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
Jefferson
July 12th, 2012
1:20 pm
If Ronmey belived in his country, AMERICA — he would put his money where his mouth is. He like many here, including the host don’t want a better America, they just want their version that can only exist in their mind. Too bad it don’t and won’t work like that. The times they are a changin’, Roll with the changes.
“We will take the cloths and food, but what’s money ?” ….Green Berets
Uh Oh
July 12th, 2012
1:22 pm
Just say no
Stop being a Richard.
You were not referring to me
Hillbilly D
July 12th, 2012
1:23 pm
“We will take the cloths and food, but what’s money ?” ….Green Berets
Where is that quote from? Just curious.
Jus' da facts, ma'am
July 12th, 2012
1:27 pm
I just LOVE all the Doom & Gloom Faux News drones here talking about how bad things are:
Warren Buffet on CNBC: ” . . the U.S. economy is still doing better than “virtually any other big economy” around the world.”
The Fortune 500 generated a total of $824.5 Billion in earnings last year, up 16.4% over 2010 and beats the record of $785 Billion set in 2006 during a roaring economy!
fed up
July 12th, 2012
1:48 pm
Georgia must not be as bad off as the taxpayers are led to believe. This state will bring in immigrants/refugees and give them Medicaid after being here for one month before they will any taxpayers. How come we do not hear of a cut in this area? Where do the taxpayers get a break for this? They pay on a federal, state and local level.
td
July 12th, 2012
1:50 pm
fed up
July 12th, 2012
1:48 pm
“Georgia must not be as bad off as the taxpayers are led to believe. This state will bring in immigrants/refugees and give them Medicaid”
Federal policy
carlosgvv
July 12th, 2012
1:59 pm
Kyle – 1:02
First it’s pro bono.
Now it’s “what the state DOG pays”.
Which is it?
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
2:01 pm
Warren Buffet on CNBC: ” . . the U.S. economy is still doing better than “virtually any other big economy” around the world.”
Yep, Warren should have been a combat surgeon, I can hear him now. “What’s with the tears and the sad look, you only lost your legs, three of your fellow soldiers were killed in that explosion. Cheer up fellow, you were the lucky one.”
td
July 12th, 2012
2:10 pm
The one thing that Kyle mentioned that has not really been discussed is the cost to the state and where is the money going to come from? Right now 70% of the states budget goes to Education and Medicaid. This recession has stripped the rest of the state government down to bare bones (see the latest blogs about wait times at DSS for an example). We the people of Georgia are not going to raise taxes (you can put that one in the bank) so what do you what programs do you libs want to cut to come up with an additional $1 to $2 billion? How many more children do we want to add to our classrooms? How many fewer police do we want on the streets? Firefighters? Child protective services workers? Let us add here that to put an addition 650,000 people all the rolls would mean hiring an additional 650 to 100 caseworkers for DFCS so where are we going to get that money from?
kelly
July 12th, 2012
2:17 pm
I’m glad to hear the lawyers worked pro bono. Maybe if doctors worked pro bono for a small percentage of needy patients I would feel more sympathetic.
Uh Oh
July 12th, 2012
2:19 pm
kelly
There are doctors right here in the Atlanta area that work do volunteer work or for a reduced fee.
AmVet
July 12th, 2012
2:35 pm
You may now return to the Children’s Table.
Looks like Tib is gonna have to get yet another death penalty to learn his lesson.
Rule #1. Anyone who comes onto the blog with PERSONAL ATTACKS and little to nothing of substance to say will be banned permanently.
Here’s to hoping it comes sooner than later…
md
July 12th, 2012
2:37 pm
“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.”
And you just made the argument for our defense spending………which is supposed to be “provided”. And then remeber that to counter a big army such as those you listed, one might want to have one as big or bigger…..and then remember that Pearl Harbor was a surprise attack and that the British never thought Hitler would do much of anything……..
All it takes is one of the wacko’s running those big armies to make a wacko decision…..as the past indicates does happen.
As for the promote part of Obamacare……sorry, it has moved into the provide (forced) realm……
Jefferson
July 12th, 2012
2:37 pm
Hill – The movie Green Barets, with John Wayne. A scene where they were helping some South Viets to get info.
Steve
July 12th, 2012
2:39 pm
“We the people of Georgia are not going to raise taxes”
Hence, Georgia will forever remain a wasteland state where only the wealthy prosper.
I grew up in New England and we paid taxes yet reaped the benefits of clean communities, solid infrastructure, excellent public schools and colleges.
