A question for those who say expanding Medicaid is a no-brainer

Liberal think tanks and columnists have been cranking out the arguments about why a state like Georgia would be foolish to reject Obamacare’s expansion of Medicaid. The expansion, which was made optional for states in the Supreme Court’s June ruling upholding the bulk of the law, would cost Georgia an estimated $2.5 billion over 10 years, according to state officials. Gov. Nathan Deal has said our state will not participate, but Obamacare supporters are trying to pressure him to change his mind.

Proponents of the expansion say hospitals and doctors in the state would receive an additional $33 billion in federal funds during that time frame. To hear them tell it, this is tantamount to finding $33 billion in between the couch cushions; they never mention whose pockets it’s falling from.

“The economics of this are very strongly in favor of adopting the expansion,” said John Holahan, study co-author and director of health policy research at the Urban Institute, in a recent AJC story. Holahan’s study puts the total federal cost of expanding Medicaid via Obamacare at $952 billion over 10 years if all 50 states participate. That’s a 26 percent increase on top of what’s already one of the federal government’s fastest-growing budget items. And, for you non-math majors, that comes out to $95.2 billion per year on average.

But here’s my question: Where do we find another $95.2 billion per year in a Washington that is currently:

  • running annual deficits of at least $1 trillion;
  • trying desperately to avoid an automatic spending cut (the “sequester” portion of the fiscal cliff) that would shave about $133 billion per year on average (over the next nine years);
  • and discussing tax increases on “the rich” that would raise, at most, $160 billion per year?

No one in Washington seems to be talking seriously about deeper spending cuts or sharper tax increases than these, so we are talking about continuing to run annual deficits of well over half a trillion dollars before tacking on $95.2 billion in new Medicaid spending.

And remember: This is just the Medicaid portion of Obamacare. We’re not talking about subsidies for the federal exchanges or new costs for long-term care.

Why is it that none of the “found money” advocates ever explain how we’re going to pay for this new spending? Or do they think Georgia taxpayers will truly believe someone else will handle that federal portion of the cost?

– By Kyle Wingfield

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308 comments Add your comment

Hillbilly D

November 27th, 2012
12:32 pm

Whether money is federal, state, or local, it all comes from the same place. It just having money in a different pocket. Most folks don’t understand that. You hear it all the time on the local level; “we can get a grant for that”.

You’re still paying for it, either way.

Lil' Barry Bailout - OBAMAPHONE!!!

November 27th, 2012
12:48 pm

Why is it that none of the “found money” advocates ever explain how we’re going to pay for this new spending?
———–

Because Obozo’s parasite base is all on the “taking” side of the equation.

Stop being such worthless, thieving scum, Obozobots!

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
12:59 pm

Lucky for the rest of us, you Cons are holding less and less power in the USA.

Centrist

November 27th, 2012
1:00 pm

It is not just “Liberal think tanks and columnists” pushing for Georgia to expand Medicaid – but the editors and journalists of your AJC employer: http://www.ajc.com/news/news/medicaid-expansion-would-bring-state-33-billion-co/nTGBJ/

Increased spending is the liberal mantra, even during the “fiscal cliff” negotiations.

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
1:01 pm

Kyle wrote: tax increases on “the rich” that would raise, at most, $160 billion per year

http://www.alternet.org/economy/ten-numbers-rich-would-fudged

The world derivatives market is estimated to be worth over a quadrillion dollars (a thousand trillion). At least $200 trillion of that is in the United States. In 2011 the Chicago Mercantile Exchange reported a trading volume of over $1 quadrillion on 3.4 billion annual contracts.
A quadrillion dollars. A sales tax of ONE-TENTH OF A PENNY on a quadrillion dollars could pay off the deficit. But the total sales tax was ZERO.

HDB

November 27th, 2012
1:02 pm

When CEO’s cry that the way to balance the budget is to cut social spending while simultaneously cutting business taxes….you wonder who the parasites really are!

How to get $100B…..eliminate the Bush tax cuts for everyone, merge governmental departments in Defense like procurement…….eliminate the overlap….eliminate the subsidies to big oil , agribusiness, and to business….then do a cost/benefit analysis to see where additional savings cvan occur!! That’s a start!!

