Medicaid expansion is a bad deal for Georgians

Amid the confusion about who won what in the Supreme Court’s Obamacare ruling last month, there was one clear winner: the states.

When Georgia and a couple of dozen other states joined Florida’s lawsuit to overturn the 2010 health-care reform, they were contesting the part of the law that affected their governments: the Medicaid provisions. Obamacare called for expanding Medicaid to cover anyone earning up to 138 percent of the federal poverty level; it aimed to force states to go along with this plan by threatening to withhold current Medicaid funding if they didn’t acquiesce.

The states argued this coercion was unconstitutional, and seven of nine Supreme Court justices agreed with them. Instead of striking down the provision altogether, however, the court offered a remedy: Washington couldn’t take away what it’s now giving states for Medicaid, but states could choose whether to participate in the expansion.

That’s left some governors — including our own Nathan Deal — wondering if they should stay out of the program, or join it to catch the billions of federal dollars that would flow to them. It really isn’t that tough a question. Deal should tell the feds thanks, but no thanks.

First and foremost, Medicaid is already a program of limited effectiveness. Its promise of health care for the poor is somewhat theoretical: In a national survey conducted before the court’s ruling for Alpharetta-based Jackson Healthcare, one in four doctors said they won’t see Medicaid patients, and one in three said they won’t accept new Medicaid patients. In Georgia, 42 percent said they refuse new Medicaid patients.

The reason some Medicaid patients have trouble finding a doctor is the program’s low reimbursement rates, which in some cases are below the cost of providing the care. The expansion to 138 percent of the federal poverty level — from the current 42 percent, or less, for most adults in Georgia — is essentially a gamble that doctors can be duped into thinking they might lose money on each Medicaid patient, but they can make it up in volume.

In the first year, according to state estimates, we would add more than 500,000 people to the 1.8 million Georgians already covered by Medicaid (putting one in four Georgians on Medicaid — and stretching the definition of “safety net”). A likely result is even fewer doctors will accept Medicaid patients, making matters worse for Georgians already in the program.

In what sense is that the “fair” thing to do?

What’s more, the expansion is also a bad gamble for taxpayers.

The salient number here is not $35 billion, which is the estimated amount Washington would chip in toward Georgia’s Medicaid expansion between 2014 and 2023. It’s $4.5 billion, the minimum amount this move would cost Georgia taxpayers in those years.

I say “minimum” because that’s the best-case scenario: It assumes the feds keep their word and fund the expansion fully in the first years, declining to 90 percent of the cost by 2020. Washington already borrows more than a trillion dollars a year, with both Social Security and Medicare due to push Uncle Sam even further in debt, so it’s very possible the federal match will decline further.

If it hits 80 percent, that’s more than $1 billion a year by 2020. If it hits 60 percent, which is the current level, that’s more than $2 billion a year from state coffers. That’s money that can’t go to roads, schools or — pass the smelling salts — taxpayers.

By comparison, Georgia just started a 2013 budget year in which it will spend $19.3 billion in state funds.

Even if state lawmakers were inclined to spend an extra billion or two on health care, they’d be wise to avoid the golden handcuffs of a Medicaid expansion. Take the feds’ money and you have to follow the feds’ rules, forever and ever, amen. Turn it down, and that money could go toward lower-cost catastrophic coverage for the same uninsured, mostly young, adults.

Finally, if Georgia and enough other states turn down the Medicaid expansion, it just might force Congress to make more rational, effective arrangements for the program. Block-granting Medicaid funds to states is one possibility. Another is the grand swap proposed by Sen. Lamar Alexander: Washington takes over Medicaid completely and passes k-12 education totally to the states.

Any way you slice it, the Medicaid expansion was a bad enough deal to push Georgia to fight it in court. Now that we’ve won, let’s accept the victory and move on.

– By Kyle Wingfield

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447 comments Add your comment

I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...

July 12th, 2012
7:06 am

The reason some Medicaid patients have trouble finding a doctor is the program’s low reimbursement rates, which in some cases are below the cost of providing the care. The expansion to 138 percent of the federal poverty level — from the current 42 percent, or less, for most adults in Georgia — is essentially a gamble that doctors can be duped into thinking they might lose money on each Medicaid patient, but they can make it up in volume.

So if you lose money on every patient but you see more of them you might break even? Is dummycrat math mandatory for all of us now?

No wonder we are in such trouble.

