Medicaid bed tax: Misnamed, unsustainable, divisive — and apparently irresistible
For an up-close view of the brokenness in our political and health-care systems, and especially of the way they make one another worse rather than better, you could hardly do better than watch the debate over Georgia’s hospital bed tax. It has it all.
First, there’s Medicaid. It’s the program states can’t live with — no matter how much money they pour into it one year, the cost only rises the next, in part because states have limited control over it — and can’t live without — the federal dollars involved are too numerous to pass up.
Medicaid funding is an inherent contradiction in fiscal responsibility: In order to balance their budgets, states look for ever more ways to get ever more money from a federal government that is ever more in debt. Meanwhile, even as Medicaid funding rises, Medicaid patients have ever more trouble finding doctors who will accept them because of the program’s low reimbursement rates.
So, Medicaid is so broken as to somehow render politicians incapable of anything but pouring more money into it. Which, I suppose, means it meets the threshold for being a true government program.
There’s the tax itself. Politicians like to call it a “hospital provider fee,” even though a “fee” is something the state charges for a service it provides. The only service provided here is the state’s role in asking the feds to dole out another half-billion dollars a year in matching funds, roughly $2 for every $1 raised by the tax, er, “fee.”
Those matching funds flow back to the very same hospitals that pay the tax. That makes it more akin to an extremely high-return investment, the kind of consistently high return one normally associates with an investment scam. (Given how unsustainable this entire arrangement is, that sounds about right.) It’s as if the hospitals are charging U.S. taxpayers a usurious interest rate for the pleasure of holding their money awhile. And yet, despite all this, the hospitals still end up losing money on many Medicaid patients.
Then there’s the way in which Georgia legislators have approached the tax this year compared to its initial approval in 2010. Three years ago, the tax was the source of much drama toward the end of the session. And while I’m hard-pressed to name a legislator who lost re-election after voting for the tax in 2010, the impact on the Senate wound up being truly historic.
Passing the tax involved a great deal of arm-twisting, including the loss of committee chairmanships for some senators who opposed the tax. The bullying was one of the reasons GOP senators cited the most after the 2010 elections when they staged a coup against their fellow Republican, Lt. Gov. Casey Cagle, and opted for governance by consensus within their caucus. That schism shaped the past two sessions, with fallout that continues today: Disaffection with leadership of the Senate by the Senate led to wholesale changes for this year’s session.
Having learned their lesson, GOP leaders don’t want to force legislators to walk that plank again. So they’re asking them to let someone else walk the plank.
This year’s bed-tax bill would delegate authority for levying the bed tax to the nine-member board of the Department of Community Health. It would be four years — that’s two legislative cycles and one gubernatorial race from now — before lawmakers had to act on the tax again.
Finally, there’s the near-certainty that, after jumping through hoops to renew this tax without being seen renewing it, Georgia Republicans will campaign during the next electoral cycle on the notions of cutting spending and refusing to raise taxes. They’ll probably add a few barbs about federal spending for good measure.
And, if history is our guide, almost all of them will be re-elected two Novembers from now — right about the same time Georgians of various loyalties will begin demanding their favorite football teams replace this coach or that one because he’s made a mess of his team and can’t seem to fix it.
– By Kyle Wingfield
Tell us what you think about the site
Customer Care »
Vacation stops, manage subscriptions and more
AJC Services
Sections
Other Editions
Visitor Agreement | Privacy Statement
© 2013 The Atlanta Journal-Constitution
97 comments Add your comment
md
January 17th, 2013
1:41 pm
“Please define the ideological question in what is effective in treating cancer, diabetes, heart disease …”
Cost. There are differing ideologies on condums, you think it won’t be any different when it comes to major procedures and treatments and the costs involved?
md
January 17th, 2013
1:44 pm
“This is a stupid argument to have in our legislature, when our governor turned down BILLIONS in aid from the Federal government to expand Medicaid and help hospitals cover their costs.”
And the factoid that it will cost the state more money to take the money. Come on folks expand your thought process a bit.
The Fed does not cover 100% of the costs and the program is forever and a day. Then add to that the additional costs of expanding the delivery system. Then add in the fact that many states are balanced budget states and are already cutting everything they can to meet their budgets.
THINK people……….
Georgia
January 17th, 2013
1:45 pm
Goodbye, my fine friend. I’ll see you in the round tables on Sunday morning. Dont you dare not believe that you will get there. You’ve got that “it” factor. you know, the x factor. you do. You are a very young george will. We need the conservative check on liberal excesses. Your voice will always sell. Just don’t write nothing. Pay for writers. Okay? Let your interns write your blog and you’ll be fine. Not kidding here. You want to make it or not? Stop writing. Just talk on camera. Love you.
