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
Phineas
July 12th, 2012
5:18 pm
Conservatives whole argument against Medicaid expansion, or any health care reform to try and provide health care to the poor or those with low incomes who can’t afford private health insurance, is that it simply costs too much. We shouldn’t provide adequate health care or coverage to the poor and those with low incomes because it costs too much, period. That’s the argument.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
5:20 pm
HD
I don’t know what the answer to health care is but what we have now, is a damn mess
Amen to that!
1961_Xer
July 12th, 2012
5:21 pm
A realist on this board wrote: 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?
Or how many prisoners are you willing to let out of jail? How many OTHER government services are you willing to forego so that 650,000 more people do not have to pay one iota for their medical care?
The pool of money is fixed. Everything has to be paid from the same pool of money. In the past, Medicaid recipients have screamed murder when faced with paying *anything at all* towards their medical care, and now we want to add 650,000 voices to that chorus?
carlosgvv
July 12th, 2012
5:23 pm
Kyle – 2:51 (sigh)
Arguing befor the Supreme Court is a privledge only a few attorneys ever have. Only the cream of the legal crop ever gets to do this.
So, Kyle, WHY OH WHY do you actually believe any lawyer would do this for NOTHING?
I know you have a document from The State of Georgia stating these services are pro bono. My question is, considering what these attorneys are doing and who(The Supreme Court) they are doing it in front of, why would you even think they would do it for free?
Isn’t it far more likely that, one way or another, they will be handsomely reconpensed?
1961_Xer
July 12th, 2012
5:28 pm
We shouldn’t provide adequate health care or coverage to the poor and those with low incomes because it costs too much, period. That’s the argument.
That is because the “We” isn’t “We” at all. It is, for the most part, the top 50% of wage earners.. the same folks who ALREADY foot the bill for the entire Federal government. There hasn’t been a true “WE” paying for government… whether federal or state, in a very long time.
Phineas
July 12th, 2012
5:29 pm
Well 1961Xer, I don’t necessarily agree with you that the amount the government has to be spend is fixed — taxes could be raised a little, back to the rates they were in the 1950s, 1960s, 1970s, 1980s, or 1990s. But even assuming you’re right, maybe we could do without spending more on defense than the next 42 countries combined. That’s some money that we could probably put to more useful use.
td
July 12th, 2012
5:29 pm
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?
Sorry for jumping in md. The answer is NO. Someone has to pay these HC bills. It is not FREE. Why did I go to school, receive a college degree and work 40 plus hours per week to pay for someones HC so that they can have unlimited text messaging and internet on their phone?
Uh Oh
July 12th, 2012
5:30 pm
carlos
Great point. Even if not paid directly, the indirect benefits that will probably come to the individual and the firms for touting their appearance before the Supremes will not come with a negative outcome, be rest assured
And good for them
Dusty
July 12th, 2012
5:31 pm
td 4:30
I have found that liberals only answer the questions that reflect well on Democrats. This is, if they can find anything that reflects well on Democrats or their liberal policies.
I don’t spend a whole lot of time here. It aint healthy! I begin to feel that some Americans think this country is a free boarding house hospital established for their convenience. They reject the thought or use of words such as “patriotism, faith, allegiance, self reliance” and angrily question anyone who uses them. Other countries are so much better, is another liberal view..
I don’t feel that way. And I know that everybody doesn’t. But reading here makes me feel that a large majority have formed a definite Moocher class of government dependents.
—————————————————————————-
(Dictionary tip: The meaning of “mooch” is available. Please check before asking.)
eaconnor
July 12th, 2012
5:34 pm
“First and foremost, Medicaid is already a program of limited effectiveness.”
Of course, Medicaid is imperfect; I don’t know anyone who would disagree. But your response is to deny 500,000 without health insurance anything at all? That seems cruel. As far as the blue-skying where you project unsustainable expenditures — why can’t the same legislature that expands a Medicaid program also cut it back when it becomes unaffordable?
td
July 12th, 2012
5:38 pm
Phineas
July 12th, 2012
5:29 pm
Let me frame the question in another way. When your children were young and starting to read did you make them struggle and sound out the words or did you just take the book from them and read it to them because it was to hard on them? If you know a person is a sober alcoholic and they come to a party you are hosting, do you throw them a beer as soon as they walk in the door?
If we a society keep giving the poor everything they need in life then we are doing nothing more the enabling them to continue in behavior that is detrimental to not only their well being but also to the countries well being. When are people going to be held accountable for their actions?
Uh Oh
July 12th, 2012
5:38 pm
Dusty
Well since I own my own consulting business as well as several rental properties and retired from a Fortune 500 company based here in Atlanta, I am glad your broad brush and naive take on people who do not fit your ideology do not encompass me.
