Numbers for Medicaid expansion don’t add up
Obamacare supporters want to talk numbers when it comes to expanding Medicaid in Georgia. OK, let’s talk numbers:
When they returned last month, Georgia’s legislators already faced a $774 million hole for Medicaid through June 2014. That was before any expansion, and even after assuming renewal of the “bed tax” that brings in some $700 million a year for the program.
Medicaid is already the fastest-growing part of Georgia’s budget. Including PeachCare for kids, it will consume $1 of every $7 in state funds in fiscal 2014, up from $1 per $9 a decade ago.
That increased ratio means almost $616 million will go to Medicaid next year instead of transportation, tax cuts, whatever. State lawmakers can do precious little to arrest the trend.
Still, Obamacare supporters want Medicaid to grow faster.
Pressure is mounting on Nathan Deal to follow the path taken by some other Republican governors — Florida’s Rick Scott and New Jersey’s Chris Christie joined the list in the past eight days — and accept the expansion included in Obamacare.
At first, they note, Washington will pick up the tab. Only after three years will the feds begin reducing their share of the expansion, to 90 percent by 2020. How long that rate sticks, I note, will depend on the generosity — or profligacy — of future Congresses.
But today I want to address two other arguments the expansionists are pushing.
Scott made one argument last week when he announced support for expanding in Florida: “[O]ur options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, or taking federal money to expand Medicaid.
The same claim is made here. We’re going to pay for it, so why not benefit from it?
The arrangement might make sense if it were Washington whose budget was balanced and the state whose finances were in shambles, not the other way around.
The notion taxpayers are already funding the Medicaid expansion requires one to ignore the serially large deficits Washington is running — as well as lawmakers’ reluctance to accept the relatively small cuts of sequestration, due to hit Friday.
Spending that rises while huge deficits persist is not “paid for” in any meaningful sense. Scott, Christie and the others are wrong about the responsible course.
And persist deficits will. Just this month, the Congressional Budget Office projected only two years out of the next 11 in which the deficit will be smaller than the very largest deficit (adjusted for inflation) between 1940 and 2008. That’s probably an optimistic take: CBO’s belief the deficit will soon fall to “only” $430 billion in 2015, before rising in each subsequent year, rests on the hope our sluggish economy is about to achieve and maintain a growth rate not seen in a decade and a half.
Speaking of rosy forecasts, another new argument is that expanding Medicaid in Georgia by $4 billion a year over 10 years (the federal share) would create thousands of jobs and boost our economy by more than $8.1 billion a year, a 103 percent return on “investment.”
A review of federal jobs data and state health expenditures makes me skeptical. Using the most recent figures available for both, and adjusting them for inflation, a five-year average for both Georgia and the entire nation showed there was one direct health-care job for roughly every $200,000 spent on health care annually. That $8.1 billion economic boost assumes one direct health-care job would be created for every $110,000 spent.
It’s possible newer jobs would be created more efficiently. But if the earlier average of $200,000 per job held up, and even if we accept the study’s other multipliers, the return on “investment” may be closer to 20 percent — $4 billion in new spending creating $5 billion of activity — than 103 percent. That’s not worth raising state taxes to fund our share of the cost.
The bases for weighing the Medicaid expansion are whether the state can afford its portion, whether we can count on the feds to deliver on their promises, and whether we should expand Medicaid before reforming it. All three answers remain “No.”
– By Kyle Wingfield
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354 comments Add your comment
md
February 28th, 2013
12:28 pm
From the ajc:
“State officials estimated that the Medicaid expansion would cost Georgia $4.5 billion over 10 years, and the state already is facing a $300 million shortfall this year for the program.”
md
February 28th, 2013
12:31 pm
“It’s no accident that so many of us already are declaring George W. to be the worst president in US history. ”
And I’m sure you will find an equal number of folks that will say the same thing about the current guy to this point.
So what does that do for us?
Stephenson Billings
February 28th, 2013
12:31 pm
“The Great Bush Recession is so bad that it will still be many years before we get back to any sense of “normal”. ”
Ah yes, Bush Derangement Syndrome is still alive and well. Don’t worry, Obama’s “laser like focus” on jobs will cure it…. oh, wait….
