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
Dusty
July 12th, 2012
6:39 pm
Uh OH, 5:38
Well, thank you, Uh Oh.. So glad you are enjoying my “generalities”. Wish I could say the same for yours.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:39 pm
UH OH
As far as MA goes, two things, the prices of health insurance in MA lead the nation.
Also, the MA health care law was designed to provide care for those not currently insured, which was about 8%. Unlike Obamacare, they did not rewrite health insurance laws for those, who were already covered. They left folks, who had coverage, undamaged!
Uh Oh
July 12th, 2012
6:41 pm
Dusty
You can’t because I do not make blanket statement in terms of politics or the individuals discussing them. I may go aftter the policy or politician but it is not with con this, lib that, etc.
That is for the shallow minded
But nice try and good work on the “painting”……..
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:42 pm
Uh Oh donated zip to make her dream of health care for all a reality.
Hillbilly D
July 12th, 2012
6:43 pm
In North Georgia, the only two sectors of the economy that are expanding are the College and University system and healthcare. If hospitals lose money, why are they lining up to build knew ones? Either it doesn’t make sense or they’re not losing what they claim they are. i hardly ever see a doctor move into a smaller office, either. They just keep getting bigger and bigger. Somebody must be making some money, somewhere.
Uh Oh
July 12th, 2012
6:43 pm
Rafe
Great points. However people were added to the rolls. Maybe not you but many on the right have contended that with all those being added, services would suffer.
I ask again, are there stats that say with added folks have services suffered.
Maybe they have, I haven’t seen the information
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:44 pm
Hillbilly
Disagree with you on loser pays. If a poor person has a good case and stands to win, a ambulance chasing lawyer is going to weigh the odds and if he thinks he can make money, he is going to gamble that he is going to get his 40%. Bad case, you are right, no lawyer takes it, but we do not need anymore bad cases being tried.
Uh Oh
July 12th, 2012
6:45 pm
Dusty
Notice I usually use many, most, several, few………… While that is not an exact number it surely allows anyone with common sense to see that I am not looking to “paint” every individual
Everyone is not the same, politically or otherwise, an attempt to paint as such is either ignorant, naive or just childish.
Uh Oh
July 12th, 2012
6:46 pm
manana
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:47 pm
It’s just too easy…when you try.
——————-
Massachusetts Medical Society Releases 2011 Study of Patient Access to Health Care
Longer patient wait times, continued difficult access to primary care physicians,and gaps in physician acceptance of government coverage
http://www.massmed.org/AM/Template.cfm?Section=MMS_News_Releases&Template=/CM/ContentDisplay.cfm&CONTENTID=54338
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:48 pm
UH OH,
Doctors leave because they are not getting paid as much as they think they are worth and they can earn more in other states or do not want to work for that little money. Nothing in MA insurance reform effects the rate of pay. Everyone has private insurance, even the previously uninsured.
Doctor pay is usually based on what the insurance companies or medicare or medicaid will pay. Nothing about that changed in MA, but Obamacare changes everything about how they are paid.
Apples and Oranges, again.
Uh Oh
July 12th, 2012
6:48 pm
Barry
Thanks for the info and exchange. I will certainly check it out
later
Hillbilly D
July 12th, 2012
6:49 pm
Rafe
I think there is an easier way to solve the problem. I’m no lawyer but seems to me that judges could throw out more of the “frivolous” cases, early on and cut down on some of this. Of course, judges are lawyers and they’ve all got their finger in the same pie.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:52 pm
I think what Lil Barry’s research shows is that you can’t add all these new patients and not add doctors. Preview of what we will be facing under Obamacare.
@@
July 12th, 2012
6:56 pm
Their lawyers do. Put up or shut up, parasite lawyers.
Interesting. So the lawyers would determine what is and is not winnable. They’d probably take their previous losses out of the next victim’s win. As long as the victim understands, I’m good with that.
