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(The Atlantic Wire)   The biggest Affordable Care Act losers will be left-leaning cities in states that won't expand medicaid because red state governors and state legislatures have rejected health care resources   (theatlanticwire.com) divider line 55
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803 clicks; posted to Politics » on 11 Nov 2013 at 2:35 PM (41 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-11-11 02:31:42 PM
You mean the places with the highest populations that are controlled by Republican governors and legislatures will fare the worst? If only we could figure out what they have in common.

AHA! It must be the number of people.
 
2013-11-11 02:37:33 PM
Texas is very close to turning blue.
 
2013-11-11 02:40:16 PM
I'm sure those city folk will learn how to vote right next time...
 
2013-11-11 02:40:37 PM
PA, a model of how not to get things done
 
2013-11-11 02:42:09 PM
Problem: long term demographic trends bode ill at the ballot box for your party
Solution: enact long term extermination program directed towards the demographics which do not support you
 
2013-11-11 02:45:11 PM
I'm trying to suss out why they think the failure to expand Medicaid would hurt bright-red rural areas any less.  Sorry... poverty is not an overwhelmingly urban thing (aside from the fact that most poor people live in cities... because most people live in cities).  There's no shortage of dirt-poor people in trailers in Kansas or Missouri who would qualify for expanded Medicaid, and (if they had full insurance) would improve utilization rates at those tiny rural hospitals on the edge of closing down.

Of course, the rural voters are so well captured... you can do anything you want to them and they'll blame the Democrats.
 
2013-11-11 02:45:40 PM

mcreadyblue: Texas is very close to turning blue.


said no one, ever.
 
2013-11-11 02:48:45 PM
Putting people on medicaid and forcing them out of private insurance does those people real harm.
 
2013-11-11 02:49:54 PM

Lawnchair: I'm trying to suss out why they think the failure to expand Medicaid would hurt bright-red rural areas any less.  Sorry... poverty is not an overwhelmingly urban thing (aside from the fact that most poor people live in cities... because most people live in cities).  There's no shortage of dirt-poor people in trailers in Kansas or Missouri who would qualify for expanded Medicaid, and (if they had full insurance) would improve utilization rates at those tiny rural hospitals on the edge of closing down.

Of course, the rural voters are so well captured... you can do anything you want to them and they'll blame the Democrats.


imgs.xkcd.com
 
2013-11-11 02:52:17 PM

mcreadyblue: Texas is very close to turning blue.


Perhaps if someone tightened the grip around its throat.
 
2013-11-11 02:55:22 PM
It continues to stun me all these governors declined resources, screwing their constituents majorly, as a middle finger to Obama.

This should be a much, much bigger story than it is.  In fact, it may be right behind the death of bin Laden and the implementation of the ACA into law as the most important story throughout the current administration.
 
2013-11-11 02:58:45 PM

Lawnchair: I'm trying to suss out why they think the failure to expand Medicaid would hurt bright-red rural areas any less.  Sorry... poverty is not an overwhelmingly urban thing (aside from the fact that most poor people live in cities... because most people live in cities).  There's no shortage of dirt-poor people in trailers in Kansas or Missouri who would qualify for expanded Medicaid, and (if they had full insurance) would improve utilization rates at those tiny rural hospitals on the edge of closing down.

Of course, the rural voters are so well captured... you can do anything you want to them and they'll blame the Democrats.


Because those rural areas generally don't have intensive care or specialist care resources, so when they have desperately ill poor people, they send them to the hospitals in the urban areas. Thus in turn when those same desperately ill poor people can't pay their bills, it is the urban areas that eat the costs, not the rural areas, because the hospitals are supported by the local city taxpayers and not the whole state.

In short, the entire state uses the health care resources of the urban areas, but only the urban areas pay for them. So the cities are disproportionately affected when the Republican governors turn away free health care money out of ideological spite.

Seriously now, they explained this in TFA. Did you not read it?
 
2013-11-11 02:59:51 PM

Scorpitron is reduced to a thin red paste: It continues to stun me all these governors declined resources, screwing their constituents majorly, as a middle finger to Obama.

This should be a much, much bigger story than it is.  In fact, it may be right behind the death of bin Laden and the implementation of the ACA into law as the most important story throughout the current administration.