Georgia
January 17th, 2013
1:46 pm
D’OH!!
Dusty
January 17th, 2013
1:46 pm
MarkV,
You are saying things like YOU see them with your predilection of seeing all things in liberal government as good.
You also know that Obama gave the impression that EVERYBODY, even those without money, would have healthcare. That is know as FREE.
Please google Obama health plan and read under the section listed as Subsidies. “Individuals and families who do not qualify for Medicaid or SCHIP will receive an income related federal subsidy.”
IN other words, if you can’t get free care one way, the government will give you the money another way to pay for your health needs. Still known as FREE.given to you by the broke but generous ObamaCare. Dependent liberal voters knew what he meant and voted for him.
Georgia
January 17th, 2013
1:47 pm
Pay no attention to the last two comments behind the curtain….oh dear, I’m not even a good wizard…..
md
January 17th, 2013
1:49 pm
TD, what do you mean “repay”. The fed doesn’t have it to begin with, so folks like Lynnie must be missing the fact that the fed will get it from us and then turn around and give it back and ask for a big thank you as if they are doing us a favor………….
Cletus
January 17th, 2013
1:55 pm
“…Medicaid patients have ever more trouble finding doctors who will accept them because of the program’s low reimbursement rates.”
Forget Medicaid, the bigger problem is MediCARE. Seniors are basically forced into the Medicare system, and at the point in life when they require the most medical help there are fewer and fewer MDs who are participating in the program because of the low reimbursement rates.
md
January 17th, 2013
2:02 pm
“…Medicaid patients have ever more trouble finding doctors who will accept them because of the program’s low reimbursement rates.”
And what many fail to understand is that these rates are a major factor in rising healthcare costs. Our benevolent masters will tell the masses that they are doing a great job of holding down the costs and point to these rates (and use it to justify single payer), what they fail to say is that doctors/hospitals/nursing homes have to make up for those lower rates by charging everyone else more.
Dusty
January 17th, 2013
2:13 pm
Hey, Governor Deal just presented a BALANCED BUDGET for the state of Georgia.. I like his closing statement. “Together we will run the state rather than the lives of our citizens.
Too bad the present federal administration can’t do and say the same thing for our country. .
MarkV
January 17th, 2013
2:14 pm
md @ 1:41 pm
MarkV: “Please define the ideological question in what is effective in treating cancer, diabetes, heart disease …”
md: “Cost. There are differing ideologies on condums, you think it won’t be any different when it comes to major procedures and treatments and the costs involved?”
This issue neatly demonstrates not just the extremism, but a total mindlessness of the conservative fringe. So a group of professionals advising on the effectiveness of medical treatment cannot be trusted on ideological grounds, because they may take cost into consideration. So what is the alternative? Leave it up to the insurance companies, who would make a decision on the grounds of what? How about cost? Or the medical providers, who might make a decision based on the profit based on the number and choice of tests and procedures?
And what about that group of professionals, when the administration changes and a different party comes into power. Will the “ideological grounds” change?
And why not extend this “thinking” to everything else. Should we have an FDA to test drugs a food? Why, they might make decisions based on ideological grounds, such as costs. Let’s get rid of it.
What about NASA? They might decide which planet to land on based on ideological grounds, such as cost. What the heck, let’s get rid of the Defense Department! They might make military decision based on ideology! The choice is endless!
MarkV
January 17th, 2013
2:21 pm
Dusty @ 1:46 pm
“You also know that Obama gave the impression that EVERYBODY, even those without money, would have healthcare. That is know as FREE.”
That is known as “Free” only either to people who do not think, or as a shortcut we all use. When we get a “free coupon,” it is not free. Any “free offer” is not really free, but we all understand the meaning.
“Please google Obama health plan and read under the section listed as Subsidies. “Individuals and families who do not qualify for Medicaid or SCHIP will receive an income related federal subsidy.”
I do not need to google, I am quite aware of it. What is your point? You are against any subsidy? Really? Think about it before you answer.
Lil' Barry Bailout - OBAMAPHONE!!!
January 17th, 2013
2:42 pm
If you think folks making $100k are the moochers, and that federal Medicaid dollars are conjured from thin air, then you’re part of the reason our economy sucks and we have a liberal fascist in our White House.
Lil' Barry Bailout - OBAMAPHONE!!!
January 17th, 2013
2:44 pm
Subsidies should only be available to the severely mentally or physically handicapped. Everyone else gets what they work for.
