Sorting out the ‘we’ in Medicaid expansionists’ claims

When someone tells me I can get something of value for “free,” I raise an eyebrow. When that “free” thing is coming from the government — and worth billions — I reach for my wallet.

So it goes with the question of whether Georgia should opt into Obamacare’s expansion of Medicaid.

In upholding most of the health reform law this summer, the U.S. Supreme Court did allow one concession to the states that sued to overturn it. The court ruled Washington could not threaten to take away states’ existing Medicaid funding if they declined to expand Medicaid. Each state must now decide whether to take part in the expansion and make anyone earning 138 percent of the federal poverty level eligible for Medicaid.

Georgia Gov. Nathan Deal in August said he would decline the offer on two grounds. First, the state can’t afford its share of the expansion’s cost. Second, Deal doesn’t believe a heavily indebted Washington will uphold its end of the bargain, possibly putting the state on the hook for even more than projected. Medicaid already accounts for more than $2 billion in state spending each year, or almost $1 of every $7 from the state’s general fund — and rising.

There’s no sign Deal is wavering on this decision, but Obamacare supporters keep making their case to the public.

They scarcely try to convince us the state’s portion of the expansion is affordable — though they do argue the state’s projection of $4.5 billion over 10 years is too high.

Instead, they focus on the federal money Georgia will forgo if we don’t participate. A recent study by the Kaiser Family Foundation, reported in the AJC this week, put the figure at $33 billion over the next decade. This, proponents say, is a matter of getting what’s due to us.

The gist of one of their key arguments is: We are going to pay the taxes levied by Obamacare, so we at least ought to get the funding it’s meant to provide us.

This argument assumes Obamacare will actually pay for itself, a dubious proposition given Washington’s history of missing high on revenue forecasts and low on cost projections. But that’s not my point today.

Instead, I want to point out that “we” isn’t always we. Sometimes “we” is they.

In the above example, the payers of the tax are indeed “we.” But “we” are not the beneficiaries. The beneficiaries are the health providers, mostly hospitals, who have their eyes on that $33 billion.

New Medicaid enrollees would gain some benefit, though even that’s limited because the number of doctors who don’t accept new Medicaid patients is large and growing. But many of these potential enrollees already receive care that simply isn’t paid for.

While no one’s calling this a hospital-bailout program, that’s what it boils down to.

But aren’t we already paying for these patients? What about that “care that simply isn’t paid for”?

Yes, we’re already paying for them, in part via higher insurance premiums. But not as much as you think: A study by the Urban Institute found uncompensated care accounts for just 1.7 percent of health premiums. The Medicaid expansion would reduce this by only a fraction. The Obama administration itself has said the Medicaid expansion would reduce the “cost-shifting” from the uninsured to the insured by just $1 billion a year nationwide.

Compare that $1 billion a year in savings to the estimated $95 billion a year Obamacare would spend to expand Medicaid.

The reduction of cost-shifting may be smaller than one might expect because Medicaid payments often don’t cover the cost of treatment, which explains why so many doctors don’t accept new Medicaid patients. When you lose money on every patient, you can’t make it up in volume.

So don’t expect the Medicaid expansion to lead to smaller premiums in your private insurance. History tells us the opposite will happen. Expanding a broken program is of no real help to the uninsured or to taxpayers.

Perversely, the states that decline to expand their Medicaid programs may actually make Obamacare more sustainable by lowering its costs. But it should keep pressure on Washington to come up with real reform that benefits the uninsured and our health system more broadly.

– By Kyle Wingfield

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247 comments Add your comment

Lil' Barry Bailout - OBAMAPHONE!!!

November 29th, 2012
5:48 am

[T]he payers of the tax are indeed “we.” But “we” are not the beneficiaries. The beneficiaries are the health providers, mostly hospitals, who have their eyes on that $33 billion.
—————————-

Correction: The payers of the tax are the people who actually work for a living and pay taxes. The beneficiaries are Obozo’s base–the slothful, the lazy, the parasites.

The productive are going to pay regardless, and receive no benefit. The Obozo receptacles would have the productive pay even more.

Governor Deal is right to decline to raise taxes on the productive. All real Americans agree.

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

November 29th, 2012
6:00 am

But . . but . . . but . . . Kyle! It’s free money! And it will help the poor children! And it’s paid for! And the seas will lower!

All because Obama said so!

Skip

November 29th, 2012
6:01 am

The greatest nation the world has ever seen and it’s too greedy to take care of its poor.

Lil' Barry Bailout - OBAMAPHONE!!!

