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
ElephantWhip
July 12th, 2012
11:26 am
jose:
Maybe the powers-that-be in med school and licensing will quit keeping the supply of doctors suppressed. And don’t tell me they keep the number low because they only want the best-of-the-best as doctors. I know two people who went through the med school app process and were highly qualified. They had to apply twice (which is apparently a regular occurrence) and they did not get any more highly-qualified the second go-round when they were accepted.
Shortages in high-demand professionals drives the salary up. Scarcity in places in med school drive the tuition up. Under the guise of controlling the quality of doctors (and I don’t know how effective these quality controls are based on my family’s personal experience with doctors), much money is made by keeping the demand high (demand for the education and then demand for doctors’ services after they are practicing) and the supply (seats at med school and number of practicing doctors) low.
Kyle Wingfield
July 12th, 2012
11:28 am
Some people @ 11:14: See what you think of this idea.
iggy
July 12th, 2012
11:28 am
“Yes let us expand it to any lifestyle choice that could effect your health. Drinking? Risky sexual behavior?”
That is precisely what the govt wants. However and due to political correctness, certain demographics will be granted waivers.
Kyle Wingfield
July 12th, 2012
11:31 am
Doug B @ 11:22: I didn’t leave it out of my calculations. But that good has to be balanced by the fact that some people with access now will find it harder and harder to get care if the expansion leads to more doctors declining Medicaid patients.
See, the point of my column is not to explain how we can screw the most people. The point is to say that the Medicaid expansion is a bad idea on many levels, and all of us — the people who need coverage, and the people who would pay for it — would be better-served not to pour more money into a deteriorating system.
Tiberius - pulling the tail of the left AND right when needed
July 12th, 2012
11:31 am
“It someone has suffered some harm due to negligence, how can you put a limit on how much they should get. You can’t predict the future and what this person would have done if said event had not happened.”
Some people, of course you can. Instead of setting a fixed amount for medical costs that might be anticipated, you give them a fixed (and extremely limited) amount for pain and suffering, then work up a contract with the doctor’s insurance company that will provide a health care policy (paid by the company or doctor) based on the long-term needs of the person affected. No limits, but ONLY for the related problem, subject to independent review. The agreement would state that if the provider were no longer able, they would be required to move that policy to one that could.
That’s what I would do TODAY if anyone in my family were injured due to negligence or malpractice, and I probably wouldn’t need a jury to make that happen, either.
jose
July 12th, 2012
11:32 am
Elephantwhip….whether or not your points are accurate, we have a real shortage now and even if med schoiols adapted as you propose, it would not have an impact on the shortage for a minimum of 5 years and as many as 10 in the case of a surgeon. On the topic of tort reform, I know a handful of physicians who pay more than $120,000 a year in malpractice insurance premiums…just the premiums!…and they have no record of commiting medical errors. Again, the health care “reform” bill totally missed the opportunity to do anything about a significant cost driver.
Tiberius - pulling the tail of the left AND right when needed
July 12th, 2012
11:35 am
Shorter, AmVet.
Conservatives=Bad, Liberals=Good!
You may now return to the Children’s Table. You’ve covered everything you’re going to contribute to the discussion today.
JDW
July 12th, 2012
11:37 am
@Kyle…”proving once again to be the king of counterfactuals.”
Really? What constitutional moves has this state has made in the last 10 years to actually address access to and cost of healthcare issues.
md
July 12th, 2012
11:38 am
“Now they actually posit that man’s role in climate change is a non-factor.”
Now now Am…..don’t be throwing out talking points like “want dirty air and dirty water”. There is a huge difference in saying man’s role is a non-factor and man’s role is the only factor. Many are smart enough to realize it more than likely falls somewhere in between…………
md
July 12th, 2012
11:40 am
“My point in posting about smoking related illness is that we are ALREADY paying a tax on smoking (and obesity) in that $100 plus million a year of our tax dollars that could be spent elsewhere are instead treating the consequence of bad choices not our own.”
Unfortunately, the only way to stop that is to remove all the bad choices…..bye bye KFC…..
Some people are stupid
July 12th, 2012
11:42 am
I don’t know about that one. The ponit of workers comp is to pay for accidents that happened in or relating to the workplace.
I see a medical lawsuit as more of a penalty for doing something wrong. If you cut off my pinky toe versus remove an ingrown toenail, then you should have some sort of punishment. I would need more information on how everything would work before I could say that’s a good idea.
Tiberius - pulling the tail of the left AND right when needed
July 12th, 2012
11:44 am
“There is a huge difference in saying man’s role is a non-factor and man’s role is the only factor.”
Or even a major factor, md.
But let’s not get in the way of a good whine . . .
md
July 12th, 2012
11:45 am
My Doc once told me I could eat anything I wanted to…………as long as it didn’t taste good.
