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
Tell us what you think about the site
Customer Care »
Vacation stops, manage subscriptions and more
AJC Services
Sections
Other Editions
Visitor Agreement | Privacy Statement
© 2013 The Atlanta Journal-Constitution
447 comments Add your comment
Dusty
July 12th, 2012
9:14 pm
I report,
Is that true about Condi Rice or just someone’s passing fancy? Romney and Condi in Washington! Imagine ! Two smart, ethical, experienced people at the top of the line.
After the past three + years, we surely could use some good news!
We’d get that good Bush feeling of honest and integrity again.
Liz
July 12th, 2012
9:36 pm
What can be cut to saves lives in Georgia. Hum… how about all those special sales tax exemptions to start. For 50K each, you could hire some top gun young CPAs, to go after all those scofflaws. We have loads of them, and lots of tax laws to be enforced. It is so bad, federal and state revenue employees feel duplicitous, as they are told with a wink and nod which of those not to go after.
Lynnie Gal
July 12th, 2012
9:51 pm
First of all, Medicaid for a higher number of the working poor–those who work (sometimes two) jobs but are not offered an insurance plan by the employer(s)–should be implemented. It’s a black-hearted person who does not want people to have health care, and I’m ashamed of the way our governor and the legislature is acting toward it’s own people. This lack of empathy is almost sociopathic. Next, no one should be excluded from being able to obtain health insurance because of a pre-exiting condition. AND, NO ONE should lose their house–their primary residence–because they were sick and either had no insurance or couldn’t obtain it or couldn’t afford it. It should be ILLEGAL to take away a person’s home for a hospital bill, so they can be dumped on the street. The problem with our health care system isn’t because it’s socialist. The problem is, because the system is capitalist, with an emphasis on money and profit.
ld
July 12th, 2012
10:29 pm
States would be better served focusing most of the money spent on “free” or “sliding fee” care on children provided via existing county health departments and its referrals; HOWEVER, in order for that to work, all doctors in the state must have a participation obligation linked to license to practice; AND, it would serve the state’s interest to encourage younger doctors to participate via a “reward” to those medical professionals that have student loan debt outstanding as a result of having attended a STATE school w/some degree of debt forgiveness, not unlike some teachers are able to get debt forgiveness by teaching in schools that find it difficult to recruit good teachers.
md
July 12th, 2012
10:45 pm
Good ole Fred….never met an insult he could walk away from. But I guess then he wouldn’t be Fred.
As for your rant on jobs Fred….the American consumer is complicit in the outsourcing as they are the ones buying all that crap (what we buy is a choice)…..so rant at them when you get a chance too….OK?
Colin Micheals
July 13th, 2012
1:21 am
For those of you against Medicare. What do you propose happen to the disabled, whether they are born that way, or become disabled later in life, as could happen to you or your loved one? Should they be left in the street to die? What is your plan? Let’s say you get in a car accident and become quadriplegic and your whole family loses health insurance because you can no longer work? And you have a child that needs medication to live and without insurance you can no longer afford it? What do you think of Obamacare now? The ignorance of some people makes me sick.
Ragbatz
July 13th, 2012
1:50 am
Wingfield’s analysis reminds me of the teenager who kills his parents and then begs the court to show mercy because he is an orphan. According to Kyle, huge problems would result from accepting federal funds to expand Medicaid. There are two roots to this potential calamity: the fact that reimbursement rates for Mediicaud are low and the fact that federal government might reduce the federal share of Medicaid.
He’s half-right on both counts. Both of these two factors could complicate a Medicaid expansion in Georgia. But for each factor, there’s something important he’s leaving out.
Medicaid reimbursement levels in Georgia are determined by Georgia lawmakers. They could, and certainly would, be a lot higher if the members of the Georgia wing of Wingfield’s own political tribe allowed them to be.
On the other hand, federal lawmakers will determine the federal percentage of Medicaid costs. And that share will only be reduced if the members of the national wing of Wingfield’s own political tribe allowed that to happen.
Seriously, does anyone think that It’s Georgia Democrats who keep Medicaid provider payments in Georgia low? Or, nationally, that anyone other than Republicans is likely to call for reducing Medicaid spending?