The mentality down here is of such ignorance and greed it makes me sick.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
2:40 pm
Speaking of pro bono, has there ever been a case of a dentist working pro bono. I was talking with a poor working man this AM, who is having extensive dental work done in the low thousands because he was never able to afford dental work in the past. Most of the poor people I run into, are more in need of Dental work than medical treatment.
There are no “free” emergency rooms to visit for dental problems. Is dental work supposed to be covered by medicaid?
I’ve never understood why a crown costs $1200 and why poor people are forced to pull their teeth, because some dentist wants to make $1000 for prepping a tooth and installing a crown. I know his time is valuable and his education expensive, but $500/hr?
Not sure who is at fault here, but there are a lot of problems out there facing people who are unprepared and unmotivated to take responsibility for earning a living.
Just don’t think we can continue to make everything right, for everyone.
md
July 12th, 2012
2:42 pm
“If Ronmey belived in his country, AMERICA — he would put his money where his mouth is.”
I believe he has, one may want to check on his out of pocket expenditures in the last 2 races.
As for his commitment……not too sure how one can question that when the guy is taking one of the crappiest jobs in the country (imo) with a pay cut to boot……………
md
July 12th, 2012
2:44 pm
“I grew up in New England and we paid taxes yet reaped the benefits of clean communities, solid infrastructure, excellent public schools and colleges. ”
Which is why half those states now live in the south and their migration numbers continue to decline as the cost of living continues to soar??
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
2:45 pm
Steve
The mentality down here is of such ignorance and greed it makes me sick.
You chose to live here and if you change your mind, Delta is ready when you are.
As for NE, great place to visit, but don’t want to live there. Taxes are incredibly high, too many rules and regulations, the population much too dense, and the winters are terrible.
md
July 12th, 2012
2:46 pm
Never did understand why people move to another area and then belittle the area they moved to by harping on why where they came from was/is so great.
If it’s that darn wonderful, why are they here????
How Inciteful Is That!
July 12th, 2012
2:46 pm
As usual, there’s Kyle’s rendition and there’s a more complete picture.
MarkV
July 12th, 2012
2:47 pm
Dusty @12:14 pm
“Doctors like to make a “living” like everybody else.”
Last time I wrote exactly the same you accused me of “indicting doctors.”
“Don’t expect them to work for free. Do you?”
And then you lectured me about doctors working sometime for free.
Inconsistency, Thou Name is Dusty.
Jefferson
July 12th, 2012
2:48 pm
md, he just banks offshore — why do you reckon ?
Kyle Wingfield
July 12th, 2012
2:51 pm
carlosgvv @ 1:59: (Sigh) The state DOJ does pay some attorneys to work on some cases. The document listing these payments does not show any for the attorneys working specifically on the Obamacare case.
Liz
July 12th, 2012
2:52 pm
When my poor adult son badly broke his arm, my eyes were opened to what adults in poverty had to deal with. The emergency room would not set his arm, and two weeks later, working hard every single day to find a doctor that would offer him “terms” he still could not find a doctor who did not require full payment upfront to set his compound displaced fracture.
He could have easily ended up cripple for life, but for one kind doctor who offered him an incredibly discount, out of the goodness of his heart.
People are under the false impression that all you have to do is be poor, and go to any emergency room and your health care needs will be met. Bad circumstances will teach you otherwise, the hard way.
Our health care system is broken. If you don’t feel it, thank God. But, please don’t be inhumane. I don’t think anyone here is demanding rights to equal healthcare, but setting broken arms, getting chemo therapy, and other basic life sustaining treatments should be covered whether you have the means to pay or not, at the time the service is NEEDED.
md
July 12th, 2012
2:52 pm
“md, he just banks offshore — why do you reckon ?”
When I was growing up my Dad called it not putting all ones eggs in one basket………..sounds smart to me.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
2:52 pm
md
Then they tell us how they did it up north. I guess they hope they can talk us into changing into what they just voluntarily fled.
md
July 12th, 2012
2:55 pm
“As usual, there’s Kyle’s rendition and there’s a more complete picture.”
Well that link certainly doesn’t………no mention whatsoever of the added costs to the states administratively……which will add millions.
As I asked earlier and td asked above, what you going to cut in all these balanced budget states??
The left never has an answer except…..but, but, but we need to do it.
Guess what, the worst kind of program one can implement is an unaffordable one, no matter how much good it is supposed to do.
Steve
July 12th, 2012
2:56 pm
When I read the responses in here it’s hard not to imagine the banjo song from Deliverance playing in the background.
Steve
July 12th, 2012
2:57 pm
Who’s fleeing from up north? Maybe from the weather, but not from the quality of life up there compared to here.
