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
@@
July 12th, 2012
3:27 pm
Uh Oh:
@@
Thank you. You prove my point so well.
Not sure how you came to that conclusion.
Were it not for your overly sensitive nature, I was gonna say “If you don’t know what one is, you just MIGHT be one” but I didn’t.
schnirt
How Inciteful Is That!
July 12th, 2012
3:31 pm
Before I go:
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.
Actually, I believe it’s just a lower cost of living that has Costa Rica’s costs lower than they are here but if you have some evidence to present that shows their lower costs are driven by their free market as opposed to our over-regulated unfree market, I would love to see it.
Hillbilly D
July 12th, 2012
3:33 pm
Paying your own way brings down prices, just look at Lasix surgery in America.
That’s another pet peeve of mine. All my life, I’ve had very poor eyesight. Went to the same doctor from the time I was a small kid until I was a young adult. When I first started hearing about Lasix, I asked him about it. He said, “You really aren’t a good candidate for it, it wouldn’t do you much good”. So I said fine and forgot about it. 2-3 years later, he started doing the surgery and started telling me I ought to think about it. I was already getting irritated with the guy, so I changed doctors. Asked the new guy about it and guess what he said? “You really aren’t a good candidate for it, it wouldn’t do you much good”. So long story short, I still got that doctor, 20 plus years later, and he does the surgery now, too, but at least he still tells me it’d be a waste of money for me.
And on the subject of Lasix, I had a co-worker who did do the surgery (somewhere else) and was happy with it. However, they put him on a payment plan, no interest if you paid it off on in a year and full interest if you didn’t. Luckily, he was smart enough to read his contract, though, because if he made the payments in the agreement, for the year, they didn’t add up to the full amount, so he would’ve been hit with the interest at the end. I suppose that may be legal and I guess it’s anybody’s fault if they don’t read the fine print but still, it’s not right, in my way of thinking.
woodrow
July 12th, 2012
3:37 pm
You are against this extension of Medicaid for the poor because you think it will force lower costs for medical care (you said this, I did not). And I’m thinking you missed the point from the beginning. The problem, which you seem to have forgotten, is the spiraling high cost of medical care and the lack of access to health care due to expense. And once again, like a true Republican, you’ve muddled the issue because it doesn’t benefit you. To which, I say, this is a public service worthy of more serious consideration.
@@
July 12th, 2012
3:41 pm
Discount and/or free dental care is out there. Eleven in Atlanta.
DawgDad
July 12th, 2012
3:45 pm
“As if healthcare was an optional expense”
I guess that pretty much sums up why we have Obamacare. Imagine the shock these people will have when they discover just how “optional” the Federal Government considers their health care.
Skip
July 12th, 2012
3:49 pm
Delta’s ready when you are? That’s always a hoot, the on time schedule sucks. So no, they aren’t ready when I am.
Hillbilly D
July 12th, 2012
3:52 pm
Somebody may have already mentioned this but the clothing to be worn in the opening and closing ceremonies by the US Olympic team was made in China.
http://olympics.yardbarker.com/blog/olympics/article/team_usas_opening_and_closing_ceremony_uniforms_were_made_in_china/11206375
We’re putting the gun to our own head.
Uh Oh
July 12th, 2012
3:58 pm
@@
Thanks again for showing your unwillingness or inability
md
July 12th, 2012
3:59 pm
And what happens when we add a giant unaffordable entitlement program:
“I think if I had to tell you the probability, I’d say the chances are we are going over the fiscal cliff,” Bowles said. “I hate to say it, but I think that’s probably right.”
http://news.yahoo.com/erskine-bowles-going-over-fiscal-cliff-153722521–abc-news-politics.html
And Bowles is the democrat just for clarity.
md
July 12th, 2012
4:00 pm
“We’re putting the gun to our own head.”
Good luck getting the herd to understand how……..
Uh Oh
July 12th, 2012
4:01 pm
How hilarious that some of the same people who say “Delta is ready when you are” if a comment is made about GA, yet complain about Obama but are not on a Delta international flight leaving the US.
Same exact principle
Just sayn
Hillbilly D
July 12th, 2012
4:03 pm
Good luck getting the herd to understand how……..
You got to get the bell cow to understand before the herd will follow. I don’t have much hope of that happening, either.
Hillbilly D
July 12th, 2012
4:09 pm
Uh Oh
The comments about Georgia weren’t political in nature, they were about Georgia and her people. There is a difference.
md
July 12th, 2012
4:09 pm
“How hilarious that some of the same people who say “Delta is ready when you are” if a comment is made about GA, yet complain about Obama but are not on a Delta international flight leaving the US. ”
No Uh Oh, you must have missed the rest of the conversation…..it is no where near the same principle.