ElephantWhip
July 12th, 2012
11:47 am
ElephantWhip @ 11:13:
1. The SCOTUS ruling did not find a “constitutional right to healthcare coverage.” It said the federal government has the constitutional power to tax people who don’t buy health insurance. Big, big, big difference.
And to subsidize those who cannot afford it through Medicare. So the states are preventing me from receiving my benefit from the feds of subsidized health care.
2. The very policy we are talking about — letting states choose whether to participate in the expansion — was a remedy for the unconstitutional coercion that the justices themselves created. I have full confidence they would not turn around and declare that they’d blown a constitutional issue in creating their remedy.
A little illogical.. It’s no more unconstitutional than making you pay your income tax now. No need to address.
3. It’s a moot point, because states already provide Medicaid at differing levels of income. If you live in California, you can get on Medicaid at a higher income level than in Georgia; if you move here, you will lose it. If there’s a class-action lawsuit just waiting to happen on this basis, it’s been waiting an awful long time.
This is your best argument. It’s got me thinking. It will probably come down to the language of the regulations.
sambo
July 12th, 2012
11:48 am
sambo, needs money from this hes us it to pay crack bill
Mash
July 12th, 2012
11:49 am
Kyle,
I’m truly stunned that Georgia hasn’t taken the rather large bone that the SCOTUS has thrown the States and simpley opted out, like the rest of the States that challenged the medicaid expansion in the first place.
Is this decision to opt out or not left to the sole descretion of Governor Deal? I’m just wondering if attempting to voice our concerns with our local representatives would do any good. Or are we stuck we voicing our outrage to the less accessible Governor?
If Governor Deal ends up accepting this expansion for Georgia, I certainly hope he has some primary opposition in 2014 because I’m sure there will be plenty of voters that would like to vote him out of office based on this huge decision alone.
@@
July 12th, 2012
11:52 am
When something’s “free”, people tend to ignore cost.
Being pro-active when it comes to private healthcare can offer rewards overall.
I’ve dealt with a shoulder injury for some time. As the pain intensified, I finally went to the doctor. They wanted to send me for physical therapy. My response?
“Are you kidding? Like I’m gonna approve the expenditure of big bucks to have some PT put me through pain?” “No thanks! Give me a list of exercises I can do at home.”
The orthopaedist, obviously having dealt with patients who fail to follow through, questioned whether I would actually do the exercises, to which I responded…”Why the heck wouldn’t I…I’m experiencing limited mobility and excruciating pain?”
It’s that personal motivation thingy. I was amazed at the results after just three days.
ElephantWhip
July 12th, 2012
11:54 am
Mash, et al.
It’s amazing how big money can make perfectly normal people relish the idea of preventing poor people from getting medical coverage (all the while squeezing every dime out of everyone).
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
11:56 am
Bad idea all around, decline the medicare expansion. It seems that most ideas conceived by the Feds eventually turn into poorly run, under financed, poorly thought out, disasters. Why these elected elites think they know how to solve every problem in America, always amazed me.
When I was in Management training, I was taught to investigate the problem, sit down with those effected, and brain storm solutions. Seems our elected elite, do little of that. Because they can borrow these massive amounts of money, they think that gives them carte blanche authority to implement the solution.
Someone needs to start over, first by talking with the Doctors, the patients, the insurance companies, the hospitals and clinics, and put together some health care strategy that is affordable, sustainable, and makes economic sense.
The immediate response for the left to all ideas for radical change, like this or tax reform is the tired ole Oblamer Mantra of “We ain’t going back”. So, we continue to head full speed toward insolvency and hard times for all.
Auntie Christ
July 12th, 2012
12:04 pm
md @ 1056: Considering the fact that words actually do have meaning, one should notice the the first objective clearly states to “provide”, while the second objective clearly states to “promote”…..there is a difference and it was put there for a reason
+++++++++++++++++++++++++++++++++++++++++++
I recognize there is a difference between the words, but I fail to see how it has any bearing on the argument I made concerning the disparity in spending on armies and spending on the citizenry’s well being. I guess you admire n korea, china and the other tin horn countries that let their citizens die from lack of care, so they can show how big their cojones/armies are.
Promote: To contribute to the progress or growth of; to further. To urge the adoption of; to advocate for.
Provide: 1. To furnish; supply 2.. To set down as a stipulation.
++++++++++++++++++++++++++++++++++++++++++
The Constitution urges the adoption of measures for our common welfare .Obamacare does the same, therefore it follows the Constitution.
Jefferson
July 12th, 2012
12:05 pm
You are wrong, GA needs to comply.