JDW
February 28th, 2013
12:31 pm
@Tiberius…”Doesn’t matter if they are murders, accidental, suicides – you name it – they all go into their calculations for our life expectancy numbers and therefore skew our overall rating numbers.”
“Skewed” by facts…thats your argument
I suppose the other data points like infant mortality, cost of care, access to care and obesity are “skewed” too.
Go on back to studying the Constitution so you can provide us with more of your insightful fabrications.
JDW
February 28th, 2013
12:35 pm
@md…”State officials estimated that the Medicaid expansion would cost Georgia $4.5 billion over 10 years, and the state already is facing a $300 million shortfall this year for the program.”
It has already been noted that little bit of fantasy is unsupported by any creditable third party analysis….but lets say that in spite of all odds Repugnican math is right for once…now it costs $1.80 per $1000 in purchases…still an outrageous bargain.
JDW
February 28th, 2013
12:38 pm
@md…”And I’m sure you will find an equal number of folks that will say the same thing about the current guy to this point. ”
Actually no you won’t. But do continue.
md
February 28th, 2013
12:45 pm
“Actually no you won’t. But do continue.”
Too funny, seeing as how those numbers are not available, it’s a bit comical that you declare victory when none is achievable………
SeeLow
February 28th, 2013
12:58 pm
Enter your comments here
JDW
February 28th, 2013
1:07 pm
md…”Too funny, seeing as how those numbers are not available”
It’s not that they aren’t available…they are so available that anyone with an interest should know them. Here’s just one…
http://www.usnews.com/news/articles/2010/07/02/survey-ranks-obama-15th-best-president-bush-among-worst
HDB
February 28th, 2013
1:18 pm
Lil’ Barry Bailout – OBAMAPHONE!!!
February 28th, 2013
7:34 am
“Those on the left think it’s a good idea to borrow money to buy $27 a gallon biofuels for Navy ships, to spend billions on soon-to-fail solar, battery, and auto companies, and to send fighter jets to the Muslim Brotherhood. Don’t pretend that you pretend to care about the debt. Your messiah is busy increasing it just as fast as he can, and you cheerlead for it.”
Lets’s see: taking the advice of the Joint Chiefs to become more energy INDEPENDENT….and taking that advice further so that the nation finally gets on the path advocated by REPUBLICANS in the past….saving American industries to mitigate a recession/depression aren’t good ideas?? Please inform us as to what would be!!
The US is the ONLY MAJOR industrialized nation that doesn’t have universal health care; Theodore Roosevelt advocated for this over a century ago! If this nation had the vision to embrace this ideology, we wouldn’t have to address these issues now! Since we must…..if we can progress towards the single-payer system (yes, the transition would throw some for a loop….), this would start bringing the cost of health care DOWN….along with practicing some PREVENTIVE medicine…starting with diet….
SeeLow
February 28th, 2013
1:22 pm
Currently 40% of all children born in America are born to a parent or parents on Medicaid. Currently 40% of all children born in America are born to a parent or parents on Medicaid. It’s time we fiscal conservatives demand a zero tolerance policy on this affront to taxpayers, a policy which combines comprehensive sex education, easily available low cost or no cost birth control and no hassle access to abortion.
With a federal mandate to abort should the parents forego birth control and education?
md
February 28th, 2013
1:23 pm
“Well if it bothers you that much lets have a sales tax increase to pay for it…based on our GDP of around $418B annually, assuming it doesn’t grow a dollar we will need to bump sales taxs by 6/10,000 of one percent to handle it. That means that if you spend $1000 at the local mall it will cost you an additional 60 cents….”
