Expanded Medicaid is too good a deal to refuse

Posted by AzBlueMeanie:

The Neoconfederate "states' rights" Tenthers who are Tea-Publican Governors and legislators, like we have here in Arizona, are threatening not to participate in the "expanded Medicaid" provisions of the Affordable Care Act on ideological grounds. "We hate Obama! We hate the federal guvmint!"

They also object to covering more people under expanded Medicaid on the ground that it will cost taxpayers too much money. This is code for access to medical care is a privilege, not a right, and should be rationed according to the ability to pay. Medical care is only for those who can afford it. If you can't afford it, the GOP healthcare plan is simple: "Let them die!" How this comports with their alleged Christianity, I don't have a clue.

The first three years of expanded Medicaid is 100% covered by the federal government. Thereafter, the state share would gradually increase to around 10%. Suzy Khimm at Ezra Klein's WonkBlog has this important factoid. The truth about Medicaid’s cost to states, in three charts:

What would happen to state budgets if all states went ahead with the Medicaid expansion? The Congressional Budget Office says that it would increase state spending on the program by $73 billion by 2022—the equivalent of a “2.8 percent increase in what states would have spent on Medicaid from 2014 to 2022 in the absence of health reform,” the Center on Budget and Policy Priorities explained.

That said, this is an aggregate look at the expansion: the budgetary impact on states will vary considerably, depending on how far a state has gone already to cover its low-income residents. The Urban Institute has a state-by-state breakdown of the impact, available here. (.pdf).

As Khimm points out:

“Despite beliefs that Medicaid is claiming a larger share of state budgets, the share of state general fund dollars for Medicaid has remained fairly stable increasing from 14.4% in 1995 to 15.8% in 2010 at the same time general fund spending for education increased from 33.4% to 35.3%,” Kaiser says.

The most recent uptick is largely due to the recession and the accompanying drop in state revenues, as well as the expiration of federal stimulus money for Medicaid.

In a perverse sense of fairness, it is the Neoconfederate "states' rights" rebelious red states opposed to "Obamacare" that stand to benefit the most from the expanded Medicaid provisions. Ezra Klein explains, The Affordable Care Act’s big giveaway to stingy red states:

The deal the federal government is offering states on Medicaid is too good to refuse. And that’s particularly true for the red states.

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Everyone earning up to 133 percent of the poverty line, which is less than $15,000 for an individual, gets Medicaid. And the way it does that is by telling states the feds will cover 100 percent of the difference between wherever the state is now and where the law wants them to go for the first three years, and 90 percent after 2020.

To get a sense of what an incredibly, astonishingly, unbelievably good deal that is, consider this: The federal government currently pays 57 percent of Medicaid’s costs. States pay the rest. And every state thinks that a sufficiently good deal to participate.

But, somewhat perversely, the states that get the best deal under the law are states like Texas, which have stingy Medicaid programs right now, and where the federal government is thus going to pick up the bill for insuring millions and millions of people.

* * *

That is to say, the less you’ve been doing on Medicaid so far, the more the federal government will pay on your behalf going forward. And that gets to an irony of the health-care law: Red states have, in general, done less than blue states to cover their residents, so they’re going to get a sweeter deal under the terms of the Affordable Care Act.

In May 2010, the Kaiser Family Foundation ran the numbers for all 50 states. Of the top 10 beneficiaries — which I’m defining as the states that get the highest percentage of eligible adults moved to insurance by the Medicaid expansion — nine of them are states that went for John McCain in 2008. Of the 10 states that get the least help from the Medicaid expansion, eight of them went for Barack Obama. As Alec MacGillis wrote in The Post back in May 2009, “The Democrats’ No. 1 domestic policy initiative, universal health care, is likely to help red America at the expense of blue.”

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[G]overnors will also have to answer to non-Republican voters who don’t want their state missing out on billions in federal dollars, and to the hospitals in their state who have to treat uninsured patients that end up in their emergency rooms, and the insured voters who end up paying for their uninsured brethren.

As to Ezra's last point, hospitals have about $40 billion riding on the health law's Medicaid expansion – and see a "potentially disastrous outcome" if states opt out. Sarah Kliff explains Why hospitals (heart) the Medicaid expansion:

Hospitals regularly get stuck with bills that the uninsured cannot afford to pay. Every year, the American Hospital Association adds all those bills up to calculate the total amount of uncompensated care that its members provide. Every year, the number gets bigger and bigger, hitting $39.3 billion in 2010.

Under the health reform law, hospitals will see reductions in some of their Medicare reimbursement rates. They will be forced to deliver higher quality or see financial consequences.

All of that was worth it, in hospitals’ eyes, because of the insurance expansion. That would finally put someone on the hook for the medical bills that have, for decades, gone unpaid.

If states opt-out of the Medicaid expansion, that essentially means there’s no one on the hook for some of the poorest patients. And that explains why Bruce Siegel, president of the National Association of Public Hospitals, calls states opting out a “potentially disastrous outcome” . . . For them, the status quo is the worst possible outcome: One where they have accepted cuts to Medicare, and still get stuck with billions in unpaid bills.

So contact our delusional Governor Jan Brewer and our idiot Tea-Publican legislators and tell them that you will not tolerate their ideological nonsense. Arizona must participate in expanded Medicaid. It is the morally justified thing to do and is too good a deal to refuse.

UPDATE: Jeffrey Young at Huffington Post reports Health Care Reform Defiance By Republican Governors Worries Hospital Industry:

[T]he result in Arizona will be increased pressure on hospitals' finances, said Peter Wertheim, the vice president for strategic communications at the Arizona Hospital and Healthcare Association. Arizona hospitals provided $4.8 million in uncompensated care in 2011, according to the association, and the Urban Institute says 463,000 state residents would qualify for the Medicaid expansion. In 2010, 1.2 million Arizonans under 65 were uninsured, or 21 percent of its working-age residents, the Kaiser Family Foundation reports.

"If we opt out, we're still going to have this issue of people going to hospitals without coverage and continuing to add to the uncompensated care," Wertheim said.

Arizona Gov. Jan Brewer (R) described the Supreme Court ruling as "disheartening" and renewed her call for the entire law to be repealed. State House Speaker Andy Tobin (R), meanwhile, came out against the Medicaid expansion. Given budgetary issues and the state's conservative politics, Wertheim said, growing Medicaid will be difficult. "We're going to have to sit down and weigh carefully what is reasonable to expect of our political leaders," he said.