MarkV
January 17th, 2013
2:51 pm
Dusty @ 1:46 pm
“IN other words, if you can’t get free care one way, the government will give you the money another way to pay for your health needs. “
To help you with your answer about subsidies, and specifically, this subsidy for health insurance, let’s be clear about the choices:
If people do not have money for the health care insurance, and cannot pay for a treatment, there are the following alternatives:
1. Let those people suffer or die.
2. Let them use the medical facilities anyway. Somebody will still have to pay for the treatment, which will be – another form of subsidy.
Your choice.
Lil' Barry Bailout - OBAMAPHONE!!!
January 17th, 2013
3:01 pm
Choice 3: big-hearted liberals contribute their own money to health care charities.
That’ll never happen. Liberals are too greedy to help.
Georgia
January 17th, 2013
3:37 pm
Corporations are people that cant get sick.
USC-69
January 17th, 2013
3:51 pm
The bed tax will, of course, increase the cost of hospitalization for those Georgians who require in-patient care. It will raise insurance premiums for all of us. We will all be paying Federal taxes that will be dispersed to those states agreeing to expand their Medicaid Services. Therefore, if you get sick in Georgia, you have to pay for Medicaid services for Georgians through the Bed Tax and also pay for Medicaid services in California, New York, etc. Jan Brewer, Governor of Arizona, and a vigorous Obama hater, finally realized that to turn away 100 percent coverage of Medicaid in her state was foolish. Governor Deal, not known as a clever or successful businessman, thinks that he can sabotage Obamacare by refusing to accept the return of federal taxes. He doesn’t care that Georgia children will be denied healthcare or that Georgia will continue to be seen as both mean and uneducated.
JJohnson
January 17th, 2013
3:53 pm
You guys are missing the point – most Medicaid receipients in Georgia are children (about two-thirds). The rest are either dual-eligibles with Medicare coverage, a pregnant mom (and coverage ends a few weeks after the baby is born) or someone with Social Security. You can’t just be poor and qualify for Medicaid. So when you are calling some moochers, keep in mind you’re talking about someone disabled, someone old and disabled, a pregnant woman or a kid. That’s all.
Georgia
January 17th, 2013
3:54 pm
See? The Martians in H.G.Well’s “War of the Worlds” need not have given up, if only they attacked in the person of their corporations, (like the Chinese and Saudis are doing).
Lets shift the discussion to our own protection, shall we? People with vulnerable immune systems? Hello? I know you’re out there.
Dusty
January 17th, 2013
4:01 pm
MarkV
Only you, could try to change the meaning of the word FREE. If you don’t know, I won’t try to tell you.
Lil Barry is correct. A third choice is to support charity hospitals as run by charity. Many hospitals WERE once run by charity but were taken over by government. or corporations.
My denomination supports (manages) a hospital in Palestine. among other charitable endeavors. I believe st Judes (USA) is another example of a charitable medical center..
Perhaps we should turn over hospitals to those who really care about all people including the poor. The Salvation Army is not a hospital but it really takes care of the poor and helpless. There are innumerable such organizations not run by government.
Try and turn your mind from the premise that only government can answer big questions. With your thinking, the government should do everything even when it does not have the money. So you would keep raising taxes on citizens to pay for everything for everybody, not just the poor.
Don’t you see where this is heading as fast as possible? It is communism which has already been proven to fail.. Money earned goes to the government who makes all decisions. Your blindness is inexcusable.
md
January 17th, 2013
4:06 pm
Let me put the word “cost” into perspective for Mark in the terms of ideology.
I mentioned condums for a reason, as to one that is a proponent of personal responsibility, an individual will go get their own condum (birth control) if they CHOOSE to participate in recreational sex. Much like buying the gas and the boat if one CHOOSES that form of recreation.
Those that believe in the collective will vote for others to pay for those choices…….as they just did.
So cost in the broader discussion of healthcare means one side will make decisions based on choices and affordability while the other side will base decisions on providing whatever they feel (operative word as emotions play a big role) is necessary and worry about raising taxes when the time comes………….
THAT is the cost based on ideology.
MarkV
January 17th, 2013
4:16 pm
Dusty @ 4:01 pm
“Only you, could try to change the meaning of the word FREE. If you don’t know, I won’t try to tell you.”
Dusty,
No, it is you who refuses to admit that we use that word in different meanings. When you go to a hotel and they tell you that “breakfast is free,” how do you understand it? One way is that you do not have to pay for it. But you still pay for it, or for part of it, with all other guests, by paying the hotel bills.
