Obamacare and Medicaid: looting your estate after you die

Courtesy of a link at Phlegmmy's place, we learn that Obamacare is forcing more and more people into the Medicaid program, and into a situation where their estates - the inheritance they hope(d) to leave to their loved ones - may be in danger of confiscation.

Prior to ObamaCare, state Medicaid programs (enacted in 1965 and expanded in 1993) offered help to poor people who couldn't afford health coverage but required states to recover their health costs from their estates when they died. However, state exemptions for personal goods and residences meant that such “estate recovery” efforts were modest as most people either had no other assets or had “spent down” those that they had to a minimal level.

But with the expansion under ObamaCare, more and more people will qualify for Medicaid without realizing that the coverage is really not free, but instead a hidden secured loan whose terms aren't explicit. As Carol Ostrom, the Seattle Times health reporter, explained:

... health insurance via Medicaid is hardly “free” ... It’s a loan, one whose payback requirements aren't well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs ...

. . .

Barry Blake lived with his mother who owned her own home and was covered under Medicaid. When she died, the state of Kentucky “took the house ... to be sold and pay those expenses” according to a suit Blake filed to recover it in 2009. The state also took the washer and dryer, their lawn mower, gardening tools, kitchen appliances and other personal items.

There's more at the link, with a lot more details of how this works.  Important reading.

Obamacare has also just raised individual tax rates across the board.  The more we learn about this program, and the more we see of its implementation, the more obvious it becomes that it was nothing but a scam on the US electorate from beginning to end.  It's raised medical costs, drained the pockets of millions of individuals who can't afford its premiums, and engendered tens of thousands of new bureaucrats dedicated to making our lives a misery.

Who will have the courage to end it?  I'd like to hear each of the current Presidential candidates commit themselves, one way or another.

As for the confiscatory policies of Medicaid under Obamacare, I suspect that for those who have sufficient time to make arrangements, creative planning will soon become the order of the day.  If John Smith learns he has incurable cancer, he might choose to buy a number of assets in his final months of life - for example, gold coins.  If those assets can't be found after he dies, the state won't be able to confiscate them.  Pity about that . . .  Of course, that will mean that taxpayers have to foot the bill;  but since we do so anyway under the present system, that won't be an additional burden.

There will doubtless be those who argue that we should take the assets of people who consume taxpayer resources in this way, to repay at least part of their debt.  I can understand that perspective from an economic point of view.  Unfortunately, that also impoverishes those who may be reliant on their parents for the final gift of a financial fresh start.  How many people do you know who relied on a bequest to put down a deposit on a home, or pay off a student loan?  I know several.  If they're unable to do those things, is the economy as a whole better off, or worse?  I suspect the latter.

There's also the problem of individuals demanding end-of-life care that may be uneconomic and impose crippling side effects.  I'm facing this reality myself (hopefully in the distant future) in terms of the long-term impact of my injury-caused disability.  Should I demand the maximum possible expenditure in a "do-everything, keep-me-alive-at-all-costs" approach?  Or should I accept that death is inevitable, one way or another, and I can do my family and friends a lot more good by going out as peacefully and painlessly as possible when the time comes, without imposing a crippling future financial burden on them to pay for care that will only give me an extra few months of life?  I incline towards the latter approach.  (Interestingly, so do many doctors, particularly because many treatments do nothing for the remaining quality of life as opposed to the remaining quantity.)

Spending money on extravagant end-of-life care also means that less is available for others needing health care.  As a doctor put it recently in the Wall Street Journal:

By paying without limit to slow any progressive disease ... we destroy other opportunities for promoting healthy and fulfilled lives. Without a dialogue about the value of costly interventions, we are failing to ask how our choices can do the most good for the greatest number of people. We forget that paying for one medicine is often synonymous with denying another group an equally necessary intervention – one that may add far more value.

Again, more at the link - and thought-provoking, too, despite the doctor being unashamedly utilitarian in his approach.

Peter