Now go back up and read the rest. For it to be the same, one would have to move into the US and then poo poo Obama………
MarkV
July 12th, 2012
4:10 pm
Hillbilly D @3:52 pm: “Somebody may have already mentioned this but the clothing to be worn in the opening and closing ceremonies by the US Olympic team was made in China.”
Obama’s mismanagement!
Uh Oh
July 12th, 2012
4:11 pm
md
whatever
When someone cries about a comment made about GA and says Delta is ready when you are, they need to follow their own advice about crying about Obama
plains and simple
good day
Uh Oh
July 12th, 2012
4:14 pm
Hillbilly D
Got ya. With that said, this is not the 1st time on this blog where I have read the Delta is ready when you are comment.
If it doesn’t apply in this case, my bad, but that statement is as weak as people that would knock the people of GA.
Even if the bloggers opinion is incorrect, there is no need for them to go anywhere. If they want to be unhappy in GA, let them be unhappy.
They can get glad in the same pants they got mad
md
July 12th, 2012
4:15 pm
Again Uh Oh…..the reference to Delta is to go BACK to whence one came if they don’t like their new surroundings……….
Uh Oh
July 12th, 2012
4:18 pm
md, my apologies for this particular time
With that said, it isn’t the 1st time I have read that comment. Maybe not from you, but it has been posted several times and yes some of it had to do directly with politics.
Since it wasn’t this time. I apologize for the inference
Hillbilly D
July 12th, 2012
4:19 pm
If they want to be unhappy in GA, let them be unhappy.
The problem with that is they make us unhappy, too. lol
Up here in the Hills, we get people who move in (some from other parts of GA, even) and the first thing they want to do is try to change this place to be like where they came from. So why the hell did they move in the first place?
Some folks move in here and mind their own business and do fine. When in Rome, you need to do as the Romans do. If you don’t like the way the Romans are, don’t live in Rome.
@@
July 12th, 2012
4:20 pm
Am I the only person who finds Uh Oh slightly off kilter, much like our “friend” fred?
Hillbilly D
July 12th, 2012
4:21 pm
*And by you I don’t mean you personally, Uh Oh.
Uh Oh
July 12th, 2012
4:21 pm
“If you don’t like the way the Romans are, don’t live in Rome.”
To a degree, yes, however we do not all live in tee peas or other Indian style housing.
Hillbilly D
July 12th, 2012
4:22 pm
@@
The world needs it’s off kilter folks, too………unless maybe you’re talking about Scots clothing. (IWH)
Darwin
July 12th, 2012
4:23 pm
Healthcare as a commodity to be bought and sold. Only in America.
Hillbilly D
July 12th, 2012
4:24 pm
however we do not all live in tee peas or other Indian style housing.
That’s true but the Cherokee took the land I live on from the Creeks (that’s how Blood Mountain gets its name) and neither group was here when DeSoto came through, so who do we emulate?
Uh Oh
July 12th, 2012
4:27 pm
HillBilly D
That is a great question?
@@
July 12th, 2012
4:27 pm
Hillbilly:
There was a time when I wanted to see Sean Connery’s kilt off.
Hillbilly D
July 12th, 2012
4:29 pm
@@ 4:27
That ain’t none of my business. (ISH)
Uh Oh
July 12th, 2012
4:29 pm
HillBilly D
If you do not mind me asking, are you in what is know considered the “outer” burbs or further up than that?
I’m sure as suburbanites moved to the “outer” burbs, some of the ones living in those towns moved even further north
Uh Oh
July 12th, 2012
4:30 pm
now considered
td
July 12th, 2012
4:30 pm
Checking back in and I see not one lib will answer the question as to what programs to cut or how many children are you willing to add to a classroom so that 650,000 more people do not have to pay for their own insurance?
Hillbilly D
July 12th, 2012
4:34 pm
Uh Oh
I’m farther out. It’s not as far as it used to be though. I still can’t see any of my neighbors in summertime but it’s getting crowded for my tastes. I come from a long line of folks that like to keep to ourselves.
Uh Oh
July 12th, 2012
4:37 pm
HillBilly D
Thanks. My niece lives outside of Rome. She likes it up there.
My parents used to own a home on Lake Blue Ridge, but sold it because they were spending more time in Central America and are not into renting 2nd homes to supplement the cost.
Chuck Doberman
July 12th, 2012
4:41 pm
LOL “Turn it down, and that money could go toward lower-cost catastrophic coverage for the same uninsured, mostly young, adults”
I guess it maybe COULD go toward lower-cost catastrophic coverage for cotizens… but how many of you believe that if the state were given control of these funds they WOULD be used for such purpose? Anyone?