November 29th, 2012
6:03 am

Skip, how much did you donate last year to provide health care to the poor?

Lil' Barry Bailout - OBAMAPHONE!!!

November 29th, 2012
6:06 am

Oh, and Skip, we didn’t become the greatest nation the world has ever seen by running a socialist economy. We did it by having free markets, by protecting private property rights, and by allowing the profit motive to incent people to actually go out and work for a living.

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

November 29th, 2012
6:07 am

We were once the greatest nation this world has ever seen because we used to take care of our selves, Skip.

Both are in the past however, due to people like you.

Skip

November 29th, 2012
6:30 am

No time to play with the slackers, I have work to do.

Jefferson

November 29th, 2012
6:31 am

It’s not free and you will pay, how much clearer can it be. Nobody expects selfish people to like it, grow up.

Lil' Barry Bailout - OBAMAPHONE!!!

November 29th, 2012
6:35 am

LOL…Skip talks the talk about “taking care of the poor” but doesn’t do anything to make that a reality. She just knows that SOMEONE ELSE should be paying.

Skip, your greed for other peoples’ property is disgusting and filthy and un-American.

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

November 29th, 2012
6:47 am

Why should I pay for something I don’t use (like health care), Jefferson?

Why should I pay for teachers in Florida, firefighters in NY and cops in Chicago if I don’t ever need their services, Jefferson?

tiredofIT

November 29th, 2012
7:30 am

Why should I pay for this disaster?
The F-35 Joint Strike Fighter, still plagued by technological troubles, will ultimately cost taxpayers $396 Billion dollars.

middle of the road

November 29th, 2012
7:38 am

“Why should I pay for something I don’t use (like health care), Jefferson?”

So you must be Superman – invincible and immortal if you think you will NEVER use healthcare. I hope you don’t fall off a ladder tomorrow hanging Christmas lights.

Just Say No to New Taxes

November 29th, 2012
7:43 am

Our votes should be weighted by the amount of federal income tax we pay, for the 49% who are takers (aka dead beats), please note that zero times 1 is zero, exactly what you are worth!

parah salin (the governor)

November 29th, 2012
7:44 am

Lil Barry,

Actually the republican base is more likely the ones that don’t work and pay taxes. Here is the undisputed fact that might be food for thought for you – of the ten wealthiest states in the US, nine went for Obama. Of the ten poorest states in the US, nine went for Romney. If you don’t believe me, look it up yourself.

Tib, so if I understand you correctly, you have never visited the doctor or gotten any medications. Many medicines are already developed with federal funds. The law that made this so was passed by a Republican controlled congress and signed by St. Ronald Reagan in 1983. I would tell you the name of the law, but I am sure you already know the laws on healthcare inside and out.

The rest of the developed world has had universal healthcare coverage for four generations now, and I don’t see a “going out of business” sign posted at their borders. Here is a quick math lesson, if you want to insure an additional 50 million people it will logically cost more than if you don’t. It is called addition. When you get a chance you should read up on it.

BenDaho

November 29th, 2012
7:45 am

This argument assumes Obamacare will actually pay for itself, a dubious proposition given Washington’s history of missing high on revenue forecasts and low on cost projections. But that’s not my point today.

Really Kyle? Look at the resounding success of the profitable postal service, all of the money locked away in the s.s. trust fund, and our budget surpluses.. (sarc) Of course Obamacare will be self sustaining.. (gag)!

middle of the road

November 29th, 2012
7:46 am

“Yes, we’re already paying for them, in part via higher insurance premiums. But not as much as you think: A study by the Urban Institute found uncompensated care accounts for just 1.7 percent of health premiums.”

So if uncompensated care is so little, why don’t we pass a (federal) law making it illegal for hospitals to cost-shift. Then the hospitals should be able to bill the federal government for the uncompensated care, since that is an unfunded mandate caused by EMTALA.

rwcole

November 29th, 2012
7:47 am

Aren’t you proud, Kyle, to have such supporters like Barry? Such a patriotic and respectful guy and he agrees with everything you write. If I ever agree with anything lil Barry, the racist, says, I would seriously have to rethink my position. Yuck!

JDW

November 29th, 2012
7:51 am

@Kyle… :roll: Typical Republican selfishness.

The we does include the health providers and hospitals or rather the companies the operate them and provide good high paying jobs to the people of Georgia which you want us to forgo, after complaining incessantly that not enough is done to create them. The we is the poor among us that today receive inadequate health care and suffer the consequences. The we is those among us that struggle to pay their premiums and will still do so, preventing those dollars from flowing into other local businesses. The we is the economy of Georgia which is stagnate, desperately in need of a boost because the Republican mantra is not working here. The we is the people of Georgia that should be ashamed at ranking 49th in the country in providing medical care to its poor.

