Anti-federalists on Obamacare

When I was reading the material on the anti-federalists, I immediately thought of Obamacare.

One of the many critics of Obamacare is that the states do not have enough discretion in implementing Obamacare and various safety net plans. For instance, state governments have almost no control over Medicaid, making Obamacare the predominant healthcare available to those citizens. This, ultimately, disables the representatives of the state from “[knowing] the minds of their constituents and the people [knowing] their representatives.” (Kaminski and Leffler 3) Obamacare may not work the same for everyone, and there should be other options out there for everyone.

On the other side, the argument is for each state to submit state plans to the Centers for Medicare and Medicaid Services (CMS) that specifically outlines all the state’s needs. After that is submitted and approved by the federal bureaucracy that runs Medicaid, the state should then be covered by Medicaid. This means that the state should then be fully covered by Medicaid if the plan is approved by the federal bureaucracy that runs Medicaid, right? Wrong.

Just because a state is covered by Medicaid, it doesn’t guarantee that you will get healthcare. The federal government forces states to control Medicaid spending, which is rendering them broke. This is causing them to have to cut provider rates. Medicaid pays so little compared to other private insurances that doctors are dropping out of the program all together. This, basically, eliminates the safety net program guaranteed by the federal government. The anti-federalists feared a large republic would “deteriorate into monarchy” and would the diverse population resulting in “constant clashing and disorder.” (Kaminski and Leffler 3) In states like California, this diversity between state and federal government highlights this clashing and disorder with the lack of healthcare options for citizens.

Not only are citizens not receiving healthcare, the government is creating all the rules and regulations for Medicaid. For example, nursing homes are completely funded by Medicaid. This means that toilet paper, tissues, nutrition, etc. are all funded by Medicaid. How meals are given out and how the quality of life of a patient are then determined by CMS and, subsequently, all rules and regulations as follows. The state has little room to experiment with the current system in place and in order to amend or change a rule or regulation, a state must submit a waiver. This process could take years. This is not the best example of state interests being met by a large government, as the anti-federalists fear with a new constitution.

As of right now, states have some ideas on how to run, and even improve, current Medicaid programs. Some states would like Medicaid patients to have complete control over the funds so that they may become more cautious with their use, some want to basically convert it into more of a private insurance, and some want to penalize unnecessary ER use from patients. However, none of this is attainable given the current federal Medicaid rules. What is currently in play is what has to stay in play. Although it seems as if states play a major role in healthcare regulation, they are merely puppets. The CMS are the ones actually in control. This sounds exactly like what the anti-federalists feared: a strong centralized government that lead to clashing of opinions and under representation of small states.

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4 Responses to Anti-federalists on Obamacare

  1. Satchel Wells says:

    I feel that many of the funding problems that Medicare/Medicaid faced aren’t because of federal funding but more that each state is reluctant to accept those funds. The federal government offers money to each state for CMS programs in the form of a categorical grant but because the states don’t want to follow what the federal government wants, funds lack for that states usage of Medicare/Medicaid. Most of the issues faced with these programs stem from not the federal, monarchy but because the states are non-compliant with the federal government.

    Many of the news rules are regulation have been created to try and hold back the rapidly increasing healthcare costs for Americans which programs like Obamacare has actually allowed 16.4 million people who were previous uninsured were able to get insurance because of the Affordable Care Act.

    While I can see how this intrusion into the market can be seen as tyrannical, the healthcare insurance providers we’re holding the reigns are forcing people to pay enormous cost for marginal coverage. I feel that this justifies government intervention as the market was not providing a service effectively that is needed and should be considered a public good. I believe that we all have the right to be healthy and should be able to access it reasonably and that’s what Medicare/Medicaid do and the A.C.A is attempting to do.

  2. becca7420 says:

    In response to both the original post and the above comment, I have to admit that I can easily see both sides. From the original post, it can be argued that Obamacare is indirectly helping to facilitate a monopoly in the healthcare system. It has become borderline impossible for states to decide what is best for their own citizens, which can be important as needs may vary among regions. However, I agree with the comment above (authored by Satchel Wells), that Obamacare, through the federal government, is trying to give funding to states but it is not being accepted. Unfortunately, it isn’t just a matter of states not wanting the funds, one of the main reasons states are turning away the money is due to distrust in the federal government. In an article written by McClatchyDC.Com, it is noted that if the states agree to accept the funding for Medicaid they must expand their regulations for Medicaid acceptance, meaning more people would qualify. The federal government claims that it will carry the burden of Medicaid costs for newly enrolled citizens, upwards of 90%, but the states refuse to believe this. Should the government not be able to support these hefty costs in the years to come, the responsibility would fall back on the states, many of which would not be able to afford the cost of providing healthcare to these new, previously ineligible, members.

    There are two sides to every argument, right?

  3. fendogmillionaire says:

    I think both this post and all the comments here bring up good points in the argument, but I have to land on a big-government side in this argument. As Satchel and becca7420 point out, the federal government is offering to pay for the expanded costs necessary, but the states don’t trust the federal government enough to accept this. Now, I know socialization of healthcare is not exactly a popular idea in America, but it’s hard to argue with it’s popularity in other countries; if you’re going to take the NHS away from the British, you’re going to have to pry it from their cold, diseased hands. The real problem that both prevents millions from receiving health care and leads to millions more Americans paying an absurd amount for basic coverage is the states. This anti-federalist attitude is, instead of presenting a better option for the average citizen, merely preventing the federal government from taking action that will help the entire nation. In fact, this fear of big government is in part what prevented Obamacare from being a full on socialized healthcare system like many other First World nations have. While there is a great deal of validity in the anti-federalist argument, the federalist ideal seems much more appropriate for healthcare in a modern world.

  4. I think there’s an over-arching issue that comes with evaluating how the federalists and anti-federalists would have viewed medicaid. Obviously we can’t get any of the original fathers’ opinion on the Affordable Care Act because, well, they’re dead, but we can get close into the minds of what they think from the text. None of this is controversial. But what I think is being left out of the picture is the fact that the federalists would nonetheless agree that Obamacare is an overreach of power (and they’re the ones who were for big government!) The main problem both sides would have had with Obamacare is TAXATION, but that’s an economic issue for another time.
    As to your point of the tyranny of the healthcare industry and the government’s role in creating regulations. Healthcare is a relatively newer concept in history that (arguably) isn’t a right, and it most certainly isn’t a natural right. If you were to take the average cost of healthcare for an individual and multiply the accrued total annually by, say, ten years, it can accumulate up to $10,000. That money could go towards, well, anything that I see fit, and it could even act as the possibility to increase capital overtime (use it to invest). But to relate it to the federalists and anti-federalists, isn’t this in itself an overreach into my right to my property? After all, my money is my property in a technical sense, for it’s simply a middle man used to pay for whatever I wish to purchase that belongs in my name. There’s no way around it; It is not only an economic over-reach, but a private one as well. I’d presume (it is a presumption though, and those are worth nothing) that the federalists still believed in the concept of private property, of natural rights, of freedom of choice, just as the anti-federalists did, but with the exception of a large government. I suppose it’s possible to have both. Nonetheless, I must say, there is a point to be made for Obamacare. It does save lives, provides common necessities for the elderly, and all at a seemingly affordable cost. But how long will it be able to stay afloat? I certainly couldn’t say.

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