I certainly hope Crist bangs that drum loudly during his fight for the Governorship. Not that I particularly like the man, but at least his incompetence is better than Skeletor's evil.
 
2013-11-11 03:00:04 PM
The biggest Affordable Care Act losers will be left-leaning cities all the people in states that won't expand medicaid because red state governors and state legislatures have rejected health care resources

Here, if you make about $15k a year, you can get subsidies to make health insurance reasonably affordable - about $400 a year for a healthy 30-year old male.  You get preventative care, you get to not go broke if you get hit by a bus.
If you make about $14k a year, you get nothing.  No subsidy.  No medicaid.  Jack farking shiat.  That same insurance is more like $2500 a year, or you can go to the ER and declare bankruptcy.  Because the subsidies only work for 133%+ of the poverty level, under that you're SUPPOSED to get medicaid, but our teabagger governor said no.

Even farking KENTUCKY has a state exchange and medicare for people who don't qualify for subsidies. It's a disgrace.
 
2013-11-11 03:02:53 PM

Scorpitron is reduced to a thin red paste: It continues to stun me all these governors declined resources, screwing their constituents majorly, as a middle finger to Obama.

This should be a much, much bigger story than it is.  In fact, it may be right behind the death of bin Laden and the implementation of the ACA into law as the most important story throughout the current administration.


I live in NC. If we manage to elect a sane government any time in the future can we opt back into the Medicaid expansion?
 
2013-11-11 03:03:53 PM
They can still get a Federal Exchange plan if they like.
 
2013-11-11 03:05:22 PM
Suck it, libs!

obamacarefacts.com
 
2013-11-11 03:08:39 PM

Scorpitron is reduced to a thin red paste: It continues to stun me all these governors declined resources, screwing their constituents majorly, as a middle finger to Obama.


i48.tinypic.com
 
2013-11-11 03:10:10 PM

BojanglesPaladin: They can still get a Federal Exchange plan if they like.


but they can't get medicaid because the gov didn't accept the expansion. so a lot of them will have to pay the fine and go to the er for treatment because they can't afford a plan. it's a gap that could have been filled but was left open by the red state gov.
 
2013-11-11 03:15:01 PM

BojanglesPaladin: They can still get a Federal Exchange plan if they like.


As in my post above, they can't get subsidies if they're between the old medicare cutoff point and the new one at 135% of the poverty level.

The subsidies cut in at I think 133%, so anyone over that can afford a plan (the actual numbers I looked up in this state for someone at 135% of poverty is about $400 a year), but anyone under that number would have to pay about $2500 for that same plan.  The very poor actually can't afford an ACA plan whereas the merely slightly poor can.  The medicaid expansion was supposed to fill that gap, but in states where it was refused, it's still the same old "hey you get jack shiat" situation.

135% of the poverty level basically means 40 hours a week at minimum wage.  So that means two jobs for anyone without marketable skills.
 
2013-11-11 03:16:18 PM

mcreadyblue: Texas is very close to turning blue.


I dont care if you were born here and got a PHD in farking Texasology from the University of Alamo from Sandy Squirrel herself,  You know nothing of Texas.

Austin is not Texas, it is merely surrounded by it.
 
2013-11-11 03:19:20 PM

DemonEater: 135% of the poverty level basically means 40 hours a week at minimum wage. So that means two jobs for anyone without marketable skills.


Obviously they should take their barely any money and spend it on a college education.
 
2013-11-11 03:20:48 PM

Scorpitron is reduced to a thin red paste: It continues to stun me all these governors declined resources, screwing their constituents majorly, as a middle finger to Obama.


That's what the governor of South Dakota did. His justification was that everyone in South Dakota who would of qualified for a subsidy under the Medicaid expansion is "able bodied" and doesn't need a subsidy to help cover the cost of an insurance plan. So in his mind he wasn't actually screwing anyone over... they are screwing themselves over by not being paid enough.
 
2013-11-11 03:21:40 PM

DemonEater: The subsidies cut in at I think 133%, so anyone over that can afford a plan (the actual numbers I looked up in this state for someone at 135% of poverty is about $400 a year), but anyone under that number would have to pay about $2500 for that same plan.


