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-- Supreme Court may have passed the Affordable Care Act last week but it is given states the option to opt out of Medicaid expansion.
A move that could potentially millions of Americans un insured Steve blank a senior fellow at the Manhattan is just joins us now in states.
The banks are breaking on the state level do you think that many states will decide to opt out of Medicaid expansion.
-- personal to bargaining chip and how far it goes I think depends on how flexible the federal government is if you think about Obama care.
Is it basically gives you a very narrow definition of what insurance -- And it doesn't give states much flexibility on Medicaid so it's already breaking the bank Medicaid is now -- number one budget item for.
Four states you know and so what -- -- is bargaining -- something they can say well maybe will join the program but you have to give us flexibility to save money right.
Now let me get a couple number six taxes did an estimate this is gonna cost them 27 billion dollars.
Because of best in Missouri 225000.
Extra people going to be added to Medicaid and that state.
They're the freaking out and I'll say it I mean it deplores the money -- -- come from -- how to write a handle on a Haitian refugee problem.
Here's -- thing let's acknowledge -- the federal government says is look we're gonna pay for 90% of the expansion.
Okay you're rolling in have to -- -- 10% that's there that's our position and it's a valve doesn't.
However one of the things we've seen over the years is that whenever we project expand Medicaid and project what it's gonna cost it always -- way more.
As other states are wary I didn't example look at last year Medicaid funding.
-- spending in the states went up nineteen billion dollars education funding was cut like 3.2 billion.
Everything else is being cut so stations saying under those circumstances even 10% more if it's a billion dollars a year -- -- 500 million dollars a year.
We don't want to pay that unless you give us some opportunities safe and -- State some battleground states and this is an election here lest we forget.
Are saying that they may make this exactly -- their -- it's it's Florida Ohio Pennsylvania Colorado -- You know but the crystal ball on I mean this is going to be a huge political issue does that change the discussion is that change the the further implementation of a -- Well I think this is something the first of -- doesn't go into effect in 2014 anyway so what we get what what -- did you get as a negotiating stance -- yeah actually.
Yeah I don't know -- the election to negotiating stance what actually happens after the election depends on who gets elected.
-- -- -- -- -- -- -- Now are limiting reimbursements.
That -- yeah.
The federal funding so they're limiting reimbursements to doctors who are saying okay I'm not gonna take -- Medicaid patient what the limiting reimbursements to hospitals are saying that maybe we'll see you maybe you will not depending on -- are.
-- doesn't get worse -- you just hit the nail on the head the reason they're limiting reimbursements is because that's basically the only way under the federal program that they can save money they want to do things like try health savings accounts managed care for for Medicaid patients the federal government is extremely narrow one it lets them do so this is the bargaining -- we can't.
Doctors anymore we're not gonna pay you anymore for this we're we're gonna pay you less that's the bargaining chip.
Steve millennia they have fireworks were here just now thank you very much for being on the show have the -- -- authority to -- every.
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