So, Kyle Wingfield, I ask you: do you favor increasing Medicaid provider payments in Georgia? Do you favor maintaining the federal Medicaid percentage and spending levels found in current law? Or will you and your GOP tribe go on, like the orphan whose killed his parents, complaining about a horrible situation caused by your own conduct.
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
7:33 am
Lynne Gal: It’s a black-hearted person who does not want people to have health care
———-
How much did you donate to charity last year to make that a reality?
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
7:36 am
Seriously, does anyone think that It’s Georgia Democrats who keep Medicaid provider payments in Georgia low?
———
Yes. If we had fewer Democrats on the dole, Medicaid reimbursements could be increased.
How Inciteful Is That!
July 13th, 2012
7:40 am
We donate time and money and material goods to charity every year. What does that have to do with ensuring every person gets needed healthcare without imposing strictly on the hospitals to provide said service in the emergency rooms. How many millions of uninsured in need of healthcare does Lil Barry take care of each year with his tax deductible charitable giving.
How Inciteful Is That!
July 13th, 2012
7:41 am
Yes. If we had fewer Republicans on the dole, Medicaid reimbursements could be increased
Stan
July 13th, 2012
7:43 am
Medical care is not a luxury. It’s one of the necessities of life. When I see articles like this one and when I read over some of the cruel comments, I wonder why so many of us feel so little concern for the poor. And I wonder why God has created people without a soul.
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
7:46 am
If you were walking your talk, there would be no need for Medicaid, because your charitable contributions would cover the cost. The existence of Medicaid in itself demonstrates that Democrats are greedy, do-nothing hypocrites.
How Inciteful Is That!
July 13th, 2012
8:20 am
If you were walking your talk, there would be no need for Medicaid, because your charitable contributions would cover the cost. The existence of Medicaid in itself demonstrates that Republicans are greedy, do-nothing hypocrites.
How Inciteful Is That!
July 13th, 2012
8:21 am
Lots of things are “necessities of life”. That’s why responsible Americans work for a living, and why loser parasites vote Republican.
md
July 13th, 2012
8:37 am
“Medicaid reimbursement levels in Georgia are determined by Georgia lawmakers. They could, and certainly would, be a lot higher if the members of the Georgia wing of Wingfield’s own political tribe allowed them to be. ”
And for the umpteenth time, what do you plan to cut to compensate for that rise?
Seems some here are clueless as to how a balanced budget state must operate…….but that doesn’t surprise me considering the entire calamity of 2008 was the result of folks taking on more and more debt……..
A health conscious observer
July 13th, 2012
9:00 am
The liberals responding here have lost site of the big picture. It is not about cruelty. It is about fiscal responsibility and more importantly having the right incentives in this country, including the right incentives in healthcare. That is what made this country great at the start and we are losing that edge and going into ever greater debt. The underlying opposition to Obamacare is not about protecting big business or the wealthy. The opposition is to the fact that if you give more healthcare away – or require hospital ER’s to provide free care to some while charging others more to cover the cost – there is less incentive for individuals to work hard, work smart, take care of themselves and take risks to achieve a better financial future and afford the care they want. Giving away even more expensive healthcare (not to mention the education, retirement, food stamps and other social services benefits that we already offer those in need) by taking from one echelon of society and giving to the other echelon is not the government our country’s successful founders envisioned and it does not create the right incentives and is breaking the country. Enough is enough. People need to go after what they want in life and treat one another with respect and let’s all get Washington to protect our citizens by ensuring there is a more level playing ground for the “small guy” who really wants to work hard and compete with the bigger guy and powerful corporations. Let’s not just give away more benefits away. The federal government’s role is to protect, not provide. Health is something to be maintained by individuals who take preventative measures (that are not costly!!) and health care services are a privilege to be earned not en entitlement to be expected.
Ragbatz
July 13th, 2012
11:59 am
“And for the umpteenth time, what do you plan to cut to compensate for that rise?”
First, as regards argument, my point was simply that his argument is like the plea for mercy by the parenticidal orphan. What Wingfield calls flaws in Democratic policy are policies he and his ilk have put in place.
Second, I’ll admit that something must be cut to improve Medicaid provider. How about after-tax incomes of Georgia citizens who earn incomes over, say, $250,001 dollars? So, Health conscious observer, paying for Medicaid improvements by revenue increases is just as fiscally responsible as paying by offsets.
