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
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:24 pm
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.
Softballs all.
If those articles were a boxer they would call you old pillowhands.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:26 pm
Bottom line it doesn’t matter who does the research…we are lacking…just look at the results.
No dont you know.
Those results are rigged.
And the polling was skewed during this last election.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:31 pm
Kyle Wingfield
Presidential prediction: The candidate who defies history and wins will be . . .
My gut tells me Romney picks up North Carolina, Florida, Virginia, Colorado and at least one of Michigan/Ohio/Pennsylvania — and will become the 45th president of the United States.
That is the problem with these people JDW. They think with their gut and Brownie is doing a heckuva job.
They love America like a two year old loves Mommy. Anybody says anything bad about Mommy is a bad person. Love it or leave it !!
Us liberals love America in an adult way. We understand its not always pretty. But the good outweighs the bad and we can strive to improve.
It really comes down to that.
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
3:34 pm
Hot damn! A lb finally told the truth!
Too many people die of cancer or organ failures during the six month waiting period to get on Medicaid.
No kidding, how do you think medicaid for everyone is going to work out?
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
3:35 pm
cheesy – No, it’s the crack babies in Chicago.
duh
Kyle Wingfield
February 28th, 2013
3:39 pm
JDW @ 3:23: Re: Infant mortality, the CDC explains:
“The primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births. In 2004, 1 in 8 infants born in the United States were born preterm, compared with 1 in 18 in Ireland and Finland. Preterm infants have much higher rates of death or disability than infants born at 37 weeks of gestation or more (2-4, 6), so the United States’ higher percentage of preterm births has a large effect on infant mortality rates. If the United States had the same gestational age distribution of births as Sweden, the U.S. infant mortality rate (excluding births at less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births, a 33% decline. These data suggest that preterm birth prevention is crucial to lowering the U.S. infant mortality rate.”
And why do we have such a high rate of preterm babies? As this article in not-exactly-right-wing Slate explains:
“[M]odern medicine isn’t good at preventing prematurity—just the opposite. Better and more affordable medical care actually has worsened the rate of prematurity, and likely the rate of infant mortality, by making fertility treatment widespread.”
So, do you want to raise our infant mortality rate if it means making it harder to get fertility treatment? Look on the bright side, it’d probably bring down our spending on health care, too! We’d shoot way up in the statistics!
But would anyone think our health care system was actually better?
Cutty
February 28th, 2013
3:43 pm
You praised an ethics bill that hadn’t passed both houses and is bound to have loopholes, simply because the republicans did ’something’. Say what you want about Bookman, but at least he hits dems (Dekalb School Board) when its warranted. You wrote that softball piece about Chip Rogers getting a cush state job, knowing your take wouldve completely different had Rogers been a dem.
And you talk about someone attempting to impugn your integrity in a snarky way.
Kyle Wingfield
February 28th, 2013
3:44 pm
Cheesy: How you get from an incorrect prediction to “they love America like a two year old loves Mommy” might make sense to you, but it’s laughable guff to me.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:46 pm
“The primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births. In 2004, 1 in 8 infants born in the United States were born preterm, compared with 1 in 18 in Ireland and Finland. Preterm infants have much higher rates of death or disability than infants born at 37 weeks of gestation or more (2-4, 6), so the United States’ higher percentage of preterm births has a large effect on infant mortality rates. If the United States had the same gestational age distribution of births as Sweden, the U.S. infant mortality rate (excluding births at less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births, a 33% decline. These data suggest that preterm birth prevention is crucial to lowering the U.S. infant mortality rate.”
This is spin of the first degree.
Sounds like rigged data to me.
Kyle Wingfield
February 28th, 2013
3:52 pm
Cutty: Go read the comments about that piece about Rogers. You’re in the minority if you thought I was going easy on him.
As for the ethics bill, as I’ve told others: The bill’s not perfect, but if I got as much of what I wanted in a tax-reform bill (or, on the federal level, entitlement reform), I’d be happy. I still hope to see the Senate improve it further.
Let’s face it: You’re never going to be happy as long as I don’t scream about Republicans from the top of my lungs, every day. Actually, I could have stopped that sentence at: “You’re never going to be happy.” I could write “Cutty is swell,” and you’d complain I didn’t call you “awesome.”
The irony is that you’re far more consistent about damning me than I am about praising Republicans. You just can’t see it.
Kyle Wingfield
February 28th, 2013
3:52 pm
Cheesy @ 3:46: So now the CDC is spinning to make the conservative case?