Jefferson

November 27th, 2012
1:05 pm

Taxes is where the money comes from, what do you think they are for ? Follow the money if you have a problem with the costs, thats where the devil lives.

southpaw

November 27th, 2012
1:05 pm

Gov. Deal states that Georgia can’t afford the 10% share of the funding that would be required in three years. Here’s an idea for getting around that (turn on your irony meter, folks; I realize this would never work. It’s tongue-in-cheek food for thought). How about we participate for the three years that the federal government pays for its own idea, and then, when it starts becoming a partly unfunded mandate, we opt out?
(turn irony meter off)
It’s actually pretty clever. Start out by sending federal money and subjecting the state to federal rules. Then gradually decrease the federal money (does anybody really believe that the federal government will provide 90% funding from now on, and that it won’t be decreased as part of future budget cuts?) while keeping all of the federal rules in place.

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
1:07 pm

Where do we find another

single dollar for military spending when we already spend more than the next 20+ countries combined. Are we that Chicken S***?

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
1:11 pm

when it starts becoming a partly unfunded mandate, we opt out?

This is called “conservative responsibility”. Let’s get what we can from our fellow americans and then just screw them over in the end.

This is how Wal-Mart operates. Wal-Mart takes local tax incentives to open a store INSIDE a town’s boundaries (no taxes for 5 years if you open up a store in our town.) After 5 years, Wal-Mart abandons the location and opens a new store outside the town’s boundaries.

Tiberius - pulling the tail of the left AND right when needed

November 27th, 2012
1:13 pm

“Lucky for the rest of us, you Cons are holding less and less power in the USA.”

Yeah, ’cause gaining governors offices and state legislatures in a national election of an American Idol President, is always considered “losing power”. :roll:

Note to Finn: The majority of decisions governing your daily life are made at the LOCAL level.

JDW

November 27th, 2012
1:13 pm

@Kyle…”But here’s my question: Where do we find another $95.2 billion per year in a Washington that is currently:”

You are mixing questions…the correct question is why should Georgians pay the taxes associated with the program yet refuse to reap the direct benefits? We are going to pay the taxes and other costs and those revenues will be distributed to states that participate. By refusing to participate Raw Deal simply forces those tax dollars out of the pockets of Georgians and into the pockets of another state…mostly “Red ones” that also currently underfund Medicare.

Tiberius - pulling the tail of the left AND right when needed

November 27th, 2012
1:20 pm

” We are going to pay the taxes and other costs and those revenues will be distributed to states that participate.”

We would if the government actually funded their programs with actual revenues, but they simply write another deficit check and move on. Since the inevitable outcome is national insolvency (because you people on the left can’t get your heads out of your behinds), why not just opt out of another unfunded program?

southpaw

November 27th, 2012
1:23 pm

“you wonder who the parasites really are!”
Here’s an excerpt from http://dictionary.reference.com/browse/parasite?s=t

a person who receives support, advantage, or the like, from another or others without giving any useful or proper return, as one who lives on the hospitality of others.

So a business that gets its rates cut, but still pays taxes (albeit a smaller amount) TO government instead of getting a check FROM government without doing anything to earn money, is not a parasite.

“eliminate the subsidies to big oil , agribusiness, and to business”

Possibly. Is the government writing checks to these companies without them paying taxes or doing any service? If so, you have a great idea. On the other hand, if these companies are earning their own revenue and the “subsidies” consist of letting them keep more of what they’ve earned (the NERVE of anyone who would allow that to happen!), it might or might not be so good. In that event, the rallying cry of “cut subsidies!” is just the next round of saying, “raise taxes!,” and that debate is already well under way.

JamVet

November 27th, 2012
1:25 pm

Because Obozo’s parasite base is all on the “taking” side of the equation.

Stop being such worthless, thieving scum, Obozobots!

Woo Hoo!

Excellent job, Lil!

With friends like you, the GOP doesn’t need any enemies!

jconservative

November 27th, 2012
1:32 pm

We have made some progress on deficit/debt in the last couple of years. The Bush/Obama Tax Cuts will sunset on 12/31/2012. The sequestered spending cuts go into effect 1/2/2013.

That is already done and if no one lifts a finger it will go into effect as scheduled. And both were bi-partisan bills and both sides are happy.

Correct?

Rockerbabe

November 27th, 2012
1:36 pm

So Kyle, what is YOUR solution to the issue of the uninsured and the cost of unreimbursed medical care? Everyone gripes about our medical system, which is essentially a private system, but no one has come up with a solution to caring for the uninsured. So, how about it? What is your solution our the medical care crisis for at least 50+ million people?