Just Say No to ObamaCare
July 12th, 2012
2:59 pm
Liz – I seriously doubt your won was turned away with a broken arm, but let us assume that is true. What value do you and your son place on having two functioning arms? You could skip beer and cigarettes for a year, that would raise some money, skip the mortgage or rent payment, eat out less, forgo the illegal drugs. But I suspect you did not want to pay anything, so I assume you place no value on two functioning arms.
Kyle Wingfield
July 12th, 2012
2:59 pm
Inciteful @ 2:46: Only if by “a more complete picture” you mean something you find more agreeable.
First, the CBPP analysis relies on the CBO estimates about how much the feds will pay. And, indeed, if Congress sticks to the plan, those CBO estimates about the feds covering 93% of the costs of the expansion may well turn out to be true. But as I wrote in the OP, given the dire condition of the federal budget, it’s more likely that Congress will not be able to stick to the plan. Which means more of the burden would shift to the states.
Second, the CBPP analysis says states’ spending will increase by only 2.8%. That might be true for some states. Georgia, however, expects its Medicaid costs to rise by $4.5B over 10 years, or $450M per year on average, which is 2.8% of $16.1B. We spend only $19.3B on the entire state budget, about 55% of it on education. So, either Georgia’s estimates are wildly off, or the national average CBPP forecasts is wildly different from what will happen specifically in our case.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
2:59 pm
Steve
Well you have come to live amongst us, so better learn to love that banjer music, or hop a Greyhound.
md
July 12th, 2012
3:02 pm
“Bad circumstances will teach you otherwise, the hard way. ”
Unfortunately, that applies in many other areas, and tends to come down to choices….
I didn’t see you mention why your son had no hc, so I won’t assume.
But the same can happen when one chooses not to have flood insurance, or not have enough medical coverage on their auto when they accidentally run somebody over, or have zero boaters insurance when they are jet skiing through bathers on lake lanier, or choosing to not have renters insurance in an apartment, etc etc…….
At some point, folks have to get a grip on their own actions/choices and many begin with the choice to drop out of school and be an idiot…………
Hillbilly D
July 12th, 2012
3:03 pm
Jefferson @ 2:37
Thanks, I thought that’s what you meant but wasn’t sure. I have a distant relative who was an officer in the Green Berets. He told me that he was trained to rob banks. I assume that was to finance clandestine missions but he wouldn’t really talk further.
Most of the poor people I run into, are more in need of Dental work than medical treatment.
Dental care is also a very important part of overall health. Any number of serious problems can start with the dental stuff. My old dentist, who is now retired, does do a good bit of free work for low income people, as his time and health allows.
The mentality down here is of such ignorance and greed it makes me sick
You don’t even have to wait for Delta. I-85 is open 24/7. And as for the NE, y’all are the ones who burned witches; we never did that.
md
July 12th, 2012
3:03 pm
Then why you here Steve??
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
3:08 pm
Hillbilly D
Glad to know there is one. The guy I was talking about said he never got the work done because the Dentist wanted cash, no credit. He said he would have paid him, but was never given a choice, just cash up front. Not meaning to indict all Dentist, but just wondering if they were all that way. Seems Dental prices have escalated tremendously in the last 20 years. I fear it is the advent of Dental Insurance.
MarkV
July 12th, 2012
3:10 pm
Whenever the subject of the blog is healthcare, most arguments are about money for “programs.” From which box the money should or should not be taken. As if healthcare was an optional expense, such as building or not building a monument, or going or not going to Mars. What gets forgotten is that the major part of the expenses, whether it is through ObamaCare, Medicare, Medicaid, goes to treating people who need care because of illnesses or injuries.
Dusty writes: “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.” Then, why do we debate and worry about Medicaid? According to Dusty, there are no such people in great need of medical treatment, so apparently the federal Medicaid money would not even be spent and needed.
What the debate should be about is mainly the cost of medical care, which is so much higher here than in other developed countries. Then we would realize that universal health insurance, whether in the form of a single payer system or as attempted by the mandate of ObamaCare, is one of the most important tools for cutting the cost through preventive care, early diagnosis and avoidance of the misuse of emergency care.
How Inciteful Is That!
July 12th, 2012
3:10 pm
Kyle’s argument is that getting something from the fed to cover more of our uninsured poverty-stricken population in doctor’s offices is far worse than getting nothing more to offset their cost on our strained hospital system when they show up in the emergency room and they are required to be stabilized anyway, by law, regardless of their ability to pay. Or perhaps Kyle has an Alpharetta poll that gives us some solutions that doctors will buy into that he’s not mentioning.
