Friday, August 5, 2016

Medicaid or bust?

Expand Medicaid! Expand Medicaid! Expand Medicaid! So goes the mantra mindlessly mouthed by many in Mississippi.  The lure of Medicaid expansion is easy to understand.  Many Mississippians lack access to health care.  Many more can't afford to pay for health care.  The Affordable Care Act held out a golden branch to the states: expand Medicaid and the federal government would pick up the tab for several years.  However, and there is always a however, the golden branch might turn to fool's gold as the states eventually have to pay for 10% of the Medicaid expansion costs.  There is now a growing body of data to review on the results of Medicaid expansion.  John Daniel Davidson did so in a column published in National Review earlier this year:



In the wake of Louisiana governor John Bel Edwards’s announcement last week that his state would expand Medicaid under Obamacare, the White House rolled out a new scheme to persuade the 19 states that are still holding out to fall into line and expand their programs: throw more money at them.

The offer, which Obama will include as a legislative proposal in his 2017 budget, is that any state that expands Medicaid will get the first three years of expansion free — paid for entirely by the federal government. As written, the law says that Medicaid expansion in a given state will be paid by the feds for the first three years, beginning in 2014, and after that the state gradually picks up an increasing share of the tab until by 2020 the federal government will be paying only 90 percent. Obama is proposing to extend the three years of full federal funding to states regardless of when they expand, which means those 19 non-expansion states are still eligible for 100 percent federal funding should they follow Louisiana’s lead.

The purpose of this little twist on the Medicaid expansion deal is to give President Obama a fighting chance to claim victory for his otherwise failing health-care law. Full federal funding for three years would mean potentially billions of federal taxpayer dollars for holdout states like Texas and Florida, where large numbers of poor, uninsured adults enrolling in Medicaid would mean a revenue windfall for Medicaid providers and managed-care organizations...

But these state officials should resist the temptation, for at least three reasons. First and most obvious is that expansion states have all experienced the same thing: More people signed up than expected, and it blew a hole in the states’ budgets. Jonathan Ingram and Nicholas Horton of the Foundation for Government Accountability studied this trend and found that expansion states routinely underestimated the number of people who would sign up in 2014, such that after one year of expansion, “several states have already seen more adults sign up for Medicaid welfare than they thought would ever sign up or even be eligible.”

The numbers are staggering. In Colorado, officials thought only 61,000 people would sign up in FY 2014, and an additional 100,000 by the end of FY 2015. But by March more than 210,000 people had already enrolled, and the total was more than 307,000 by year’s end. To varying degrees, the same thing happened in Arkansas, California — where 2 million enrolled in 2014, nearly three times what was projected — Illinois, Kentucky, Michigan, Ohio, Washington, West Virginia, and every other expansion state. Those extra enrollees cost states money, even with 100 percent federal funding, because many of them were “previously eligible,” meaning they aren’t part of the Medicaid expansion group and states must pay for about 43 percent, on average, of the cost of covering them. That works out to billions of state tax dollars. In Ohio, the Medicaid program went $1.5 billion over budget in the first 18 months. In Illinois, $800 million. In Kentucky, $1.8 billion. Washington State increased its biennial budget by $2.3 billion just to deal with expansion costs.

The second reason is that there’s no such thing as “free” federal dollars. The money comes with conditions, which effectively shifts policymaking from the receiving state’s legislature and governor to a distant federal bureaucracy (in this case, the Centers for Medicare & Medicaid Services), which dictates how states must spend federal Medicaid funds. The so-called “cooperative federalism” scheme under which programs like Medicaid operate is designed for one purpose: to transfer as much federal funding to states as possible in order to impose uncompetitive liberal policies in those states. Medicaid now soaks up about a quarter of most state budgets, and any increase in total Medicaid expenditures will increase that share, making state governments even more in thrall to federal bureaucrats.... Rest of essay.

The question is how much would Mississippi pay once the Federal freebies are over and the 10% share begins. 

29 comments:

Anonymous said...

Yeah! I mean, now that we are only the 49th healthiest state in the country, we should be content.

Anonymous said...

Just as importantly, how much would MS have to pay when the Feds reach a Grand Bargain and lower the match rate to the regular Medicaid Match Rate?

Anonymous said...

Some people only hear that one word, FREE. They do not look past that word to see if there is any strings to free. Some think the govt. is footing the entire bill. For some reason they fail to understand the govt. does not have any money they do not take away from the people. Then you have those who just don't care which takes up a good % of the people.

Anonymous said...

People forget that Obama has already proposed in 2 different earlier budgets that the 10% state reimbursement go to a "blended rate" to free up money for other spending. In 10 years, all of the medicaid will be reimbursed at the current normal rate of about 50%/50%, because the numbers will simply be too large to support.

The “previously eligible,” or "out of the woodwork" people is a huge unknown expense, because they aren’t part of the Medicaid expansion group and states must pay for them as regular medicaid. Most state budgets only planned for the 10% after 3 years (which kicks in next year for many)

The states have already begun trying to game the system, trying to avoid the "previously eligible" tag, and the feds are aggressively auditing them, finding many people have been incorrectly classified.

PittPanther said...

