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
You dont say
November 29th, 2012
10:56 pm
barry
when did you serve and defend anything? Running your mouth and playing blog bully doesn’t count
catlady
November 30th, 2012
6:52 am
Well, Kyle, I do think “we” will benefit because “our” hospital costs won’t be upped to pay for those who are unable to pay. My neighbor, for instance, who has little income (by choice–not willing to work, but has skills–who goes to the hospital and claims indigency, leaving the bill to be made up by me, who works, pays insurance premiums, deductables, and copays. At age 58, weighing 350+ and having no regular, preventative care, he will be making more and more of these hospital trips yet stoutly (heheh) proclaims he will NOT buy insurance–they will have to fine him.
catlady
November 30th, 2012
6:53 am
After all, what’s $84 per year?
stands for decibels
November 30th, 2012
7:26 am
Link please.
Didn’t think so.
Liar.
Lil’ Barry, your current screen name alone is a racist dogwhistle.
I don’t expect you to own it, I don’t expect you to so much as acknowledge that rational people would see it as such, but it is what it is.
So, there’s your link.
CC
November 30th, 2012
7:31 am
We made it ’til 7:26 before anyone typed “racist” this morning! Hope this isn’t indicative of the way the day will go. That word means absolutely nothing anymore, and says much more about the user than the person it is used against.
stands for decibels
November 30th, 2012
7:35 am
CC @ 7.31, I was addressing Lil’ Barry’s denial upthread. t’werent me who used that term, originally.
Sorry if you find typical online conversation to be upsetting.
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
8:04 am
Last House race brings 2012 election to an end
How many seats did the Cons lose in the House and Senate?
Ouuuuuuch
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
8:05 am
That word means absolutely nothing anymore
but you just can’t stop using it…..
JDW
November 30th, 2012
8:11 am
@Tiberius….”And JDW,your ignorance about what caused the housing bubble and why it burst knows no bounds”
:roll” So enlighten us “o great one”. Impart your supreme wisdom. Why it must have been excess gubmint spending. Didn’t have anything to do with lax oversight, reduced standards, greed and easy money AKA as the environment created by Duhbya.
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
8:14 am
It’s also time this regime fixes it’s spending problem.
I believe on Nov 6th the AMERICAN PEOPLE told you to STFU.
But you just cant…….
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
8:15 am
The American values I defend…were made irrelevant on Nov 6th.
mwuahahahahahahahahahaha. LOSERS!
stands for decibels
November 30th, 2012
8:23 am
for the record:
That word means absolutely nothing anymore
When used as a noun I tend to agree. 20+ years ago right wingers on the AM radio circuit started using it to describe pretty much any well-known black person they didn’t happen to like. I think it gave them some kind of special forbidden-fruit kind of feeling inside, but that’s just irresponsible speculation on my part.
Anyway, whatever power it might have had as a simple insulting pejorative is largely gone now from overuse.
stands for decibels
November 30th, 2012
8:35 am
[T]ime this regime fixes it’s spending problem.
The only “spending problem” we have at the moment is that we’re not spending enough on infrastructure, health insurance, and renewable energy. Stuff we need anyway, which will put more people to work and ultimately increase our GDP as we emerge from this ongoing self-inflicted economic wound.
And if I’m wrong, you can always drop your stupid austerity bomb, if you ever manage to win a majority of American voters again.
CC
November 30th, 2012
8:41 am
“Anyway, whatever power it might have had as a simple insulting pejorative is largely gone now from overuse.”
EXACTLY my point . . .
“Sorry if you find typical online conversation to be upsetting.”
Nothing written here, or anywhere else for that matter, upsets me.
Lil' Barry Bailout - OBAMAPHONE!!!
November 30th, 2012
8:47 am
stands for decibels
November 30th, 2012
7:26 am
————
So you have nothing either?
That’s what we thought.
Liar.
Lil' Barry Bailout - OBAMAPHONE!!!
November 30th, 2012
8:51 am
Finn: I believe on Nov 6th the parasite Obozo receptacles pretended to have some sort of authority to tell Real Americans to STFU.
———–
Fixed.
And good luck with that, liberal fascists.
stands for decibels
November 30th, 2012
8:52 am
Liar.
…and our Little Barry lives up to his name by name-calling.