That truly sucks. Makes you wish they had checked to make sure they had the details worked out and/or had people signed on before they pushed this thing through doesn't it?

But it's still a net gain of people on Medicare isn't it? Meaning people making 15K a year in 2008 couldn't afford insurance then either, right. but more people can it now than before (even if it's crappy) with the subsidies?
 
2013-11-11 03:24:16 PM

BojanglesPaladin: That truly sucks. Makes you wish they had checked to make sure they had the details worked out and/or had people signed on before they pushed this thing through doesn't it?


They definitely messed up in assuming that Republicans governors wouldn't be douchebags.
 
2013-11-11 03:24:34 PM

orclover: mcreadyblue: Texas is very close to turning blue.

I dont care if you were born here and got a PHD in farking Texasology from the University of Alamo from Sandy Squirrel herself,  You know nothing of Texas.

Austin is not Texas, it is merely surrounded by it.


Her name is Sandy Cheeks, get it right!

images.buddytv.com
 
2013-11-11 03:36:32 PM

BojanglesPaladin: That truly sucks. Makes you wish they had checked to make sure they had the details worked out and/or had people signed on before they pushed this thing through doesn't it?


They DID have the details worked out.  They set up subsidies for 133%+ of the poverty level ("These people can afford to pay at least some of their health insurance expensives"), and they expanded medicare for people who were below that ("These people are near-destitute and should be taken care of").  The only trick was that they couldn't FORCE the governors to take the BASICALLY FREE MONEY they were offering for the latter part.  They said "Here's this expansion, we'll pay for it, you just have to say OK".  It's like where Detroit refused to let Canada build that new bridge completely free of charge to Detroit - you don't expect someone to turn down a clear benefit to themselves that's free of charge.

But it's still a net gain of people on Medicare isn't it? Meaning people making 15K a year in 2008 couldn't afford insurance then either, right. but more people can it now than before (even if it's crappy) with the subsidies?

In Indiana, it's not a gain of people on Medicare.  Medicare is exactly what it was before.  Because the governor's a partisan douche.
People making 15K a year in 2008 couldn't afford insurance before, and now they mostly can ($400 a year is for a bronze plan, which isn't brilliant but it's better than most healthy 30-year old people without employer-provided insurance carried before).  They weren't on Medicare then, they're not on Medicare now.
People making 14K a year are unchanged - still not on Medicare, they still can't afford insurance.

It's a clear win for people in the 135-400% of poverty bracket.  It just COULD be a clear win for people under that, too, and it's not, because of partisanship and for no other reason.
 
2013-11-11 03:38:24 PM

The Brains: Suck it, libs!

[obamacarefacts.com image 379x175]


Maybe my sarcasm detector is on the fritz today but I did very well through the kynect site.
 
2013-11-11 03:51:15 PM

mcreadyblue: Texas is very close to turning blue.


This is (sadly) not true.  If it was, they would have already (or be in the latter stages of) altered their electoral voting to prevent a winner take all scenario.
 
2013-11-11 03:52:20 PM

DemonEater: The only trick was that they couldn't FORCE the governors to take the BASICALLY FREE MONEY they were offering for the latter part. ...It just COULD be a clear win for people under that, too, and it's not, because of partisanship and for no other reason.


That's a bit of an over-simplification. It was fully funded to START, but would eventually wean federal money away, leaving the States to figure out how to pay for the difference with a much bigger dependent population. I know it's easy to see this as a PURELY "RED STATER!" issue, and it certainly is a factor, but it's worth noting that not all Republican governors opted out and many of the states that declined are also facing serious state budget issues already, without adding an uncontrolled, unpredictable budget increase to the future.
 
d23 [TotalFark]
2013-11-11 03:59:11 PM
Indiana's AG has basically filed suit because we wants no one in the state to be able to take advantage of ACA subsidies.

That's an asshole move.  He is so stuck in his right-wing bubble that he can't give it up and move on and help citizens of the state to take advantage of the law.  At some point you think these idiots would start to think about constituents, but they are not capable of that apparently.

And the idiot voters in Indiana will probably mindlessly put him in for another term in a couple of years.
 
2013-11-11 04:04:05 PM

BojanglesPaladin: DemonEater: The only trick was that they couldn't FORCE the governors to take the BASICALLY FREE MONEY they were offering for the latter part. ...It just COULD be a clear win for people under that, too, and it's not, because of partisanship and for no other reason.

