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Do You Have To Take Medicaid If You Don’t Want It?

Medicaid with ObamacareIt’s been a little while since we talked about the Affordable Care Act or Obamacare. Love it or hate it, you are supposed to be signed up for some sort of health care coverage by March 31st. Many states have expanded their Medicaid programs so that a larger number of people are eligible. One big issue I have with the whole Healthcare.gov system is that you have to take Medicaid if your income falls into that bracket, even if you don’t want it.  This is a long post, but I have tons to say about this topic, so get a snack or beverage if you need to.

What Is Medicaid?

Medicaid is a social program for low income families and individuals who have limited income and resources. It is jointly funded by the state and federal government, but each state has to decided whether or not to participate. Every state has some sort of Medicaid program presently. Medicaid is not like Medicare, which covers senior citizens and is partially funded by your payroll deductions over the years.

In the past, children and pregnant women whose income was below 133% of the poverty limit qualified for Medicaid. Also if you were disabled or had other special circumstances, you could qualify. For everyone else, Medicaid eligibility used to take assets as well as income into account, so it wasn’t possible to qualify for Medicaid if you had a high net worth.

Medicaid For All With Obamacare

Obamacare expanded Medicaid so that anyone whose income meets the 133% of the poverty level qualifies for Medicaid. Not every state has adopted the Medicaid expansion, but many, including my home state of Colorado,  have.  In Medicaid expansion states, you likely qualify if you make $16,104 as a single or $32,913 as a family of 4.

If you are enrolled in Medicaid, your basic medical costs are pretty much zero. There are no premiums. You might have a very small copay for certain services, but it’s usually no more than $5. Medicaid offers prescription drug coverage, but you have to choose from drugs on their approved list. I see no rhyme or reason to their list at least with eye medicines. Some of the more expensive drugs are covered while cheaper ones might not be. Medicaid covers most services for kids, but adults usually do not have coverage for things like routine dental or vision. However if there is something medically wrong, if a patient has chronic conditions, or needs maternity care, it is usually covered by Medicaid.

What Is The Problem With Medicaid?

Free health care sounds great, right? Yes and no. For truly poor or disabled people Medicaid is a life saver. Without Medicaid in the United States, you’d see many individuals going without basic health or pre-natal care only to show up at the emergency room in dire straits, which raises heath care costs for all of us. While even Medicaid covered persons do not always seek timely treatment, you can’t argue that Medicaid allows much greater access to vital health care than if the program didn’t exist.

However, from a provider standpoint, Medicaid reimbursements to doctors and hospitals are generally a very small percentage of normal fees. Yes, normal fees are usually outrageous, but Medicaid payments often do not cover the operating cost of a facility. With eye care, Medicaid pays about $20 for an eye exam that would normally cost $100. If we did Medicaid exams all day, we couldn’t afford to pay staff or keep the electricity running.

Added to that fact is the reality that Medicaid patients are the least reliable of any patient demographic, at least in our office. I’m not sure if this is due to poverty that affects transportation, inability to take off work, not having a working phone to call and cancel in advance, or something else. With my work for the Public Health Service over the years, it also seems that having free access to care lowers the value in a patient’s mind. Regardless, Medicaid patients have more than double the rate of no-show appointment than non-Medicaid patients.

As a result, many providers are declining Medicaid patients altogether or strictly limiting the number of them that can be seen. We limit non-emergency Medicaid to one per day in an unpopular time slot. If we get cancellations, we can take more, but we don’t actively schedule them. That may sound harsh, and I sometimes question it myself, but there is nothing worse for a doctor’s bottom line than having a no-show.

If patients have Medicaid but can’t get an appointment with their doctor, that sends people right back into the emergency room, which kind of defeats the whole purpose.