Sales tax revenue is roughly 6 billion annually jdw, so your math is way off………
JDW
February 28th, 2013
1:29 pm
@md…”Sales tax revenue is roughly 6 billion annually jdw, so your math is way off”
Not so much…problem with our sales taxes is the exemptions…GDP is $418 billion annual and that is what should be taxed. That aside…$1.5 billion over 5 years is $300 million a year. So you would need a 5% bump in the current 7% rate which equals 35 basis points.
md
February 28th, 2013
1:31 pm
“It’s not that they aren’t available…they are so available that anyone with an interest should know them. Here’s just one…”
Another funny…..makes one wonder who they polled.
I doubt seriously that the 47% of the country that just voted for another guy to be the president would do so if they thought Obama was in the top 15……..
md
February 28th, 2013
1:34 pm
“Not so much…problem with our sales taxes is the exemptions…GDP is $418 billion annual and that is what should be taxed. That aside…$1.5 billion over 5 years is $300 million a year. So you would need a 5% bump in the current 7% rate which equals 35 basis points”
Am I surprised you want to tax the crap out of everything? No……which is why you are who you are.
And advocating for just a little 5% bump huh…….you must have missed the part about currently having a 300 million shortfall in the program, you also need to account for that.
Cheesy Grits is gone but not forgotten
February 28th, 2013
1:54 pm
Another funny…..makes one wonder who they polled.
Probably the same conservative polls that showed Romney winning
This is a classic conservative move.
Dont like the results blame the polls.
How did that work out on election day ?
independent thinker
February 28th, 2013
1:55 pm
I see that Mr. Tiberius, a resident spokesperson for the stupid party is questioning the findings of the World Health Org. in their finding that the US no 37 in overall delivery of health care . Apparently cost and efficiency does not matter since the cons designed a socialist system with Reagan’s passage of EMTALA and now we got more socialism with the bed tax..
“”"”"”"”"”"2 years ago, the World Health Organization released the World Health Report 2000. Inside the report there was an ambitious task — to rank the world’s best healthcare systems.
The results became notorious — the US healthcare system came in 15th in overall performance, and first in overall expenditure per capita. That result meant that its overall ranking was 37th.
Click here to see who beat the US >
The results have long been debated, with critics arguing that the data was out-of-date, incomplete, and that factors such as literacy and life expectancy were over-weighted.
So controversial were the results that the WHO declined to rank countries in their World Health Report 2010, but the debate has raged on. In that same year, a report from the Commonwealth Fund ranked seven developed countries on their health care performance — the US came dead last.”"”"”"”"”"
Read more: http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1#ixzz2MDoOC5dm
JDW
February 28th, 2013
1:59 pm
md…”And advocating for just a little 5% bump huh…….you must have missed the part about currently having a 300 million shortfall in the program, you also need to account for that.”
A $300 million shortfall in a program within a $19.2 billion budget is chump change…as Raw Deal knows….see that’s the point the numbers are tiny in relation to the big picture. This whole mess is about partisan politics…the other Repugnicans are taking their medicine, my guess is Raw Deal does as well.
md
February 28th, 2013
1:59 pm
“Dont like the results blame the polls.
How did that work out on election day ?”
As I said, common sense dictates that if 47% of voters voted to change the President then it is highly unlikely they would have him in the top 15 of all time……
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
2:00 pm
A day after Woodward’s claim that a senior White House official had told him he would “regret” writing a column criticizing President Obama’s stance on the sequester, Lanny Davis, a longtime close advisor to President Bill Clinton, told WMAL’s Mornings on the Mall Thursday he had received similar threats for newspaper columns he had written about Obama in the Washington Times. – WMAL
What’s that word again? Oh yeah, fascism.
Rafe Hollister preparing for an Obamanist America
February 28th, 2013
2:01 pm
Well, we are #37, while Cuba is much higher, and still fighting a 19th Century like Cholera outbreak. If they are so dang progressive, you would think they could eliminate a disease caused by poor sanitation.
WHO about as objective as MSNBC!
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
2:02 pm
Only 6% Rate News Media As Very Trustworthy
What’s that word again? Oh yeah, tools.