Don’t ever change, babe. It is ever so entertaining.
stands for decibels
November 30th, 2012
8:57 am
Nothing written here, or anywhere else for that matter, upsets me.
CC, thank you for the clarification. I suspect you and I might get along ok, then.
(although I suspect I could get nitpicky and find *something* in writing that might theoretically upset you, like, say, a foreclosure notice due to some bank’s robosigning error…)
/drive-by
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
9:03 am
Look, you Cons lost big time on Nov 6th. No one is interested in your points of view, your opinions, your ideals, your goals, or what gives you the wet dreams.
the AMERICAN PEOPLE don’t care. Understand?
Didn’t think so…..
Glenn Beck
November 30th, 2012
9:06 am
Lil Barry is defending America again. Must have put two more made in China US flag magnets on his car to go with the one he already had.
Lee Greenwood and LLB saving America.
You tough little guy.
JamVet
November 30th, 2012
9:17 am
Lil BB could be the poster boy for why the GOP just got trounced again.
Everybody and everything but him is the “problem”…
independent thinker
November 30th, 2012
9:19 am
Unlike the biased political statement of the Cato Institute that Kyle cites, here are some facts from health care professionals who have a huge finacial stake in the dillemma of unreimbursed medical care due to “Romneycare”’s unfunded mandate:
“”"”"”"”"”"The per capita health costs of the roughly 46 million uninsured in 2004 were $1,629 compared to $2,975 for the insured. Since EMTALA by definition makes hospital EDs responsible for providing treatment regardless of ability to pay, and provides for no specific funding mechanism, who is footing the bill for the majority of these costs, which go uncompensated? In short, everyone. Physicians lose a portion of their annual income to uncompensated care; those insured through their employer help to foot the bill as cost-shifting drives up their medical bills and insurance premiums; and taxpayers more broadly pay a portion of the bill as publicly funded hospitals levy greater taxes to offset uncompensated charity care. This isn’t to say that the cost burden on the uninsured isn’t significant as well. Full-time uninsured individuals who lack health insurance for the entire year pay for 35% of the cost of care out-of-pocket. Part-time uninsured individuals pay for roughly 25% of their care out-of-pocket, while the figure for insured individuals hovers around 20% annually.[[#_ftn2|[2]]] Nearly 85% of the cost of uncompensated care is funded through federal, state, and local government, mostly through the form of Medicaid disproportionate share hospital (DSH) payments. However, since physicians’ uncompensated care is not generally subsidized through government dollars, an estimated $5 billion in uncompensated care costs are still absorbed annually by providing physicians.[[#_ftn3|[3]]]
Hospitals charge that EMTALA patient requirements have led to increases in uncompensated care, since they can’t obtain an individual’s insurance information before examining them where the law applies, a charge which the evidence backs up. This increase also corresponds largely with a rise in the number of uninsured and a decrease in physician access more generally over the past two decades.
A figure which reflects EMTALA’s impact on emergency department utilization is that the amount of uncompensated care delivered by nonfederal community hospitals grew from 6.1 billion dollars in 1983, before passage of the law, to 40.7 billion dollars in 2004.[[#_ftn4|[4]]] According to a May 2003 American Medical Association study, the average emergency physician provided $138,300 of EMTALA-related care yearly, with a third of these physicians providing over 30 hours of such care per week. Physicians in other specialties provide, on average, about six hours a week of care mandated by EMTALA, and on average incurred about $25,000 of EMTALA-related bad debt in 2001.[[#_ftn5|[5]]] Community health clinics and free clinics, two of the only viable alternatives to EDs for the uninsured, are also disproportionately overcrowded and lacking funding. “”"”"”"”"”"”"”"”"”"”"
http://healthcarefinance.wikispaces.com/EMTALA
Of course if you are just looking to air your grievances towards the Dems and Obama and could care less that Obamacare has now been supported by all three branches of the government and the US voters, keep spewing out nonsensical garbage . The usual suspects on here probaly have no idea what EMTALA is or why Romneycare was created in Mass. to solve a problem that the cons here will not even address but they will jump if the NRA or right to life people want to ram legislation through the Georgia legislature.
No wonder Obama got a mandate.