Why Basing Medicaid Solely on Income Is Wrong

Basing Medicaid eligibility on income alone is not a good idea in my opinion. For one, it encourages people to work less so that they can qualify. I recently talked to a patient who worked at a fast food restaurant. He has been a maintenance person there for years and is pretty talented at fixing mechanical equipment. He actually loves his job and wants to work full time, but he has a few chronic health conditions. He ended up cutting his hours so he could qualify for Medicaid. With his regular salary, he still couldn’t afford normal coverage, even with a subsidy, so he now works less to get Medicaid. I know a mantra of the PF community is to work smarter not harder, but this just seems wrong to me on so many levels.

Medicaid bases your eligibility on mean adjusted gross income alone. If you are really smart with your tax strategy and have no debt and low expenses, you could easily have millions socked away in various accounts, have a fully paid for home, and still structure your income to qualify for Medicaid. I realize Fox News hates Obamacare, but I thought this story was pretty compelling. Basically, a couple who have made a fortune and don’t currently work who  live in a $5 million dollar paid for house have qualified for Medicaid.

On Healthcare.gov, if your adjusted income qualifies for Medicaid, you have to take it. You cannot opt out. I have no problem with the government offering a subsidy to help pay for an insurance policy, but you can’t get one if your income qualifies you for Medicaid. Your option is to take Medicaid or pay full price off the exchange. Unlike ambulance chasers or people who purposely work the system, you literally  have no other option if you want to follow the Obamacare laws and not spend a fortune on private insurance. You can stick it to the government and take their free health care while laughing every month as your net worth grows.

When we do end up with no debt and can live on very low expenses, I’m not so sure I’d take advantage of Medicaid, even if we qualified. I’d have a real problem with the stigma of being on government assistance when I knew I could afford more. Also, being on Medicaid would probably limit my care because of the reasons mentioned above. Hopefully, this loophole in the system will be fixed or at least the option to decline Medicaid will become available.

Would you take Medicaid if you had a high net worth but low MAGI? Do you think there is a stigma attached to people on Medicaid? Is that deserved or not? 

Image: Freedigitalphotos.com/cooldesigns

About Kim Parr

Kim Parr is a private practice optometrist, freelance writer, and personal financial blogger. You can follow her journey to 20/20 financial vision at Eyes on the Dollar.

45 comments

  1. Yet another shining example of our country’s flawed health care system …

    • I am not trying to be negative, but this is a huge issue in my opinion. I’m afraid putting so many people on Medicaid is going to keep adding to the national debt, especially if we are adding people who can actually afford insurance.

  2. It’s a tough issue. If it’s not based on income, what should it be based on? Net worth? I would say net worth is harder to track and verify than income so income is the default choice. I haven’t thought about what I would do if I had the money for a regular plan but technically qualified for medicaid. Hopefully I don’t have to make that choice.

    • The old application made you list your assets like savings, home value vs what you owed on a mortgage, things like that. It was hard to verify and I know people lied, but at least you could show you did not qualify. Although, at that time, people who were high net worth probably would not have applied. I think it’s fine to go by income, but you should be able to decline it if you don’t want it and can afford something else. It’s kind of like free or reduced lunch. I know several people who qualify but don’t want their kids getting free lunch so they pay. You should have the choice.

  3. That’s a tough one, but I don’t believe we’d take Medicaid. The stigma that is attached with it is one thing, but for me it would be the issue of being limited in terms of who we could see. I’m not really so concerned about that myself, but both my wife and our kids have doctors they love and fear they wouldn’t be an option if/when Medicaid became an option. I think there is somewhat of a stigma attached and the shame is that for some it’s not because they’re trying to game the system at all.

    • I really had a great example of the stigma of Medicaid today as I had a patient who came in and her chart said she had no insurance. She ended up having a medical problem, so I asked if she had any medical insurance because lots of people think medical does not pay at a vision place, but it often does if there is a medical diagnosis. Anyway, she had Medicaid but didn’t want to use it and she was going to pay out of pocket. Her 16 year old daughter had cancer and their insurance got maxed out and they had to go on Medicaid so her daughter could have chemotherapy. To me, anyone in that situation should take whatever they can get and not be ashamed at all, but she was almost apologizing.

