The Instigator
dairygirl4u2c
Pro (for)
Winning
12 Points
The Contender
Francisco_DAnconia
Con (against)
Losing
1 Points

all states should have opted into medicaid expansion

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Post Voting Period
The voting period for this debate has ended.
after 2 votes the winner is...
dairygirl4u2c
Voting Style: Open Point System: 7 Point
Started: 7/3/2014 Category: Politics
Updated: 3 years ago Status: Post Voting Period
Viewed: 918 times Debate No: 58519
Debate Rounds (3)
Comments (0)
Votes (2)

 

dairygirl4u2c

Pro

all states should have opted into medicaid expansion

it basically amounts to politics alone being the reason people are dying.

obamacare included a medicaid expansion for people with low income.
(people with more than little income are part of the normal obamacare insurance exchange program, that may or may not include subsidies.

the main reason the states should have opted into the expansion, is because so many people will die if they don't. an estimated 17,000 people will die because they opted out of the expansion.

http://healthaffairs.org...

https://scontent-a-ord.xx.fbcdn.net...

also, getting medicaid to one's state is a financial boon to that state. it causes funds to flow to the state. it's in the states interest to take the money. even if there were some strings attached, or a co pay with teh state, overall it is more beneficial cause it's basically free money, at least with respect to the state.

also, government run insurance is known to be more cost effective than other programs anyways... usually. the USA spends 17% of its GDP on healthcare, and has worse results than other developed countires. the other countires spend 10% on health care and get better results. most of those countires have govenment health care. (some have tightly regulatd private markets, but this is getting into another debate)

also, the states can work with the federal government to create their own program. it's not like they are without options.

while there may be principled reasons to be against the expansion, none are sufficient to overcome the above points. even if you quibble with some of the points, the fact that 17000 people will die otherwise is sufficient reason to take the expansion. if you have quelms with the system, work to reform it. in the mean time, take what you got.

the polticians knew it would make them look bad to take the expansion, so they went against it.

it basically amounts to politics alone being the reason people are dying.
Francisco_DAnconia

Con

Medicaid expansion forces states to irreversibly secede a large portion of their fiscal and governing autonomy to an appointed federal agency without sufficient guarantees to the quality of service or long-term funding. It would be a breach of democratic principles and a betrayal of the voting public for governors to accept Medicaid expansion against the desires of their electorate.
Debate Round No. 1
dairygirl4u2c

Pro

i would think the states could opt out after they have opted in? i may be wrong.
and to my understanding they could take the expansion, and work with the government to tailor it to their state so it's less of a federally overreached situation.

as for quality of service, medcaid has been successfully doing what it does for decades upon decades. if someone needs serivce, they get it. as for the long term service, same point.

the only way con's point would stand, is if the federal government itself was questionably not going to last. there are some theoriest that say it won't, but most don't see this to be the case. we are still almost perfect credit rating from credit rating agencies. the best predictor of default some say is what percent our debt payment is as a percentage of GDP, and if' ts at 12% we are screwed, but we aer no where close to there. ben bernanke said that he sees us staying a thirving country due to the way we optimally manage money. of course that could change, but it still is notable for the foreseeable future. our debt to GDP is high, but it's been higher, and it's not unrealistic for us to stay where we are or go down from that point.
Francisco_DAnconia

Con

Under Title XIX Medicaid (pre-ACA), states retained broad leeway in determining eligibility for their own programs, thereby allowing them to ultimately control the costs of the programs and maintain an adequate level of fiscal autonomy. As a result, all 50 states opted into the Title XIX Medicaid program. Under the ACA Medicaid expansion, states are required to provide Medicaid coverage for any individual earning less than 133% of the Federal Poverty Line, regardless of existing eligibility criteria. This rigid implementation forces states to concede significant administrative authority over their Medicaid programs to the Federal government, specifically the CMS. Considering that Medicaid is one of the largest line-item expenses for state governments, averaging nearly 17% of general expenditures, this secession represents a significant forfeiture of governing autonomy. In exchange for this secession, the Federal government offered to cover 100% of the expanded cost for the first three years of the program, but only 90% after 2020. Therefore, after 2020 the states would be saddled with the fiscal liability for the costs of a program that the Federal government, and not the states themselves, retained the authority for determining eligibility. This represents a direct relinquishing of fiscal autonomy by the states to the federal government.

It is reasonable to assume that some citizens believe that state governments can better administer public healthcare spending than Federal authorities. These citizens would rightly elect state officials who would opt out of the Medicaid expansion in order to preserve state autonomy and retain public healthcare administration at the state level. If these citizens democratically elect such officials, then it would be wrong for those elected officials not to execute the will of the electorate by opting out.
Debate Round No. 2
dairygirl4u2c

Pro

con basically said. all states accepted orgiinal medicaid as it gave them money, helped poor people to some degree, and allowed the states to determine eligibility.

con says many don't want the expanded medicaid because in this version they would be religuishing control of elibility, and having to pay a portion of the bill. con admits that that portion is ten percent.

the problem. states on average already pay 43% for its beneficiaries under the old rules. under the new rules, they only pay 10%. and more to hte bottmline, the average state's share after the new rules are estimated to range as an increase of only 1.1 to 2.8%.

http://www.cbpp.org...

so states would be according to con, quibbling about losing a little more money, but while at hte same time getting a ton more money in return to their state. getting that large of influx of cash to your state, for such a small obligation yourself, is a no brainer in terms of stimulating your economy, at least from the perspective of the states.

also, states would be according to con, placing a relatively small degree of control over their dealings, inproportioally higher than the amount of money they can get, and above the value of the human lives involved.

is it worth getting a lot of money to your state and saving a lot of lives.... in return for a very small state budget increase, and very relatively small reliquishment of control?

yes, it definitely is.
Francisco_DAnconia

Con

To simply reiterate, a reasonable citizen could believe that centralizing public healthcare at the Federal level would be detrimental to overall wellbeing. As a result, opting into the Medicaid expansion would be most harmful to overall citizens. There is certainly evidence to support that view, particularly in light of the current VA scandal - where a federally run and budgetarily constrained healthcare agency caused serious harm and death to patients due to operational misconduct. The patients of the VA were promised the same level of service as is promised under the Medicaid expansion, so is it really unreasonable for citizens to decide to opt against such a federal promise in lieu of a state run system in which they have greater confidence?
Debate Round No. 3
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2 votes have been placed for this debate. Showing 1 through 2 records.
Vote Placed by neutral 3 years ago
neutral
dairygirl4u2cFrancisco_DAnconiaTied
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Total points awarded:70 
Reasons for voting decision: Con's disagreement reads like a excuse, not even a valid disagreement.
Vote Placed by FuzzyCatPotato 3 years ago
FuzzyCatPotato
dairygirl4u2cFrancisco_DAnconiaTied
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Total points awarded:51 
Reasons for voting decision: Pro, learn to grammar. Pro provided sources, Con did not. Pro proved affirming would save lives and provide states money, Con proved only that perhaps 1.7% (10% of 17%) of state budgetay autonomy would be lost. Lives outweigh state autonomy here. Moreover, Con didn't prove that state autonomy is actually useful; consider the nat'l drinking age as contrary evidence. And we all know the reason states aren't joining isn't because they want autonomy, but because they hate Obama and Obamacare, and would like to see both fail. States NEVER pass up free money.