The Data Agenda

Tuesday, February 5, 2013

Will You Be Forced into Medicaid?

Government "insurance" exchanges (or "marketplaces") are going to force many people into Medicaid, the government subsidy program for the poor.

As Brandon Clark from the consulting firm FrogueClark told CBS Charlotte, "A lot of middle class individuals are going to apply for a state exchanges... thinking they're going to get a Blue Cross Blue Shield plan or a United Plan, like they had before... But they will find out they're not on private health insurance, but rather, a state Medicaid program."

Section 1311(d)(4)(F) of the Affordable Care Act states that "if through screening of the application by the Exchange, the Exchange determines that such individuals are eligible for [Medicaid, State Children's Health Insurance Program (CHIP), or] any such program [the Exchange shall] enroll such individuals in such program."

The law requires the use of "modified adjusted gross income" (which includes deductions) to determine eligibility so Clark says, "you could easily have a family of four or five making well over $50,000 per year ending up on Medicaid."

When you think about the ramifications, consider that one-third of physicians already refuse to take new Medicaid patients.

CCHF Health Freedom eNews, October 31, 2012


P.L. 111-148 Text
Section 1311(d)(4) - FUNCTIONS- An Exchange shall, at a minimum--

(A) implement procedures for the certification, recertification, and decertification, consistent with guidelines developed by the Secretary under subsection (c), of health plans as qualified health plans;

(B) provide for the operation of a toll-free telephone hotline to respond to requests for assistance;

(C) maintain an Internet website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans;

(D) assign a rating to each qualified health plan offered through such Exchange in accordance with the criteria developed by the Secretary under subsection (c)(3);

(E) utilize a standardized format for presenting health benefits plan options in the Exchange, including the use of the uniform outline of coverage established under section 2715 of the Public Health Service Act;

(F) in accordance with section 1413, inform individuals of eligibility requirements for the medicaid program under title XIX of the Social Security Act, the CHIP program under title XXI of such Act, or any applicable State or local public program and if through screening of the application by the Exchange, the Exchange determines that such individuals are eligible for any such program, enroll such individuals in such program;

(G) establish and make available by electronic means a calculator to determine the actual cost of coverage after the application of any premium tax credit under section 36B of the Internal Revenue Code of 1986 and any cost-sharing reduction under section 1402;

(H) subject to section 1411, grant a certification attesting that, for purposes of the individual responsibility penalty under section 5000A of the Internal Revenue Code of 1986, an individual is exempt from the individual requirement or from the penalty imposed by such section because--
    (i) there is no affordable qualified health plan available through the Exchange, or the individual's employer, covering the individual; or

    (ii) the individual meets the requirements for any other such exemption from the individual responsibility requirement or penalty;
(I) transfer to the Secretary of the Treasury--
    (i) a list of the individuals who are issued a certification under subparagraph (H), including the name and taxpayer identification number of each individual;

    (ii) the name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under section 36B of the Internal Revenue Code of 1986 because--
      (I) the employer did not provide minimum essential coverage; or

      (II) the employer provided such minimum essential coverage but it was determined under section 36B(c)(2)(C) of such Code to either be unaffordable to the employee or not provide the required minimum actuarial value; and
    (iii) the name and taxpayer identification number of each individual who notifies the Exchange under section 1411(b)(4) that they have changed employers and of each individual who ceases coverage under a qualified health plan during a plan year (and the effective date of such cessation);
(J) provide to each employer the name of each employee of the employer described in subparagraph (I)(ii) who ceases coverage under a qualified health plan during a plan year (and the effective date of such cessation); and

(K) establish the Navigator program described in subsection (i).

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