  4. This is just one of the many problems with Obamacare. It takes the incentive out of work at almost any level. Our MAGI hovers really close to the subsidy cut-off after our retirement contributions. Earning a little more costs us a ton.
    I would probably take Medicaid if I qualified. I have paid so much in taxes….I deserve it!!!!

  5. My dad is a physician and jokes about breaking down life events into Medicaid payments (i.e. college would cost 4000 Medicaid procedures), but what he says and what you say are true, often Medicaid coverage comes at the backs of the physicians that provide services, and every physician has to run a profitable business otherwise they won’t be there, which means making harsh decisions around Medicaid patients. And this is unfair to people who have the financial flexibility to get better medical treatment, but fall into a loophole. I am curious about the story you mentioned, though, because Medicaid has the ability to go after estates to recoup coverage costs when people pass, so I wonder if they will have access to these people’s estate when they pass as well.

    • I’m sure they will make some sort of loophole to avoid that. I do think lots of people might be surprised if they under report their income and then have to pay back their subsidy. I’m afraid health care may get as complicated as the IRS if it isn’t there already.

    • Its called the estate recovery act. Yes they can take your home as repayment for health care.

  6. In the states that did not expand Medicaid there is now a gap. People with very low incomes qualify for Medicaid and pay zero. For some states that cut off could be 50% of the poverty level. People with incomes between 100% and 400% of the federal poverty level get a subsidy to hep pay premium costs. Those whose incomes fall in between pay full price – oops!

    • It kind of pretty much says that on healthcare.gov when talking about living in a state that didn’t expand Medicaid. It pretty much says hang tight and maybe things will change later. There has to be a happy medium somewhere.

  7. Some states have moved from SNAP benefits from being just income based to including an asset test after outcries of lottery winners getting food stamps. My guess is that there will eventually be a similar test for Medicaid coverage and subsidy levels for coverage.

  8. I certainly don’t live in 5 million dollar home but I have 20k in a ROTH and I think I can probably qualify for medicaid (I’ll find out when my insurance runs out in June).

    • If you do go on Medicaid, I would love to hear about the coverage and if you feel doctors treat you differently or if they assume you have no money.

      I would not expect anyone to liquidate all their retirement savings to buy insurance, but at some level of wealth, it just isn’t right to take public assistance. I’m not sure what that cut off is, but if you don’t want it, you should be able to decline.

      • Kim I am on Medicare and Medicaid because of low income but a recent inheritance puts me over the allowed maximum resources. Although I have used more then half to purchase a good reliable I would rather not use anymore just to spend it down to qualify for the Medicaid. In fact, I would rather pay my part b premium and get a medigap plan and just get the extra help for the part d prescription plan which I still qualify for. I’m just having trouble talking to someone who actually knows if I can do this or if I have to keep medicaid once I meet the resource level again. Although I have had no problems getting the proper care with Medicaid, except for dental, I do hate filling out their stupid long application every year plus I don’t like having to live to their standards and report to them every time I have to use the bathroom, so to speak, lol

      • I am on medicaid and have received much better medical treatment than I ever did with private insurance. My husband, son and I all have great doctors and have received excellent. I have not experienced any stigma from it from doctors but the hardest part is that Medicaid always messes up the paperwork and we sometimes have to wait at the dept of human services income support division to talk to someone who can straighten it all out. And sometimes even then it’s still a mess. But in terms of actual medical care, I’ve always been able to get into doctors quickly and they have been great to me and my family. In terms of the care I’ve received as well as the cost of course, I greatly prefer Medicaid over my past insurance companies for sure. I don’t really advertise to everyone that were on medicaid but if anyone judged me for it then I would just say I wish they were able to recieve the medical care we have recieved at pretty much no cost to them just as it’s been for us.

  9. I’m so glad you are writing about this topic. I commented about this exact thing on another site and was basically laughed off the board. People thought I was just an Obama hater. This move by the ACA accomplishes two things. First, it makes more people dependent on the government largesse and guess which political party will claim they are looking out for your benefits, and which one will be the evil party who wants people to have no health care. Second, there is a provision that upon a recipient’s death, the government can seize any assets to be repaid for whatever it provided through Medicaid, thus leaving the person’s heirs with no inheritance. To force someone on to Medicaid when they don’t want to be in that system is just wrong and I sincerely can’t understand why our supreme court is allowing it to happen.

