[alttag]

> Medicaid is a loan.

Um, ... no. Or, at least not in my case.

Our son was diagnosed with cancer at the age of three. Medicaid served as secondary insurance, and thankfully so, as the bills from the first month exceeded $300,000. This went on for nine months.

It's now been eight years since he passed, with no mention from any agency about recovery.

Besides, it seems you left a few things out of your diatribe. From the medicaid.gov link:

    > For individuals age 55 or older, ... recovery of payments 
    > from the individual's estate for [specifically enumerated things, 
    > which does not appear to include doctor visits].

Also:

    > States may not recover from the estate of a deceased Medicaid 
    > enrollee who is survived by a spouse, child under age 21, or
    > blind or disabled child of any age. States are also required to 
    > establish procedures for waiving estate recovery when recovery 
    > would cause an undue hardship.

So, at best a fear-mongering half-truth. Maybe we can agree Medicaid is for people with no money. The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.

[_wp3r]

The OP may be over the top and on the fear-mongering side of things, but there are some very difficult situations monetarily especially for elderly recipients. While there is some policy to not completely bankrupt surviving spouses, the reality of a long term care spouse utilizing medicaid is that the surviving spouse must reduce assets to below $2500 with few exceptions or shelters. That policy will almost guarantee that the surviving spouse if not a homeowner, will be strongly below the poverty line for the rest of their life. The primary cause of that scenario is the huge gap between enough money to be retired(50k-150k), and the amount of money required to be retired without assistance(350k-500k). Full time skilled care like a retirement home, can easily cost $7k a month on the low end, with averages around 28months.

The OP may be able to make a more widely accepted argument, by more empathetically communicating that medicaid is at best emergency support for crisis, and not a vehicle for long term or widespread medical care. He is correct that using Medicaid as a primary vehicle for ACA coverage expansion ensures a very large group of people will have huge negative motivations to exit poverty, even more so than were previously. I would guess that the OP has first hand experience with Medicaid policy completely eliminating a family member's entire life's monetary worth, which is a hard pill to swallow when someone has paid into Medicaid for decades.

http://www.longtermcarelink.net/eldercare/nursing_home.htm https://www.ahcancal.org/ncal/facts/Pages/State-Data.aspx

edit: typo medicaid

[rebootthesystem]

In the US it is extremely easy to rack-up hundreds of thousands of dollars in medical bills. A single operation can cost $200K. Be ill for an extended period of time and the idea of millions of dollars in medical care isn't out of the realm of the possible.

And so, imagine selling the family home to try to pay medical bills or provide more favorable circumstances only to get a knock on the door by the Medicaid estate recovery folks who have first dibs on the proceeds of the sale.

Not only that, the sale also means the patient is now kicked off Medicaid because they have money.

I'll repeat it because the shift in perspective is important:

If a private insurance company had exactly the same clauses in their policies people would be up in arms, they would be brought up on charges and some of their management would land in jail. Yet we are willing to accept this from our government? And enroll people by the tens of millions?

This should not be. We should provide care to the needy without any such preconditions. Our government should not sink hooks into them at all.

Readers seem to be confusing passion for fear mongering. This is real and, as far as I am concerned, it is seriously immoral. We should not be in the business of doing this to our own citizens. This isn't health insurance. Not sure what it is, but I know what it is not.

This is the point that is being missed in my exposure of this issue: This is an abomination. The US should not have a program fraudulently presented as insurance that takes people's property at all. Even if the net effect was that this only affected ten people, it would be wrong.

We should take care of those who need care and not set hooks into them or their estate.

[maxerickson]

You've typoed medicare/Medicaid in your first paragraph.

The income limits for Medicaid expansion are really low, people aren't going to pass on a $10 an hour job + subsidized ACA plan to stay on Medicaid.

[rebootthesystem]

First and most importantly, sorry for your loss. That is truly terrible and unimaginable.

This isn't a diatribe, fear mongering or half-truths. The links I provided are real and from government agencies.

If you wish to refute the reality I am presenting you need to do better than your situation because yours is atypical.

Yes, in your case you fell outside the domain of estate recovery.

Of the projected 100 million people who will be on Medicaid, how many do you think will have three year old kids with Cancer?

Your kid's life was invaluable. I would have spent my last dime had I been in your situation and I am sure you likely did. That goes without saying.