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:54 pm
Cheesy: How you get from an incorrect prediction to “they love America like a two year old loves Mommy” might make sense to you, but it’s laughable guff to me.
Maybe so. But I see it played out almost every day right here.
Cheesy Grits is gone but not forgotten
February 28th, 2013
3:58 pm
Cheesy @ 3:46: So now the CDC is spinning to make the conservative case?
So now the WHO is spinning to meet a liberal case ?
Cutty: Go read the comments about that piece about Rogers. You’re in the minority if you thought I was going easy on him.
Count me in the Minority
At age 44, Rogers is too young to write off as a potential comeback candidate one day. But for now, like that first GOP-led era, Rogers’ legacy will be a mixed bag: Some big early successes, followed by less accomplishment even as the GOP’s majorities grew larger, and more questions and infighting than answers toward the end.
That is tough stuff.
md
February 28th, 2013
3:58 pm
“They ALL have lower rates of heart disease. Diabetes. Infant Mortality rates are generally lower. ”
And if one doesn’t know why then one doesn’t want to know why……and it has nothing to do with healthcare.
Choices is a hint……
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:00 pm
And if one doesn’t know why then one doesn’t want to know why……and it has nothing to do with healthcare.
Choices is a hint……
Like 2 year old loves mommy category.
Numbers-R-US
February 28th, 2013
4:01 pm
And I just can’t wait to see Kyle’s more detailed analysis of all that is wrong with “The Economic Impact of Medicaid Expansion in Georgia,” by William S. Custer, Ph.D., and why we should accept his most thorough and scientific approach to pulling numbers out of one’s arse instead.
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
4:01 pm
No kidding, obozo just told all of America to do without 2% of it’s pay by stopping the medicare payroll tax holiday but when told when government has to do without 2% he acts like it’s a death sentence.
md
February 28th, 2013
4:05 pm
Infant mortality just by the numbers? Not a good comparison:
“No one denies the problem. Our infant mortality rate is double that of Japan or Sweden. But we live different lives, on average, than people in those places. We suffer more obesity (about 10 times as much as the Japanese), and we have more births to teenagers (seven times more than the Swedes). Nearly 40 percent of American babies are born to unwed mothers.
Factors like these are linked to low birth weight in babies, which is a dangerous thing. In a 2007 study for the National Bureau of Economic Research, economists June O’Neill and Dave O’Neill noted that “a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity” are connected “to the low birth weight and preterm births that underlie the infant death syndrome.”"
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:10 pm
No kidding, obozo just told all of America to do without 2% of it’s pay by stopping the medicare payroll tax holiday
Somebody has to pay for all those bombs dropped on Iraq.
They weren’t free.
Bush cut taxes during wartime, unprecedented in US History.
Worst President Ever.
md
February 28th, 2013
4:10 pm
“Like 2 year old loves mommy category.”
Typical, don’t debate the issue or supply counter information, just attack the person.
Not to worry Cheesy, I didn’t really expect anything more……
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:11 pm
Not to worry Cheesy, I didn’t really expect anything more……
Im not.
JDW
February 28th, 2013
4:12 pm
@Kyle…”If the United States had the same gestational age distribution of births as Sweden, the U.S. infant mortality rate (excluding births at less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births, a 33% decline.”
Yahooooooo….that moves us from 29 to 23. How would you like to spin the rest or should we just declare that there must be other factors and we are “still #1″
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:13 pm
Seems to me Southern Conservative Governors are famous for their stands against the big bad federal government.
Oh yeah last one was when little black girls wanted to go to school.
Perish the thought lordy !!
JDW
February 28th, 2013
4:17 pm
@md…”In a 2007 study for the National Bureau of Economic Research, economists June O’Neill and Dave O’Neill noted that “a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity” are connected “to the low birth weight and preterm births that underlie the infant death syndrome.””
Now that is part of your problem, you think those factors are unrelated to the health care system when they are DIRECTLY related. A heath care system that is doing it’s job helps address those problems through access to care and education. Ours does not.
md
February 28th, 2013
4:25 pm
“Now that is part of your problem, you think those factors are unrelated to the health care system when they are DIRECTLY related. A heath care system that is doing it’s job helps address those problems through access to care and education. Ours does not.”
Sorry jdw, I don’t buy that uneducated mumbo jumbo…..we’ve been spending millions of dollars on smoking ads and folks still choose to smoke, and one has to be awful uninformed to not know that eating at Mickey D’s every day or living off twinkies is unhealthy and will make one fat……
I think you just like to make excuses for peoples choices……….
gerald eaton
February 28th, 2013
4:26 pm
the first step to reforming medicare would be repealing obamacare and replacing all the money they stole from medicare budget
md
February 28th, 2013
4:27 pm
Oh, I left out substance abuse……are you trying to say we have that many people in this country that have no clue that doing drugs can be bad for them?
