Why Obamacare Still Not a Sure Thing

mariebailey, MSN, RN · Nov 19, 2012

Bobby Jindal of LA appears to be the most vocal governor opposing the ACA, and his state is ranked #49 in health. Maybe he should give it a shot; what does he have to lose? Side note: LA receives one of the highest amounts of federal aid per capita.

MunoRN, RN · Nov 19, 2012

The State insurance exchanges, which Republican Governor's are refusing to implement, certainly aren't optimal. Nationally standardized plans would have been preferable and would have provided a better competitive field for purchasing insurance. The Exchanges were the compromise they came to because the Republican Governor's Association wanted to be free to keep their state specific regulations, now the same group of Governors opposes the exchanges. Makes sense.

SC_RNDude · Nov 19, 2012

Bobby Jindal of LA appears to be the most vocal governor opposing the ACA, and his state is ranked #49 in health. Maybe he should give it a shot; what does he have to lose? Side note: LA receives one of the highest amounts of federal aid per capita.

That would make sense that Louisiana would be ranked 49 in healthcare, and would receive one of the highest amounts of federal aid. Their education system is probably not so hot either, and they probably have a lot more poverty then the US average. All of that would make sense as Louisiana has been mostly under the control of the Democrats for the last 120-130 years until just recently.

So, he should probably stick with doing things his way as that is what got him elected and then re-elected by a overwhelming margin.

MunoRN, RN · Nov 19, 2012

I find it a little hard to believe that political preference makes people healthy or unhealthy. Although if we want to entertain the idea, are red states healthier than blue states?

SC_RNDude · Nov 20, 2012

I find it a little hard to believe that political preference makes people healthy or unhealthy. Although if we want to entertain the idea, are red states healthier than blue states?

I don't believe that either, and that is not what I said.

I do believe that policies put in place by the Democrats who were in control of Louisiana for a long, long time have effected education, poverty, and health in negative ways.

The same can be said for many urban and southern U.S. areas that at the local level have historically been under the control of Democrats.

SC_RNDude · Nov 20, 2012

Bobby Jindal of LA appears to be the most vocal governor opposing the ACA, and his state is ranked #49 in health. Maybe he should give it a shot; what does he have to lose? Side note: LA receives one of the highest amounts of federal aid per capita.

My first reply actually got us off the topic, so I'll try again.

In reality, he probably has more to lose if he does go along and have his state set up the exchanges as the state doesn't have the money to do so and to administer the new law. Are the citizens going to be happy when money is taken from other state programs in order to administer the ACA?

"By declining to build exchanges, the states would pass the burden and costs of the exchanges to the administration that sought this law."

Having the states run the exchanges is supposed to give the states more control. However, all the exchanges are to be run in accordance to federal regulations. According to the article, the regulations aren't even in place yet, so who knows how much or little flexibility the states will have.

SummerGarden, BSN, MSN, RN · Nov 20, 2012

OP, your article is late news but I will respond anyway...

All of that would make sense as Louisiana has been mostly under the control of the Democrats for the last 120-130 years until just recently.

Ah, yes... the GOP spin on history!!! First of all, most of the politics in Louisiana has been Conservative (not Liberal) in the state of Louisianna no matter which party was in charge because COSERVATIVES ran the South into the ground back then and continue to do so today. Which is why the States are RED and not BLUE.

So, he should probably stick with doing things his way as that is what got him elected and then re-elected by a overwhelming margin.

Yes, this we can agree on!!! If Conservative/GOP Governors attempt to block affordable health care for his/her constituents while the rest of the country has access to affordable health care through an Exchange, this will be political suicide for Conservatives. The poverty rate and the lack of access to health care are HIGHEST in RED States due to the implementation of ancient (100-200 year old) political policies of the GOP. Soon, the impoverished (those that know that they are not a concern of the GOP), will go to the polls and vote those Governors out of office.

llg, PhD, RN · Nov 20, 2012

Soon, the impoverished (those that know that they are not a concern of the GOP), will go to the polls and vote those Governors out of office.

Or they will move out of those states, leaving "more room" there for the conservatives who don't want the impoverished to live in "their state" to begin with.

DoGoodThenGo · Nov 20, 2012

Anyone who thinks Obama and the Democrats are going to let their major sucess be taken down by a handful of states had better think again. In case anyone has not noticed BO is walking with allot of "Texas Swagger" since his re-election which he and his party take as a mandate against many basic Republican beliefs including small government.

The rubber will meet the road over the next few years as the costs of ACA start to make themselves known. Unlike much of the EU and elsewhere that have some sort of "socialised medicine" the USA does not control many levers of the healthcare system outright. For the most part physican's, drug and other medical suppliers, wages paid to healthcare workers et all are out of their direct control. What influence the federal government does have mainly comes via Medicare/Medicaid and the various (limited) parts of the ACA

It is one thing to provide health insurance, it is quite another to find physicans/hospitals and so forth were that insurance is welcomed and or covers a major part of expenses. Private practice physicans cannot be forced to accept any sort of insurance or Medicare/Medicaid funds as payment. Hospitals and other facilities OTHO are rather more dependent but can and are looking for ways to cut their exposure and or lessen their loses.

So far under "Obamacare" Medicare/Medicaid reimbursement rates to physicans and facilities has *increased* as both are finding ways to bill for what they previously considered money left on the table. The movement towards smaller numbers of inpatient beds means a hospital can have a lower census and still make their money. You also have waves of facility/heathcare system mergers and closures leaving many areas with one or a handful of dominate players. They in turn will use their size and clout to do what every other business does; obtain the best prices for their services and pay as little as possible for everything from supplies to labor.

SC_RNDude · Nov 20, 2012

OP, your article is late news but I will respond anyway...
Ah, yes... the GOP spin on history!!! First of all, most of the politics in Louisiana has been Conservative (not Liberal) in the state of Louisianna no matter which party was in charge because COSERVATIVES ran the South into the ground back then and continue to do so today. Which is why the States are RED and not BLUE.
Yes, this we can agree on!!! If Conservative/GOP Governors attempt to block affordable health care for his/her constituents while the rest of the country has access to affordable health care through an Exchange, this will be political suicide for Conservatives. The poverty rate and the lack of access to health care are HIGHEST in RED States due to the implementation of ancient (100-200 year old) political policies of the GOP. Soon, the impoverished (those that know that they are not a concern of the GOP), will go to the polls and vote those Governors out of office.

Maybe old news, but people are just now starting to pay attention to it.

So you are saying conservative Democrats were in charge? In relation to today's, they were conservative. The Southern states being red is a relatively recent thing. Ever heard of the "Solid South"? Anyway, I don't really have interest in arguing that point as it doesn't really matter. Even if one of us convinced the other we were right, that wouldn't accomplish anything.

They wouldn't be blocking the creation of the exchanges. They would be putting the responsibility of creating and administering them back on the Federal Gov't, for which the ACA allows for. However, even though the law allows for it, the gov't does not have a plan of how to do it. If enough states refuse to set up the exchanges, Congress will have to go back and come up with another plan.

Political suicide? Having the state pay for the set up and administration of the exchanges and pay for the increased numbers of people on Medicaid, and doing so according to federal regulations that aren't even written at the time I decide to do so, over having the federal governement do all of that sounds like the more likely recipe for political suicide.