Why States Should Not Be Allowed to Alter the ACA with Waivers

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run75441
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CMS is allowing states to seek waivers to alter parts of the ACA. According to Republicans, state government knows better than the federal government the needs of its citizens and can design a better healthcare plan for them. Michigan along with Kentucky and another state have applied for waivers. Michigan and Kentucky have been approved. The Michigan bill has made it through the Republican legislature and will go to the governor to be signed (hopefully vetoed). The troublesome part of Michigan State Senate Bill 0897 (2018) can be found in SEC. 107B.

(E) If A COUNTY’S UNEMPLOYMENT RATE REACHES 8.5%, ALLOW A RECIPIENT IN THAT COUNTY TO MEET THE WORKFORCE ENGAGEMENT REQUIREMENT IN THIS SECTION BY ACTIVELY SEEKING EMPLOYMENT ACCORDING TO THE MICHIGAN EMPLOYMENT SECURITY ACT, 1936 (EX SESS) PA 1, MCL 421.1 TO 421.75. IF, ONLY AFTER A COUNTY’S UNEMPLOYMENT RATE HAS REACHED 8.5%, THE COUNTY’S UNEMPLOYMENT RATE SUBSEQUENTLY DROPS TO 5.0%, THE RECIPIENT MUST, AGAIN, MEET THE WORKFORCE ENGAGEMENT REQUIREMENTS AS REQUIRED UNDER THIS SECTION.

This is a relief valve for “counties” with high unemployment. In effect if Michigan counties have a high unemployment rate (8.5% or above), the unemployed workers in that county can have Medicaid until such time as the Unemployment Rate drops to 5%. Then the workers are expected to seek employment to be eligible for Medicaid. Ok, that should cover Detroit, Flint, Saginaw, Muskegon, etc. high unemployment rate. which exceeds 8.5%. Or does it qualify them?

The issue with SEC 107B is the word “Counties.” By using solely the word counties, SEC 107B does not make an exception for townships, villages, or cities. For example, Wayne County has an unemployment rate of 5.5% and not 8.5% or greater. As a result, Detroit which does have an unemployment rate greater than 8.5% does not qualify because it is not a county. Neither would the other Michigan cities in other counties with low unemployment rates qualify. Set this aside for a moment.

As many of you may know, Amazon rejected Detroit as a site for HQ2. While mentioned in the Amazon response, the claim of a lack of talent can be refuted as there are 52 million people living within 5 hours of Detroit, plenty of schools of higher education located in and around the Detroit, and also far more of each than exists Seattle. What Fortune Magazine pointed out as the primary issue for Detroit being rejected was the lack of a regional transportation system similar to what may be found in Chicago. Dan Gilbert fleshes out the bones of the reason with this detail:

“What became crystal clear to us from countless surveys, discussions, observations, studies, and even Amazon itself, is that having a strong mass transit solution is the ante to play for a ‘millennial’ workforce, as well as for the most successful and dynamic companies in the world.

Amazon conducted an internal survey of their employees, and the results showed that the ability to move seamlessly around a city with strong mass transit was a critical priority.

Companies like Amazon and their employee base require and depend upon a dynamic and reliable transit. If we are determined to attract exciting opportunities to metropolitan Detroit, then it’s time to get in a room and figure it out.”

The last go-around for a mass transit system was rejected.

The largest citizen cohort in the US wants to utilize public transportation rather than tool-around in pickup trucks to get to work. Amazon and other companies are looking beyond the baby boomer generation requirements to satisfy this new and larger cohort of citizens – Millennials. Automotive OEMs are in for another rude awakening in the next decade after they cut back on building smaller vehicles in favor of ever larger SUVs and Pickups. Gasoline sits at $2.90 today. If demand goes away and gasoline goes up in price, the OEMs will be retooling again.

Now back to high unemployment rates in cities as compared to the counties in which they reside.

Detroit Free Press, Nancy Kaffer:

“Sen. Patrick Colbeck, R-Canton, who is a gubernatorial candidate, told Gongwer that there were 31,000 job openings within an “easy commute” of his district. Colbeck, an Islamophobe and general holder of screwy beliefs, failed to mention that Canton opts out of SMART, the regional bus system. Commuting how, Senator?”

If Amazon believes there is not enough Public Transportation available for its “desired” labor force to get back and forth to work, then why would the legislature believe it is possible for the residents of cities to be able to travel outside of city limits? The cost and insured ownership of an automobile is expensive by national standards. Senate Bill 0897 will require residents in high unemployment cities to travel a distances even if there is no regional transportation available or a community with jobs opts out if the already low income and unemployed want Medicaid. It begs a question:

Is the failure to allow Michigan cities the same exemption as counties a feature or a bug?

The Great Lakes Beacon’s Danielle Emerson had this to say about the application of the exemptions.

So, who will get exemptions? Based on the unemployment information collected, there are 17 counties with unemployment rates meeting or exceeding 8.5 percent: Kalkaska, Oceana, Alcona, Iosco, Lake, Emmet, Chippewa, Ogemaw, Ontonagon, Arenac, Schoolcraft, Roscommon, Alger, Montmorency, Presque Isle, Cheboygan and Mackinac.

The majority of those counties (15) are represented solely by the Republicans with only parts of two counties being represented by Democrats.”

It is a feature and meant to penalize cities of which, by-the-way, the population is predominately minority. SEC 107B pits cities against rural areas. Michigan is going back to pre-ACA when it penalized single adults and under employed married adults with or without children if they were not working enough hours to satisfy the state mandated minimum. In the end the hidden costs of no insurance surpass the cost of Medicaid.

In 2013 upon the passage of Medicaid Expansion in Michigan, Michigan State Senator (Fowlerville) Joe Hune said; “I voted ‘no’ because I could not stomach pushing this garbage forward.”

Here is what Senator Joe Hune had to say in 2018 on Senate Bill 0897: “Making people reliant on the government for life’s necessities does not empower them or improve their situation, I heard a lot of absurd language calling this bill disgraceful. What I think is truly disgraceful is trapping people in a cycle of poverty and victimhood so that they have no choice but to relinquish their God-given freedom to certain politicians who genuinely disdain them.”

During his first term, Senator Joe Hune voted himself and other Senators a lifetime of taxpayer paid-for healthcare insurance in 2012. Soon to be citizen Joe Hune has had little experience in the private sector; but, he has little to worry about as his healthcare will still be intact if he loses a job there.

Of course the trapping of people in a cycle of poverty only applies only to cities with a predominantly minority population and not those populations living in rural areas outside of cities. Go figure what the reasoning is . . .

HT to Charles Gaba at ACAsignups.net whose article caught my attention.

run75441 at angry bear blog