Jefferson

November 27th, 2012
1:39 pm

Sounds too easy eh jcon ? Truth is Ga will be left behind, they will pay the Feds but get nothing for being obstructive. Even FL knows what to do.

southpaw

November 27th, 2012
1:40 pm

This is called “conservative responsibility”. Let’s get what we can from our fellow americans and then just screw them over in the end.
————————————————–
If that’s really how it works, perhaps the federal government would be wiser not to allow us the opportunity to “get what we can from our fellow americans” by not trying to implement the program.

“This is how Wal-Mart operates. Wal-Mart takes local tax incentives to open a store INSIDE a town’s boundaries (no taxes for 5 years if you open up a store in our town.) After 5 years, Wal-Mart abandons the location and opens a new store outside the town’s boundaries.”

Two Wal-Marts have opened up near me since I bought my home 19 years ago. One of them is within city limits and hasn’t moved since it opened over 10 years ago. The other has been open only a few months, and it isn’t anywhere near a city. To my knowledge, it hasn’t replaced any store that closed. In other words, Wal-Mart didn’t replace a store; they expanded into a new area.

Darwin

November 27th, 2012
1:44 pm

Start by taking it out of an over bloated defense budget. Make NATO countries provide the cost of THEIR protection instead of using US bases as an economic engine for local economies.

td

November 27th, 2012
1:47 pm

Finn McCool (The System isn’t Broken; It’s Fixed)

November 27th, 2012
12:59 pm

Lucky for the rest of us, you Cons are holding less and less power in the USA.

Not meant to be a factual statement.

30 Republican governors the most ever in the nations history.
Republican control both sides of the legislature in 30 states. Most ever in in the nations history
Republicans control at least one chamber in 6 additional states.
Republicans control the US House of Reps now and that number will increase in two years due to new gerrymandered districts.

Yes, the Republicans seem to be losing power now.

getalife

November 27th, 2012
1:48 pm

Keep fighting it until we get single payer cons.

Stay the course.

So, our President will have a Dem house and rubber stamp congress his last two years.

You cons are doing a heck of a job.

1961_Xer

November 27th, 2012
1:49 pm

“Lucky for the rest of us, you Cons are holding less and less power in the USA”

… and in 10 more years when the U.S. is a total 30 TRILLION in debt, nobody in the USA holds power (just as Greece holds no power). We will all be debt slaves, NOBODY will get SS, NOBODY will get food stamps, NOBODY will get government healthcare, and the rich will still have everything they have today.

This is a simple math problem: Debt in 10 years = current debt + (10 * yearly deficit).

30+ Trillion in debt is a hole that the US will not be able to dig out of. A lot of people are going to go hungry and homeless and without healthcare.

Linda

November 27th, 2012
2:00 pm

Obama said that by pulling out of Iraq, like we had planned to do anyway, we could “save” the money we were borrowing from China (to fund the Iraq War) & spend (invest) it on his union buddies, who are employed directly by the state governments in states in which workers have no right to work. We could take that saved, borrowed, spent money & spend it again on Obamacare!
(My liberal friend taught me that liberal accounting technique.)

Don't Tread

November 27th, 2012
2:01 pm

Yeah, let’s accept a permanent liability (which will only increase) and set of rules (which will only get more complex) along with a temporary revenue stream (which will probably decrease or become worthless in the future). What on earth could possibly go wrong with that? :roll:

Wonder if John Holahan’s previous occupation was “used car salesman”?

JDW

November 27th, 2012
2:03 pm

@Tiberius…”We would if the government actually funded their programs with actual revenues, but they simply write another deficit check and move on.”

I guess you blather about so many things you tend to forget…as you might remember the ACA contains a list of defined revenue sources and/or taxes that will fund the implementation. Some of them are:

-3.8 percent surtax on investment income earned in households making at least $250,000
-Increase in Medicare Payroll Tax to 2.35% on incomes over $250.000
-2.3% excise tax on medical devices
-Individual and employer mandates

So in a nutshell the bill is going to be funded by Georgians, queue the blathering about underestimating the costs, whether Georgians participate or not. To repudiate $33 billion in benefits that these taxes should provide is just plain stupid.