Georgia, The " New Mississippi "
July 12th, 2012
12:05 pm
The participating states will figure out how to make this work to the advantage of its citizens. The allocation for non participating states will go to those states and make healthcare affordable and available to its citizens. The Johnny Reb states will keep doing what they have been doing since the The Johnny Reb Rebellion of 1862.
Jefferson
July 12th, 2012
12:08 pm
Get over the fact that its not free and will need to be paid for and plan for the fundings is what adult americans would do.
Dusty
July 12th, 2012
12:14 pm
Seems like so many basics are missing here or maybe I missed them
Medicaid in Georgia is already loaded and cannot afford more participants. The state is not in a fiscal condition to funish more funds. Taking from the Feds is just taking money from our debt ridden central government. Debt here and debt there and add more debt is not sensible.
Doctors like to make a “living” like everybody else. Don’t expect them to work for free. Do you?
Cut expenses? Yeah. Buy your medical equipment for brain scans, MRI , etc at GOODWILL. Let the nurse’s aide do surgery. Reuse OR “tools & supplies” and ignore infection. Rinse off those rubber gloves. Lotsa ways to cut expenses for healthcare.
I have great compassion for all those people dying in the streets but the fact is I haven’t seen any. Not here but in Africa, India , etc. etc. Americans are now getting ready to ruin one of the best heathcare systems in the world.
I will not assist those ruining what is good and expecting no one to die. There is no healthcare in this world that stops dying and liberals will complain and blame about their fate to the last minute (and probably saying “Bush did it!).
They BOTH suck
July 12th, 2012
12:17 pm
Has anyone been able to provide the following and not a link from an advocacy group. “I want hold my breath waiting”
“Please provide link to that tort reform survey that indicates doctors nation wide claim 30%. Would hope it would not be some advocacy group but some org that we can somewhat agree on. ”
Hilarious that the request clearly stated what was asked for, yet all that was posted was the exact opposite.
Nothing more what would be considered a non biased source.
Typical.
Good day
DawgDad
July 12th, 2012
12:18 pm
Somehow, despite the inhumane horror and anguish inflicted upon us by uncaring, greedy, racist Republicans, I and my forefathers have survived and raised families WITHOUT any of the benefits of Obamacare.
The issues in our health care system were NOT screaming for thousands of pages of legislation and regulation, thousands of bureaucrats on the public payroll, thousands more IRS agents and employees, millions of people-hours of relentless demogoguery and political maneuvering, and billions of dollars more pressure on the National Debt and State budgets, all of which will have untold but certain serious unintended consequences on what was WORKING before.
The costs to our economy and freedom are far too great to allow Obamacare to gain a foothold of acceptance. It was a political creation and it must remain in-play as such. Obamacare is not the end for its supporters, it’s the beginning, and it’s the wrong solution.
getalife
July 12th, 2012
12:20 pm
The gop opting out will give us Canadian health care.
“Records Suggest Romney Stayed With Bain Years After He Claims”
Slick willard can’t tell the truth about anything.
Uh Oh
July 12th, 2012
12:20 pm
Kyle or @@
Can either of you tell me what a “dummycrat” is?
Is it a general reference, a name being called to those who do not fit a certain ideology or maybe just the lack of intelligence and inability of the blogger to post without childish bs?
Thanks for the clarification
Uh Oh
July 12th, 2012
12:23 pm
It will be watered down, however Obamacare is here to stay in some form or fashion.
We can argue all day, but Obamacare is with us.
Calling names, huffing and puffing is not going to make it go away.
It would behoove the Republican Congress and what will be a reelected Obama to work together to improve on a flawed law that needs work
Chris Sanchez
July 12th, 2012
12:31 pm
Georgia, and every other state with any sense, will decline to participate in Medicaid expansion. If states determine that investing additional funding into healthcare for the poor, then they have the ability to do so now without the strings that come with the federal government’s borrowed money.
The best way to help those in need is to get the economy growing and reduce the unemployment rate and provide opportunities for them to develop marketable skills. There are some great non-profit organizations in Georgia who could receive funding to assist with this if people would take there mission seriously.
Lil' Barry Bailout (Revised Downward)
July 12th, 2012
12:32 pm
Skip: How bout a 35th vote, think that will fix things?
————
If it occurs after January 20th of next year it will.
td
July 12th, 2012
12:35 pm
ElephantWhip
July 12th, 2012
11:47 am
ElephantWhip @ 11:13:
“And to subsidize those who cannot afford it through Medicare. So the states are preventing me from receiving my benefit from the feds of subsidized health care.”
And the great thing about this country is that you have the right to live where ever you think best fits your needs.
Dusty
July 12th, 2012
12:35 pm
DawgDad @ 12:18
Well said, Dad. Good to hear from those who do not believe that everything should be “given” to them by others for a better life. Independence is being pushed aside.