    • I don’t hate Obama or really any politician. I do hate all the party line crap, but that’s another post. I think the President has really given it a good shot with the ACA, but any time politicians try to make rules about things they don’t understand, you end up with things like this. Hopefully with enough discussion, problems like the Medicaid issue can be worked out. I don’t think it was any better when insurance companies could drop or exclude you for getting sick, but giving so many people Medicaid is really not a good solution in my opinion.

  10. I feel very fortunate that my husband’s employer offers insurance so we are covered through him. This is just so hard. Physicians absolutely deserve to be paid and people absolutely deserve health care. I don’t know what the right answer but it doesn’t seem right where somebody works fewer hours so they can qualify for medicaid because they couldn’t afford the premiums if they worked more.

    • It is kind of a messed up system. Really poor and really rich seem to be the easiest to classify. Everyone else in the middle is a bit harder.

  11. This is why we are seeing physicians cutting their practices and joining hospitals. They are getting paid very little from Medicaid. I am sure there is a stigma for those on Medicaid. I do think it is a necessity for some, but now it is too easy to game. It also doesn’t give anyone an incentive to do more with their lives and change their situations.

    • I do sort of see the writing on the wall for most private practices. It’s really hard to run a business and meet all the health care regulations that you have to today. It’s not as bad in a small town, but eventually, I think group practices with multi-specialties (kind of like a Costco for health care) will be the norm.

  12. I think it’s so sad that in the 21st century the Medical Sector sees people as Clients rather than Patients.
    the entire medical industry has grew into a capitalist corporation and have deviated from it’s humanitarian mission!
    the basic health needs should be made free of charge for everyone,
    The army’s infirmary is free for all the army personnel, why can’t we do the same for the public, the public is already paying huge taxes for the state.
    Many thanks and Best wishes!

  13. Medicaid takes people’s incentive away to stay healthy. Here in Hawaii we have Quest which is a medicaid version on steroids, medicine is free up to a certain point.. Some people take 14 medications and complain that they have to pay a copay on half of it. I know their health plan is much better than at my company.

  14. Here in NYC, we’re losing hospitals who survive on Medicaid payments. The government only recently reduced Medicaid reimbursements a few years ago and a hospital around the corner from me where a majority of patients are on Medicaid can’t afford to stay open. It’s the only hospital for a few miles in Brooklyn so theres is an impetus to keep it open, especially by local politicians but I don’t know where the money would come from if they succeeded.

  15. I work on the insurance side of the health care spectrum, so I’ve got plenty to say on it… but maybe save my rant for elsewhere. There are definitely disincentives to work within our current system, and I agree that more should go into the process than a strict application of need based on income, although the size of our population limits what we can do. I think a lot of providers are actually moving towards not accepting medicare/medicaid patients due to the increasingly small reimbursement rate, and I wouldn’t feel bad if I were you. You have to focus on the health of your practice. If you want to do some pro bono exams for an afternoon, sure, but not at the cost of your income and financial vitality. At some point, something has to give. The only way we can barely float these programs is by slicing reimbursement, which in turn actually hurts the people the programs are designed to help. One way or the other, something is going to have to change.

  16. Medicaid is best of you have to go into a nursing home. Otherwise, many doctors do not take it form what I have heard. having said that, I am covered by the VA Healthcare system, so hopefully that is always available. But I will still need a high deductible plan, just in case an emergency happens, and I wake up $100K later in a private hospital…

  17. It is a very difficult topic and I don’t feel I am knowledgeable enough to really have an informed comment. But I have seen examples of people who have taken advantage of Medicaid. They are employed in cash businesses or might even own the business but are able to hide their assets and get Medicaid. I don’t know how this can be fixed, but something needs to be done because at some point the money will run out.