But do carry on with the paint strokes. Your generalities are very amusing
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
5:40 pm
Hillybilly D
Had much the same problem with myopia, half blind, and they told me Lasix would only make the glasses thinner. At 62, not satisfied with my optomotrist and saw Opthamologist about diminishing vision. He said I had cataract in both eyes and although it was just beginning, insurance would pay for surgery. Short story, I paid extra for a corrective lens, think it was $800 bucks more than the medicare lens, now seeing 20/20 for the first time in my life. Something to keep in back of your mind.
Phineas
July 12th, 2012
5:40 pm
Ok td, so if someone has a low income, low enough that they can’t afford private health insurance, but too high to qualify for Medicaid, and they have a cell phone that they text on, and then they have a heart attack and need heart by-pass surgery to survive, what should we do? Just say sorry, you’re too poor to get heart by-pass surgery? Or you have a cell phone, so you don’t get heart by-pass surgery? Do you think if they didn’t have a cell phone then they could afford private health insurance or to pay for heart by-pass surgery?
md
July 12th, 2012
5:41 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?”
Except the aca will never cover it 100%. What it covers is 100% of service costs dropping to 90% of service costs, and 0% of any additional costs for administrative costs and forever maintenance.
The additional administrative costs alone will be in the millions for many states. Unless one believes or wants the system to try to handle the additional workload with the status quo numbers.
Dusty
July 12th, 2012
5:44 pm
easconnor,
The Medicaid program is already unafforable. It is already stretched to its financial limits in Georgia with no new patients. What is more cruel? To bankrupt a state or provide cheap heathcare for a limited number of people? And in case you haven’t notice, the Feds have us up to our necks in debt so don’t depend on them. . Please don’t tell me you did not know that.
Phineas
July 12th, 2012
5:44 pm
Yeah td, I worked hard in school and in life and my work and teach my kids to do so also. But a lot of people are doing that these days, and still can’t afford health insurance, or to pay out of pocket if something catastrophic health-wise happens. What do we do then? I think the whole idea of Obamacare is to partially subsidize the health insurance for people who can’t fully afford it. Isn’t that ok?
Liz
July 12th, 2012
5:46 pm
Carlosgvv,
A well written open records request would show how much paid work that particular lawyer or law firm got over the last several years. In relation to the total spent on outside counsel. You could compare billable rates. Law firms work very hard over years to draw favor with elected officials. They buy “tables” at fund raisers, throw parties to make impressive block campaign contributions, give away sports tickets…, and donate their time “pro-bono”.
td
July 12th, 2012
5:46 pm
Phineas
July 12th, 2012
5:29 pm
Just a little more:
Life is hard and we have to make decisions in life. We choose to go to school. We choose to study in college instead of going to the party and we choose to stay late at work to get the assignment completed to impress the boss. We sacrifice that nice car and buy the used car because we want to pay our house off faster or to put some money in a 401k account for our retirement.
Where are the sacrifices the poor make in this country? Why did they not forgo the party in school? Why did they think they needed to stand up to the boss instead of keeping their head down and working harder? When are the poor going to be held accountable?
Uh Oh
July 12th, 2012
5:48 pm
Liz @ 5:46
exactly
Dusty
July 12th, 2012
5:50 pm
Rafe,
I’m glad you finally went to an MD. An optomotrist is not an MD as you probably know. Sometimes it pays to see the best. We won’t have much of the “best” should ObamaCare really come to pass.
Phineas
July 12th, 2012
5:51 pm
Also td, I assume that beacuse you want people to be held accountable for their actions, that you are against medical malpractice tort reform. I mean, if people should be responsible for their actions, then health care providers should be responsible for their mistakes, right?
md
July 12th, 2012
5:52 pm
“We shouldn’t provide adequate health care or coverage to the poor and those with low incomes because it costs too much, period. ”
For starters, those that know of me know that I operate off the fact that we choose everything we do (it’s a fact, no if’s and’s or but’s).
From that point of reference, I believe we have an obligation to help any and all individuals that are incapable of helping themselves…….
Which leaves those that for the most part choose not to help themselves and would prefer others to do it for them. And for these, I’m not heartless, but tough love should apply. It’s the way I was raised and the way I raised my own, so I see no problem appying it to those I don’t know.
