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We all know that Nancy Pelosi said "we need to pass the bill to know what's in it," but one of the more insidious problems with Obamacare relates to the rules already in place for Medicaid, and the attempt to move as many applicants to Medicaid as possible.
An application for the Oregon Health Plan / Healthy Kids program - our version of Medicaid - contains the following passage:
"When a person that received OHP/HK [Oregon Health Plan / Healthy Kids] dies, OHA [Oregon Health Authority] or its designee may recover from the "estate" (as defined in ORS 416.350) of the person the amount of OHP/HK received by the person starting at age 55. This includes monthly payments made by OHA or its designee to coordinated care organizations. In cases where the person receiveing benefits is in an institution (such as a nursing home) for 6 months prior to death, the state will recover money for all OHP/HK provided regardless of age when received. OHA or its designee will not claim this money if the person receiving benefits is survived by a natural or adopted child that is under age 21, blind, or meets Social Security Administration criteria as permanently and totally disabled. If the person receiving benefits is survived by a spouse, OHA or its designee will wait until the spouse dies and submit a claim to the spouse's estate."
This is where things get crazy. This estate encumberance is not new to Obamacare, but the expansion of Medicaid under Obamacare is. As of today, not a single person in Oregon has signed up for private insurance through the private exchange. Instead, applicants are being told (when they are actually able to complete a paper application) Medicaid is their ONLY OPTION. And it's happening at an alarming rate.
A friend of mine in the know relates the following scenario: "Cover Oregon covers both Medicaid (Oregon Health Plan) and insurance (companies in the exchange). If you are at 138% of the poverty level, you qualify for Medicaid - and that's where cover Oregon will try to sign you up. If you are in Medicaid, they can recoup some costs from your estate. The example I heard was over a certain amount of assisted living before you die. If you are over the Medicaid line, you can get subsidies for the insurance plans through the exchange. But if you qualify for Medicaid but don't want it because of the estate issue, you're in a serious bind. You can still buy a plan through the exchange instead of Medicaid, but you won't qualify for the subsidy because you already qualify for Medicaid. They are coaching those people to inflate their income to get over the Medicaid line. And it only applies to Medicaid / Oregon Heath Plan - not private insurance bought through the exchange. This is where the working poor are getting the worst possible deal. If they qualify for Medicaid, they can't get subsidies for the exchange plans that people making more money qualify for. So they are forced onto Medicaid with the estate lien liability. Just another example of the Frankenstein's Monster that is Obamacare."
His point is well taken: the two parts of Obamacare - the nonfunctional exchanges and the expansion of Medicaid - are creating a two tier health care universe. When the exchange plans get more and more expensive, they will do the obvious and compassionate thing and continue to increase the income threshold to qualify for Medicaid. Service on Medicaid was already problematic, and in many cases providing substandard care. Imagine how bad it will be after untold numbers of new users are added to the system. The end game will be very much like the NHS in Great Britain (which I've blogged about previously) - If you have a good job, you get private insurance. If not, you are on single payer (Medicaid), forever relegated to the welfare system. And there you'll be an indentured servant, even after you die.