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
Oh well
November 29th, 2012
5:32 pm
Tiberius
And you are who? The wannabe Deputy Fife. Take it up with the AJC. maybe threaten to sue them or something.
Oh well
November 29th, 2012
5:33 pm
md
That may or may not be the truth, but if you are happy with it, I am glad for you.
If not, keep working and I am sure you will be able to purchase a house, trailer or rent something a little larger one day.
Oh well
November 29th, 2012
5:38 pm
md
Haven’t numerous counties around the state increased millage rates to offset some of the decreased home values and subsequent lowered tax assessments?
mike
November 29th, 2012
5:43 pm
Don’t make him put his bullet in his gun.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
5:47 pm
Tthanks for confirming your sock puppet status, Oh Well.
Transparent as always.
Dusty
November 29th, 2012
5:47 pm
Uh oh… Mz O W!!…the new class monitor..
I guess Oh Well was clutching her crayons when she decided to take the job.. Poor baby! She luvs to fuss and hiss!
Oh well
November 29th, 2012
5:47 pm
“Don’t make him put his bullet in his gun.”
It is really just a cap gun, but don’t tell him. He is so proud of it along with his plastic deputy of the blog badge.
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
5:48 pm
rwcole: lil Barry, the racist
rwcole: lil Barry, whose every comment drips with racism
——————————
Link please.
Didn’t think so.
Liar.
Oh well
November 29th, 2012
5:49 pm
Tiberius
Don’t blow a gasket and get kicked off yet another blog.
Wouldn’t want your badge taken away.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
5:52 pm
I see that Oh Well has the liberal Playbook down pat: Can’t play the game so insult and whine.
Oh well
November 29th, 2012
5:54 pm
“Can’t play the game so insult and whine.”
No Tiberius, I am not going to play your little game of dolls and threaten to sue the AJC. Those are your games, so no need to project onto others the things you like to do.
md
November 29th, 2012
5:56 pm
“Haven’t numerous counties around the state increased millage rates to offset some of the decreased home values and subsequent lowered tax assessments?”
I haven’t looked it up, but is that your solution….just keep raising taxes??
Tiberius - pulling the tail of the left AND right
November 29th, 2012
5:58 pm
So, Oh well, which sock puppet are you? Why must you hide behind a different name than you’ve posted with before?
mike
November 29th, 2012
5:58 pm
Did Tiberius threaten to sue the AJC? I haven’t heard about that.
Oh well
November 29th, 2012
5:59 pm
md
I asked a question about the fees, changes to mortage interest and millage rate changes. Those have all taken place in GA. You purposely overlook these things when done by Republicans and only want to cry when it is done by Democrats?
I haven’t said I agreed or didn’t agree with Deal on the issue pertaining to this article. He has made a choice which is clearly his right to do. We will see out it plays out.
Oh well
November 29th, 2012
6:01 pm
Tiberius is obsessed with me and all these so called “sock puppets”.
I blogging fatal attraction. WOW.
One can only hope he finds a friend or two.
Does he do this with other bloggers?
Dusty
November 29th, 2012
6:09 pm
Well, this is the day for poetry (or poetic justice or something).
Here are a few encouraging lines from Shakespeare’s MUCH ADO ABOUT NOTHING That title reminds me of Mz Oh Well so I dedicate it to her
Then sigh not so, but let them go,
And be you blithe and bonny,
Converting all your sounds of woe
Into Hey nonny, nonny.
Yes, and call her Honey, Honey to give her a little sweetness.
Oh well
November 29th, 2012
6:12 pm
Dusty
Good one, little fella.
Now about some originality.
Dusty
November 29th, 2012
6:16 pm
Well, Tiberius, seems your honesty and integrity are not appreciated by one who does not recognize such virtues. Or maybe it is just envy, wishing she had some.
Or maybe she’s just hungry. which reminds me: dinner time!! .
md
November 29th, 2012
6:20 pm
“I asked a question about the fees, changes to mortage interest and millage rate changes. Those have all taken place in GA. You purposely overlook these things when done by Republicans and only want to cry when it is done by Democrats? ”
Not overlooking anything…..both sides over the years got us to where we are, that’s a given. And that isn’t the question……the question was what next? How high do we take taxes or how much other stuff do we cut to keep a balanced budget?
