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June 24, 2014

Obamacare Medicaid in Missouri

Since the time Obamacare was passed, states such as Missouri that have always been considered as the hub of Republican candidates opposed the legislation staunchly. The degree of criticism and opposition of the people of Missouri can be manifested from the fact that in the year 2010 an overwhelming majority of Missourians voted against the Affordable Healthcare Act or Obamacare as it is known with a massive 71 percent. Known as Proposition C, it was a state law that actually kept the government from mandating people to get health insurance and imposing fines on them for not purchasing it. Passing of Proposition C placed the state government in direct confrontation with the federal government. However, an important dimension that cannot be sidelined is the opposition of Missourians towards the Obamacare.
A prominent reason for this is the dramatically high level of health insurance premiums that Missourians will have to pay once Obamacare is promulgated in their state. According to a report from the Center for Data Analysis at the Heritage Foundation the average premium of a 27-year-old will rise from $159 to $244 per month registering a 53 percent rise in the premium that will be paid. Similarly the average insurance premium for a 50-year-old will also skyrocket from an average monthly premium of $299 to $416 making it extremely affordable for the people of the state to afford health insurance or pay for it (Kampis, 2013). On the other hand Missouri Medicaid is currently in line with the requirements and the needs of Missourians and is playing an effective role towards satisfying their needs related to health care.
The story of Josh and Rayanna Robiinett and their daughter Aria is a case in point. They were able to afford the expensive treatment of their infant daughter who suffered from lymphoblastic leukemia. She was supposed to be injected with a syringe every other week each of which had a cost of $3000 (Bale, 2013). Even though Aria could not survive much, the parents were still happy that they were able to do something for their daughter because of the services that were offered to them by Medicaid. Missourians will be deprived from these facilities of medicaid after the promulgation of Obamacare which means that more than 300,000 Missourians get sick or need any other kind of treatment they will have to find health care centers that are funded by the federal government to acquire any sort of treatment, something that not all Missourians will be able to afford.
Being a predominantly Republican state in terms of political composition Missouri has always exhibited a major resistance towards Obamacare. This is clearly manifested in the form of the opposition that Obamacare has faced in the state of Missouri in the year 2010 when the people of Missouri voted massively for Proposition C demanding an expansion of their health care insurance plans under the medicaid program rather than choosing or purchasing from the insurance plans that Obamacare intended to offer them. In the words of the House Republican leader John Boehner, "the steadfast opposition of the American people to out-of-touch Washington Democrats' plan.” (Montopoli, 2010) With the help of the successful opposition campaign that Republicans were able to organize and launch for the Affordable Care Act it became prominent enough that the state court and the federal government had to consider the will of the people and act in accordance to it which implied directly in the postponement of the health care bill that the Obama administration so desperately wanted to pass.
It has been four years since Obamacare first came on the surface in the US parliament, and with the passage of time resistance and opposition towards it has increased. To this day people disapproving it are at 57 percent according to the latest Pew Research that was conducted. It is important that Obama administration introduces some proper restructuring of the health care bill and its overall mechanism so that it can help in producing some tangible changes for the people in the long run.
One of the major policies due to which small-scale community health centers working within a state and catering to the needs of a small target market may not intend to expand Medicaid under Obamacare is the fact that they will simply fall short in terms of providing the people to their health center in terms of the services and facilities that they provide to them. The concern is not just being felt in Missouri, but even other states of the country have similar concerns. "If the larger organizations decide they're going hard after all those newly insured patients, you could see a feeding frenzy," was the concern registered by Dr. Robert Winn, associate vice president for community-based practice at the University of Illinois Hospital & Health Sciences System (Lowry, 2013).
The notion due to which community health centers will never be in favor of expanding medicaid services under the banner of Obamacare is simple. The entire phenomenon is simply based on the maximization of profit margins and naturally, medical centers that are well funded by the federal government will be able to offer state of the art services to their patients, leaving others in the race of competition and overtaking one another.
At the same time it is also important to mention here that an estimated 877,000 Missourians are currently uninsured at present (Lowry 2013). Reason being that these people could not afford the monthly expenditure that they had to pay in order to maintain or buy an insurance from the Medicaid program. Now with the Obamacare taking control of all healthcare facilities, the costs for health care are going to increase making it difficult for them to make their ends meet with a higher portion of their incomes going as premium.
One of the issues that can actually serve as an alarming point for Samuel U Rodgers Health Center is that being headquartered in a state of Missouri which is as mentioned earlier a Republican state it might not be on the priority list of the federal government which is currently under the control of the democrats. On the priority list of states for the federal government it would definitely be states who have democratic governments and who were more than ready to accept the funding that the government was ready to offer them as compared to Missouri and its health care centers who went to every possible extent to ensure that they triumphed in providing the government with the resistance on the expansion of medicaid program becoming operational under the banner of the Obamacare.
Another reason that will further play a role in driving the attention of Samuel U Rodgers Health Center towards the Obamacare issue is the fact that when it comes to funding, it will be higher and large scale health care centers equipped with the state of the art healthcare facilities incorporated with them who will be the first ones to receive funding and benefit from the money that will be provided in the form of health programs launched by the government. A health care center like Samuel U Rodgers trying to help a small segment of the population will not be able to top the list of fund beneficiaries who will occupy top slots.
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The skepticism over Obamacare especially in Missouri is not without its legitimate reasons. The Medicaid programs have found to be ineffective and less successful especially in the public healthcare sector. The doctors at University of Virginia conducted an insightful study to examine the surgical outcomes of patients at national level. According to their findings, the rate of in-hospital deaths of people using Medicaid is higher than those using private medical insurances. The stay in hospital is also longer. The study reveals that the average length of stay for people using Medicaid was 19 percent more than the rest. (Medicaid Policy Research, 2013)