Cheesy Grits is gone but not forgotten
February 28th, 2013
2:03 pm
As I said, common sense dictates that if 47% of voters voted to change the President then it is highly unlikely they would have him in the top 15 of all time……
47 percent is actually pretty low for a challenger. Kerry got 48 percent in 2004
Romney got pretty much destroyed. The exact opposite of the way Fox News ( lol ) and the conservative media saw it.
Of course they are wrong almost every day
Difference is that day somebody was keeping score.
New York Times nailed it. They had it exactly right.
Funny how that worked out huh
Cheesy Grits is gone but not forgotten
February 28th, 2013
2:08 pm
Every single first world country has universal healthcare.
They all spend much less and get better results than we do.
Duh.
Of course the knuckle dragging conservatives will complain kick and scream all the way.
But Obamacare is here to stay.
Its over.
If a Republican bubba governor wont do his job then the federal government will
Just like in the South during segregation etc.
Ever notice how the red states are the biggest takers and have the lowest education levels ???
Coincidence…..hardly.
Cheesy Grits is gone but not forgotten
February 28th, 2013
2:12 pm
At a time when the Republican Party’s image is at a historic low, 62% of the public says the GOP is out of touch with the American people, 56% think it is not open to change and 52% say the party is too extreme…
Id say those numbers are a lot worse than Obama’s opponent getting 47 percent of the vote.
Kyle Wingfield
February 28th, 2013
2:12 pm
I don’t have time to respond to everyone today, but I did want to take issue with yuze’s 11:02 since it appears intended as an attack on my character, and certainly my credibility. It reads, in part:
“It sounds like you are reading from a list of discredited talking points provided you by Governor Deal’s office. For example, Deal consistently has stated the states share of expansion would be more than $4 billion over 10 years while even the most conservative non-partisan analysis concludes it will be about $2 billion. That is more than a math error. It is a starting point which is a falsehood.”
In fact, the very study which expansionists are using to trumpet the economic boost of $8.1B that a bigger Medicaid would bring says the state cost would be $4.5B from 2014 to 2023. For comparison’s sake, the cost from 2014 to 2019 comes to about $1.7B, which is fairly close to the $1.5B JDW cited in his 10:49 mention of another (older, I’d note) study.
If you take a moment to think about it, the fact that the state would be paying 10 percent of the cost in four of those 10 years — importantly, the last four of those 10 years, when costs presumably would be highest — means it makes perfect sense for the state’s cost to be fairly close to 10 percent. It’s even more logical when you consider that the first three years, when the feds are supposed to pay 100 percent, are the years when enrollment is projected to be ramping up — and thus 100 percent of the cost in those years actually equals less in total dollars than in the latter years when the federal match is 90-95 percent.
Now, as noted in the study, the point some expansionists have made is that some of the $4.5B in state costs will materialize anyway, because some people who currently are eligible for Medicaid but aren’t enrolled in it are expected to join the problem due to the so-called woodwork effect (as in, people will come out of the woodwork to sign up for the program). But how many of those people will actually do so if Medicaid isn’t expanded to others? In other words, will the woodwork effect be so large if there’s no expansion — and thus less publicity about joining the program? I tend to think not, though I think reasonable people can disagree about that.
In any case, for the purposes of this discussion it does not matter which portion of the increased cost would come from the expansion and which portion from the woodwork effect, because the economic arguments in favor of expansion tend to include the $40B federal match figure that covers both parts, not just the part that owes to the expansion. The expansionists want to have it both ways: The state cost is really only the part due to expansion, but look at all the money we’d get from both parts! That’s a disingenuous argument. OTOH, in my piece I stuck with one basis to make my arguments. The $40B figure is the one that tends to get the most attention, so I went with that basis (that is, the one with both expansion and woodwork effect).
But then, all this information is included in the link in the OP about the alleged benefits of expanding Medicaid. I’ll repeat it here for a third time in this comment. If you want to have this discussion, I suggest you yuzeyurmouse to click the link and yuzeyureyes to read it before you try to yuzeyurkeyboard to question my integrity.
Kyle Wingfield
February 28th, 2013
2:19 pm
Rafe @ 2:01: One of the WHO’s criteria for ranking countries’ health-care systems is whether they’re publicly funded. It is a left-wing bias built into a supposedly objective study. So, we should not be surprised that the U.S. ranks behind a number of countries with socialized medicine.