This is simply a non factual statement…”This argument assumes Obamacare will actually pay for itself”

Georgians will pay the associated costs or incur a pro rata share of any debt. Either way we will pay the price and under Raw Deal’s plan forgo the benefits.

BenDaho

November 29th, 2012
7:53 am

rwcole

November 29th, 2012
7:47 am
Aren’t you proud, Kyle, to have such supporters like Barry? Such a patriotic and respectful guy and he agrees with everything you write. If I ever agree with anything lil Barry, the racist, says, I would seriously have to rethink my position. Yuck!

17 posts in and the race card is out. See you at the Klan meeting Barry. Is it my turn to pick up the dry cleaning on the way?

CC

November 29th, 2012
7:55 am

LBB and Tiberius:

It appears that Skip skipped out . . .

rwcole

November 29th, 2012
8:02 am

Ben, I’ll say this again for your benefit. Not all GA Republicans are racist but all racist white Georgians are Republican. And if you are defending lil Barry, whose every comment drips with racism and disrespect for our nation, then you haven’t read very many of his posts. Or you’re the same breed as Barry.

CC

November 29th, 2012
8:07 am

Here’s an idea . . .

Why not let those who are so concerned about the Medicaid availability sign a pledge to support this program in Georgia, no matter the cost, and agree to pay whatever their computed ‘share’ of the cost is determined. Once all the pledges have been signed, the mathematicians for the state can set each pledger’s cost and it can then be deducted from their paycheck or bank account on a monthly basis.

Now, which one of you leftists want to be the very first kid on your block to sign this pledge?

I suspect your feelings are (as always), we want to be very generous WITH SOMEONE ELSE’S HARD-EARNED MONEY!

CC

November 29th, 2012
8:15 am

rwcole:

The only “racist” comment added here this morning has been yours.

Have you been a racist all your life?

carlosgvv

November 29th, 2012
8:20 am

but but but but but………we’re supposed to be the richest Nation on Earth. Kyle, are you saying we’re actually so poor we can’t provide proper healthcare to our citizens? All other industrailized Nation do it. Are they richer than us?

GB101

November 29th, 2012
8:29 am

You are right, but…

we are damned if we do and damned if we don’t. Georgians, as federal tax payers, will be funding the federal share of the Medicaid expansion whether we want to or not, and whether Georgia participates in the expansion or not. As state taxpayers, we will not have to pay the extra 4.5 billion (over ten years) but we will be paying our share of the 33 billion that will go to other states.

Damned if we do; damned if we don’t.

Lynnie Gal

November 29th, 2012
8:33 am

Kyle, did you miss the article in this paper about Georgia hospitals losing half their federal funding because Medicaid expansion was designed to take up the slack? Yes. Grady and other state hospitals will have to cut services due to less funding and NO increased payments by patients from Medicaid. That means, if you have an auto wreck and need trauma services, your services are cut. If you have a stroke and need neurological services at Grady, your services (nurses, etc.) will be cut, thanks to our Governor Deal who does not want people who make too little to have health care but too much to qualify for current Medicaid, to get healthcare.

GB101

November 29th, 2012
8:35 am

Skip

As federal taxpayers we spends one trillion per year in means tested programs. At the state level, Medicaid is one of the biggest items in the budget. There is no basis for saying we do not take care of the poor. Unless you are thinking about your grandchildren. They will be poor because of the debt we continue to incur.

BenDaho

November 29th, 2012
8:55 am

rwcole;
It has been my experience in life that people who have a chip on their shoulder are usually the most intolerant people. That’s why libs are the most fervent stereotypers and name-callers.

Bye Bye Cheesy Grits

November 29th, 2012
8:57 am

Once again the state of Georgia will lose and be the laughingstock of the Nation.

Bye Bye Cheesy Grits

November 29th, 2012
8:58 am

Every advanced country in the world has Universal Healthcare.

They all pay much much less and get far better results than we do.

Obama is going to drag us ( some kicking and screaming ) there as well.

Bye Bye Cheesy Grits

November 29th, 2012
9:02 am

Governor Deal is right to decline to raise taxes on the productive. All real Americans agree.

” Real Americans ”

Is code for White people.

The reality is its the red states are the biggest takers. Mostly the very poor Southern states.

The bluer richer states basically subsidize them by sending more to Washington than they get back.