  18. Very simply: It’s not affordable health CARE. It is affordable health COVERAGE (urass)…as in… INSURANCE. I signed up because I HAD TO. Private premiums were KILLING US. Of course, when I agreed to share our financial details with DEAR LEADER, HE determined that we require state assistance for our child. We do not WANT state assistance. We would love what Americans refer to as a FREEDOM TO CHOOSE whether or not I will have the Governor checking in with my 7 year old as to whether or not he or she brushed their teeth this morning. OH, and BY THE WAY….the much acclaimed affordable health NOOSE does not permit unique Americans who may not feel compelled to spend everything they have at Wal-Mart so they can boast about the neat coffeemaker, or this, that or the other fucking thing that must be had by most it seems… Americans are being PUNISHED for frugality. Does it piss off the LEADER that some people CHOOOSE to live simply? Is it possible in these United States to love time over money? Isn’t that implied in the FIRST AMENDMENT? Look, I realize that we don’t MAKE what we’re $uppo$ed to apparently. But we don’t SPEND what most feel is necessary EITHER. So what if we don’t CHOOSE to travel? So what if we don’t CHOOSE to choke down the crap they sell on DirecTV or SHIT, I mean DISH. Gimme a BREAK. HERE IS A PROPOSAL. Consider the possibilities Heir Obama: people are required to show proof of insurance on their tax returns. If they do not, they pay a fine. Go ahead and garnish their effing wages for all I care. If people lack assets and cash flow, HELP THEM OUT! These people do not choose poverty, but are trying to figure out how to keep the lights on! Still, let other Americans who have assets, no debts, etc. who choose a high ASSET to DEBT ratio make alternative choices. Try to remember this is a PLURALIST society. Even LOW INCOME people are NOT HOMOGENOUS – ya Libril Elitist! I may not make a lot of dough, but I pay my effing taxes. If health insurance companies could compete nationwide for customers, perhaps they could assemble a network of health providers to agree to respective actuarial tables of predictable costs, etc. They could pull their resources together and dare I say it, keep the cost of health CARE down! Making the Department of Health and Human Services or State Departments of Children and Families the clearing houses for this negotiation is just STUPID. Let HISTORY be your guide DEAR LEADER. Please show me when, WHEN in the history of these United States has the Florida Department of Children and Families proven themselves COMPETENT? UN EFFING BELIEVABLE!. And YOU insist that I turn healthcare provision for my only child to THEM? Wow! Good thing ur the Presdent! You don’t have to deal with your own debacle. You and your minions are conveniently outside of the labyrinth that others might refer to as the FINAL SOLUTION. Why don’t you try to spend 5 hours on the phone wishing for someone to help you navigate a socially imposed purgatory in a FREE COUNTRY only to find out after being on hold and listening to hideous music prescribed by some organizational psychologist for an hour that your website is down for maintenance! Perhaps you should commission an economic study on the loss of productivity due to having to wait on hold for someone in DEAR LEADER’s healthcamp to get their act together. But you don’t have to worry. In fact you’re in Hawaii right now taking some time off from your stressful yob. Perhaps you’re taking in a game of human chess. Must be nice to the KING.

  19. Your article is very interesting. I must be in the minorities. I live in a state that does not participate in the medicaid expansion. I have been using the obamacare since last year. I applied for it for next year too. Today I received a letter from the state offering medicaid. I was devastated. I did not want to lose my doctors I’ve used for the past ten years. So I called them up and refused medicaid! I rather spend my money on the premium and be on obamacare so I can still receive the quality care as before. Nothing wrong in that. I don’t understand the people who are trying so hard to get Medicaid (apart for the true needy. I think it’s better than nothing for someone who has no option) The other half, the pranksters, might as well forget about getting sick or plan to see any decent doctor. Just my opinion. Thanks for reading.

  20. What if I did not qualify for Medicaid at the beginning of the year when I signed up on healthcare.gov? But, then I got pregnant which now qualifies me?

    Do I have to take it or can I keep my current coverage? I don’t want Medicaid because I would have to switch doctors.