We as a society provide everybody the opportunity to take an easier road in life by providing a free education……that is the starting point for any and all assistance, as knowledge is power and can never be taken away. Any future assistance should be tied back to program number 1 and go from there………all help for these individuals should come with conditions………
td
July 12th, 2012
5:53 pm
Phineas
July 12th, 2012
5:40 pm
Ok td, so if someone has a low income, low enough that they can’t afford private health insurance, but too high to qualify for Medicaid, and they have a cell phone that they text on, and then they have a heart attack and need heart by-pass surgery to survive, what should we do?
Why did that person make the sacrifice of the loaded cell phone ($100 to $200 per month) to purchase insurance? I have compassion for the poor that are truly disabled and can not work or will be working for $7.25 their entire life but I worked in DFCS for a few years after college (work experience) and saw way to many people not doing anything but gaming the system and getting bailed out for making poor decisions in their lives. I have very little compassion for these (and I can tell you it is about 70% of welfare rolls) “poor people”.
Skip
July 12th, 2012
5:54 pm
Could we make the poor, those lazy &%$# that lost jobs to outsourcing sell a couple internal organs? That could pay for some care.Heaven knows we can’t pass on a chance for a war.
td
July 12th, 2012
5:56 pm
Phineas
July 12th, 2012
5:51 pm
Also td, I assume that beacuse you want people to be held accountable for their actions, that you are against medical malpractice tort reform. I mean, if people should be responsible for their actions, then health care providers should be responsible for their mistakes, right?
If you want to go to a loser pays system then I would accept your statement.
Phineas
July 12th, 2012
5:56 pm
So td, you think everyone who is poor is poor because they party too much? Hmmm. I actually did pretty good in school and work hard and make sacrifices and try to make the right choices, and it’s pretty hard for me to afford private health insurance for me and my family — especially when the cost of health insurance goes up about 20% per on average as it basically has since I can remember. A LOT of good peopla can’t afford private health insurance, td.
md
July 12th, 2012
6:01 pm
And just so folks know, I don’t limit my choices meme to only those on one end of the spectrum……..I also have a beef with rich folks that have ever filed for bankruptcy and have bounced back and amassed some wealth. My tough love also applies to them. They should have to make those they screwed over whole again once they have returned to prosperity………
Same with bad credit card debt…….bad housing debt…….etc. Shafting others for ones actions should not be the American way……..
Dusty
July 12th, 2012
6:05 pm
Phineas,
If you live in Atlanta, do you not know that major surgeries are performed every day at Grady Hospital which is a hospital designed for poor people? Do you know that most hospitals have budget allowances built in their budgets for patients who cannot or will not pay for services rendered? That most counties have health clinics to help those who cannot pay? That there are agencies and people who can help the poor find care?
Do you actually know someone who is dying without healthcare because no one will help them? I am sure there are people suffering who could have better care, but to say there is no care is wrong.
How Inciteful Is That!
July 12th, 2012
6:06 pm
I believe it was the AJC that ran an article that stated that Georgia hospitals lost 1.5 billion last year on uninsured patients.
td
July 12th, 2012
6:09 pm
Phineas
July 12th, 2012
5:56 pm
So do you have a cell phone with unlimited text and internet access? We know you have internet access or you would not be on this blog? How often do you trade cars? How much of your monthly household income goes to your home? Do you have cable TV and if so is just the very basic package or a bigger package?
Why should taxpayers money (another citizens money) go to pay for your insurance when you have not made all the sacrifices yourself?
Dusty
July 12th, 2012
6:09 pm
Skip
“Pass for a war!” Pure propaganda. If you don’t want to fight terrorism, just say so and wave a white flag.
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:13 pm
Phineas: Conservatives whole argument against Medicaid expansion blah blah blah…
————————-
Liberals whole argument for Medicaid expansion is that there is no limit on the amount of other folks property that can be taken by the government to buy votes.
How much did you donate to charities that provide health care to the less fortunate last year?
That’s what I thought.
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:14 pm
If libtards walked their talk, there would be no need for Medicaid, now would there?
Libtards: Do-nothing, greedy hypocrites.
Uh Oh
July 12th, 2012
6:15 pm
“Libtards: Do-nothing, greedy hypocrites.”
LIAR
Uh Oh
July 12th, 2012
6:17 pm
“Libtards: Do-nothing, greedy hypocrites.”
Ignorant generality to pump up the self esteem of the blogger.
link?
md
July 12th, 2012
6:17 pm
“If you want to go to a loser pays system then I would accept your statement.”
Stipulating that 50% comes out of the attorney’s pocket……..that should cut down immensely on the ambulance chasers out there……..
Uh Oh
July 12th, 2012
6:19 pm
Barry
You going to post unfounded BS as you usually do, I will call BS.