Willis

July 12th, 2012
7:20 am

What you left out is that people without insurance and those already on Medicaid go to hospital emergency rooms where they will be seen, and hospitalized, if necessary. When they don’t pay, the cost is passed on to the rest of us in higher charges and higher insurance premiums.

So go ahead – keep your head in the sand if you wish – but health care and the cost of that care are not going to be able to be ignored.

Skip

July 12th, 2012
7:21 am

How bout a 35th vote, think that will fix things?

Jm

July 12th, 2012
7:40 am

Agree

In particular because it is a one way trip

AU Liberal in ATL

July 12th, 2012
7:40 am

Just let ‘em die. Right, Kyle. As long as they are not you or your family, just let them die.

swga

July 12th, 2012
7:41 am

Providing basic healthcare is just the right thing to do. All other industrialized countries have some sort of health care plan. The money spent on healthcare largely goes into salaries, and thus is recirculated back into the community, a tremendous economic stimulus. Medicaid expansion will help keep your local hospital open for you, too.

Some People are stupid

July 12th, 2012
7:53 am

I Report-

So if you lose money on every patient but you see more of them you might break even? Is dummycrat math mandatory for all of us now?

Thanks for shooting your theory of “if you lower rates for everyone, but more people pay, you take in more money”

carlosgvv

July 12th, 2012
7:59 am

Georgia and other states have spent untold millions in legal fees fighting Obamacare. Protecting the interests of their Big Business sponsors means everything to them. Protecting the jobs of policemen and women, firefighters and teachers, just to name a few, obviously means nothing to them.

It’s clear the “victory” here is not for the people.

Why do conservatives continue to support politicians that make it crystal clear they could not possibly care less about the people.

sirwinston

July 12th, 2012
8:02 am

Medical professions are always thinking about how much they will lose from potential patients who has money; or what they can bill the insurance companies. People have to have a way to pay for medical insurance and while all of the politicians having their hands in the bucket with the medical professions seeking to overturn this or that, it is wrong, it is very, very sad that those who seek to disturb things that keep us safe that it put all of its time in making things the way they want it! Once you get down and out, who do you turn to, when you can’t afford this who do you turn to and then who do you talk about it. Damn if hedo and damn if he don’t. This had nothing to do with the President, its been on the table for you, me, your kid, and family members for years…………you who are trying to overturn or stop it are merely looking at your pockets that the cash won’t continue to flow the way it has been. Stop lacking in your duties and help keep america safe by ensuring insurance for healthcare prevail. You never know when potential “outbreak” will hit america and you will be right in the center of it and it will affect your families just as it will affect ours! We need for America Citizens to have some healthcare somehow! If this fails, when an outbreak hit us……..will you blame Obamacare? Yes……….I think you would be the first one’s!

Ayn Rant

July 12th, 2012
8:06 am

Bad for which Georgians? For those who need health care, but can’t afford the insurance premiums or the out-of-pocket expense? For those who pay the cost of indigent emergency room expenses through their medical insurance premiums?

Aren’t poor Georgians, which are 30% of the population, people just as much as corporations and the ultra-rich, and just as deserving of government subsidies?

Yeh, the way Americans pay for health care is a mess, but less of a mess under the Affordable Health Care Act. Since no elected politician has the guts to expunge the useless, parasitic health care insurers and lawyers from the health care process, Romney/ObamaCare is the best we can do.

Atlanta Mom

July 12th, 2012
8:08 am

Kyle,
You made it clear on your TSplost blog, if it doesn’t benefit you personally, you don’t vote for it. You have a job and health insurance, so why would support health care for someone who doesn’t have any?

jconservative

July 12th, 2012
8:09 am

Willis at 7:20 has it right.

And I see nothing wrong with the national health plan we have had for the past 25 years. Anyone, citizen, non-citizen, legal, illegal, in the United States who is sick can go to a hospital and receive medical care. The system takes care of the charges if that person can not, or will not, pay. Universal health care.

But don’t thank me, thank President Reagan who signed the bill into law. It’s part of the Republican Party’s gift to the American welfare state.

I agree with Kyle, pass on the expansion of Medicaid.

@@

July 12th, 2012
8:21 am

Government rarely thinks things thru to their logical conclusion. They operate under the assumption that their audience is captive.

I wonder why.

If doctors choose not to operate in a state where medicaid expansion takes place, they move to a state where they’re not overburdened. Medicaid patients can do the same.

JDW

July 12th, 2012
8:25 am

Kyle is against implementing the health care plan to take care of our citizens in need. Color me :shocked: …not.