That's a bit of an over-simplification. It was fully funded to START, but would eventually wean federal money away, leaving the States to figure out how to pay for the difference with a much bigger dependent population. I know it's easy to see this as a PURELY "RED STATER!" issue, and it certainly is a factor, but it's worth noting that not all Republican governors opted out and many of the states that declined are also facing serious state budget issues already, without adding an uncontrolled, unpredictable budget increase to the future.


Bullshiat, dude.  It starts off fully funded and then gets horribly slashed http://www.advisory.com/Daily-Briefing/Resources/Primers/Medicaid-exp a nsion from 100 to 95 percent and then all the way down to a measly 90% federally funded by 2020.  The horror!

Red states will turn blue eventually, even if it's for a microsecond, and they will sign up for this.  OR republican governors will quietly do this when no one is looking just to make the books balance.
 
2013-11-11 04:13:33 PM

d23: Indiana's AG has basically filed suit because we wants no one in the state to be able to take advantage of ACA subsidies.

That's an asshole move.  He is so stuck in his right-wing bubble that he can't give it up and move on and help citizens of the state to take advantage of the law.  At some point you think these idiots would start to think about constituents, but they are not capable of that apparently.

And the idiot voters in Indiana will probably mindlessly put him in for another term in a couple of years.


Let him raise state taxes by however much people are getting. That should win him lots of elections.
 
2013-11-11 04:44:51 PM

plewis: It starts off fully funded and then gets horribly slashed http://www.advisory.com/Daily-Briefing/Resources/Primers/Medicaid-exp a nsion from 100 to 95 percent and then all the way down to a measly 90% federally funded by 2020. The horror!


Yeah. A few hundred million here, a few hundred million there, and pretty soon you are talking about real money.

For instance, in Ohio (Just to pick a state at random), it's 2,5 Billion to expand Medicaid and provide coverage for additional 275,000 Ohioans. That will be well in excess of an additional 250 Million in about 6 years. That's a bit more than a rounding error on the state's budget.

/(Also, look at those numbers and ask yourself if per capita that is the best way to spend this money)
 
2013-11-11 04:46:13 PM
Sounds like a job for a dedicated Democratic SuperPac - airing ads in the states that refused to expand Medicaid coverage and explaining how the people of that state were screwed by the Republicans controlling their local government.  Start in January and do a new spot every month (hell, every two weeks if you have the money), and continue through election day.
 
2013-11-11 05:06:24 PM

DemonEater: The biggest Affordable Care Act losers will be left-leaning cities all the people in states that won't expand medicaid because red state governors and state legislatures have rejected health care resources

Here, if you make about $15k a year, you can get subsidies to make health insurance reasonably affordable - about $400 a year for a healthy 30-year old male.  You get preventative care, you get to not go broke if you get hit by a bus.
If you make about $14k a year, you get nothing.  No subsidy.  No medicaid.  Jack farking shiat.  That same insurance is more like $2500 a year, or you can go to the ER and declare bankruptcy.  Because the subsidies only work for 133%+ of the poverty level, under that you're SUPPOSED to get medicaid, but our teabagger governor said no.

Even farking KENTUCKY has a state exchange and medicare for people who don't qualify for subsidies. It's a disgrace.


Kentucky's governor isn't a Republican.
 
2013-11-11 05:18:26 PM

DemonEater: Here, if you make about $15k a year, you can get subsidies to make health insurance reasonably affordable - about $400 a year for a healthy 30-year old male.  You get preventative care, you get to not go broke if you get hit by a bus.
If you make about $14k a year, you get nothing.  No subsidy.  No medicaid.  Jack farking shiat.  That same insurance is more like $2500 a year, or you can go to the ER and declare bankruptcy.  Because the subsidies only work for 133%+ of the poverty level, under that you're SUPPOSED to get medicaid, but our teabagger governor said no.

Even farking KENTUCKY has a state exchange and medicare for people who don't qualify for subsidies. It's a disgrace.


That's the farkup in all the non-Medicaid-expansion states.  And the health industry lobby would really, really like this fixed (which is part of the civil war drama in the GOP... the old guard listen to lobbyists like that, the new ones really don't care).