There are other problems with the study, such as the fact its life expectancy numbers aren’t adjusted for things like murders and fatal injuries that have nothing to do with health care. Not that Cheesy wants to let the facts get in the way of a long-time favorite talking point.
Politico
February 28th, 2013
2:26 pm
Kyle
Don’t know much about WHO, so I am not defending or implicating them and their rankings.
With that said are they not using the same criteria you state in the second paragraph for all countries or just as a bias against the US?
Don't Tread
February 28th, 2013
2:28 pm
Kyle @ 2:12
yuzeyereyes, yuzeyermouse, yuzeyerkeyboard….too funny
I needed that.
Politico
February 28th, 2013
2:33 pm
Kyle
2nd paragraph of your 2:19 post.
Sorry about that.
Kyle Wingfield
February 28th, 2013
2:36 pm
Politico: Same criteria for all. The point is, what do those things have to do with the quality of health care?
Kyle Wingfield
February 28th, 2013
2:36 pm
Put another way, would you rather be operated on in Cuba just because lots of people get shot in Chicago?
Jefferson
February 28th, 2013
2:37 pm
Look where the GOP is, a back dirt road to nowhere…
Reasonable people can come to reasonable conclusions under reasonable conditions, unless you are a republican.
Rings truer everyday.
Numbers-R-US
February 28th, 2013
2:43 pm
Kyle continues to use fluff-n-stuff as his basis for his arguments.
Politico
February 28th, 2013
2:54 pm
Kyle
Nice spin. Again, I don’t know much about WHO and certainly not how these rankings coming about. They could be as biased as you say, but of course you are coming from a biased narrative that wouldn’t give them any credit unless it met your narrative.
Truth probably is in between somewhere but really not worthy of any investigation and more time. Was just asking because your statements about WHO were as slanted as you claim them to be.
But as always, thanks for the reply.
Rafe Hollister preparing for an Obamanist America
February 28th, 2013
3:03 pm
Kyle, thanks for the info, I knew it was biased, just did not know the means used to get the info they desired. Anything from the UN or their associates is usually incredibly anti US, gotta keep the anti-American potentates, despots, and dictators happy.
independent thinker
February 28th, 2013
3:06 pm
If I understand the cons on this blog, it is okay if Georgia puts a cap on Medicaid expenditures and covered services and limit services to the poor and illegals (as required by Saint Ronald’s program). However it is definitely not okay if the state of Massachusetts which has universal health care puts any limits on services and expenditures. Are these the same cons who said it is not okay for Obama to trim $716 billion from Medicare for private profits of insurers under George W’s Medicare Advantage plan. Granny sure needs that free gym membership to survive, but its okay with the same cons if her co-pay skyrocket under Medicare Advantage so an insurer can profit and pay big bonuses?
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:10 pm
only 12,174.
“Only”
Meanwhile in countries where guns are illegal the number is closer to 12.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:11 pm
Kyle, thanks for the info, I knew it was biased,
Everything is biased to Cons
Unless they agree with it.
Its how they get through the day.
Kyle Wingfield
February 28th, 2013
3:14 pm
Politico: To be clear, the only bias I’m accusing WHO of has to do with including public funding of health as a criterion for rating countries. That’s an obvious ideological bias on WHO’s part, as that’s a subjective criterion for a supposedly objective exercise. Or do you really believe favoring public funding is objective on WHO’s part?
The other elements aren’t necessarily bias, they just have the effect of making the U.S. look worse than it really is.
Ray
February 28th, 2013
3:15 pm
Jconservation says: “Actually there is nothing wrong with the current health care delivery system in Georgia and the nation. If one gets sick and has no insurance, the system absorbs the costs by increased fees to those companies and individuals holding private insurance plans.”