I have a better idea, lets charge the ones that are on Medicare today…at 42% of the poverty level a family of four makes about $9700 a YEAR. Wow they must be rolling in dough. Just so happens I have insurance for a family of four. Blue Cross Blue Shield $2500 deductible per person. It only costs about $9000 a year so they will have $700 a year left. Why that’s more than someone in say…Haiti, Chad or Uganda. Of course then we will have to fork out to move the bodies from the street but I am sure that will be ok with the Republicans.

JDW

July 12th, 2012
8:29 am

O’ and Kyle…Medicare Expansion isn’t a bad deal for anyone in Georgia. The doctors that want to participate will and the people that are helped will have somewhere to go. Only people it’s a bad deal for is those that stay up at night worrying that someone might get a penny’s worth of help from the…gasp…GOVERNMENT…you know the one BY THE PEOPLE AND FOR THE PEOPLE.

Old timer

July 12th, 2012
8:46 am

Good points Kyle…

colin micheals

July 12th, 2012
8:47 am

Shame on you! Get down on your knees and thank God you do not have a child with a life threatening preexisting condition (as I do). No one who does could ever be against the new healthcare law. It will save millions of lives. It will save billions of dollars also because people will be covered instead of being forced to go to the ER for help. It will save our hospital’s budgets. It provides free preventative services which will also save lives. Until you have a child who is very ill or withe a dire condition for which they need health insurance, you need to keep you mouth closed on this matter. And as I said, get down on your knees and thank God.

SBinF

July 12th, 2012
8:49 am

“I got mine, you get yours however you can, just don’t ask me to pay for it!”

Just like Jesus would do.

Old timer

July 12th, 2012
8:50 am

I think there are better..free market, open exchange between states, ways to offer insurance to poor.

Bob Loblaw

July 12th, 2012
8:52 am

Kyle, you have no answer for those uninsured and in all candor, you sound ignorant. GA has a huge population that’s uninsured and a huge Medicaid population. GA can’t do away with Medicaid, so we’re stuck with it. Adding the newly eligible 600k people to the rolls will inject folks that are healthier into the risk pool. More money would be eligible to pay providers. Those 600k don’t have insurance and hardly make enough money to buy gas to get to work and back. They won’t buy insurance. So they’ll show up at the ER, sicker than if they would have seen a primary care doc early on and cost YOU and everyone else with insurance (lucky you) more in premiums. Or, you can add 600k people to Medicaid, draw down 100% of the costs for a few years and then with the risk pool strengthened and more money in the program, have a more stable Medicaid program.

It frankly seems like you’ve borrowed someone’s opinion on this one and copied it. You’re not in Hartford, buddy. This is Georgia. We have poor people. Act like you care. You offered zero in terms of solutions to covering working people who can’t afford health insurance.

killerj

July 12th, 2012
8:53 am

Its good that they are changing the by laws in this country,lets hash it out and see where it leads,I will hold my ire for now,big brother can,t even pay for what they have in place now let alone promise more in the future.

curious

July 12th, 2012
8:53 am

I bet the hospitals would rather get the medicaid payment rather than nothing.

It’s amazing how selfish people are.

Kyle. go join the military and do something for your Country.

politicdiscourse.com

July 12th, 2012
9:00 am

Either way we pay.

Without Obamacare, the insured will continue to pay higher premiums to for-profit insurance companies.

With Obamacare, the already insured will pay higher taxes in order to provide health insurance for Americans that cannot afford it.

The issue boils down to who you are more comfortable financially supporting–the parasites at the bottom of the economic food chain or those at the top.

Welcome to American politics.

DawgDad

July 12th, 2012
9:03 am

Around Memorial Day Illinois, a pillar of socialism in America, was cutting $6-7 BILLION dollars from its Medicaid program, which aside from being off-the-charts ironic was producing all the anticipated cries of anguish from the leaders on the left, at least from those who weren’t responsible for funding the program. Medicaid in its current form is unsustainable, and all the demagoguery in the world can’t change the facts.The same people who scream about the insured picking up health care costs for the uninsured seemingly have no problem when it comes to the unfunded portion of Medicaid expense and want to EXPAND the coverage. Stupid is . . .

Finn McCool (The System isn't Broken; It's Fixed)

July 12th, 2012
9:03 am

Love how christians let dollars and cents trump the health of their neighbors time and time again.

Finn McCool (The System isn't Broken; It's Fixed)

July 12th, 2012
9:05 am

passes k-12 education totally to the states.

