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ObamaSwindleCare: The Final Payment


(by Anthony Freda via wendydavis @ flickr)

From time to time, we must all read something related to government policy to which we act so viscerally that we double over in pain, nausea, rage…or all three.  For most of us, I’d imagine, it comes from something that we were unprepared for, something that had we suspected beforehand we’d find grievous or soul-damaging, we might have armed ourselves against psychically in advance protection.  There are many such subject areas these days, from war, torture, extra-judicial murders and assassinations…but we know that going in, and try to steel ourselves a bit, no?

But this week a piece by Paul Craig Roberts on ObamaCare came in on the Liberty Underground Newsletter.  Please understand that I may be one of the most least informed people on the ACA at this website, or indeed…anywhere, except for the most basic levels, like being the best gift ever to the health insurance industry and BigPharma, and a most nefariously evil mandated punishment on most Americans.  Perhaps I do know another couple things after reading Ohio Barbarian’s recent post on the subject of ‘gifts given to capital’.*

But I digress.  What happened when I clicked into his piece should have been a warning, as it was entitledObamacare: The Final Payment–Raiding the Assets of Low-Income and Poor Americans’.  But even with that title, I breezed in and began to read it rather perfunctorily, not guessing of the whallop of a sucker punch readers were in for.  Upon having read a mere fourth of it, I clicked out, so sick to my stomach I had to walk away for air and a measure of relief (aaaaahhhooooomm).  ‘I won’t even think of that tomorrow’, must have been my unconscious litany to myself.

But oy; FDL’s juliania brought a Naked Capitalism link to our current Open Menu thread for us at Café Babylon; Yves Smith had covered the Roberts’ piece.  He says that it’s the second post which was essentially authored by an anonymous ObamaCare expert, make of that designation what you will, but he/she does seem to know the dirt and reports it meticulously, as PCR notes.

The header under the title is about ObamaCare herding the poor into Medicaid, sometimes resulting in forfeiture of their houses and other assets to ‘pay back’ the costs of their medical care.  Well, it’s a notch or two past that, if I’m understanding the moving part of the underlying laws and policies.

The first subject heading is: Obamacare: the Final Payment, concerning which, he says, defies the rules of justice in that “…some of the poorest Americans will pay the highest cost of health care as they, and they alone, are subject to having the family home and any other assets they might possess confiscated by the state in order to reimburse Obamacare for the cost of their medical expenses. The compassionate rhetoric aside, Obamacare makes the poor pay the most.”

Okay, we know that if we didn’t sign up for the crap insurance, we’ll receive a tax penalty via the IRS.  Now, ‘qualified individuals and families with incomes between 138 and 400 percent of the Federal Poverty Level are able to shop for commercial insurance policies at ‘exchanges’, and may be eligible for a subsidy from the government to help pay for a plan (not too easy to procure, apparently).

Those with incomes at or below 138 percent of the Federal Poverty Level will be tossed into Medicaid unless there are specific reasons why they would not be eligible.  In order to avoid being stuffed into Medicaid, a single individual in the 48 states and D.C. needs an income that is more than 138 percent of $11,670 (more than $16,105). A family of four needs an income that is more than 138 percent of $23,850 (more than $32,913).  Well, wait, wot?  Why would a person not want to be on the newly expanded Medicaid?  What’s not to like?  Among other things:

Well, because Estate Recovery.

Anonymous Expert reports that the term ain’t even in the zillion pages of the ACA, but it IS in the Omnibus Reconciliation Act of 1993 (OBRA 1993)–a federal statute which applies to Medicaid.  Thus, if you are enrolled in Medicaid, it will apply to you. As in: listen up if any of this is coming to a theater near you or yours.  Hell, any of us: we’re all in this together, dammit.  But the tips and further information will be of value to the Coming Soonest among us.  The state clawbacks:

‘OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased Medicaid patients for medical services received in a nursing home or other long-term care institution, home- and community-based services and related hospital and prescription drug services regardless of age. It also allows, at state option, recovery for all services used in the Medicaid state plan at age 55 or older. At minimum, states must pursue recovery from the probate estate which includes property that passes to heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds. The state keeps a running tally, and even if you have a will, your heirs are chopped liver.’

An estate is everything you own, your house, your bank accounts, annuities, what have you.  Now consider cash-strapped states in search of any and all available revenue streams; oh yes: Medicaid states will be hunting assets to beat the band.

Now if you’ve been found ‘eligible’ for Medicaid upon application for a subsidized plan, it’s not optional: there you go.  But additionally, if you’re in an exchange plan, but your economic circumstances change for the worse, Bam!  You’re shoved into Medicaid.  Receiving SNAP benefits can zoom you there automatically as well.  Are you feeling potentially old and in the way yet?  It gets worse:

‘Obamacare revises Medicaid regulations in order to make more Americans eligible for Medicaid. Revised regulations include an increase in age and income limitations, and the asset test no longer applies. Prior to these revisions, applicants were not eligible for Medicaid if they had more than a specific dollar amount in assets. But, under Obamacare, those who likely own a home or have savings set aside–for example, early retirees or people who have lost their jobs and, as a result, are in a low income bracket–will find themselves in Medicaid, and their assets will be looted by the government when they die for medical services used at age 55 and up.

Estate recovery can have a damaging impact on low-income and poor Americans. It is a pernicious death tax on those who have the least and are the most vulnerable. Often, the only asset they have is the family home and what’s in it, and, for some, this has been the family home for several generations. The threat of losing the home causes people to forego health care.’

Do read more at either link.  That’s all I have the stomach for, except to say that Mr. wd and I are in a relatively comfortable place with all this.  We know we’ll take the fine, but will only need to for several years until we’re eligble for some socialist program like Medicare.  And then, we don’t do docs, so it’s no biggie.  For those of you who really need some sort of health insurance, I am so bloody sorry this damnable ACA is all so hideous a revenue stream grab to the Nth power.

Please free to add what you suss out, or correct what I’ve gotten wrong.  And warn everyone you can about this new round of Capitalistic Duplicitous Cupidity!  Oh, and I amost forgot…but no really:

‘This Medicaid clawback not only confiscates family property but also robs people of their dignity as Medicaid allows only an amount it considers reasonable for services provided by a funeral home and burial costs. In some states, funeral homes are responsible for notifying Medicaid if there is excess money in a burial trust fund so it can also be pillaged.’

(cross-posted at

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