especially as the demographic trend continues apace and as voters come to “understand” this behavior for self-empowerment.

Jaango

Any of the ACA’s alleged protections for citizens are again, thwarted under color of state’s rights. Not very equal, to the objective viewer.

Leveraging people into servitude to state based health insurers and providers is an old vile trick, at odds with the Hippocratic Oath.

1) You state in the article that implementation of the changes will cost the states only 1 percent of their budget. If this was 1999, well, perhaps no one would care.

But thirty five states are already seriously underwater, in terms of budgetary spending. To try and receive an additional one percent when that money doesn’t exist is rather Quixotic.

2) Then there is the “people processing” aspect of implementation. In my state, it takes the County (any County,) some 75 days just to approve someone applying for Food Stamps and MediCal. (MediCal being California’s assisted insurance program for people who make less than around $ 800 per person per month.) MediCal allows help for many people, as once the County application subtracts the cost of rent and utilities, far more people than you’d imagine are eligible. However, people having assets, including ownership of a home, RV van they live in, trailer, or car less than four years old are not eligible till they get rid of the asset.

The County can make it possible to get health insurance benefits retroactive to day of application, but they like to stall and say that is not possible. So many people can end up being put into bankruptcy through this “Glitch” in service delivery.

3) Furthermore, buried inside the 2,000 pages of the Big Health Insurance Give Away to the Big Insurers, what we get to call ACA, is the stipulation that in terms of helping employed people meet their insurance premium, the government only has to assist the person who is employed and paying for insurance. No mention is made of any need by the Feds or any states to assist the non-employed family member of someone who is working. So if you are working, and can hardly afford your health premium, the government offers assistance. But if your spouse or kids has a pre-existing condition and that makes your policy very expensive, there isn’t any mention of how, or even whether, the government steps in to help.

4)It goes without saying, but I’ll say it anyway, and in doing so echo what a passionate young black man running for the Illinois Senate said in 2004, “the best and most logical way to reform health care would be to have Single Payer Universal Health Care.” Unfortunately, no one I know knows what ever happened to that young black man.

There isnt really a problem. We already have the answer. Its called Single Payer health care. If States would adopt legislation to place all medicaid receiptients under a single payer system, every state would save 45% of all costs on top of the Affordable Care Act. Delaware has a single payer bill that will be voted on in the spring. Many States have single payer legislation ready to go. The Affordable care act does not prohibit any state from going to a single payer system. As long as your system protects and serves your constitutents there is no problem. Very soon all states will be responsible for 100% of their medicaid. That was the deal when the Affordable Care Act was enacted. This is not a surprise! Feds gave states lots of money to get their people in the system. Now its time for states to go the next step and legislate a single payer system. Just as happened in Canada, once a state goes to a single payer system and the citizenry discovers they are fully covered less expensively, all the other states will get into the act too. If you want a copy of the single payer bill for Delaware go to: deinformedvoters.org. Take the bill change the state name and put it through. It has already been updated under the Affordable Care Act.

The underlying political realities are changing, glacially but still changing. What kind of change will be apparent by Feb or Mar 2013.

Medicaid is not a program where serious cuts have not political consequences. That is because the relatives of many middle class families are being supported in nursing homes through Medicaid. The practical effects of constricting that program will surprise some middle class families now pushing for cuts.

The failure of state and national exchanges means the failure of a market-based solution for health care financing. And likely also means the failure of employer-provided health care coverage. Which opens the political landscape for Medicare for All.

Given the constitutional and electoral decisions about Obamacare, the market environment is predictable enough for insurance companies to start gaming the system. That will diminish calls for repeal and put pressure on state regulators (and that has already started, for example in Mississippi) to set up exchanges favorable to their operations. The question is whether this will hold down patient costs sufficiently to avoid another call for health care reform by 2016.

Vermont has applied for waivers to deliver a single-payer system within the Obamacare framework. It should be easy within a couple of years to compare its experience with that of other states.

And National Nurses United and other groups are continuing their mobilization of people in support of Medicare for All.

Yes. There was. His name is Max Baucus.

It’s sad he’s otherwise occupied, else Mitt could’ve been a valuable consultant on ACA implementation.