Then we can correct the spelling to what it should be: reedin, rightin, and rithmetic!

And we can leave any mention of slavery or injuns out of our history books!

md

July 12th, 2012
9:14 am

“I say “minimum” because that’s the best-case scenario: It assumes the feds keep their word and fund the expansion fully in the first years, declining to 90 percent of the cost by 2020. ”

And unless I’m mistaken, those figures only cover the actual costs of service….not the additional costs for administration and maintenance of program for ever and ever……..

What all the bleeding hearts above seem to not understand is many of the States are balanced budget states…….which means all these additional costs have to come from somewhere…..these are the same people that are currently screaming about the cuts to education………

Ok then……what are you going to cut to provide these services to the “poor”…..and I put that in parenthesis because many of those “poor” choose to be poor……if one doesn’t think so, just go find a gangbanger somewhere and ask them what they are doing to better themselves……..

md

July 12th, 2012
9:16 am

“Just like Jesus would do.”

That cunard is getting a bit stale……as he’d more than likely tell those choosing to drop out of our education programs to get their act together and quit mooching when they just chose to skip an opportunity.

Tiberius - pulling the tail of the left AND right when needed

July 12th, 2012
9:17 am

The best way to sum up this Medicaid scam from Obamacare is in the immortal words of J Wellington Wimpy, who proclaimed: “I’ll gladly pay you Tuesday for a hamburger today”.

Even better, how about the “Lucy holding the football for Charlie Brown” analogy? Yeah, we’ll buy into your system at THIS rate of reimbursement, pretty much figuring out that you’re going to reduce it in later years leaving us to hold your bag once again. Fortunately for us, the voters and elected officials in Georgia aren’t as trusting as Charlie Brown.

Add to that, you gotta love the libs on here falling all over the DNC talking points about how all those sick people without insurance are causing rates to skyrocket, yet when it comes to discussing the tax increase for those uninsured people, they are quick to exclaim, “But it’s less than 1% of the people!”

The uninsured are a huge burden on our health care system, until it comes time to make them pay the bill, apparently.

Is there any wonder why we can’t believe a thing they say?

md

July 12th, 2012
9:18 am

“So they’ll show up at the ER, sicker than if they would have seen a primary care doc early on and cost YOU and everyone else with insurance (lucky you) more in premiums.”

I see this one a lot, but the math just doesn’t add up………a few trips to the er will cost about the same if not more than many trips to the doc……it’s a wash.

JF McNamara

July 12th, 2012
9:21 am

There’s only one problem with your assertion that people won’t be able to get care on medicaid. You assume that everything is static. If there are people with medicaid who can’t get care, then some entrepreneurial person will find a way to cut costs and provide care. That’s the free market. It will happen, because there is too much money to be made that way. I’m not worried about that at all.

The money part of it is debatable. That’s the good thing about doing something. Some States will probably we winners while others are losers. At least we can finally see what works and what doesn’t and (hopefully) all migrate to the right solution along the way.

Kyle Wingfield

July 12th, 2012
9:23 am

Willis @ 7:20: “people without insurance and those already on Medicaid go to hospital emergency rooms where they will be seen, and hospitalized, if necessary”

If this is a problem among the uninsured and Medicaid patients, how does expanding Medicaid without addressing its flaws solve the problem?

All the talk about “we pay through higher insurance premiums” rings hollow, too, when the alternative is … paying through higher taxes.

The problem many people on the left have is that they choose to believe anyone who disagrees with their methods disagrees with their goals. This is a particularly bad problem for them when their methods have failed to achieve their goals.

Personally, I’d rather try something else. And sinking more money into the existing, failed program is a lousy impetus for trying something new.

retiredds

July 12th, 2012
9:23 am

leave this stuff up to the states, like GA, and the people lose every time.

Tiberius - pulling the tail of the left AND right when needed

July 12th, 2012
9:23 am

For all you posters invoking Christianity and Jesus in a comical attempt to make the case for government mandated health care, I would remind you that this nation is not, nor can it ever be, a theocracy.

If you wish to invoke what YOU would do on your own in a religious context, feel free.

But leave religion out of the realm of government, if you would please. The irony of having to read that from people who would usually wish for all religious references to be removed from every facet of government life in any other instance is just too rich.

DannyX

July 12th, 2012
9:24 am

“That cunard is getting a bit stale”

Yes because Jesus was all about sticking up for the rich. Jesus would love American values, spend almost a trillion dollars a year on our war machine while ignoring the health of the working poor.