I’m not of a litigious nature.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
6:56 pm
HD
Judges are lawyers and like to help other lawyers make money as you said. This goes with something else you said about hospitals and doctors expanding and growing. I think they are in cahoots with the insurance companies. They work out procedure payments, neither have an obligation to control costs, because the insurance companies just raise premium rates and maybe….get some kickback from the hospitals (the ones they don’t own anyway). The people paying the premiums are defenseless.
@@
July 12th, 2012
6:58 pm
At 6:59 I’m gonna call someone a horrible name.
Where’s Getalife?
(ISH)
Lil' Barry Bailout (Unexpectedly Revised Downward--Again)
July 12th, 2012
6:59 pm
You also can’t pay for your own health insurance, pay for the new mandates placed on your insurance company, pay for the health insurance that is now an entitlement, pay for expanded Medicaid, pay higher taxes for pharmaceuticals, pay higher taxes for medical devices….and “bend the cost curve down”.
You would have to be an economic retard to believe that. Or an Obozo receptacle.
md
July 12th, 2012
7:08 pm
Apparently, MA hc is working so good the legislature there is working on applying price caps on the system…….which means it’s out of control and the gov’t is going into dictate mode……..
md
July 12th, 2012
7:16 pm
Moderation time?
@@
July 12th, 2012
7:48 pm
?
@@
July 12th, 2012
7:48 pm
Someone left the lights on.
Fred ™
July 12th, 2012
7:51 pm
of course it’s moderation time. You right wingers can’t abide free speech.
@@
July 12th, 2012
7:54 pm
Fred:
It may be a test. ‘Ya wanna talk recipes?
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
7:54 pm
Now, now ladies, play nice.
Just The Facts
July 12th, 2012
7:57 pm
“of course it’s moderation time. You right wingers can’t abide free speech.”
Oh sure, as if you liberal demwits just LOVE the Right having the freedoms of expressing our views and voices, right? {eye roll}
Anyway, the liberal children in the Obamazombie camp are trying to pin Romney on lies and his representation of Bain Capital. These clowns just can’t run on their own failed record, can they? Here you go Obamazombies, read it and weep…
“Fortune obtained the offering documents for a Bain Capital Fund circulating in June 2000, as well as a fund in 2001. None of the documents show that Romney was listed as being among the “key investment professionals.” As Fortune put it, “the contemporaneous Bain documents show that Romney was indeed telling the truth about no longer having operational input at Bain — which, one should note, is different from no longer having legal or financial ties to the firm.”
@@
July 12th, 2012
7:57 pm
Now, now ladies, play nice.
Always, I Report…
.
.
.
.
.
.
Andy
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
7:57 pm
I just dropped by to tell Wingnut to batten down the hatches, cinch her up and hunker down, if Condi Rice gets the nod for VP the liberals will literally freak the ^%$* out. Turn loose the lynch mobs. Grind their teeth incessantly. Rend their clothing.
Call her every name in the book.
eck
td
July 12th, 2012
7:59 pm
Still no answer for the people in favor of expanding Medicaid? What are you willing to cut to give free insurance to 650,000 more in Georgia?
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
7:59 pm
kookman’s hair will stand on end. He’ll require immediate medical assistance.
carlosgvv
July 12th, 2012
8:01 pm
Kyle, how’s your new baby doing?
Is this your first?
@@
July 12th, 2012
8:02 pm
carlosgvv:
It’s his second.
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
8:03 pm
Good God, this woman has more brains than the whole entire dummycrat collectively put together and they’ll be calling her “stupid.”
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
8:04 pm
eh, dummycrat party
Fred ™
July 12th, 2012
8:06 pm
@@
July 12th, 2012
7:54 pm
Fred:
It may be a test. ‘Ya wanna talk recipes?
++++++++++++++++++
I’d love to. How have you been BTW? Did you ever go to USinUK’s recipe site? Very interesting. She has some good stuff there.
@@
July 12th, 2012
8:11 pm
Fred:
I was kidding about the recipes. It’s the last thing I wanna talk about. I’ve offered up one, maybe two…but that was years ago. We’ve got more important things on our plates right now.