The ACA is a huge, complex boondoggle designed to prop up Capitalism by funneling trillions to an “industry” with essentially inelastic demand. It has little to do with actually healing human beings, as DD has highlighted in this post and the following comments.

Can we imagine a truly humane system based on community clinics where all were served within a geographic area without any red tape? Beyond that, there would be regional centers that provided higher levels of care based on referrals from community clinics.

No profit for shareholders. Doctors would have to learn to live more like the rest of us, as they did until the last generation or two.

Bernie Sanders’ little portion of the ACA is a step in this direction. This is where the future lies, not in huge programs with layer upon layer of bureaucracy, and not in for-profit medicine.

It looks to me as if we are going to get single payer system in spite of everything. Except it might still be too expensive, unless we begin putting pressure on pharmaceutical companies and the entire medical establishment. Also, what I am afraid might happen is that they are going to give the administration of the exchanges to insurance companies, and the whole thing is just going to crash. The key is cost, and I can’t see anything happening right unless costs are reigned in. There is no way this is going to work unless it is a federal program, with all the rules set by the feds. Just look at the way successful programs work, and you will understand.
No price controls will mean failure.

One major pitfall of ACA implementation is its impact on small business. Medical costs are rising, and with it the cost of medical insurance which is a cost of doing business that is directly tied to employment. When government effort is needed to encourage employment, this requirement on small business to provide medical insurance actually discourages employment.

another mess we had to see coming:

http://www.examiner.com/article/colleges-cut-adjuncts-hours-to-avoid-affordable-care-act-laws-and-costs

involuntarily under-employed workers
getting their hours cut by employers who don’t want to
pay for their ACA health-insurance (note: i did not say ‘healthcare’).

people already just scraping by will now lose income -
and still be without decent healthcare. ugh!

Indeed! has there ever been a more ridiculously named act of legislation?

It should have been called the “Already Unaffordable and Inadequate Health Insurance Act”

or “AUIHIA”

…which also closely approximates the sound you’ll make when you receive the bill.

The fundamental design flaw of the ACA is the same as the fudnamental design flaw of the Constitution — state sovereignty.

There was never any reason, at all, for there to be different programs in different states, to give the states any role in running the thing, other than to give the folks who wanted to make the ACA not work some prospective way to make it not work. Well, these folks still want the ACA to not work, so yes, they will use state control in their red states to the hilt to make it not work. Surprise, surprise!

The Founders at least had the excuse that they had to leave state sovereignty in, or the sovereign states would not have signed on to the Union. What’s our excuse?

There were Senators who were only going to vote for the thing if the exchanges were split up at the state level? Senators who were only going to vote for the thing if the subsidy to the poor element were done via Medicaid, one of those legacy dumb idea state-fed “parnerships”?

You’ld think Senators from reddish states would have been happy to have the whole damn thing a fed-only project, you’ld think they would rather it not become a political football back home. Unless, of course, their entire intent was to for it to become a political football back home, and thereby sabotage the thing.

My biggest concern for the ACA all along wasn’t its medical and ideological failings. Great as those were, they clearly were better than the medical and ideological cast of the status quo. The problem with the ACA is that it seemed designed to fail in terms of its practical operation. That would seem to have been a valid concern.

mR BIGCHIN, tHAT’s the most real and accurate definition ever, ‘UNAFFORDABLE”.

Presumably, the single payer will have an obvious incentive to rein in costs, and will do so. Costs right now are about 200% higher than in other industrialized societies. Only about 30% of that 200% can be attributed to the adminstrative costs of leaving insurance in the hands of private insurers. The rest is due to the private insurers being locked in cartels with the providers of medical services. They have no incentive to dun down what the providers charge, because they are in bed with them. The big savings of single payer would not be reducing the administrative costs of insurance, it will be finally having a payer that actually wants to dun down costs, rather than run them up to enrich the cartel of which they are a part.

And it is not simply small businesses that feel the “employer must pay Health Care Costs” decision is a bad one. Years ago, when GM started moving its operations out of the country, one reason they gave was the high cost of providing medical care to their workers.

If we had National Leaders of either party who actually cared about returning good paying jobs to this nation’s workers, Single Payer Universal or MediCare for All would now be the law of the land, with the government, not businesses, supplying the monies.