Just Say No to ObamaCare
July 12th, 2012
12:37 pm
Just say NO to ObamaCare!
getalife
July 12th, 2012
12:37 pm
“While Republicans lambast the cost of implementing health care reform, a new report shows that their efforts to repeal the law have come at a major cost to taxpayers — to the tune of nearly $50 million.” Aol.
What happened to cutting spending?
@@
July 12th, 2012
12:41 pm
Uh Oh:
Kyle or @@
Can either of you tell me what a “dummycrat” is?
It’s a word…just a word.
Do you take personal offense to it? If so, don’t look at it…don’t draw attention to it.
You leftists are way too sensitive.
Uh Oh
July 12th, 2012
12:44 pm
@@
Just looking for clarification. Figured it was due to the inability of the blogger not to be childish.
Thanks for the reply.
Finn McCool (The System isn't Broken; It's Fixed)
July 12th, 2012
12:45 pm
off topic: the banker hits just keep on coming:
Revealed: JPMorgan Paid $190,000 Annually to Spouse of Bank’s Top Regulator
http://www.alternet.org/economy/156259/revealed:_jpmorgan_paid_$190,000_annually_to_spouse_of_bank’s_top_regulator
Dusty
July 12th, 2012
12:45 pm
getalife,
In answer to your question: What happened to cutting spending?
It happened over three years ago when Obama was elected president. Hope & CHARGE IT!
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
12:45 pm
Uh Oh
July 12th, 2012
12:20 pm
Can either of you tell me what a “dummycrat” is?
It’s the same thing as a dimwitocrat, if that helps any.
Jefferson
July 12th, 2012
12:46 pm
Expect situations if you don’t.
curious
July 12th, 2012
12:46 pm
The $50 million will help save Billions, maybe Trillions.
That’s the same rationale I use when I buy my lottery tickets.
Uh Oh
July 12th, 2012
12:47 pm
@@
Thank you. You prove my point so well.
carlosgvv
July 12th, 2012
12:47 pm
Kyle – 9:29
You still believe high powered attorneys would appear pro bono before the Supreme Court for the State of Georgia?
OY VEY!!!
Kyle, why would you believe this? WHY IN THE WORLD would you believe such a foolish thing?
Hillbilly D
July 12th, 2012
12:49 pm
Washington takes over Medicaid completely and passes k-12 education totally to the states.
Given the current climate, I think that’s about the only possible, workable solution, right now. Probably the best of a lot of bad choices.
Hillbilly D
July 12th, 2012
12:52 pm
I should add to my 12:49, that I think K-12 education should be under the states, anyway.
Kyle Wingfield
July 12th, 2012
1:02 pm
carlosgvv: We’ve been through this before. I showed you a link to the documents that show what the state DOJ pays out to contract attorneys…you said you didn’t believe trust the document…
ElephantWhip
July 12th, 2012
1:04 pm
A follow up on my brief research on Google re: how states might be forced to pay for people who received the benefit in another state who accepted medicaid.
Writing for the majority, Justice Brennan stated, “An indigent who desires to migrate, resettle, find a new job, start a new life will doubtless hesitate if he knows that he must risk making the move without the possibility of falling back on state welfare assistance during his first year of residence, when his need may be most acute.” Shapiro v. Thompson, at 629, 89 S.Ct. 1322
I realize that this situation assumes that the indigent would qualify for state welfare after a year, whereas in a future AHCA situation the benefit would never be available even after a year in a state who did not raise its Medicare income level. Nevertheless, this language looks workable. I have not found anything directly on point about qualifying for Medicare in one state and not in another. Maybe it’s just never been tried. The Shapiro case is from the 60s and it was cited in a 2007 for the quote above.
Just watch when the law goes into effect and someone moves and loses coverage. The lawsuit is coming.
ElephantWhip
July 12th, 2012
1:15 pm
td:
Are you suggesting I move to Mass.?
Fortunately, I have health insurance. I just care about those who don’t.
carlosvv:
The attorneys probably did do it pro bono in GA. They are still rolling in the $$$ fromt the Voter ID suits.
Just Say No to ObamaCare
July 12th, 2012
1:15 pm
Most of the problems in health care were created by the idiots in Washington, they are the ones who made the emergency departments havens for drug seeking losers, illegals, and other assorted deadbeats. Since Washington cannot bring itself to admit to a mistake, they pass other reckless laws to hide their original error. Just check with any ER in the country, they will have a list of frequent flying drug seekers, and guess what? The same names appear on lists for several hospitals, the druggies are making the rounds on a schedule! With free medicaid coverage, the frequency will increase. My solution would be to give the scum a lethal overdose, but my legal staff has informed me that would be considered murder in 95% of the country. Always a catch 22…….