These “State Exchanges” Are a Health Care DMV

By Rush Limbaugh | July 3, 2012 |


RUSH: Michael Tanner at the Cato Institute has a piece, and he says that Obamacare is now a bigger mess.  He focuses on the Medicaid expansion.  Now, let me summarize this because it can get a little complicated when it needn’t be ’cause it uses terms that are a little nebulous.  But I’ll try my best.  What we do here is make the complex understandable.  The health care law, in order for Obama to get a score on the total cost from the CBO of under a trillion dollars, shifted much of the new expense to the states.  The health care law requires the states to bear the brunt of most of the costs of insuring all the 30 to 40, whatever million numbers of people that don’t have insurance.  And largely this occurs through the Medicaid program.

Well, the states don’t have a lot of money.  The states can’t print their own money.  And the one thing in this ruling that might be seen as helpful is the court said that the states cannot be punished if they refuse to accept these new expenses.  And what that meant was that the federal government, Obama, cannot take away their existing Medicare funds if they refuse to accept the demand of spending new amounts.  So they can’t be blackmailed.  They can’t be penalized.  They can say, “We’re not gonna accept this responsibility.  You want to spend the money, you spend it.  We don’t have it, we’re not.”

Now, having explained that, let me pick up with Tanner’s piece halfway through.  “Here’s another complicating factor: Most states have not yet set up an exchange.”  Let me go one paragraph earlier.  Remember, now, this is a law that already will cost as much as $2.7 trillion from 2014 to 2024.  It will add more than $823 billion to the federal deficit, and these are estimates that assume state taxpayers will be picking up some Medicaid costs.

“How will Congress react if billions or perhaps trillions of dollars in new costs are added to the federal budget?  Here’s another complicating factor: Most states have not yet set up an exchange. Many, especially ones with Republican governors or legislatures, may refuse altogether. By most estimates, as few as 15 states are likely to have exchanges in operation by the 2014 deadline.” Now, the exchange is where you’re going to go to get insurance.  And we touched on this yesterday.  If the states don’t set up these exchanges, then where are you gonna go?  Well, by 2014, 2015, enough damage will have been done to the private sector insurance industry that you won’t have any option.  You’ll be forced to go to the Feds.  But it gets a little complicated there.

“Obamacare gives the feds the authority to step in, setting up and operating an exchange in any state that doesn’t set up its own — but there is reason to doubt that they have resources to do so in so many states,” 35 to 40 states.  “Anyway, federal subsidies –” this is the states subsidizing the cost of an insurance policy “– federal subsidies are available only through exchanges that the states set up. The feds can’t offer subsidies through a federally run exchange.  Thus, if states neither expanded Medicaid nor set up exchanges, that would effectively block most of Obamacare’s new entitlement spending.”

Now, this is theoretical because Obama wouldn’t let that happen.  He’s not shown any concern about spending restraints anywhere.  Well, under the law, there’s only a certain amount of money budgeted for the law.  Under the law, they may not have the money to set up exchanges in as many states that will not set them up.  If the states do not follow and set up the exchange — that’s what these governors are saying, “We’re not gonna play. We are not gonna implement Obamacare.”  What they’re telling you is they’re not going to establish any of these exchanges that the law requires, because they don’t have the money to pay for them.  And under the terms of the bill, under the terms of Obamacare, the costs that are in there, the states do not have the money, the Feds don’t have the money.  They’ve off-loaded it to the states for that very reason.  If the states don’t spend the money, the Feds don’t have it under terms of the law.

Now, again, we’re dealing with Obama who doesn’t care about law.  I mean, this was a lawless decision.  His amnesty for the Hispanics, that was lawless.  If everything happened according to the law, we would have a very interesting situation.  But the law doesn’t matter to the people who are running the show right now, and I don’t know how to say it other than that.  I’ve got no interest in lying to you about this.  The bottom line is that if the states neither expand Medicaid or set up these exchanges, that could effectively block most of Obamacare’s new entitlement spending because, according to the law — and don’t ask me why; I don’t know — according to the law, the federal government can only offer subsidies in state-run exchanges.  They can’t offer subsidies in an exchange that they set up and run themselves.  I don’t know why.  All I know is it’s what the law says.  I don’t know what the thinking is behind it.  The obvious question is why would the federal government penalize itself and allow itself to be put in this position? I can’t answer that right now.  I don’t know.  Just telling you what’s in the law.

“One last wrinkle: It is those subsidies that trigger the penalty,” or the tax, whatever you want to call it, “under Obamacare for employers who fail to provide workers with insurance. So states that don’t set up exchanges could also escape the ’employer mandate.’  That is, Obamacare requires employers with 50 or more workers to provide health insurance or pay a fine…er, tax. But that tax only kicks in if at least one employee qualifies for subsidies under the exchange.”  I don’t know what you have to do to qualify for a subsidy, but it ain’t much.  Because they want everybody to think the government’s giving them health care, so it isn’t much.  All it takes is only one employee out of the 50 quantifying for subsidies to have the tax kick in.