  21. I’m going through this nightmare right now. I really really really wanted to stay with my current psychiatrist even if it means paying out of pocket (still way cheaper to pay out of pocket every couple of months than to pay monthly insurance premiums that I can’t afford) but I’ve just been informed since they found out I have medicaid they’re not allowed to let me pay them. That’s right. I’m not allowed to see my psychiatrist or therapist for treatment for depression.

    • If they are not a Medicaid provider, I believe you can choose to pay and see them. If they are a provider, then they can’t charge you and can limit when and if they take Medicaid patients. I’m so sorry you have to deal with all that.

  22. I see the original article was posted over a year ago but I just came across it. I’m one of those people that qualifies for MediCal since I’m now unemployed, but I don’t want MediCal because I want to keep my doctors. In addition, per the MediCal documents I received when I was told I qualified for MediCal, there are no doctors that accept MediCal near me. However, I was told I can’t decline MediCal, so I am technically still on MediCal but I also pay full price for non-MediCal insurance through Blue Shield. Of course, Blue Shield takes my monthly premium, so I have not had push back from them.

    My interpretation of the law is that I won’t get government subsidies for my Blue Shield insurance since I qualify for MediCal, but I have not found anywhere that it states I can’t purchase full price insurance even though I qualify for MedCal. I did purchase my Blue Shield insurance through the exchange, though, just in case I do get income before the year ends, which would then put me in the category above MediCal qualification where I could take advantage of the gov’t subsidies….at least, I think I did. 🙂

    As someone stated earlier, though, if I don’t have any emergencies this year, it would have been cheaper for me to just pay the full charges from my doctors rather than the Blue Shield premium. The premium will end up costing me $3,600 for the year, whereas, my medical bills so far this year would have been $114 (I don’t go to the doctor often).

    • That is a tough one. I think in your case, I would drop Blue Shield, keep MediCal for emergencies and pay out of pocket for routine doctor visits. You might even be able to get a cash discount. It’s sad you can’t choose to purchase insurance and take a subsidy if you don’t want Medicaid.

  23. 86% of people who get their healthcare via Obamacare get a subsidy. A family of four is subsidize up to an income of $95,000 a year. This is ridiculous. I am single with three kids and I do not expect my fellow taxpayers to pay for my health insurance. Yet I see healthy married couples with assets and only one or two children get very low-cost health care at the expense of tax payers. It’s ridiculous. The government should only pay for your health care if you literally are unable to. If you’re living a middle-class lifestyle, please don’t ask me to pay for your health insurance. If you have assets, please don’t ask me to pay your bills! The irony of it is that people don’t realize this is basically welfare.

  24. My situation is the same as Jen M – I left my job to return to graduate school – so I qualify for Medi-Cal – which I don’t feel I should be entitled too. I saved money so I could return to school and support myself. It’s either free or several thousand dollars per year – but since my income is “$0” I just get routed to Medical. All doctors I’ve seen are far away in sketchy neighborhoods and I waited at least two hours for all three appointments (general check-up stuff) – 3rd appointment they told me to leave after two hours because they didn’t have authorizations from my primary – and clerk was off that day. I need various vaccines due to being spleenless – can’t find anyone to give it to me. Local CVS, Walgreens etc advised they would be commiting insurance fraud if they gave me the meningitis vaccine I had been prescribed. These doctors WONT TAKE YOU even if you want to self-pay – so your suggestion to do just that is not feasible. Lots of kinks to work out – but if I choose to spend my savings on insurance premiums that allow me to see a convenient doctor, I should be able to set my priorities that way.

  25. I am presently on SSDI and have medicare and medicaid. I recently received an inheritance which puts me over the resource maximum limit to qualify for medicaid. I can spend it down to qualify again but I would rather pay for a medigap plan and get the extra help for a prescription plan but not sure if I can do this. I have called both the SS office and Medicare office and neither seem to know if I can which I don’t understand why they don’t know. I haven’t heard from medicaid yet since notifying them of the inheritance and am in need of dire medical care but don’t want to go because I will not be able to afford the 20% that Medicare doesn’t pay. I’m not sure how to proceed to get the answers I need but I will keep trying.