Tiberius - pulling the tail of the left AND right when needed

November 27th, 2012
2:10 pm

Thanks for finally admitting that Obamacare is the largest single tax increase on the middle class in American history, JDW. Isn’t enlightenment wonderful?

And YOU might remember that taxes can change with a single vote of Congress and a signature from the President.

But that would require knowledge of our Constitutional system you do not have.

curious

November 27th, 2012
2:11 pm

Last in high school graduation; soon to be last in medically insured citizens.

Georgia will soon be a very attractive location for companies seeking an educated and healthy work force.

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
2:18 pm

You Cons should stick to your Benghazi hysteria

stands for decibels

November 27th, 2012
2:19 pm

Where do we find another $95.2 billion

We continue to get people to lend it to us for close to zero percent interest.

JDW

November 27th, 2012
2:23 pm

@Tiberius…”Thanks for finally admitting that Obamacare is the largest single tax increase on the middle class in American history, JDW. Isn’t enlightenment wonderful?”

I admitted no such thing, I simply pointed out that the bill is funded, as should all spending bills be, and we shall pay whether Raw Deal screws us or not.

“And YOU might remember that taxes can change with a single vote of Congress and a signature from the President.”

Don’t remember this coming up but show me where I mentioned that this was not a possibility.

“But that would require knowledge of our Constitutional system you do not have.”

I have a pretty good grasp, why I even know that the current President was just reelected to FOUR MORE YEARS and that there is no chance he will sign a bill that that decimates funding for the program.

You on the other hand, like Kyle and several of the other “Conservatives” around seem unwilling to understand that you lost both the election and the Obamacare ruling. To be willing to pay the bills but reap none of the benefits is just plain stupid.

stands for decibels

November 27th, 2012
2:23 pm

30+ Trillion in debt is a hole that the US will not be able to dig out of.

when were we ever planning to pay off that debt?

We’ve been running a debt since Andrew Jackson left office.

Seriously–where do people come up with these strange notions?

Tiberius - pulling the tail of the left AND right when needed

November 27th, 2012
2:26 pm

JDW seems to have forgotten that the legislative body which originates all spending bills is still firmly in the hands of a party who does not wish to fund Obamacare.

Dave

November 27th, 2012
2:28 pm

I’m sure it isn’t one for one dollars; but, the people that will get added under the AHA are the same people getting inefficient care in emergency rooms, free and low cost clinics and the like. We are paying for them now. Don’t we count that money as an offset against the $95 billion you are looking for?

As to the bigger question, are we willing to let poor people linger and die for want of money, my answer would be no, we should pony up, bite the bullet, etc. So, to answer your question, we get it from us.

We do things like not build billion dollars stadiums, not put millions into bridge signage along the connector,not spend money “branding” our schools (or too late, creating a shadow charter system) we quit giving tax breaks to people and companies that don’t need them, we quit forcing spending by the military that it hasn’t asked for and doesn’t want, we reduce our world wide military presence, and so on. Will there be a shortfall when all the waste is eliminated? Probably, that’s when we share the hurt and spend a little more. Or we let people die, because? Because we got ours, let them go find theirs.

Linda

November 27th, 2012
2:30 pm

If it’s not too late, Obama could nationalize Twinkies (he’s nationalized just about everything else) & we could have a nationwide Bake Sale!
Hostess was Too Big to Fail, but Too Spongie to Survive (TSTS).
We could require fruit pies to be in every vending machine & cafeteria in every govt. bldg., including our schools. FEMA & the Red Cross could cool the air by handing out Sno Balls every time we have another Global Warming-caused disaster. K-rations could be enhanced with the addition of HoHos. We could pay Social Security beneficiaries & Medicare/Medicaid doctors & hospitals in redeemable coupons for Wonder Bread. We could pay the interest on the debt in donettes. The list, like the shelf-life, is endless.
We could become the United States of Ding Dongs!

Dave

November 27th, 2012
2:32 pm

ACA, not AHA. Sorry.

JDW

November 27th, 2012
2:34 pm

@Tiberius…”JDW seems to have forgotten that the legislative body which originates all spending bills is still firmly in the hands of a party who does not wish to fund Obamacare”

Tiberius seems to have such a poor understanding of legislation that he does not realize the revenue will be collected no matter what at this point.

Nate Silver

November 27th, 2012
2:36 pm

“We could become the United States of Ding Dongs!”