AmVet
July 12th, 2012
8:15 pm
Condoleezza Rice as Mitt’s running mate???
Holy moly!
At that point, we might as well just rename him George Willard Bush.
How many Bushies does he already have on his staff? (ANY is too many.)
Gawd knows, this country is NOT ready for MORE of that awful administration.
She would sink Mitt’s already slim chances quicker than Sarah did the other RINOs…
Fred ™
July 12th, 2012
8:17 pm
Really @@? Like what? What’s more important? The Republicans complete lack of effort to compromise on ANYTHING? Their whole Baptist idea of do it my way or you are going to hell?
Seriously, I’m here on a Republican blog. You sell fear. I’m not afraid. What have you to offer me OTHER than a good Gazpacho recipe? Because I sure as hell ain’t scared of everything like you cowards are.
@@
July 12th, 2012
8:22 pm
Fred:
Like what? Howz’bout a stagnant economy? Millions of people on unemployment?
You’re a weird little fella, Fred.
Fred ™
July 12th, 2012
8:29 pm
@@: How’s about milions of jobs offshored to China where their slave labor and forced child labor are rampant while American companies that ship those jobs to the slave labor make record profit while slashing american jobs? What’s your point?
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
8:30 pm
Ladies!
Hillbilly D
July 12th, 2012
8:30 pm
The sidewalks ain’t rolled up yet?
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
8:37 pm
D- It’s the Condi Rice for VP Special Extended Blog Night and Festivities and already the girls are scratching at each others eyes.
You can’t take them any where.
@@
July 12th, 2012
8:38 pm
Calm down, Fred.
Last I checked Ralph Lauren was an Obama supporter.
They are the pride of America — Team U.S.A. — and for the opening ceremonies of the Summer Olympics in London, they’ll be proudly wearing red, white and blue, from beret to blazer.
The classic American style — shown in an image above — was crafted by designer Ralph Lauren. But just how American is it?
When ABC News looked at the labels, it found “made in China.”
I’m out.
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
8:43 pm
Fred
You do know that most of the jobs, few to say the least, that Oblamer’s Green Energy initiative created, were created in China. Taxpayer money subsidizing jobs in China, in my mind, is worse than US Corporations off shoring jobs, in an effort to make money. I know I didn’t send in my tax dollars to fund China or Pakistan either BTW.
I Report (-: You Whine )-: mmm, mmmm, mmmmm! Just sayin...
July 12th, 2012
8:44 pm
Gonna be kinda hard to call Romney a racist now, ain’t libbies?
Rafe Hollister, suffering through Oblamer's ineptocracy
July 12th, 2012
8:47 pm
I report
They will find a way!
AmVet
July 12th, 2012
8:54 pm
Romney is a quasi-liberal, effete, northeastern RINO who championed socialized medicine and the individual mandate.
From what I have read of his life, he’s no racist. But then he is nothing close to demonstrating the courage over racial matters that his dad did either.
And…
Romney drew boos from the NAACP audience on Wednesday for blasting Obama’s healthcare overhaul and his leadership on the economy. Romney promised he could improve life for blacks by turning around the economy and cutting unemployment – at 14.4 percent for blacks compared to the national average of 8.2 percent.
But Biden said Obama had made the tough decisions that pulled the economy out of recession with his economic stimulus plan and auto industry bailout.
I’m guessing they don’t believe his promises!
No Artificial Flavors
July 12th, 2012
8:54 pm
Nice Analysis Kyle. Well done on including the bit about more doctors opting out. Liberals forget that part.
I also like how when Medicaid enters the discussion suddenly everyone is poor like Ayn Rant’s 30% of Georgians figure. Really, about one in three Georgians are poor? What does poor even mean anymore then?
Kyle Wingfield
July 12th, 2012
9:07 pm
I just got home from the AJC’s forum on the T-SPLOST (which went very well, btw) and am only now getting to put the comments thread in moderation. But in case anyone forgot I’m still doing this for the foreseeable future, here’s your reminder that comments will go through moderation from now until ~7 a.m.