  26. The problem I have with Medicaid is its not really free anyways – its a loan, and now not only can they take a person’s home, but any assets or assets they transferred to family when they die to repay their medical bills. With the new laws where I live in Ohio they stand to make 4 times as much money as before from estate recovery. The reason I don’t think this is right is because many people being forced onto medicaid because they fall into an income gap are older widows who now earn little money but their homes may be paid off from their husbands working many years and they want to leave the home to family. Health charges are way too high and Medicaid can pay premiums to private insurers that are too high and expect to recoup it when they grab the patient’s property. The person if buying on their own might not buy such high premiums. The insurance rates on the exchange are too high for most people, with ridiculous deductibles, and then the whole system also focuses on “staying healthy” using traditional care, pharmaceuticals with their dangerous side effects, chemo, etc. There is little accommodation or encouragement to pursue natural health options which is a growing trend and truly helps people get well. Our country has been rated the worst in state of health of all 20 “advanced” nations globally. In the Journal of American Medicine’s annual report well over a million people in the US die each year due to this type of medicine (errors, medication side effects, interactions, unnecessary surgeries, etc) and these are only deaths that occur in the hospital, not after they leave. So do I want to be forced to buy insurance for healthcare I don’t believe in? This is why I personally have joined one of the independent Christian co-ops that is affordable and is exempt from the Obamacare rule. I use natural medicine, I would be willing to pay for just emergencies/urgent care or ER but there is no option for that, and the decisions made regarding health insurance and Medicaid ultimately benefit the medical community who are getting paid more by people being forced onto plans, the states are collecting more, insurance companies are raking in more, and the demographic that had pre-existing conditions who are mostly older from a certain constituency can get care, but there is no limit on what insurance companies can charge. It is all about profit not getting healthcare. While a huge number of children/family of the people who are middle class or poor will pay the price when assets left for them are taken away that they need (home, life insurance, pensions, etc – any assets) while the person will probably not even get well with our current medical practices and the pharmaceutical companies, insurance companies, and doctors get richer. My sister is a doctor and since Obamacare went in (which she complained about constantly before it did because she thought she would be getting paid less due to Medicaid enrollments) and now she is making record profits.

  27. Because of disability, my wife and I both had to go on Social Security disability and thus have Medicare. We chose to go with a Kaiser Permanente administered Medicare plan. Because of our income, we keep getting signed up for Colorado Medicaid against our will, and we have no need for it since we’re on Medicare.. The following pattern occurs: We receive letters from CO DHS that we’re Medicaid eligible. Then we get letters that if we want to keep Medicaid (we don’t) we have to pay a monthly premium to stay with Medicaid. Launder, rinse, repeat.

    Meanwhile because we’re Medicaid eligible, specialists that accept Kaiser Medicare won’t take us because we’re also on Medicaid.

    Amendment 69 is no panacea. What we need is a less complex way of paying for health care. A thousand different varieties of employer sponsored health care, plus the layers of government sponsored health care has turned things into a total mess. Employees don’t really get to choose beyond maybe a couple of employer sponsored plans, medicare eligible have a few more choices but not much. No one knows the true costs of the actual medical service. We squeeze the balloon to cut costs in one area, only yo find the blowing out the other side of the balloon.

    In short I understand the dilemma providers face.

    It is time for employer sponsored health care to end. It came about after WWII as a way to provide benefits to employees in lieu of pay raises that couldn’t be granted because of price controls in place at the time. We need a system for paying for health care that has everyone on a level playing field. To me, our choice is either based on 1. Medical Savings Accounts with substantial deductibles where people self-insure for minor procedures (over-simplified for lack of space) or 2. Socialized medicine as in Canada and most of Europe…I’m leery of that choice.

  28. If you are being forced into Medicaid because you earn less than 100% (or138% in some states) of FPL, you can transfer $ from an IRA to a Roth IRA and use the taxable income generated to move your taxable income to 101% (or 139%) of the FPL. Then you can get a large subsidy for your healthcare under the ACA. This strategy will keep you out of the Medicare nightmare!!!

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