As for health concious observer’s argument about a society with the right incentives, I simply note that only a single political party among the advanced nations of the world supports the policy that health care need not be available to all without regard to ability to pay. In fact, if a conservative party in any other country put in place a plan as conservative as Obamacare, with its heavy reliance on private insurance markets, that party would be out of office in a matter of weeks and remain out of power for two decades. With the exception of one country, the civilized world considers health care a right, not a privilege.
Ragbatz
July 13th, 2012
12:35 pm
Wingfield is incorrect about free pro bono legal services in the healthcare litigation. One Georgia attorney , a Mercer law school professor, did donate his time. Georgia, however, paid a five-figure share for the services of the most expensive attorney working the case, Paul Clement. Clement was counsel of record and presented the oral argument at SCOTUS.
Since Wingfield goes sarcastic on this very point, asking, “You don’t believe a word I say, do you?”, I would say his credibility is truly in issue. He owes us a phone call to the AG, followed by a retraction.
Ragbatz
July 13th, 2012
12:57 pm
Little Barry Bailout, I am not the guy who raised or pushed the charitable donation issue, so I wonder why you are directing at me that sarcastic question and direct accusation of greed.
And, for the record, I HAVE walked my talk of health care for all for decades.
Kyle Wingfield
July 13th, 2012
1:44 pm
The disclosure forms still do not show any payments to Paul Clement, but Ragbatz is correct: Georgia’s share of Clement’s fee for this case will be $10,000. That’s the only fee related to the case for Georgia. So, it is not zero, but nor is it “untold millions.”
Given that the ruling gives Georgia the option of forgoing hundreds of millions of dollars a year in additional Medicaid costs, I’d say it was a good investment.
Ragbatz
July 13th, 2012
1:47 pm
One more thing about the claim that Georgia was represented “pro bono” in the ACA litigation. “Pro bono” normally conjures up he idea of an unpai, public-spirited attorney donating his services for the poor or for a public entity. What it certainly does not conjure up is a sovereign State government serving as a plaintiff and riding piggy-back in a litigation funded almost entirely by a political action group with a strong financial interest in the result. The ACA litigation in which Georgia was a plaintiff was primarily funded and carried out by the NFIB.
Do you think Kyle Wingfield might have “concerns” if a Democratic governor allowed controversial and politically-charged litigation in Georgia’s name to funded and carried out by the UAW, so that she could have the political cover of saying that the litigation cost Georgia nothing? Do you think the Pope might be Catholic?
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
2:03 pm
Do you think Kyle Wingfield might have “concerns” if a Democratic governor allowed blah blah…
——–
When a Democrat wins a statewide race, much less governor, we’ll let you know.
Ragbatz
July 13th, 2012
2:03 pm
Kyle says the result of the litigation was a good deal for Georgia. It paid only $10,000 in cash, but mostly it got that supposedly good deal by riding piggy-back on the NFIB, a political action group that did indeed spend millions in the litigation. A reasonable person might wonder whether the public-spirited NFIB might have bought itself some influence with its generous, “pro bono” program.
Ragbatz
July 13th, 2012
2:13 pm
Lill. Barr, why duck this issue? Do you favor letting Georgia governors or of any party lend the State’s name and authority to controversial, politically-charged litigation funded and carried out by such self-interested entities like the NFIB or the UAW?
Kyle Wingfield
July 13th, 2012
2:24 pm
Ragbatz @ 2:03: If you think the NFIB had to do that in order to have some pull under the Gold Dome, you don’t really know how things work around here.
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
2:28 pm
I’m all for anti-American legislation such as Obozocare being attacked by any means necessary.
Kyle Wingfield
July 13th, 2012
2:32 pm
Lil’ Barry @ 7:49 (now unpublished): I’m inclined to let things like “libtard” and “Repugs” stand, but lines such as “loser parasites vote Democrat” is unnecessary.
Lil' Barry Bailout (Revised Downward)
July 13th, 2012
2:48 pm
Anyone who has been paying attention for the last four years would certainly agree with your assessment, Kyle.