DownInAlbany

November 29th, 2012
9:10 am

Lynnie Gal

November 29th, 2012
8:33 am

Kyle, did you miss the article in this paper about Georgia hospitals losing half their federal funding because Medicaid expansion was designed to take up the slack? Yes. Grady and other state hospitals will have to cut services due to less funding and NO increased payments by patients from Medicaid.

Have you taken a look at the balance sheets for these so-called, “public, not-for-profit” hospitals? Use guidestar.com and look at the Medical Center of Central GA (Macon), Phoebe Putney (Albany), The Medical Center (Columbus). The literally have $100’s of millions in cash and cash equivalents. Take a look at the salaries of senior management (+$1 million in most cases). Take a look at the lavish, marble floored facilities they are constructing. To quote ‘ole Mark Taylor, “cry me a river.” Grady is a special case and the State has proven time and again that they will not allow them to fail.

Obamacare does nothing to control the COST of healthcare.

Bob Loblaw

November 29th, 2012
9:13 am

I don’t care if its 1.7% more I pay or 20% more for my insurance–it should be 0%. Where government policy dictates I pay more, its’ a tax.

Scooter

November 29th, 2012
9:14 am

But the only acceptable form of blind faith is for politicians and their government.

Road Scholar

November 29th, 2012
9:15 am

BenDaho: You have not read many posts here or in Bookman’s column, have you? Both Conservatives and Liberals have many people who rely on insults versus proposing real possible solutions. Grab some popcorn and just watch…you will get the info to rescind your comment.

iRun

November 29th, 2012
9:20 am

Kyle,

Please, you CANNOT stand by and accept the support of someone so vitriolic and hateful as LBB.

His online persons drips with hate and disdain for his fellow human and he dehumanizes those he disagrees with to the point of wishing harm and death upon them.

For you to sit silently is tacit agreement with is position.

You must, at least, distance yourself from him. Do not accept his support.

Many of us do not agree with your opinions, but you do not seem to be a man who hates The Other Side, or would wish harm upon the poor and unfortunate. You simply have a different philosophy about how to take care of the problem.

So, please, in that spirit, when LBB comes on here and begins to spew the acid of his vitriol would you rebuke those words and sentiments? This place is YOURS. It’s NOT his.

Rafe Hollister, dreading the eventual decline caused by Obamanism

November 29th, 2012
9:21 am

independent thinker

November 29th, 2012
9:21 am

middle of the road 7:46 am said:

“”"”"”"”"”So if uncompensated care is so little, why don’t we pass a (federal) law making it illegal for hospitals to cost-shift. Then the hospitals should be able to bill the federal government for the uncompensated care, since that is an unfunded mandate caused by EMTALA.”"”"”"”"”"”"”"”"”"

AMEN! I have been posting similar comments since Obamacare was passed and Mr. Wingfield refuses to acknowledge that EMTALA is the only true socialized health care program we have and it was passed by Reagan as a an unfunded mandate so there is naturally cost shifting to the insured and paying patients. If Medicaid with recent increases and Medicare is cost shifted by hospital providers, it is because they are greedy and not cost efficient. If the Feds funded EMTALA as occurred in Mass. under Romney in that phantom program, there would be natural increases in Medicaid. There they cost shifted the unreimbursed hospital fund which was insolvent to guess who?
the feds and one report shows that through 2011 8.5 billion federal excess Medicaid went to Mass.
The morons in this state would rather the hospitals and partients absorb the cost while they bow and worship at the mention of Reagan.

Buzz belle

November 29th, 2012
9:23 am

Single payer was the way to go. We got to this point by caving into the republicans. Lesson learned. This is not the first huge mistake the republicans made in their “just say no” policy and it will not be the last. It is mind boggling that we have Norquist people refusing to help this country, by protecting the rich from paying their fair share by not coming to the table and making EVERYBODY’S taxes go up. I say fall off the cliff and let the chips fall where they may. It will be fun to watch the morning news shows then.

Rafe Hollister, dreading the eventual decline caused by Obamanism

November 29th, 2012
9:23 am

Rafe here dripping with hate and disdain for Obamacare. A program that is going to bankrupt America and reduce our healthcare to third world status. Any effort to oppose it by any politician is appreciated.
There were much better ways to deal with the 40 million uninsured rather than destroy healthcare for the overwhelming majority that already had coverage.