Shock and awe Jesus is awesome.

curious

July 12th, 2012
9:26 am

If we’re lucky, we can aspire to a Healthcare system like in Haiti.
The wealthy can afford good Healthcare. The others- tough luck.

Kyle Wingfield

July 12th, 2012
9:26 am

swga @ 7:41: Medicaid already covers 1 in 6 people in Georgia. The expansion would increase it to 1 in 4 — while, as I wrote in the OP, very likely making the program even worse for the existing enrollees. How many is enough?

Tiberius - pulling the tail of the left AND right when needed

July 12th, 2012
9:27 am

JF McNamara, is it never “the free market” when government mandates it.

And I gotta love your sudden affection for the free market, anyway. I didn’t hear you calling for passage of the GOP plan which expands the free markets regarding health care coverage, did I?

Kyle Wingfield

July 12th, 2012
9:28 am

Some people @ 7:53: There’s a world of difference between losing money on every patient and reducing (what amounts to) the profit margin on each one.

Kyle Wingfield

July 12th, 2012
9:29 am

carlosgvv @ 7:59: In Georgia, at least, the legal services were provided pro bono by private attorneys.

I know, I know, you don’t believe anything you read.

@@

July 12th, 2012
9:31 am

The irony of having to read that from people who would usually wish for all religious references to be removed from every facet of government life in any other instance is just too rich.

Their attempts to judge who fails the test is even richer.

DannyX

July 12th, 2012
9:31 am

Medicaid already covers people in this state who work very little or not at all.

Do the people who work low wage jobs that have no employer insurance benefits just not deserve healthcare? How are they supposed to pay the premiums Kyle?

Kyle Wingfield

July 12th, 2012
9:31 am

Atlanta Mom @ 8:08: That’s two in a row where what’s “clear” to you is not what I wrote.

The point I made in that T-SPLOST column was that one can hardly argue it’s a good plan unless a majority of people think it makes things better for them. After all, improving things for the most people possible is, well, the entire point of the exercise.

Providing health care for the poor is an entirely different undertaking. My argument today is that Medicaid has proven to be a mediocre way of doing so, and expanding it — rather than trying something else — is a bad deal both for those in need of health care and taxpayers.

Kyle Wingfield

July 12th, 2012
9:36 am

@@ @ 8:21: Or, more likely, they simply choose not to participate in the program. The larger that program gets, the bigger a problem non-participation by doctors poses. Seems to me we should try something else.

Btw, what this problem really speaks to is the emergence of a two-tier health system, where those with the means to escape the program — which is approaching a minority of the population — do so, and those without the means are stuck in it receiving substandard care.

td

July 12th, 2012
9:36 am

Why should anyone receive FREE insurance? Here is my idea:

The state should set up a pool where anyone can come in and purchase the same plan that state employees have. The person will have to pay the same premium cost and have the same deductibles and co-pays. We should re write the medical liability laws in the state to make Dr’s that treat these patients the same immunities as EMT’s, Police and Firefighters receive because then their liability insurance cost would come down dramatically.

Kyle Wingfield

July 12th, 2012
9:36 am

JDW: First, we are talking about Medicaid, not Medicare.

Second, you don’t do hyperbole well.

Tiberius - pulling the tail of the left AND right when needed

July 12th, 2012
9:39 am

“you know the one BY THE PEOPLE AND FOR THE PEOPLE.”

Got an official document that proclaims that, JDW?

Didn’t think so. Kyle’s right about the hyperbole thing.

Heartless

July 12th, 2012
9:41 am

Next time a conservative goes into a restaurant and the low wage server waits on your table, or perhaps a lawn care service mows your lawn, or a clerk helps you at a store or the carpenter finishes building your house, tell them thanks and you better stay healthy. We all like the fact that many of these services are extremely cheap in this country, in part because we provide them just enough to live, but rarely the healthcare to sustain it long term. Should people that provide these basic services not be entitled to health insurance? We know that conservatives are vehemently against minimum wage increases and constraints on the free market requiring employers to provide such benefits so what is the alternative?

Kyle, I find your position to be shameful.

@@

July 12th, 2012
9:41 am

Kyle:

Or, more likely, they simply choose not to participate in the program.

True! I stand to lose two of my doctors as a result. I hate shopping for new doctors…especially gynecologists.

Kyle Wingfield

July 12th, 2012
9:42 am

SBinF @ 8:49: No one’s made that argument, unless you count the liberals caricaturing what I’ve said, but don’t let that stop you.