Actually, what I find sad is how many poverty-striken uninsured people we have just in Georgia. Too bad Georgia has not been able to come up with something new and different on its own to address that. It’s not like they have not had time to do something. Perhaps Tom Price and Paul Broun have secret plans to open up free clinics all across the state and fund them using charitable contributions. That’s the ticket. How about another tax cut. Those things are like elixirs. They fix anything.
Jefferson
July 12th, 2012
3:13 pm
md, did your dad use American banks ? Seems like a President of the USA would.
Sam
July 12th, 2012
3:13 pm
This is the Republican motto: I’ve got mine, so eff you.
How Inciteful Is That!
July 12th, 2012
3:14 pm
Did I forget to mention. My wife’s doctor said he went to Costa Rica for his dental work and saved a bundle. Now there’s an option the state may not have tried. Ship those in need to South America for affordable care and then ship them back. Perhaps the Medicaid money from the fed will fully cover that cost and maybe even have enough left over to throw in a few free meals.
How Inciteful Is That!
July 12th, 2012
3:19 pm
It seems like only yesterday that Kyle found a CBO analysis suited his needs to a tee. Funny how some people’s views change indeed.
md
July 12th, 2012
3:20 pm
“As if healthcare was an optional expense”
Actually, it can be…..but it requires more choices. Sure, we can’t prevent some of the biggies that may get us, but there are many, many out there that we can control…..but choose not to.
Many of our own choices can and will lead directly to some form of illness that could have been preventable……..smoking, drinking, unhealthy eating, lack of exercise, drugs, and on and on………and at some point, we need to be held accountable for our own actions vs trying to distribute those consequences on to others that may have made much better choices…….
If I choose to smoke, I don’t see how it is right for me to make my non-smoking neighbor pay for my healthcare……
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
3:21 pm
How inciteful
Ship those in need to South America for affordable care and then ship them back.
Amazing isn’t it when you have competition and free market constraints on prices. Someone I read about talked about the much less expensive medical treatment in Brazil, and how she took advantage of it. Paying your own way brings down prices, just look at Lasix surgery in America.
How Inciteful Is That!
July 12th, 2012
3:22 pm
Kyle,
I heard, for example, in Florida’s case, it was indeed the state’s estimates that were wildly off. I heard the same thing for other states as well so I would not be surprised to hear the same in Georgia’s case.
md
July 12th, 2012
3:23 pm
“md, did your dad use American banks ? Seems like a President of the USA would.”
My Dad didn’t grow up in a global economy……like it or not we are…….smart business is just that, smart business.
Hillbilly D
July 12th, 2012
3:24 pm
Rafe
Having talked to some people who work in dental offices, one a good friend, they say that in dental education in the last couple decades, there has been an emphasis on teaching the business side of things. That’s a double edged sword. They need to be efficient and make a profit like any other business but some of them also take from that a heavy skewing toward the money side of things and away from the care side. In my own experience, they wanted to give me a crown and I said, “It cost too damn much, so just pull it”. They didn’t want to do that, so here it is a few years later and I still have the tooth and no crown. I’ve survived so far.
When I was working in a car dealership, it was preached to us to be “more like your dentist”. What they meant was keep sending out those reminder cards every 6 months or whatever, to keep those people coming in for service, etc.
I’ve seen several things that I don’t like about healthcare in the last 40 years or so.
Remember back when eye doctors weren’t also in the business of selling glasses? In those days, they viewed it as unethical to sell glass because it had the potential to be a conflict of interest. In other words, if they told somebody they needed glasses, they didn’t stand to profit from it, so that person would feel they had an unbiased opinion.
I’ve dealt with doctors quite a bit in the last 4-5 years, just about weekly for a long part of that. I’ve noticed a big difference in doctors. If you can find a doctor who owns his own practice (either wholly or in partnership) they are pretty reasonable and seem more geared to the care side of things. They work with people and a lot of them do reduced rate and even free care, quite a bit. The other group of doctors are part of a corporate set-up. I’ve talked to many of these, who once had their own practices and sold out for various reasons. They all say they hate it and most are just marking time until they can retire. They have no say in the billing, they are constantly pressured to see more patients, etc. I’ve been to doctors where the guy was antsy if he was in the room more than 2 minutes. I know one doctor (known the family all my life) who was actually fired from a practice for “spending too much time with the patients”.
I don’t know what the answer to health care is but what we have now, is a damn mess.
How Inciteful Is That!
July 12th, 2012
3:25 pm
Oh well. Later, Kyle.
md
July 12th, 2012
3:26 pm
Inciteful……we still have yet to hear what you plan to cut when the states add all these folks to the rolls.
Care to give us a list or are you one of those that just like to complain about what gets cut??
What got cut in the last round…..education right? Up for cutting more education in exchange for medicaid?? That seems to be the choice………