Really?
JDW
February 28th, 2013
4:27 pm
@Cheesy…”It really comes down to that.”
I think you got them! The other problem that most Americans never set foot outside of the US and want to believe that things are just better here. By and large people that I know that travel or live abroad tend to be more liberal, Kyle being a notable exception.
independent thinker
February 28th, 2013
4:28 pm
We have two severely conservative presiden (Reagan and W.)t pass unfunded socialized health care plans (EMTALA and Medicare Part D) that forces the insured and private payers to pay as much as $1.49 for one tylenol pill and $5.00 for a gauze pad but the World Health Organization is biased when it says this unfunded covert socialism in our health care system is inefficient. And now we have a severely conservative journalist who claims WHO is biased because they favor socialized medicine. Is there something odd about this picture?
JDW
February 28th, 2013
4:30 pm
@md…”we’ve been spending millions of dollars on smoking ads and folks still choose to smoke”
Big difference between smoking ads and real live smoking cessation programs. Lets take the UK for example smoking cessation, substance abuse treatment and obesity treatment…covered…here not so much. Not to mention that annual checkup where the doc reads you the riot act.
It is about services not ads.
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:35 pm
Oh, I left out substance abuse……are you trying to say we have that many people in this country that have no clue that doing drugs can be bad for them?
Are you saying other countries dont have a drug problem
Are you that naive?
fair and balanced
February 28th, 2013
4:38 pm
Kyle is right , the WHO report is biased – the US was actually no. 1 in one category of overallhealth care-cost. What does that have to do with mortality rates?
“”"”"”"”"”"”.WHO researchers looked at, according to the group itself, “overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).”
The U.S. did come in first place in the responsiveness category, but didn’t do as well in other categories, such as who pays the costs and level of health, which was based on disability-adjusted life expectancy. Bialik also notes that the U.S. ranked much higher – 15th on “overall goal attainment”– before WHO factored in health care spending per capita. As we’ve written before, the U.S. spends much more per capita than other nations; in fact, it captured the No. 1 spot from WHO in that category. This cost-conscious measure dropped the U.S. to 37th.”"”"”"”"”"”"”"”"”"”
http://www.factcheck.org/2009/10/37th-in-health-performance/
Why be concerned about overall cost???- just borrow from the Chinese.
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
4:38 pm
Lets take the UK for example smoking cessation, substance abuse treatment and obesity treatment…covered…here not so much.
uh huh
More people in the UK died from alcohol-related deaths in 2010 than in 2009 with the figure rising by 126 to 8,790 from 8,664. However, this increase was limited to males with the number of deaths rising from 5,690 in 2009 to 5,865 in 2010.
Tiberius - pulling the tail of the left AND right
February 28th, 2013
4:38 pm
Always nice to see JDW and Cheesy ignore the facts about the WHO ratings when presented to them.
So please, enlighten us how auto accident, suicides and murders are related to our health care system.
This should be hilarious.
And nice catch by Kyle on their bias towards government funding in their ratings.
There are lies, damned lies, and most anything a liberal posts.
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:40 pm
I think you got them! The other problem that most Americans never set foot outside of the US and want to believe that things are just better here.
Exactly right and to take it a step further most of the yahoos here ill bet have never even left the South.
They dont understand its a big world out there and they live in a tiny bubble.
Of course Republicans exploit this readily.
Ive been to Canada. Ive been to England.
The people there aren’t Socialists or stupid.
They like universal healthcare and wouldn’t give it up for anything.
Tiberius - pulling the tail of the left AND right
February 28th, 2013
4:41 pm
Oh, and do keep bringing up their rating system everytime this topic is discussed.
Makes you look all the more pathetic when you knowingly post false information.
JDW
February 28th, 2013
4:42 pm
@Aseop…”More people in the UK died from alcohol-related deaths in 2010 than in 2009 with the figure rising by 126 to 8,790 from 8,664. However, this increase was limited to males with the number of deaths rising from 5,690 in 2009 to 5,865 in 2010.”
UK Life Expectancy…80.05 years
US Life Expectancy…78.37
They still live longer, have lower infant mortality, aren’t as fat and have health care for all.
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:43 pm
Always nice to see JDW and Cheesy ignore the facts about the WHO ratings when presented to them.
Its nice to see you too.
So gullible and easily led
Sad really.