However (and I'm predicting this will be the next ACORN-esque scandal when a few 'Navigators' figure it out and start suggesting it), there's very little keeping you from claiming $15k of income on your 1040, even though you could report making $14k.   It's been rare to over-exaggerate income in the past, but there's a darned huge incentive to do it now, as you noticed.  Mow your neighbors lawn one day for $1000.  Have him mow yours the same day for $1000.  Hey, looky there.... $1000 in reportable income.  Even better, lend each other a nominal $1000 (at 100% interest).  The reason that's even better... you wouldn't pay self-employment payroll tax (Social Security) on interest income.
 
2013-11-11 05:18:48 PM

BojanglesPaladin: /(Also, look at those numbers and ask yourself if per capita that is the best way to spend this money)


Nope, single-payer would be better, but that's commie socialism and we can't have that in this country.
 
2013-11-11 05:24:45 PM

BojanglesPaladin: That's a bit of an over-simplification. It was fully funded to START, but would eventually wean federal money away, leaving the States to figure out how to pay for the difference with a much bigger dependent population. I know it's easy to see this as a PURELY "RED STATER!" issue, and it certainly is a factor, but it's worth noting that not all Republican governors opted out and many of the states that declined are also facing serious state budget issues already, without adding an uncontrolled, unpredictable budget increase to the future.


States would be responsible for all of 10% down the road, and it's arguable that the cost savings by having poor populations able to see doctors rather than ending up in the ER could offset at least some of that.  After all, it's mostly local and state governments that get stuck with the bill when their hospitals get stiffed.
 
2013-11-11 05:26:51 PM

DeaH: Kentucky's governor isn't a Republican.


Yeah, that's the frustrating thing.

Come back, Evan Bayh, all is forgiven.
 
2013-11-11 05:28:45 PM

BojanglesPaladin: Yeah. A few hundred million here, a few hundred million there, and pretty soon you are talking about real money.

For instance, in Ohio (Just to pick a state at random), it's 2,5 Billion to expand Medicaid and provide coverage for additional 275,000 Ohioans. That will be well in excess of an additional 250 Million in about 6 years. That's a bit more than a rounding error on the state's budget.


$250 million/year to get $2.5 BILLION/year in benefits for your state.  Hot damn that's a good value.  Makes Ohio look even worse for not taking it.

I mean, it's not like ignoring the $2.5 billion in needed medical care will make it go away.  But instead of getting it at a fantastic discount to the state, they're saying no because SOSHALIZM.

That's like seeing your brand of laundry soap at the store for 90% off and ignoring it because you hope your laundry will start cleaning itself going forward.    Or passing up a 90% discount on an oil change in the hopes that, somehow, your car will stop needing them.  Foolish.
 
2013-11-11 05:50:37 PM

DemonEater: States would be responsible for all of 10% down the road, and it's arguable that the cost savings by having poor populations able to see doctors rather than ending up in the ER could offset at least some of that.


As mentioned above, that 10% (presumably more as time goes on) is a massive budgetary item. Also, where do you think that money is coming from anyway?

Regarding the "cheaper than them going to the ER - I hear that argument a lot, but have you looked at the numbers? Here's a hint: It's about 2-4% of total healthcare costs that go unpaid, and less than 10% of ER visits are non-urgent, and two-thirds happen outside of business hours when primary physicians aren't available anyway.

"The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006]," said Dr. Angela Gardner, president of ACEP.  "The report also makes the excellent point that non-urgent does not imply unnecessary.  As we have said repeatedly, our patients are in the ER because that's where they need to be."
 
2013-11-11 05:58:05 PM

Freudian_slipknot: That's like seeing your brand of laundry soap at the store for 90% off and ignoring it because you hope your laundry will start cleaning itself going forward. Or passing up a 90% discount on an oil change in the hopes that, somehow, your car will stop needing them.


Umm. Yeah... It's JUST like soap.

Maybe it's more like "We can barely cover the state expenses we have today, and it would be fiscally irresponsible to commit the state to hundreds of millions of dollars of additional costs, which may or may not actually reduce the underlying status quo costs".
 