This is an ignorant view of what actually happens in the real world. There are no guarantees a hospital is going to give you the care you need. They don’t provide chemotherapy, organ transplants in emergency rooms, and they rarely even set bones. Forget about hip replacements that one needs to return to gainful employment. If you don’t have the dough you can easily be left to die, or be crippled for life. Too many people die of cancer or organ failures during the six month waiting period to get on Medicaid.
We view life as precious, or we don’t. Is it priority number one?
Cutty
February 28th, 2013
3:15 pm
Integrity- A firm adherence to a code of especially moral or artistic values.
Kyle think his integrity is being questioned because he believes that health insurance shouldn’t be expanded to the hundreds of thousands of uninsured Georgians. I think you’re giving a good reason why it should be questioned. Ironic that you constantly rag on the federal government led by a democrat, but nary a peep about the clown car at the Gold dome that can’t even get the car tax right.
Kyle Wingfield
February 28th, 2013
3:16 pm
Cheesy @ 3:10: So, what does that have to do with the quality of health care in the U.S.? Or are you just going to change the subject to gun control now that your favorite statistic’s flaws have been aired?
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:16 pm
So, we should not be surprised that the U.S. ranks behind a number of countries with socialized medicine. ,/i>
Not just a number Kyle.
ALL OF THEM.
They ALL have lower rates of heart disease. Diabetes. Infant Mortality rates are generally lower.
All while spending half as much. They believe in an ounce of prevention you know.
Its cheaper than the pound of cure later.
Of course you can sit there smugly claiming its the sun that goes around the earth and not the other way around.
History will not be kind to your point of view.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:17 pm
Or are you just going to change the subject to gun control now that your favorite statistic’s flaws have been aired?
No we can stay right here.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:18 pm
So, we should not be surprised that the U.S. ranks behind a number of countries with socialized medicine.
Not just a number Kyle.
ALL OF THEM.
They ALL have lower rates of heart disease. Diabetes. Infant Mortality rates are generally lower.
All while spending half as much. They believe in an ounce of prevention you know.
Its cheaper than the pound of cure later.
Of course you can sit there smugly claiming its the sun that goes around the earth and not the other way around.
History will not be kind to your point of view.
Kyle Wingfield
February 28th, 2013
3:20 pm
Cutty: And it’s ironic that your snark about my integrity requires you to ignore the part of yuze’s statement that I said wrongly questioned my integrity, and about which I wrote several hundred words, and change the subject.
Btw, if you think I never criticize Georgia’s Republicans, you must skip all the pieces I write about ethics reform, the problems with last year’s tax reform, their unwillingness to increase school choice, etc. You might prefer that I criticize them from the left, rather than the right, but all those pieces hardly constitute “nary a peep.”
Kyle Wingfield
February 28th, 2013
3:21 pm
Cheesy: And as I pointed out, ranking behind all of them is to be expected when one of the criteria is that the country have socialized medicine. It’s called rigging the data.
JDW
February 28th, 2013
3:23 pm
I see lots of folks don’t like the WHO or thier message but it is not just the WHO other rankings from The Commonwealth Fund and OECD also pan the US system. Then there is just the plain fact…we spend WAYYYYYYYYYYYYYYYY more than anyone else….
•Pharmaceutical prices in U.S. >>> 60% higher than five large European countries
•Hospital services in U.S. >>> 60% higher than OECD average (11 countries)
•Normal delivery in U.S. >>> more than 50% higher than in France or Canada
•Caesarean section in U.S. >>> 30% higher than France, over 50% higher than Canada
•Hip replacement >>> 45% higher than in France or Canada
•Knee replacement in U.S. >>> 20% higher than France, 50% higher than Canada
for results like these:
Life Expectency—#25
Infant Mortality–#29
Cancer Deaths–#11
% Population Obese–#1 (thats a bad thing)
http://www.oecd-ilibrary.org/social-issues-migration-health/health-key-tables-from-oecd_20758480
Bottom line it doesn’t matter who does the research…we are lacking…just look at the results.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:23 pm
Infant Mortality Rate
Canada 4.5 per 1,000
USA 6.9 per 1,000
But im sure that’s just biased because of all the shootings in Chicago.