The same is true with “free health care.” If you go to a country with universal health care, people might tell you that when they go to a doctor or hospital, it is “free.” Are you so arrogant to think that they are so stupid that they believe that nobody pays for the treatment? It is just their way of saying, “we all pay by paying taxes to cover all expenses, so that when we go to the doctor or hospital, we do not have to pay, it becomes ‘free.’”
So, don’t be so condescending, it is not becoming.
Dusty
January 17th, 2013
4:24 pm
MarkV
Condescension is better than calling someone a liar. That is your way of being rude, crude and unattractive and you do it FREEly…
MarkV
January 17th, 2013
4:29 pm
Dusty @4:01 pm
Dusty,
As I wrote before, I wish you had more aptitude for political arguments.
“A third choice is to support charity hospitals as run by charity. Many hospitals WERE once run by charity but were taken over by government. or corporations. “
Are you really trying to make me laugh? Charity? Who is charity? Some animate objects? No, it means people, and the bills are still paid by other people that those being treated. So you are just substituting one group of people paying for the treatment for another group of people paying for the treatment, or for all people. It reminds me of you infamous earlier argument that hospitals are budgeting for the treatment of people who cannot pay. As if those budgets were given to the hospitals from somewhere above, rather than paid by other people – subsidized. Incredible! Of course, once you start taking you cue from Lil’ Barry, reason does not have a chance. I
“Don’t you see where this is heading as fast as possible? It is communism which has already been proven to fail.. Money earned goes to the government who makes all decisions. Your blindness is inexcusable.”
Another laugh. When someone starts arguing with communism, all rationality is lost. Just for fun, where has communism “been proven to fail?” Or to put it differently, where has communism ever been? Let’s see the extent of your knowledge of what you are talking about.
Michael H. Smith
January 17th, 2013
4:30 pm
Only one problem with replacing a bad group of politicians, Kyle – Electing a worse group of politicians!
Anyway, if you want to look at health-care remember the rules change – probably forever more – next year. We shall all be comrades then and health-care by – “gub’ment” – committee will become standard fare.
So long Representative Republic. Hello Social(ist) Democracy.
MarkV
January 17th, 2013
4:31 pm
Dusty @ 4:24 pm
“Condescension is better than calling someone a liar. That is your way of being rude, crude and unattractive and you do it FREEly…”
Quote me calling someone a liar.
Michael H. Smith
January 17th, 2013
4:33 pm
Grab a shovel or roll your britches legs up there Dusty.
I mean, it’s getting deep, real deep!
MarkV
January 17th, 2013
4:58 pm
md @ 4:06 pm
“So cost in the broader discussion of healthcare means one side will make decisions based on choices and affordability while the other side will base decisions on providing whatever they feel (operative word as emotions play a big role) is necessary and worry about raising taxes when the time comes………….”
I for one, when I go to the doctor or a hospital and will need a treatment, will hope that the decisions will be made based on what is necessary to make me well.
As for the accusation of emotions playing a big role, it is not only insulting, it is too inane to take
seriously. The subject was a group of professionals making general recommendation. Emotions toward whom? Mankind?
Lil' Barry Bailout - OBAMAPHONE!!!
January 17th, 2013
4:59 pm
USC-69: Governor Deal, not known as a clever or successful businessman, thinks that he can sabotage Obamacare by refusing to accept the return of federal taxes.
————————-
Perhaps the governor is doing what he thinks is right. Real Americans believe in smaller government. The Medicare expansion is the opposite of that.
indigo
January 17th, 2013
5:01 pm
At last!!!
Something Georgia can do!!!
http://www.ajc.com/news/news/georgia-improves-in-bed-bug-ranking/nTzJh/
ODD OWL
January 17th, 2013
5:22 pm
When ObamaCare goes into effect in 2014, the feds will combine medicare, medicaid, dental and eye care into one all encompassing ObamaCare medical program… All greedy doctors will be forced to accept the fees that ObamaCare pays or they can take down their shingle and move to Australia…
md
January 17th, 2013
5:33 pm
“As for the accusation of emotions playing a big role, it is not only insulting, it is too inane to take
seriously. The subject was a group of professionals making general recommendation. Emotions toward whom? Mankind?”
I don’t care if you think it’s insulting, it’s the way it is.
Did you not see the latest hypocrisy with Jay Carney issueing a statement about the NRA using Obama’s kids? While at the same time Obama trots out 4 kids during his presser on gun control…..that my friend is emotion.
Birth control pills……pure emotion. Made by a panel of experts??