Tiberius - pulling the tail of the left AND right
February 28th, 2013
4:46 pm
Unfair and unbalanced, our cost is directly related to us paying our doctors like the supremely talented people they are, and not like government drones.
JDW
February 28th, 2013
4:47 pm
@Tiberius…”There are lies, damned lies, and most anything a liberal posts”
I see our resident self appointed Constitutional authority has crawled out. I am guessing that in Tiberiusville all those stats like life expectancy, infant mortality, cancer deaths just aren’t that important. Guess you missed that little bit. See those numbers they are called supporting evidence. Try it sometime and you might hold your own in a debate…as long as it doesn’t entail Constitutional Budget requirements.
wallbanger
February 28th, 2013
4:48 pm
What ticks me off about this, is that if you are on Medicaid you get free dental coverage. If you are paying your Medicare at about $224 a month, and your supplemental for another $250, you can’t get dental coverage. Why is that that indigents and illegals teeth get better treatment from our government than the teeth of the responsible?
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:51 pm
UK Life Expectancy…80.05 years
US Life Expectancy…78.37
They still live longer, have lower infant mortality, aren’t as fat and have health care for all.
They will never get that through their head.
They love America like 2 year old loves Mommy And we are saying something bad about Mommy ( America ) So we must be wrong
Guess what dummies. We aren’t the best at everything.
What do you really think the ENTIRE CIVILIZED WORLD that has universal healthcare.
They are all wrong and only America is right and NUMBER 1
This is what im talking about
Your wrong get over it.
They will gladly let Republicans protect tax loopholes for the rich so people like Romney pay 14 percent.
They will squeal with glee as the pentagon wastes 100 billion dollars on a jet nobody wants or a laser hovertank nobody needs.
But just try and help poor people get healthcare
The knives come out quick
Its sad.
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
4:52 pm
Over that time, average lifespan increased among all groups. In men, it rose from 75.3 years to 76.2 for whites and from 68.8 to 70.8 for blacks. The greater increase among black men meant that the gap shrank from a difference of 6.5 years of expected life to 5.4 years. The shift appears to be because fewer African Americans are dying of AIDS and heart disease.
Care to go any farther with this?
Cheesy Grits is gone but not forgotten
February 28th, 2013
4:53 pm
Unfair and unbalanced, our cost is directly related to us paying our doctors like the supremely talented people they are, and not like government drones.
Two year old loves mommy
Tiberius - pulling the tail of the left AND right
February 28th, 2013
4:53 pm
As usual, JDW guesses wrong.
Par for the course.
But ignoring of the flaw in their rating, especially after it was pointed out for the hundredths time, shows an all too typical lack of intelligence on the part of these liberals.
JDW
February 28th, 2013
4:53 pm
@Tiberius…”our cost is directly related to us paying our doctors like the supremely talented people they are, and not like government drones.”
O’ Dear…always looking out for that 1% aren’t you.
“No other developed country pays doctors this much. In 2004, general practitioners in the U.S. were estimated to earn double — measured by purchasing power — the median for 21 nations in the Organization for Economic Cooperation and Development; for specialists, the difference was almost threefold….What explains the higher pay in the U.S.? Muscular lobbying may help. Over the past 15 years, the American Medical Association has spent $278 million lobbying the federal government — more than any other group save the U.S. Chamber of Commerce and General Electric Co. That puts doctors ahead of the largest oil and defense companies in spending to influence policy makers. ”
http://www.bloomberg.com/news/2012-12-12/to-cut-health-care-costs-pay-doctors-less.html
Maybe a little free market reality would help them out….of course doctor payments only represent 1/5 of medical spending. We could pay them ZERO and would still spend the most in the world for the same substandard results.
Aesop's Fables and other Lib Economic Theories
February 28th, 2013
4:55 pm
Any idiot can compare immigration rates to the US versus other countries to see where it is really a better place to live, well, make that “most” idiots.
Tiberius - pulling the tail of the left AND right
February 28th, 2013
4:57 pm
Thanks for proving my point, JDW.
We do pay our doctors more.
And lobbying doesn’t provide for pay rates, Sonny.
JDW
February 28th, 2013
4:59 pm
@Aseop….”Care to go any farther with this?”
Take as much rope as you want…the US ranks at the bottom of the developed world in life expectancy and it’s not because they don’t have black people.
Tiberius - pulling the tail of the left AND right
February 28th, 2013
5:00 pm
The only time government sets pay rates is for government programs.
NOT private practice rates. which make up the majority of Heath care dollars here.
Nice try at the lie, JDW.