Another study at England Journal of Medicine titled “The Oregon Experiment” showed that the Medicaid had made no significant improvements overall in the first two years. With Medicaid in place, there is certainly an increase in its use but that has not produced positive healthcare outcomes. Although the researchers noted increased rate of diabetes detection and low rate of depression but that does not involve the people facing tough financial conditions. (The New England Journal, 2013)
The law provides subsidies for seniors who cannot afford their medications with Medicare. It requires restaurants and vending machines to display the calorie count of each food. To encourage students to go into general practice, the law has helped repay their loans to pay for their medical studies and will greatly increase the compensation measures of general medicine Medicaid. A new federal agency created by law, the advisory committee of independent repayments, which will recommend Medicare reimbursement rates to hospitals and physicians.
This comprehensive bill is a phenomenal accomplishment of the Obama presidency. It will extend health coverage to millions of Americans and reduce the shameful practices of some U.S. private insurers. It is important to analyze what it does not. It does not simplify the astronomical stack of layers of payment system that overlap which increases from a few hundred billion dollars the cost of health care in the country. It does not give the United States the universal coverage at a reasonable price , managed by all industrialized countries. With this law, the U.S. health care system will remain the most complicated health care system, the most expensive and the most socially unjust major developed countries.
The new rule most important is called the "guaranteed issue". Starting from 2014, each insurer shall be obliged to issue health insurance to anyone, whatever their previous situation. This change would allow 20 million Americans who cannot now have health coverage, to have one. Meanwhile in 2014, states are expected to extend their health insurance high risk programs to cover those who are not. (William, 2013)
To work, the notion of guaranteed issue must be associated with the notion of individual mandate for example the need for each individual who buys insurance. Insurers need a broad base of insured risk that diversity is large enough to financially bear the notion of guaranteed issue. While all the other industrialized countries have integrated these two concepts long, this is the first time that the United States includes in its legislation.
The law is quite fragile - after the fierce battle with Conservative Congress - the notion of the individual mandate for health because it does not impose strict penalties for not buying health insurance, which will likely result in the choice of many Americans at low risk for not buying health insurance. In addition, prominent conservatives in several states have filed lawsuits against the federal government to demonstrate the unconstitutional aspect of the notion of individual mandate. If the individual mandate falls, the principle of guaranteed issue and this fall will be the heart of the Obamacare law. (Theodore, 2000)
The upward pressure over the cost of medical services is mainly from monopolistic behavior of providers of health services. Indeed, the opacity of the process of price negotiations between providers and private insurers allows them first to discriminate patients by price. The hospital billing system is extremely complicated and differs according to the interlocutors.
Private insurers negotiate rates with individual hospital or clinic (generally once a year) on all services. Therefore, for the same type of services, a health facility may charge customers different prices. According to studies, the difference in price paid for medical services in hospitals across the country can reach 260%. The pricing depends on the institutions and the negotiating power of private insurers, stronger or weaker depending on the degree of concentration of suppliers in the region. (William, 2013)
The poorest have much at stake in the Obama era. Not only have they received lack of specific public action but they are excluded from most social programs in place. In fact, they rather aim lower than the poorest middle classes: the reform of health benefits to intermediate classes between the poor, who are covered by Medicaid, and the middle class who can afford private insurance and the program of fight against foreclosure excludes insolvent or unemployed.
A significant portion of the poor is socially alienated and disconnected from the labor market. Thus, they cannot benefit from such assistance. As for unemployment benefits (extended to 99 weeks in the affected states), they certainly prevented families to know distress but have little impact on the lives of the working poor and have not helped people away for a long time the world of work. These constitute the underclass, covered by Obama's rhetoric, but sacrificed at the altar of other political and economic priorities. (John, 2013)
The same goes for the poor segment in Missouri. The Obamacare makes it quite difficult under-privileged people to qualify for the medical assistance. Though the insurance exchange should ideally cut down costs for people without job-sponsored coverage but estimated 226,525 other uninsured Missourians will miss out on it.
The children with special needs also seem to bear the brunt of Medicare. With taxes raised on the families with special children, the claim that Medicaid saves you money becomes invalid. What makes the Act less affordable is the provision that places a cap on FSA (Flexible Spending Accounts).
Additionally, Obamacare will further impose extra burden on taxpayers considering the amount that individuals can claim as itemized deductions for medical expenses.  Previously, individuals could claim medical expenses with having 7.5% of adjusted gross income but now that threshold has risen to 10% which certainly adds to the problems of the public. (William, 2013)
At the outset, Obamacare seems to have benefited the people with the mental health diseases. According to an estimate, at least 32.1 million Americans will have an access to the first-class mental health services once the Affordable Act Care is fully implemented.
It can be said that Missouri is one such fortunate state to have an opportunity to deal with the complications of Obamacare ever more seriously and effectively. The state had a tough call with Obamacare requiring Missouri to expand or face the loss of all state-funds until the Supreme Court ruled expansions as optional.
The expansion would not have served the interests of Missouri State well. It is high time that the lawmakers took up the downsides of Obamacare and came up with suggestions to provide an alternate plan action that encompasses and addresses the healthcare needs of socially and economically disadvantaged segment of Missouri and America on the whole.
The need for the correct utilization of public funds cannot be stressed less. It should well be kept in mind that public money is neither infinite nor free-flowing. Indebting the future generations is not a plausible idea. The policymakers should call for shrewd use of money.
The current propositions of Obamacare are not without its pitfalls hence the reform is inevitable and should be taken on priority basis.


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