You would certainly be one of the leaders for sure. No changes required for you.

Kyle Wingfield

November 27th, 2012
2:37 pm

JDW @ 2:03: This summer, the CBO issued new estimates about Obamacare’s insurance costs and new revenues for 2013-22 (the same as in the Kaiser study I discussed in the OP today). The new revenues were expected to be only $514B over 10 years while the costs were expected to be $1,680B.

We can pretty confidently assume the costs will be higher than CBO estimates; that’s one takeaway from the Kaiser study, which put the feds’ Medicaid costs from 2013-22 at $952B vs. the CBO’s estimate of $643B.

If Kaiser is right about Medicaid, and if the CBO underestimated all Obamacare costs by as large a percentage as the Medicaid costs — two admittedly big if’s — the 10-year cost of Obamacare’s insurance provisions would be $2,487B. That’s vs. new revenues of just $514B — which, if history repeats itself, will turn out to have been overestimated, making fiscal conditions even worse.

So, no, Georgians won’t be footing the bill whether we participate or not. No one is footing the bill; that’s my point.

Nate Silver

November 27th, 2012
2:37 pm

If the majority of voters in the states that will not be participating are good with these decisions then it will be what it is. If not, we may or may not see changes in those elected officials.

Time will tell.

1961_Xer

November 27th, 2012
2:38 pm

when were we ever planning to pay off that debt?

We weren’t. At some point, the rest of the world will stop financing our debt.

We’ve been running a debt since Andrew Jackson left office.

Seriously–where do people come up with these strange notions?

The ability to sell our debt was never in question as is is now. So tell us, master of finance, how much debt do YOU believe the world will buy from the U.S. before they stop buying? Or are you just full of insults with no ability to think for yourself?

You Cons should stick to your Benghazi hysteria

You would like that. All of simple this math is just boggling your brain. A simple question: how many more years can we run a $1.5 Trillion budget deficit before the world stops buying our debt? Realize that once the Chinese purse strings are cut, there is no more Obamacare, no more Medicaid, no more food stamps, no more EITC. How much debt are you willing to bet that China will take on before they say “no more”? That is what we are really talking about here.

Kyle Wingfield

November 27th, 2012
2:38 pm

stands @ 2:19: Right, because interest is the only consideration in paying back debt.

Kyle Wingfield

November 27th, 2012
2:40 pm

Dave @ 2:28: The Kaiser study’s figures purport to be net of any savings. For instance, they put the state’s cost at closer to $1.8B rather than $2.5B by making that very argument (I take no sides as to who’s right about the savings, but I wanted to point out your argument has been taken into account).

Dave

November 27th, 2012
2:43 pm

Fair enough. So we start digging into our pockets a little quicker.

southpaw

November 27th, 2012
2:43 pm

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
2:50 pm

The new revenues were expected to be only $514B over 10 years

So, what is the revenue from our military spending?

Spend on the military but not on keeping the population healthy? WE want a military that protects all the sick Americans?

Finn McCool (The System isn't Broken; It's Fixed)

November 27th, 2012
2:53 pm

yay! songs that show conservatives think personal finance is identical to national finance.

Who needs Fox News?

JDW

November 27th, 2012
2:54 pm

@Kyle…”So, no, Georgians won’t be footing the bill whether we participate or not. No one is footing the bill; that’s my point.”

Yes, yes we will. Let’s assume that you are correct and the costs is $110 billion or so a year over 10 years. Not sure I believe that but not enough time to debate it today.

Georgians will pay all associated revenues i.e. mandates, excise taxes, Medicare taxes et. al. PLUS incur a pro rata share of any accumulated debt while receiving none of the benefits…I say again THAT’S JUST STUPID.

stands for decibels

November 27th, 2012
2:55 pm

because interest is the only consideration in paying back debt.

no, it’s not. However, I really don’t see why we’d allow ourselves to be paralyzed with fear over insuring millions of Americans like, you know, a civilized country might.

At some point, the rest of the world will stop financing our debt.

Ok, how about if we first get people back to work by spending money on projects that we need, and get people insured, before those poor gullible people with the trillions of dollars get wise to us?

retiredds

November 27th, 2012
2:57 pm

John Q @ 2:19 . Please don’t ask that Kyle limit L’l Barry. Then I wont get my daily dose of comic relief.