I’m well aware both spouses got to use the credit card, now I want to know what those in favor think we should do next. The budget has to be balanced, no if’s and’s or but’s……so how do we get there after adding the cost for the medicaid expansion?
md
November 29th, 2012
6:23 pm
You see, all I ever hear is “tax the neighbor” or “cut his subsidies” or “cut their program”……it’s very rarely “raise my taxes please”.
Oh well
November 29th, 2012
6:25 pm
md
Deal has made a call and you do not read where I was complaining about it. If you have, post it for me.
I said, we will see how it plays out or did you miss that part?
MarkV
November 29th, 2012
6:27 pm
“cut their program”
Yes, we hear that a lot from the Republicans.
Oh well
November 29th, 2012
6:29 pm
Dusty
Tiberius is shining his badge, he will be back to offer you words of comfort and agreement in due time.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
6:42 pm
What can I say, Dusty? Those with intelligence appreciate my insights. Those without will forever have them unavailable to them.
md
November 29th, 2012
6:43 pm
“Yes, we hear that a lot from the Republicans.”
Except what I heard during the election was to cut everyones program to some degree…..ss, medicare, medicaid, tax deductions, tax rate changes, etc etc…….
There is a difference.
Rafe Hollister, dreading the eventual decline caused by Obamanism
November 29th, 2012
6:43 pm
I think that Oh Well just might be related to Gravy Stain, DNA is a close match.
Oh well
November 29th, 2012
6:46 pm
Insights such as Romney will be President.
Yep, you were one heck of a trail blazer with that one.
Get your badge all shined up?
Tiberius - pulling the tail of the left AND right
November 29th, 2012
6:59 pm
Oh well, your obsession with me is creepy. I don’t swing that way, fella, so take a cold shower,ok?
And if you’d recall correctly, I said that Romney might win by 20 electoral votes or less but that I wouldn’t be surprised if he lost, either.
Rafe Hollister, dreading the eventual decline caused by Obamanism
November 29th, 2012
7:00 pm
Obama is up to his usual tricks in the fiscal crisis talks, moving the goal posts constantly. He is offering no spending cuts, asking the GOP to list what they want in cuts. If the cuts were to come through and the pain began, he would then say, not my fault, these were the GOP asked for cuts.
Today he is asking for revenue now and spending cuts in the future. We have played that game before. I don’t think he really wants any cuts, he just wants to further his class warfare by punishing the rich with more taxes.
I thought that during the campaign he said he was going to be better at working with the GOP and was going to try to be a better leader. He is offering no leadership. The GOP House should have the budget committee put together something they think will work, pass it through the house, and go home and await for Obama to tell Hairy Reed what to put in the Senate bill.
I’m afraid the GOP are going to get the blame no matter what, so why make things easy for Obama. If he takes his vacation without some settlement, he might share a little of the blame. We can only hope.
Oh well
November 29th, 2012
7:02 pm
Tiberius
Obsesses over other blogger s. Who they are, when they blog, how they blog……..
Lonely man.
Good luck finding a friend or two. You really need to try having one for a change
Oh well
November 29th, 2012
7:05 pm
Rafe
Both sides will eventually come to some agreement or another. The far left and far right will cry but it will happen.
Heck, Newt is saying that there isn’t even a fiscal cliff. Didn’t he win the GA primary?
Alter Ego
November 29th, 2012
7:22 pm
The GOP is in an untenable position. Vote for tax increases, antagonize the base; vote against, and be vilified for penalizing the middle class and killing the economy.
The truth is, of course, addressing the real issue, spending, specifically entitlements, just isn’t going to happen with this President. He clearly has no interest in addressing it now or in the future. The ridiculous proposal put forth by Geithner today-in lieu of Obama actually doing his job, or course-clearly illustrates it.
Some GOP members, including Chambliss, are now actually rethinking earlier statements on tax increases. We’ll see. Perhaps calling Obama’s bluff is really the only option on this.