Ragbatz
July 13th, 2012
3:10 pm
Kyle, I think “pull” comes in different flavors. Flavors like ” more”, “less”, and ” what have you done for me lately”. But, okay, call me clueless if you must.
You, too, are invited to engage, today, on the issue of whether Georgia governors or AGs should be allowed to lend the prestige of the State to controversial, politically charged litigation funded and implemented by private, self- interested entities like the NFIB or UAW. If you remain silent about this procedure, your silence may be used against you should you choose to holler when a Democratic official similarly teams up with the UAW.
Kyle Wingfield
July 13th, 2012
3:13 pm
Ragbatz: As I wrote in the OP, Georgia had a legitimate interest in suing over the Medicaid expansion. Beyond that, I don’t take every bit of bait people throw toward me here. You’re free to think of me as you wish.
md
July 13th, 2012
3:19 pm
“So, Health conscious observer, paying for Medicaid improvements by revenue increases is just as fiscally responsible as paying by offsets.”
Interesting concept considering we choose everything we do…….and with that in mind, wouldn’t it be more prudent to require those asking for help that may have chosen to say drop out of school to get their butts back in school, get a better job and pay for their own needs??
Ragbatz
July 13th, 2012
4:01 pm
“.. wouldn’t it be more prudent to require those asking for help that may have chosen to say drop out of school to get their butts back in school, get a better job and pay for their own needs??”
By all means, let’s send those who would benefit to the point of self-sufficiency back to school. This does require schools up to the task and how we do that is a subject of some controversy, but compulsory education for self-sufficiency is a fine, old American idea.
Still, it is important to recognize that some are not capable of self-sufficiency no matter how much time they spend in school. Also, it is important to note that at this point in the economic life of the nation there are many who have been educated to and well beyond that necessary for self-sufficiency who are not able to find jobs.
As for getting “better” jobs, I think it is appalling that adequate health insurance is essentially cost-prohibitive to a full-time minimum wage worker ($15,300/year), what with the additional needs of food and shelter.
md
July 13th, 2012
4:25 pm
“This does require schools up to the task and how we do that is a subject of some controversy, but compulsory education for self-sufficiency is a fine, old American idea. ”
No it doesn’t…….it requires the gonads of an administration to say “if one wants xx, then one will do xx in exchange”……no school, no help.
Back to the “we choose everything we do” principle.
If they don’t want to help themselves….so be it, they can fend for themselves.
Ragbatz
July 13th, 2012
4:27 pm
And, for the record, I completely agree the potential benefit to Georgia resulting from establishment of the right of States to refuse the Medicaid expansion is huge if compared to what Georgia actually paid, and even compared to what Georgia might have had to pay had it not had a free ride.
Just, maybe not for the reasons you think. Part of the potential value to Georgia comes from the fact that other states may decide to turn down the expansion. A good part of the net flow of federal dollars in and out of states will tilt toward states that accept the expansion and away from states that reject it. Georgia now gets to decide whether the tilt is toward Georgia or away from Georgia.
md
July 13th, 2012
5:08 pm
“A good part of the net flow of federal dollars in and out of states will tilt toward states that accept the expansion and away from states that reject it.”
If that expansion is going to have significant implications as it most likely will for all balanced budget States, then those states will have to make that call. If states like CA continue to spend above it’s means and then requires the feds to bail them out, then I see a big fight in Congress down the pike.
GA’s problem is not the money coming from the feds, but the money needed not coming from the feds…….
They BOTH suck
July 13th, 2012
5:36 pm
The Gallup poll stated that a good percentage of doctors indicated that the practice preventive medicine
Gallup no where in that presentation backs up the 30% number within the Jackson Healthcare study
Keep trying
Wrong again
They BOTH suck
July 13th, 2012
5:37 pm
Hi Barry
Obamacare facts: Medicaid expansion points to new state taxes | POTUS NEWS
July 13th, 2012
11:30 pm
[...] Mayo Clinic stopped accepting Medicare and Medicaid patients at several of its facilities. The Atlanta Journal’s Kyle Wingfield cites a statistic that 42 percent of Georgia doctors will not accept new Medicaid [...]