“Since subsidies can only be provided via a state-authorized exchange, a state that refuses to set one up could end up blocking the employer mandate altogether.” And this is what the governors are trying to say without saying it.  “At the very least, expect some employers to sue on this point, leading to yet another Supreme Court challenge.”  This nowhere near over.  But I want to make one more observation.  Look at what I just said.  Everything I just told you is in this stupid bill.  How many of you know what the heck an exchange is?  Okay, tell me.  What is it?  It’s the DMV.  You’re gonna go to health care DMV to get your insurance.  What in the world are we talking about here?  A state-run exchange, 50 employees, but if one qualifies for subsidies…

Folks, there are 2700 pages of this gobbledygook.  State-run exchanges.  I’ll tell you who’s doing hoops in the grave is Karl Marx.  So think of the — (interruption) well, I know some people are gonna get insurance and some won’t.  Of course.  And the reasons that some get insurance while others don’t will become known as well.  And those who don’t get insurance, don’t worry, preexisting condition, if you get sick, show up them.  How many people with a preexisting condition are gonna show up thinking that for the first time they’re gonna get insurance?  The law says they get it, but who we dealing with here?  We’re dealing with a bureaucracy.  You get diagnosed with a very serious disease, I don’t even want to think about this.  This is an absolute disaster.

It is an unmitigated disaster that is so un-American in the sense of tradition, the way things happen in this country.  A state-run exchange, and then whether or not there are subsidies, and if the state set up the exchange, then the Feds can subsidize, but if the Feds set up the exchange, there can’t be a subsidy, and if there isn’t a subsidy, then somebody isn’t getting it for free.  And you, the American people, aren’t gonna be able to keep up with this; so whatever you’re told at this freaking exchange is gonna be your life.  All you want is an aspirin.  All you want is a doctor to examine you, find out what the heck’s wrong, why are you sick?  In the meantime you’re in a government office going through hoops trying to figure out if you qualify to even be at the exchange, not even fully understanding what one of those is.  At the end of the day it all doesn’t matter because the whole point of this is to have this control over you, is to have this authority over you.


RUSH: Now, back to Michael Tanner’s piece, he of the Cato Institute. As I said, “Obamacare gives the feds the authority to step in, setting up and operating an exchange in any state that doesn’t set up its own — but there is reason to doubt that they have resources to do so in so many states.” Why? They failed to appropriate the money when they wrote the bill. They screwed up! The bill is so complicated that the advocates, the people who wrote it, forgot this.

“[F]ederal subsidies are available only through exchanges that the states set up” because the law says “The feds can’t offer subsidies through a federally run exchange.” And there’s a left-wing blog out there, Talking Points Memo, that’s very upset about this. “Because as the result of a drafting oversight, Congress neglected to include automatic appropriations for federally facilitated exchanges (FFEs). That means there’s money on hand to help states that want to set up the exchanges themselves, but the government’s options vis-a-vis states that can’t or won’t act on their own are more limited.”

They just forgot. The bill was so complicated that the authors left out important parts like this. It’s 2700 pages, and they forgot this. So according to the leftists at Talking Points Memo, who are connected (I mean, they’re wired into the regime), the authors of the bill screwed up and accidentally left out the appropriations for federal exchanges. That’s why Tanner says they don’t have the resources. Now, the states have until November 16th this year to set up their exchanges. I think that’s right.

Yeah, they only have until November 16th to submit their exchange development plans to Health and Human Services. They’ve got until November 16th to tell Kathleen Sebelius what they’re gonna do. I don’t believe any of this. Just the fact, folks, that we are talking about health care this way ought to be enough to tell all of you that you don’t want to any part of it. All you want to do is go to the doctor when you need to. All you want to do is, if you need the ER, you go. All you want is a diagnosis if somebody in your family is sick. All this exchange crap, subsidies and all the rest? What are we doing?

And this is the easy stuff to understand!


RUSH:  Okay, just excuse me here.  Just one more thing.  You have to hear this and then we’ll go to the phones.  How do you qualify for an exchange?  Are you ready?  An individual can qualify for subsidies in a state-run exchange if they earn less than 400% of the poverty level.  You remember us telling you this?  When we first reported this, well, this is practically everybody qualifies.  Wait ’til you hear this.  An individual can qualify for a state-run exchange if they earn less than 400% of the poverty level, which is $44,000 individually or $88,000 for a family of four.  If you qualify to those thresholds, then you get 80% of your insurance and health care free.

If you make a dime over those thresholds, you will pay full retail price for the health care provided under an exchange managed by an insurance company, and it won’t be cheap because you’re not gonna have anywhere else to go.  You’re gonna have to buy it at your state exchange with participating insurance companies, which will be regulated to the point they won’t exist for very many years.  So an individual, $44,000 or less, qualifies for a subsidy, 80% covered.  If a state does not — (interruption) what are you laughing at, Snerdley?  Hey, this is seductive.  That’s why so many people are running around, “Is my health care free?”

If a state does not establish an exchange, then the person or family who nonetheless qualifies is lumped into a federal exchange, but there are no subsidies there, remember, because they forgot to appropriate the money for it.  Look, the bottom line here is, this is health care in America.  This is what it’s gonna be.  This is all to get your insurance.  And if you don’t have insurance, you don’t get covered, you don’t get treated?  And if you don’t have insurance, you pay a fine and you don’t get treated?


View the original transcript here.


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