2013-11-11 06:09:58 PM

BojanglesPaladin: Freudian_slipknot: That's like seeing your brand of laundry soap at the store for 90% off and ignoring it because you hope your laundry will start cleaning itself going forward. Or passing up a 90% discount on an oil change in the hopes that, somehow, your car will stop needing them.

Umm. Yeah... It's JUST like soap.

Maybe it's more like "We can barely cover the state expenses we have today, and it would be fiscally irresponsible to commit the state to hundreds of millions of dollars of additional costs, which may or may not actually reduce the underlying status quo costs".


... You believe that 2.5 billion in extra funding could possibly not reduce the underlying status quo costs?

Really?

How about all of those families that can barely cover their household expenses today?  Should they just grin and bear it that the help they need just won't be there, rather than being there at 90% of the cost to the state?  Definitely better to just not be able to pay for cancer treatments at all when the alternative would be a very slightly higher per-capita tax burden. Fiscal responsibility!
 
2013-11-11 06:41:39 PM

Freudian_slipknot: How about all of those families that can barely cover their household expenses today? Should they just grin and bear it that the help they need just won't be there, rather than being there at 90% of the cost to the state? Definitely better to just not be able to pay for cancer treatments at all when the alternative would be a very slightly higher per-capita tax burden. Fiscal responsibility!


You will notice above that I think this totally sucks, Bu these people are in the same situation as they were before. When money grows on trees, then we can just pay to fix all of society's ills. Until then, we have to make decisions. Agreeing to spend a few hundred million you don't actually have is not going to help anyone either.

How about this. I will give YOU 100 thousand dollars a year so you can buy insurance for 100 people in your town. But next year, and all the years to come, YOU will need to cough up a measly ten thousand out of your pocket. Of course, you barely clear $5,000 after all the years expenses, and times are tough - you may actually bring in less next year and the year after, but your bills won't be less even without this deal. Besides which, you still need to fix that leaky roof and re-pave the driveway, and next year's school supplies, and all those home improvement projects you keep putting off because you don't have the money AND you still have to cover your families health insurance and those costs are going up every year...

Oh. Also, TODAY it's 1,000 people, but you know, It might be 1,200 next year, who knows?

So yeah. We all agree it would be just awesome if we could just take as much money from the taxpayers as we pleased and just give it to the needy.
 
2013-11-11 06:46:46 PM

Freudian_slipknot: BojanglesPaladin: Freudian_slipknot: That's like seeing your brand of laundry soap at the store for 90% off and ignoring it because you hope your laundry will start cleaning itself going forward. Or passing up a 90% discount on an oil change in the hopes that, somehow, your car will stop needing them.

Umm. Yeah... It's JUST like soap.

Maybe it's more like "We can barely cover the state expenses we have today, and it would be fiscally irresponsible to commit the state to hundreds of millions of dollars of additional costs, which may or may not actually reduce the underlying status quo costs".

... You believe that 2.5 billion in extra funding could possibly not reduce the underlying status quo costs?

Really?

How about all of those families that can barely cover their household expenses today?  Should they just grin and bear it that the help they need just won't be there, rather than being there at 90% of the cost to the state?  Definitely better to just not be able to pay for cancer treatments at all when the alternative would be a very slightly higher per-capita tax burden. Fiscal responsibility!


SHHHHH!  They might have to increase revenues!
 
2013-11-11 10:35:31 PM
As someone who frequently moves between Athens, Atlanta, and Savannah, GA, I am not amused by this.
 
2013-11-11 10:39:59 PM

Move to where the food insurance is!

 
2013-11-12 01:24:21 AM

orclover: mcreadyblue: Texas is very close to turning blue.

I dont care if you were born here and got a PHD in farking Texasology from the University of Alamo from Sandy Squirrel herself,  You know nothing of Texas.

Austin is not Texas, it is merely surrounded by it.


Yes, there are LOTS of stupid people in Texas...
 
2013-11-12 01:40:31 AM

12349876: BojanglesPaladin: That truly sucks. Makes you wish they had checked to make sure they had the details worked out and/or had people signed on before they pushed this thing through doesn't it?

They definitely messed up in assuming that Republicans governors wouldn't be douchebags.


The law wasn't written that way.  The Supreme Court ruled that the states were allowed to decline the Medicare subsidy.
 
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