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
7:35 pm
Alter Ego: The GOP is in an untenable position. Vote for tax increases, antagonize the base; vote against, and be vilified for penalizing the middle class and killing the economy.
————————
False. The GOP will pass a bill extending the current tax rates for all tax payers.
It will then be up to the Democrats or Obozo to obstruct it, angering the middle class who will be hit with a significant tax increase.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
7:40 pm
gee Obama wanting revenue first without spending cuts.
Color me shocked.
President Incompetent strikes again.
Numbers-R-US
November 29th, 2012
7:40 pm
If Republicans would just deliver on their 2010 campaign slogan–JOBS–Medicaid, unemployment, deficit spending, etc., wouldn’t even be an issue. Then again, Republicans never deliver anything for we the people.
Alter Ego
November 29th, 2012
7:48 pm
@Lil’ Barry
They could vote to increase tax rates, but without the requisite spending cuts-what’s the point? You’ve gained nothing from the negotiation except to lose credibility-as much as existed, anyway.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
7:51 pm
Numbers, in case you missed it (and you did) it ties two houses of Congress and a president willing to compromise to get things done.
Easy in the Senate and White House we have neither.
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
7:52 pm
Republicans don’t vote to increase tax rates, Alter Ego. They’re going to vote to keep them as they are. The un-American Democrats and Obozo will likely obstruct.
Alter Ego
November 29th, 2012
7:53 pm
@Tiberius
We’ve seen this con before-and it cost Bush Sr. dearly. There’s no sense in falling for it now, but I disagree it stems from incompetence. Obama know exactly what he’s doing, and it doesn’t stem from wanting to have a ‘good faith’ negotiation on this a year from now.
Alter Ego
November 29th, 2012
7:56 pm
@Lil’ Barry
They have, and they will, IF they get the corresponding cuts. Their hand will be forced if they do not get them.
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
7:59 pm
I guess Obozo doesn’t understand what the “fiscal cliff” is. His “solution” to the economic hit the fiscal cliff’s tax increase would cause is….raising taxes.
Obozo: Just as ignorant and un-American as his voters.
Alter Ego
November 29th, 2012
8:04 pm
@Lil’ Barry
Considering what his background was prior to becoming CEO of the world’s largest economy, I wholeheartedly agree.
Tiberius - pulling the tail of the left AND right
November 29th, 2012
8:09 pm
Im a big proponent of cutting out ALL deductions and loopholes and leaving rates where they are – including the home mortgage interest deduction.
Its time this government stops driving behaviors through the tax code.
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
9:21 pm
It’s also time this regime fixes it’s spending problem. Obozo has raised federal spending from $3 trillion per year at the end of Our President Bush’s administration to $3.5 trillion every year.
JamVet
November 29th, 2012
9:32 pm
Obozo: Just as ignorant and un-American as his voters.
Poor Lil BB, in full post-election, unrepentant meltdown mode.
Don’t worry, the sting of yet another stunning failure will only last a few more years. Until the next one…
Lil' Barry Bailout - OBAMAPHONE!!!
November 29th, 2012
9:42 pm
I’ve nothing to be repentant about, JamVet. The American values I defend from scumbag Democrats are timeless and just as correct as they were when the Founding Fathers established this country.
Rafe Hollister, dreading the eventual decline caused by Obamanism
November 29th, 2012
10:33 pm
I think Obama makes it obvious with his offers, that he has no interest in reducing spending; that talk was just campaign rhetoric, as we knew. He either does not realize the fiscal peril we are in or he doesn’t care.
He has proposed new spending, which he claims is just leftover from his “jobs” bill. He used that same “leftover” reason for signing the 2009 appropriation bill that was drowning in earmarks, even though he campaigned against earmarks, pledging not to sign bills with earmarks. He is deceitful, deceptive, and duplicitious in his economic policies.
You dont say
November 29th, 2012
10:54 pm
“Republicans don’t vote to increase taxes”
Facts and history are not kind to you, but blather on.
You dont say
November 29th, 2012
10:55 pm
lil barry
when did you defend anything? You served or serve in a militarty or police capacity?