“Washington takes over Medicaid completely and passes k-12 education totally to the states”
Oh yeah, this is a great idea. Put education in the hands of the GA GOP. Yup, soon you’ll have two options:
1. Take a voucher that’ll cover maybe 50% of tuition at any one of many for-profit businesses operating under the guise of a “school” (cuz public schools will be history… and a new curse-word combination)
OR, if you can’t cover the remainder of the tuition or the for-profit business doesn’t like little Johnny…
2. Home school them yung uns’. Best way – that wey are kidz’ll know that rain is really God’s tears and that dinosaurs are a left-wing conspiracy. They’ll know they’re required to hate “them peeple” and anyone else who ain’t like them. They won’t waste time on stuff like math and science, they can go straight to training for cart gathering at Walmart or a nice career in fast food
Brilliant! Genius! This is the ultimate plan to ensure our kids are dumber than we are (and that’s saying something) and less able to realize they’re being duped by their elected officials (and that’s saying something too!). What an AWESOME idea! Leave our kids’ futures in the hands of Georgia politicians… it just don’t get any better than this
DawgDad
July 12th, 2012
5:01 pm
“Healthcare as a commodity to be bought and sold. Only in America.”
Always has been and always will be. Only difference now is you have politicians and Government bureaucrats beginning to control the market, for their benefit. I was FAR more trusting of Insurance Companies, considering their products were VOLUNTARY purchases.
“the Cherokee took the land I live on from the Creeks (that’s how Blood Mountain gets its name) and neither group was here when DeSoto came through”
Human beings have never been and never will be inherently entitled to real estate they cannot defend. Think about it, it’s a fundamental reason we have societies and government.
md
July 12th, 2012
5:02 pm
“and the first thing they want to do is try to change this place to be like where they came from. So why the hell did they move in the first place?”
Exactly…..if Steve thought so highly of the NE, then why was he here. And if it was due to a job, then evidently the NE wasn’t as wonderful as that job wasn’t up there……….
Phineas
July 12th, 2012
5:02 pm
Oh come on, Kyle. You’re criticizing this because Medicaid because it doesn’t pay out enough to doctors? You say the federal government would send Georgia $35B over the next 10 years for this Medicaid expansion, which you say Georgia should turn down because Medicaid doesn’t reimburse health care providers enough. So would it be ok with you if the federal government sent Georgia $50B instead? How about $75B? Or maybe $100B? Are you really saying this expansion of Medicaid is not big enough?
fair and balanced
July 12th, 2012
5:03 pm
Kyle’s problem with Obamacare ::
“”"”"”"”"”"”"”"”"”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.”"”"”"”"”"”"
Does that include designing the Affordable Care Act based on the plan of the heritage Foundation and Romneycare??
So I assume you believe Romneycare did not achieve its goals and should be abolished. By the way who the left wing idiot who passed it?
md
July 12th, 2012
5:06 pm
“Healthcare as a commodity to be bought and sold. Only in America.”
Of course it is as it requires the participation of others to deliver it. Unless one wants to go the forced labor camp route…..which is basically what socialized medicine is. One being told how much they can/will charge for their skills……..
Uh Oh
July 12th, 2012
5:07 pm
F & B
He meaning Romney is a “progressive”. Said so himself when running for Governor
@@
July 12th, 2012
5:08 pm
Well, this topic’s about done, Kyle. You, Tiberius and md have put up some excellent solutions and questions.
I’m gonna venture off to see what Rahm Emanuel’s been up to.
md
July 12th, 2012
5:09 pm
No Phineas, Kyle is referring to what is NOT covered by the feds and will fall on the shoulders of the States……many of which are required to have a balanced budget.
So…..adding thousands to the program will cost millions…..what gets cut to balance the budget?
Any takers…….or are you all just takers?
@@
July 12th, 2012
5:09 pm
Uh Oh:
You probably don’t know this, but I used to be a progressive/leftist/liberal.
Uh Oh
July 12th, 2012
5:11 pm
Well he said his “views” were not that he was…….. My bad
In 2002, when he was running for governor in Massachusetts, he issued a strong declaration of his basic principles while campaigning in Worcester:
” I think the old standby definitions of who votes for which party have been blown away in this campaign. I think people recognize that I’m not a partisan Republican—that I’m someone who is moderate, and that my views are progressive.”
Will the real Mitt Romney please stand up, please stand up
And quoting Obama’s bs is not a defense of what Romney said………. But in advance, nice side step
Uh Oh
July 12th, 2012
5:12 pm
@@
I voted for Bush Sr…… twice, but that is beside the point
Uh Oh
July 12th, 2012
5:13 pm
@@
I have never voted a straight ticket, but that is beside the point as well.
Phineas
July 12th, 2012
5:14 pm
Ok, md, so if the federal government covered the program 100%, and the amount sent to Georgia and the states was higher so that health care providers could be reimbursed more, then you’d be ok with it?
Uh Oh
July 12th, 2012
5:18 pm
@@
And thanks for displaying your ability to articulate without the “dummycrat” childish bs from earlier
Seriously, thanks.