Carly EngageAmerica
July 16th, 2012
2:45 pm
The ACA will not control costs. The Affordable Care Act is relying on dozens of pilot programs and demonstration projects to find better ways of delivering care, the results of which have been disappointing. Further, we will still be left with a system in which no one will be choosing between health care and other uses of money. And if no one is making those choices, health care spending will keep rising in the future with all the relentless persistence it has shown in the past (http://go.cms.gov/KuroN5).
Ragbatz
July 16th, 2012
3:30 pm
Kyle Wingfield at 3:13pm, 7/13
For the record:
The colloquy began with a posting by carlosgvv at 7:59am on 7/12 that said. “Georgia and other states have spent untold millions in legal fees fighting Obamacare[.]” At 9:29 am you replied: “In Georgia, at least, the legal services were provided pro bono by private attorneys. I know, I know, you don’t believe a thing you read.”
I pointed out (12:35pm, 7/13), and Wingfield later (1:44pm) acknowledged, that Georgia paid cash to Paul Clement for representation at the Supreme Court. I also noted (1:47pm) that the claim that Georgia was represented “pro bono” was a dubious description for the dubious practice of Georgia lending its name and prestige to litigation funded and executed by a private political action group with a financial interest in the litigation, in this case the NFIB.
I had the opportunity today to examine the case records from this litigation at the District Court and Court of Appeals levels. Not a single unpaid attorney is listed as representing the State of Georgia in the case at any level. The maximum extent of actual “pro bono” representation in the case seems to have come from a single Mercer law professor giving some advice to Sonny Perdue and Sam Olens, but who did not formally represent the State in the litigation. Georgia was actively represented in the lower courts by the same private firm lawyers who concurrently represented the NFIB and by paid counsel before the Supreme Court. Not one “pro bono” attorney represented Georgia in the litigation.
I invited Wingfield to discuss whether he thought it appropriate for a Governor or AG of Georgia to lend the name and prestige of the state to controversial, politically-charged legislation funded and carried out by a politcal action group with a financial stake in the litigation. (3:10pm, 7/13). He dismissed the invitation as “bait”, which he declined to take (3:13pm).
Attorney General Sam Olens himself declined an opportunity to defend the practice during a Q&A at a continuing legal education meeting last year.
But then, AG Olens is not the blogger/columnist who “corrected” his poster carlosgvv by writing that Georgia was represented by “pro bono by private attorneys” - and then doubled down with sarcasm about carlosgvv’s failure to trust what he reads.
Ragbatz
July 16th, 2012
4:26 pm
Carly @ 2:45pm. Catastrophic plans, available to those under 30, will have deductibles over $6K.
Kaiser Family Foundation estimates that Bronze plans offering 80:20 cost sharing will have a family of four deductible above $4K. Bronze with 70:30 cost sharing will have a much higher deductible. . ACA subsidies are based on the Bronze plans. Bronze plans of any benefit design will have an overall actuarial value of 60%, so that people covered under any bronze plans will be paying forty percent of their costs of care through deductibles and copays. This leaves room for a lot of incentive for people to compare costs of items of health care to costs of other things.
People will be able to opt for silver, gold, or platinum coverage with less cost-sharing on an item by item basis but they will compare health care to other goods when choosing between high premiums for fuller coverage and low premiums for basic bronze coverage. For low and moderate income families, ACA subsidies will only give premium support for bronze level coverage – so can expect bronze to be selected most by those who are likely to be most sensitive to choices between health care and alternatives.
As for the demostration projects, three points are worth making. First, are these even implemented yet? Most of the act’s provisions are not even in effect yet. Second, at most anything new under the Act that is all ready in effect can hardly have been in effect long enough for results to be clear. Feel free to identify the specific failures you have in mind.
Most importantly, do not forget the grandest demonstration projects at all. I refer to the provision that any state has the flexibility to produce whatever type of plan it wants, so long as it will achieve similar coverage to what the ACA will do, and the Secretary has the authority to just take essentially all federal health care money headed for that state and use it for its system, whatever it may be. Some states have already selected or are leaning to single payer, but there is no reason a state could not take the approach consistent with your suggestions. (Except that most health economists now believe, based on both models and on studies, that over-utliziation from low patient cost sharing is of signficantly lesser magnitude than the under-utlitization that would be sacrificied under high patient cost sharing, what with the Rand study having been debunked and all.
Ragbatz
July 16th, 2012
7:42 pm
Just a bit more on state flexibility under the ACA.