You are only fooling yourself.
md
January 17th, 2013
5:36 pm
” All greedy doctors will be forced to accept the fees that ObamaCare pays or they can take down their shingle and move to Australia…”
And as time goes by we will get what we pay for……oh joy, Disgruntled Doctors to join all the other disgruntled Federal employees. If you really want that sourpuss down at the dmv cutting in to you, get ready and have fun.
nathan's political arsonist
January 17th, 2013
5:40 pm
weak, spinless legislators and governor to dodge accountability on this one. they should all be unelected on November 4, 2014
Tiberius - pulling the tail of the left AND right
January 17th, 2013
5:42 pm
Odd owl once again displays a shocking ignorance of how government and existing laws work.
Suffice to say, nothing like he describes is in obamacare.
nathan's political arsonist
January 17th, 2013
5:43 pm
the arizona ding bat finally saw the light. ga politicians will let ga citizens suffer and die first
MarkV
January 17th, 2013
5:47 pm
md @ 5:33 pm
md,
The intellectual dishonesty of people who make arguments you do is staggering. When it suits them, they accuse those the government panel of professionals in ObamaCare, whose stated role is to lower healthcare expenses by recommending effective procedures, of not making decisions based on choices and affordability, but rather “on providing whatever they feel is necessary … and worry about raising taxes when the time comes.” The same people have made arguments, when it suited them in the campaign, that the purpose of that government panel was “health rationing.”
Dusty
January 17th, 2013
5:51 pm
MarkV 4:31
So you want to know when you called someone a liar..
Suppose you check back to this morning at 11:28. There you referred to one of my comments as an example of blatant lies. You might call that an indirect way of calling someone a liar
There’s the info you wanted, unimportant as it is.
.
Just Say No to New Taxes
January 17th, 2013
5:54 pm
This is the plan RoytheCrookBarnyard paid an out of state law firm 100 million dollars for back in the last years of his reign. It is a way of recycling Federal Medicaid dollars as State matching dollars, and the Feds had already told Georgia how to design the tax, saying it had to be a broad based tax on all hospital beds, not just the ones occupied by Medicaid deadbeats. Do you just hat lawyers?
md
January 17th, 2013
5:58 pm
Mark…what world do you live in?
Just about every appointed position in our gov’t comes with ideology attached.
Start with the Supreme Court…..and move to the Cabinet positions……and then on down the line.
What’s staggering is for you to expect others to believe that it will not come into play with Obamacare…….as I said, only fooling yourself.
Dusty
January 17th, 2013
6:09 pm
OddOwl @5:22
Yeah, send all the American doctors to Australia. Take the finest medical care in the world and send it to Australia. You seem to think that would be a smart move.
Why don’t you spend over twenty years learning how to care for human beings, take an oath to do so, and then get paid like you work at McDonalds?
The nurse’s aids will run ObamaCare and take care of you when you “stroke out” over taxes taking 50% of your income. Oh, you do pay taxes, don’t you?
md
January 17th, 2013
6:12 pm
And Mark, after all your complaining you have yet to explain why birth control pills are not an emotional decision. Are there not far cheaper alternatives that one may choose to use if one wants to have recreational sex and not get pregnant? (and we aren’t talking about the medicinal need here)
ODD OWL
January 17th, 2013
6:25 pm
@ Tiberious ==> Politically unaffiliated ignoramous…
MarkV
January 17th, 2013
6:38 pm
Dusty @5:51 pm
Sorry, Dusty, but I would have expected from you a better understanding of the language.
I call someone a liar only if he/she lies habitually. It would be ridiculous to call someone a liar because of one or a few statements. Most of us, who are not saints (and perhaps even those), are guilty of a lie sometime during their lives. That is not a reason for calling them liars; otherwise almost all of us would have to be called liars.
It is the same as with, for instance, calling a statement stupid, and confuse that with calling a person stupid. Again, most of us say a stupid thing now and then – I know I do – but that is not a reason to think that person stupid, or call him/her that.
Also, I find it insincere to use a euphemism in place of the word like a lie. You wrote that Obama promised people free healthcare. What do you call that? Truth? If you do, you must know when he did that, and you can quote him. Can you?
Lil' Barry Bailout - OBAMAPHONE!!!
January 17th, 2013
6:39 pm
Moron New York Democrats shoot themselves in the foot:
NEW YORK (WABC) — It appears someone forgot to exempt police officers from the ban of ammunition clips with more than 7 bullets in New York State’s new gun control law.
It’s a big oversight that apparently happened in the haste by the Cuomo Administration to get a tough package of gun-control measures signed into law.
Kyle Wingfield
January 17th, 2013
6:47 pm
All right, immediate commenting is over for tonight.