Simple as that
You want to engage in civil discourse then let’s do so
md
July 12th, 2012
6:20 pm
“I actually did pretty good in school and work hard and make sacrifices and try to make the right choices, and it’s pretty hard for me to afford private health insurance for me and my family — especially when the cost of health insurance goes up about 20% per on average as it basically has since I can remember.”
Which needs to be addressed…….those against this montrosity of a bill are not saying do nothing, but 1200 pages to reinvent the wheel and allow uncle sugar to take over was not needed.
To solve your problem (I had it too), all that needed to be done was to allow the same pools used by employers. Self-employed and unemployed should be allowed to form a pool of their own to reduce the cost on all.
Dusty
July 12th, 2012
6:23 pm
How inciteful…….
Yep, hospitals lost money but the uninsured got care. Right? Wonder how that happened?
Everybody, including hospitals and doctors, are going to lose money with Obamacare whether you are sick or not. Benevolence will be gone. The government is going to pay for everythng with your money and make “best” decisions for you.
Uh Oh
July 12th, 2012
6:25 pm
Does anyone have any statistics on how Romneycare depleted services in MASS?
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:29 pm
How much did you donate, Uh Oh?
@@
July 12th, 2012
6:32 pm
While “loser pays” might discourage some of the more frivolous lawsuits, losers don’t always have the money to pay or the desire to pay.
I’ve often wondered about legal insurance like what they have in Europe.
Uh Oh
July 12th, 2012
6:32 pm
Some have argued that adding people to rolls and the additional administrative strain would send doctors packing from the medical industry. Doctors leave their practice all the time for various reasons, including administrative burden.
People were added to the roles in Mass, yet they still have the best doctor / patient ratio in the US. I’m sure there are problems and headaches but no mass exodus.
It is claimed by some that not as many people will be wanting to go to medical school. Yet across this great nation, even in GA, there has been an increase in applicants for medical schools.
There will be headaches and it will not even be close to perfect, however this is the same as the NRA and some Republicans saying Obama was going to take your guns last election. Hype and rhetoric to scare the base.
TGT
July 12th, 2012
6:33 pm
From that point of reference, I believe we have an obligation to help any and all individuals that are incapable of helping themselves…….
Yes, a moral nation does, but govt. should not be the vehicle for such aid. (I haven’t read all your posts md, but it seems that you may tend to agree. Nevertheless…)
As I have done before, I call upon the ghost of Grover Cleveland:
While taking a stand against government aid involving a very deserving orphanage in New York City during a severe economic crisis, Cleveland, a Democrat, said, “I will not be a party to stealing money from one group of citizens to give to another group of citizens. No matter what the need or apparent justification, once the coffers of the federal government are opened to the public, there will be no shutting them again…It is the responsibility of citizens to support their government. It is not the responsibility of government to support its citizens.”
In 1887, after vetoing a bill that appropriated $10,000 to buy grain for several drought-stricken Texas counties, Cleveland stated, “Federal aid in such cases encourages the expectation of paternal care on the part of the government and weakens the sturdiness of our national character, while it prevents the indulgence among our people of that kindly sentiment and conduct which strengthens the bonds of a common brotherhood.”
If only today’s Democrat Party were in the same solar system with Cleveland. Ben Franklin said, “When the people find that they can vote themselves money, that will herald the end of the republic.” Obamacare is certainly another step in that direction.
Hillbilly D
July 12th, 2012
6:33 pm
If you want to go to a loser pays system then I would accept your statement.
Bad idea, in my opinion. Under that scenario, a poor person can never sue a rich person, even if he has a very valid case, because he can’t afford to lose. The legal system is already skewed enough towards those with money, without doing that. As it is now, if a poor or middle class person goes up against a rich person or company, all the person/company with money has to do is drag it out and delay until they bleed the other side dry.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:34 pm
Dusty, yes finally wised up that optomotrist was over his head. Glad I don’t live in Canada, it takes 18 weeks there, to be able to see a specialist. Took me one day, after the call!
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:34 pm
Uh Oh: You want to engage in civil discourse then let’s do so
————————–
I’m not here for discourse. I am here to educate and to irritate. I am the grain of sand that irritates the bottom feeding, crusty, blind libtards into thinking, and in rare cases inducing them to produce their own pearl of wisdom.
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:37 pm
@@: While “loser pays” might discourage some of the more frivolous lawsuits, losers don’t always have the money to pay.
———————
Their lawyers do. Put up or shut up, parasite lawyers.
Uh Oh
July 12th, 2012
6:38 pm
Barry
Post unsubstantiated BS and I will call you on your BS
If you can’t engage in civil discourse as Kyle laid out for the bloggers, that is on you and him, however I will be calling out for your weak talking points.
Next.