Thomas Heyward Jr

November 29th, 2012
9:25 am

There is only one solution to the problem.
Allow intelligent people to OPT OUT completely of the Federal monopolistic/crony coorporatist health system.
(there would have to be some sort of means/intelligence test…romney/obama-bots need not apply).
.
The innovations, principles/pricing, and pure market-driven efficiencies of a Free-market Healthcare system’s tide would lift ALL Americans.
Even the ones despairingly stuck in Obama/Romney-Care.
.
Like it or not, this is already happening via wealthy American health tourists fleeing to freer countries..
Give the poor a chance.
.
Beware wallet-grabbing progs………. secesh fever’s in the air.

Dave

November 29th, 2012
9:28 am

1) Obama is in office for 4 more years with a Democratic majority in the Senate. The health care law isn’t going anywhere any time soon. After four years the law is going to be further entrenched and harder to get rid of.

2) Governor Deal has made his decision, Georgia is sitting back and letting the Feds run and pay for healthcare in Georgia on the rationales that we can’t afford to run our own programs and we can’t trust the Feds to keep the money stream coming.

So what is the Governor doing to deal with the eventuality that he predicts? Beyond a big “I told you so” what is he, and for that matter what are all the other naysayers, doing to deal with the disaster they predict?

The floor is open to leadership rather than sniping.

JohnnyReb

November 29th, 2012
9:30 am

The Left constantly pukes the Right has no compassion for poor people. That Obamacare will provide cost savings by doctors and hospitals not having to provide free care, etc. As Kyle points out, that’s all BS like most of their other idiology.

Obamacare is a hodge-podge of special interest initiatives. That’s why Nancy made the infamous remark the bill had to be passed to find out what is in it – she did not know, none of them knew exactly. They are putting it together on the fly. Do you really think it would have passed had the religious controversy over who pays for birth control had been in the bill?

As BIll Whittle states in this video, the biggest threat to poor peoples health is obesity. This is an attention-getting speech that should be mandatory for all Conservatives.

http://blip.tv/davidhorowitztv/bill-whittle-6444929

the red herring

November 29th, 2012
9:38 am

everything obama/pelosi/reid have promoted about obamacare has been false so far so you can expect it to cost much much more than they projected (already has to this point)—when you can’t see a doctor you want and there are too few doctors then people will understand the real cost of obamacare which is rationing. your choices will be limited not just of who will see you but also what obamacare/insurance will pay for as well. all the supporters of socialized medicine can’t explain why people in countries that already socialized medicine are coming to the U.S. for their care. there will always be people than afford to buy and drive a better car, that will be able to afford a bigger house, eat better quality food, etc, etc— health care will be no different–they will pay cash for it so obamacare will not level this playing field — if anything it will make it much worse for the middle class as they will have no option but take what obamacare will let them have. government can not run anything as well as private industry does for there are no incentives to limit what government programs

Glenn Beck

November 29th, 2012
9:39 am

Kyle

You mentioned free at the beginning of your article. Can you provide the exact quote from the person who said “free” regarding this topic? Hopefully it is not just from another Op Ed writer.

One would think you would have provided the quote within the article since you are depicting something as truth and not hyperbole and rhetoric.

the red herring

November 29th, 2012
9:39 am

correction–no incentives to limit what government programs spend.

JDW

November 29th, 2012
9:48 am

@Rafe…”College grads 51-47% for Romney, wrong again”

No Rafe…people who ONLY have a Bachelors degree went for Romney 51-47. People who have BOTH a Bachelors and PostGrad went 55-42 for Obama. You have to pro rate and then add the two together to get the number of people with a Bachelors that went for Obama. When you do that the number comes out to 50/50.

No Degree 53 percent of the electorate, Bachelors only 29 percent and Bachelors PLUS PostGrad 18 percent…notice how those total 100 percent.

Obama carried 47 percent of the 29 which multiplied together gives you 13.63 percent of the vote. Then he carried 55 percent of the 18 percent which multiplied together gives you 9.9 percent of the vote. His total among people with a Bachelors is 23.53. The total number of those with a Bachelors that voted is 29+18=47 percent. Divide 29.53 by 47 percent and you get 50% which is the total percentage of the voters that hold a Bachelors degree that voted for Obama.

USC-69

November 29th, 2012
9:48 am

Yawn – all the name calling and accusations will not solve this issue. Grow up, work hard, pay your taxes, and be glad that most U.S. citizens will now receive proper healthcare when they need it.

carlosgvv

November 29th, 2012
9:58 am

Someday, when a History of The Decline And Fall of The United States of America is written, the selfishness and greed of Big Business moguls and their puppet cons will be judged as the number one cause.

JDW

November 29th, 2012
10:03 am

ooopss typo…should read Divide 23.53 by 47 percent and you get 50% which is the total percentage of the voters that hold a Bachelors degree that voted for Obama.