You are also wrong in this statement:

> The government seems to have a procedure that attempts to collect money from an estate, in certain circumstances, after a patient dies, if there really was money available.

This is not true. If a Medicaid member owns a home and sells it or takes out a second mortgage or comes into money (inheritance, etc.) the government takes a bite right there and then AND kicks the person out of Medicaid because now they have money.

I hope you take the time to read the various links I provided and come to understand your situation isn't typical and that it is true that Medicaid is not medical insurance.

If an insurance company had estate recovery clauses in their insurance policies they would be brought up on fraud charges instantly and most of their management would end-up in jail. Why do we demand less from our government?

Sorry for your loss. I cannot imagine having to go through that.

[maxerickson]

Go read an application for Medicaid (you pick the state).

Look at the things it makes clear and information it asks for.

[rebootthesystem]

I have. With the aid of an attorney.

And I am 100% certain that most people who get shoved into Medicaid either have no idea or have no choice but to sign on the dotted line. That's the tragedy here. Our government is making people sign onto something almost out of desperation.

Let me make my position 100% clear, because those down-voting my post and attacking it might not have understood this. Actually, no, I failed to communicate it.

Medicaid Estate Recovery is an abomination.

It should NOT be a part of the program.

It should NOT exist.

We should provide medical care to the needy without ANY recovery requirements whatsoever.

If someone needs a million dollars in medical care they should receive it.

They should not have to worry about being on the hook to repay it in any way.

That is what a decent and compassionate society does and how it behaves.

If this estate recovery business were done by a private insurance company they would be destroyed by both public opinion and brought-up on fraud charges. We should demand better from our government. We should demand that estate recovery be completely removed from Medicaid.

Hope that clarifies my position.

[tanderson92]

> That is what a decent and compassionate society does and how it behaves.

Capitalism, especially in the USA, is not an economic system that concerns itself with or encourages a compassionate society. Medicine is one of the most obvious ways that capitalism is literally killing people.

[rebootthesystem]

Perhaps I am being too idealistic.

I believe that with the right leadership and a conversation with the nation we could converge on a system that was fair, took care of the needy and got government and insurance companies as we know them to day out of the system to the necessary degree.

I don't, for a moment, believe that we can get both government and insurance companies entirely out of the system in the US. In the first instance, government, you would not want to. Oversight and rules are important. In the second instance, insurance companies, there could be an argument of their need in absorbing some of the risk. Admittedly, not an easy problem.

What we have today, this hodge-podge of laws, agencies and programs is a complete disaster. This should be obvious and evident to anyone who takes the time to take a full dive into the absolute mess healthcare is in the US. The ACA did not fix anything, it made it worst, because it isn't a real solution.

I won't claim to have the solution. As I alluded above, this requires leadership that can bring forth a national-level conversation that, over a year or four, can converge on something that can deal with all issues equitably.

One angle is what I might term a to be a moral obligation: We have the moral obligation to take care of each other. What follows, then, is that we all contribute to a fund or a national health insurance policy of some sort that covers absolutely everyone with, perhaps, reasonable co-pay's to take some of the edge off. If one of us needs a million dollars of medical care he or she should be able to get it.

This should also come with some obligations. I think there's nothing wrong with the idea of requiring regular checkups of some sort. This is where it gets complicated. What do we do about people who destroy themselves through substance abuse. I don't know how we deal with that and other matters.

Anyhow, I think we can all agree that we ought to be able to do far, far better than this mess created by our politicians in playing sick partisan games with one of our most basic needs. And this has been true over at least the last 50 years, no political party is devoid of blood (almost literally) on their hands.

We truly need to take this up to a much higher intellectual level in order to converge on a good solution.

It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid. The reaction is evidence of the political polarization out there and the disconnect that exists with what politicians have done to our healthcare system. It's a mess and what we have isn't getting any better.

[maxerickson]

It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid.

The analysis in your heavily downvoted comment is blatantly wrong!

Is Medicaid means tested? Absolutely.

Is Medicaid for elderly patients heavily means tested? Absolutely.

Is what you said: Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:

https://www.statista.com/statistics/245347/total-medicaid-en....

Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan. true? Nope, only people over 55 who have remaining assets are subject to estate recovery.