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
9:30 am
The usual suspects on here probaly have no idea what EMTALA is or why Romneycare was created
If Fox News doesn’t explain the EMTALA you can bet your undies the “usual suspects” on here haven’t a clue.
CC
November 30th, 2012
9:46 am
“No one is interested in your points of view, your opinions, your ideals, your goals, or what gives you the wet dreams.”
Exactly, Finn, no one is interested in yours . . .
CC
November 30th, 2012
9:48 am
“If Fox News doesn’t explain the EMTALA you can bet your undies the “usual suspects” on here haven’t a clue.”
. . . and if MSNBC ceases broadcasting, you will disappear!
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
9:55 am
A CC quote from October 30th:
it will confirm what I have thought all along: Obama is on a fast-track for White House departure!
mwuahahahahaha
Hey, CC, which teams you think will win on Sunday? I need to know who to bet against.
mwuahahahahahahaa
Dusty
November 30th, 2012
10:30 am
Well, looks like all the ugly Americans got up early and descended on this blog with insults, fabrications and name calling. And most of them turned out to be loud mouth LIBERALS.
I do believe the next big book will be” UGLY AMERICANS turn on their country”. Maybe Woodward will write it. There’s plenty of material right at the AJC with the blogs of Galloway, Bookman and now the invaders of Kyle’s blog.
No wonder Lil Barry raises the flag of patriotism. It seems to be mostlhy missing here. Not to mention civility and consideration.
Our founders gave us freedom of speech. Now our own citizens try to ruin it.. They live in the greatest country in the world and they try to change it to shanty-town socialism. I really don’t understand the dullard shift from democracy to dirt. .
Glenn Beck
November 30th, 2012
10:32 am
What was confimed is that CC buys whatever Fox pundits, radio pundits and right wing websites sale him.
Nothing more. Nothing less
Finn McCool (The System isn't Broken; It's Fixed)
November 30th, 2012
10:35 am
loud mouth LIBERALS.
Thy name is Finn.
Glenn Beck
November 30th, 2012
10:37 am
Dusty
Yes you were up before the rooster crowed and will be the poster child of the book you mentioned.
Congrats. It is all you. All day and you know it which is good that are comfortable in admitting It.
Way to go Dust
breckenridge
November 30th, 2012
10:40 am
The nation, and specifically the republican party, need to address the fact that 40% of kids born in this country are born to parents or a single parent on Medicaid. Every American has the right to have children but not at taxpayers expense. That’s why the GOP, being the party of fiscal responsibility, needs to promote birth control and abortion, and take a zero-tolerance policy on paying to raise more children that aren’t theirs. That’s not to say that we are not a nation of benevolent people; we are, and we will gladly help those already here. But we simply cannot allow the irresponsible creation of even more taxpayer liabilities.
MarkV
November 30th, 2012
10:43 am
“No wonder Lil Barry raises the flag of patriotism. It seems to be mostlhy missing here. Not to mention civility and consideration.”
Decrying lack of “civility and consideration” in the same paragraph with a praise of Lil Barry can only be explained by selective blindness.
Rafe Hollister, dreading the eventual decline caused by Obamanism
November 30th, 2012
10:50 am
Finn:
Look, you Cons lost big time on Nov 6th. No one is interested in your points of view, your opinions, your ideals, your goals, or what gives you the wet dreams.
MarkV
“No wonder Lil Barry raises the flag of patriotism. It seems to be mostlhy missing here. Not to mention civility and consideration.”
I will let one of your own leftwing socialist wantabee’s explain this to you two.
Hillary Clinton Apr 2003
I am sick and tired of people who say that if you debate and you disagree with this administration, somehow you’re not patriotic, and we should stand up and say, “We are Americans and we have a right to debate and disagree with any administration!”
CC
November 30th, 2012
10:51 am
“What was confimed is that CC buys whatever Fox pundits, radio pundits and right wing websites sale him.”
It confirms nothing except that you choose to assign untrue attributes to someone who disagrees with your warped perception of facts an realty, and I’m not speaking of election outcomes.
Dusty
November 30th, 2012
10:55 am
Glenn Beck
Thank you but I am not a liberal Democrat. Also I don’t get up with the chickens.
Keep trying. You may get something right yet.