Kathleen Sebelius was President Obama’s choice to Secretary of HHS. She was a popular, Democratic, two-term Governor from Kansas, an inarguably red state. She is the person before whom state plans for alternative Medicaid arrangements would be presented. Her electoral history of being able to command a re-election majority in a red state suggests that there is every reason to think that she is politically open to the kind of Medicaid policy alternatives that command a Georgia majority.
It is also true that nearly every State has, under the “old” Medicaid program, been granted dozens of waivers of Medicaid rules by administrations of both political parties.
Near the beginning of these comments on Medicaid expansion, Kyle Wingfield scolds liberals for too readily assume that conservative disagreeing about health care insurance methods were also disagreeing about health care goals. This is a fair criticism of some of the comments to which he was responding. Still, it seems to me that Wingfield himself has been entirely quick to presume that Georgia, under Medicaid expansion, would be denied the opportunity of flexible invention, like WIngfield’s (sole?) idea of charging different premiums to differently situated families. Maybe he does not know that States are expressly allowed to meet the common health care GOALS of the ACA by a breadth of different METHODS. Maybe he just does not trust that Kathleen Sebelius is committed to the Act’s goals rather than its methods. Or maybe, he just demands that liberals trust conservative protestations of common goals, but does not reciprocate by trusting that liberals at HHS would allow conservative methods to common health care goals.
When the ACA was before Congress, any Republican committed a few good ideas – like insisting that States be free to implement WIngfield’s suggestion – could have had his or her ideas for improvement enacted simply by saying “Do these and you will have my vote.” It’s called “compromise”, and it’s often possible to do when the parties share common goals but disagree on methods.
But Senate Minority Leader McConnell made clear that the primary goal of his caucus was defeating Barack Obama for re-election. Republicans simply refrained from meaningful efforts to improve the Affordable Care Act.
Gee, whiz, it sure is a shame that Kyle’s Great Idea did not get locked in stone as part of the ACA. Thank your lucky stars Georgia has a good chance of having the Wingfield METHOD approved by Kathleen Sebelius under the ACA as written, so long Georgia can show that doing so will meet the GOALS of the legislation.
Unless, perhaps, American liberals and conservatives have different goals. American liberals have the goal of universal health care. This also happens to be the policy of every major liberal party, and every major conservative party, in every developed country on the planet, with the sole exception of the Republican Party. If American conservatives have a different goal, and they certainly seem to, then liberals need not be scolded for thinking the ACA debate really is about goals.
Ragbatz
July 16th, 2012
9:36 pm
Below, the citation to a study showing that Medicaid patient acceptance rates are comparable to capitated private insurance (think HMO) new patient acceptance rates. This provides an interesting perspective on the half of Wingfield’s article that relies on low Medicaid new patient acceptance rates. Maybe 42% of Georgia physicians aren’t accepting new patients of any kind. Wingfield’s stat on the percent declining Medicaid patients is the basis of most of his case against the Medicaid expansion, but it would seem to be useless without any basis for comparison.
Declines in Physician Acceptance of Medicare and Private Coverage. Arch Intern Med. 2011;171(12):1117-1119. doi:10.1001/archinternmed.2011.251.
timbo
July 16th, 2012
10:36 pm
Regarding the problem of doctors accepting Medicaid due to low reimbursement rates: for 2013 and 2014 the Health Care Act mandates that Medicaid reimbursements must be at 100% if the Medicare rate, and the difference is fully financed by the federal government.
Ragbatz
July 17th, 2012
9:26 am
Timbo at 10:36. Nice catch.
M. Umair Javaid
July 19th, 2012
12:00 am
I am so tired of this. As long as you have healthcare you will never know what it is like to go without it. No matter what, money will always be the bottom line. Undoubtedly, it is a factor to consider, but it seems like its the only one anyone ever considers. I live below the federal poverty line with a family of four and both my wife and I work full time, still we don’t seem to be eligible for Medicaid. Your looking for some sort of panacea for healthcare and some vision of a utopia that has never existed in any healthcare system at anytime in any place in the world. You must sacrifice something somewhere; but I guess what does it matter if your neighbor dies of a curable illness as long as you feel your protected. So much for living in a society.