MarkV
November 30th, 2012
10:57 am
“They live in the greatest country in the world and they try to change it to shanty-town socialism. “
One must wonder what Dusty knows about “shanty-town socialism,” or any socialism for that matter. Why don’t you tell us, Dusty, when and where did you see that “shanty-town socialism?”
Dusty
November 30th, 2012
11:00 am
Dear MarkV
My vision is quite clear. Thanks for your concern.
Have you had your tunnel vision corrected yet?
MarkV
November 30th, 2012
11:02 am
Rafe Hollister @10:50
If you want to respond to something, you have to learn to comprehend what has been written.
MarkV
November 30th, 2012
11:04 am
Dear Dusty,
You inability to respond factually has been noted.
Dusty
November 30th, 2012
11:10 am
Dear MarkV
Your inability to recognize facts has also been noted.
I depart to the world of shops and credit cards. Wish me luck!!
Lil' Barry Bailout - OBAMAPHONE!!!
November 30th, 2012
11:12 am
Still eating for “stands for decibels” or any of the others crying “racist” to provide any links or quotes to back up their poutrage.
Liars.
Lil' Barry Bailout - OBAMAPHONE!!!
November 30th, 2012
11:14 am
“Waiting”, not “eating”…darn spellcheck.
stands for decibels: Pathetic liar.
CC
November 30th, 2012
11:28 am
“You inability to respond factually has been noted.”
The fact that you’re incapable of original thought and a lame excuse for a wordsmith has been noted.
MarkV
November 30th, 2012
11:44 am
CC @ 11:28 am
“The fact that you’re incapable of original thought and a lame excuse for a wordsmith has been noted.”
How original. You should immortalize it in your personal book of your “witty” quotations.
independent thinker
November 30th, 2012
12:12 pm
Breckenridge–
“”"”"”"”"”he nation, and specifically the republican party, need to address the fact that 40% of kids born in this country are born to parents or a single parent on Medicaid. Every American has the right to have children but not at taxpayers expense. That’s why the GOP, being the party of fiscal responsibility, needs to promote birth control and abortion, and take a zero-tolerance policy on paying to raise more children that aren’t theirs. That’s not to say that we are not a nation of benevolent people; we are, and we will gladly help those already here. But we simply cannot allow the irresponsible creation of even more taxpayer liabilities.”"”"”"”"”"”"”"”"”"”"”"
Very well said – however there are a few problems with your attempt to get the
GOP and Congress to resolve the high birth rate of government subsidized children:
1. Calling women sluts who demand free birth control;
2. Threatening to put ultrasounds up the vaginas of any women who wants an abortion;
3.Having the GOP darling and some loon from Minn. pass 39 anti-abortion bills redefining rape in the House;
4. GOP sponsored earned income credits paying the poor money based on no. of children they can claim are part of their household;
5.Trashing Planned Parenthood as a GOP policy and
6. Enacting numerous government programs that subsidize women if they have no male in the household and basing subsidies on the number of children.
7. Refusal of the Congress to adequately fund job training programs and make them a condition of welfare, Section 8 and other subsidies
As to Medicaid – would you rather that the hospitals absorb the cost of medical care?
ld
November 30th, 2012
8:37 pm
We, Georgians, need to avoid expanding federal programs that will be unfunded or underfunded by the federal government but controlled by federal rules and, instead, seek to find ways to use the health departments that already exist in every county in the state to help the poorest of Georgia’s poor, especially the children, and seek matching (?% to each ?%) of federal funds without strings attached for that purpose.
The statehouse could look at medical tort reform in Georgia in connection with the expanded use of the health departments as referring authority — IF a licensed medical professional accepts patients referred by the health department on a sliding fee basis within a system that Georgia can adjust to its own needs, then, with some consumer protections put in place, those physicians could be protected by state law from most or even all litigation, at least all except the most inexcusable (such as being under the influence or criminal conduct).
To protect consumers, medical professionals would need to be required to follow specific procedures designed to work toward identifying and correcting problems rather than the current norm of trying to cover up problems to avoid litigation and thereby begin to rid their profession of the incompetent, criminal and/or repeatedly careless.
Carly EngageAmerica
December 4th, 2012
1:11 pm
The reelection of President Obama provides a clear passage for health care reform. However, this massive top-down reform comes with major structural flaws.
The ACA promises what it cannot deliver. The reform increases demand while the supply of health care services remains stagnant.