It's hilarious that the first reason given for not expanding Medicaid is that more people than expected might sign up. So because even more people than we estimated are uninsured/underinsured, that's the reason to kill the program? Because the problem is even worse than we thought, we should stop the cure?

Anonymous said...

No, Pitt....we don't stop the cure. We stop the bleeding. Like Lake Griffin in Madison County. Quit pouring money down a piss-hole.

PittPanther said...

You're not stopping any bleeding. Those uninsured, instead of seeing doctors on a regular basis, clog your emergency rooms when problems escalate to the point they cannot be ignored. Problems that could have been addressed earlier when they were small issues.

I know it's the Mississippi way to not give a damn about the poor and working poor, since it's truly their own fault for being poor. I can only imagine what's being taught in the churches that Mississippians profess to attend.

Anonymous said...

2:09, I worked in a hospital for 20 years. Most of the people using the emergency room before Obama care was minor problems that would have been easily treated at home. Back then when the emergency room treated a person without any insurance they would ask for $1.00. The idea was to instill in the people that they could pay something for medical care. Care to guess how many would pay that $1.00?

I will agree with your opinion about the churches mainly because I don't believe in any religion.

Some of the blame can be put on the poor and working poor. How many people do you know who works at a low paying job because of their lack of education? There is no excuse for a person not having a high school diploma.

Anonymous said...

KF, I love how you harp on how foolish it is for the government to pay for health care when the real social problem is that health care costs cannot be sustainably borne by anybody or any entity, except for maybe the upper echelons of the income scale. Why is the price of this vital service getting more and more out of balance with actual incomes of individuals? Costs need to be controlled, regardless of how the bill gets paid. Until we do that, round and round we go with our red herring arguments about the role of government and personal responsibility.

Anonymous said...

You are free to move @4:37 PM to Venezuela. Economic controls have done wonders for their economy.

Anonymous said...

We are already paying for each of those hundreds of thousands of Mississippians who do not have healthcare. Each time they use a healthcare provider and cannot pay those amounts the costs are passed on to those who have health insurance through higher premiums. When someone who has not been able to afford going to a doctor for 15 to 20 years ends up in the hospital with a $2 million bill the hospital has to pass those costs on to the insurance companies and those who have healthcare insurance see their premiums rise each year. While our "conservative" state government pretends they are saving money they are actually making us pay much higher costs.

Anonymous said...

4:37, the cost of medical treatment is rising because the people are able to raise the prices. If they have a business that produces drugs they can charge anything they want. Hospitals can charge anything they want. Of course there is so many chances for criminal acts that are almost impossible to catch. In truth, there doesn't seem to be anyone interested in controlling prices except for the people who need medical care. These people have absolutely no power.

Anonymous said...

4:37, how about we control fat people. Ready to step up to that?

Anonymous said...

5:39 PM I am not much in favor of price controls but something is very seriously wrong when the same surgery costs 10 to 20 times more in the USA than it does in other countries that offer similar quality levels of care. While it is theoretically possible to shop around for prices few people do that because they are stuck with the provider networks of their insurance companies who will penalize them if they go out of network.

Anonymous said...

Kentucky created 20,000 jobs. The forecast for Mississippi is 9,000 jobs. Why would we pay for 9000 jobs (3000 physicians billing $2mill each), when we can easily recruit tire plants and a oil ship maker who has no current plans to build ships (per Anita Lee). Add Stion and their 1000, er 500 jobs. Add Kior.

Anonymous said...

"Free.....Free.....Free!!!! You DO realize that the federal government is NOT the preverbal money tree, don't you??/ Those dollars that you so eloquently espouse to be "free" are TAX dollars just like State tax dollars!!! Noting is free and the socialist branch of our government can only give to one state what it first takes from another.

Anonymous said...

7:21, many of those who want free stuff from the govt. do not work and pay taxes. Some actually think the money is actually the govt.'s money. They do not care how much of our hard earned money the govt. takes from us. As long as they continue to get something free. We already have more people collecting benefits than we have working. How much longer can this go on? Our country has already borrowed money from every country that will lend to us. We even borrow from Mexico.

Anonymous said...

And Ms. already gets back over 3 times the amount we send in to the feds. That means there are already other states supporting us. Imagine how they feel when they see how we spend their money.

The Ghost of LBJ said...

Medicaid in this state is 'played' just like every other government program. The players know the program rules better than the government workers do. Qualifying for the program and working the program are a way of life for several demographics.

Walk into the Medicaid office on east frontage 55 north any day of any week. If it's Friday, half of the workers are off. You'll see three to six girls with a baby in their lap, another standing beside them and one in a carrier. Sometimes the baby-momma's momma will be there to hold one. They are there to add a new name to the file and increase the monthly benefit.

People who work the system will qualify for benefits from now on. People who don't qualify will NOT be going to the emergency room day in and day out. Maybe once or twice a year. New medicaid rules in this state no longer require a recipient to show up for an interview once a year to renew eligibility. That's nice.

There are six workers behind glass, answering phones, in this reception/waiting room on 55 north. You will never see a white eligibility worker, supervisor or director in this office. That may be irrelevant. Or it might not be. Yes, you'll see black, white and Hispanic girls with babies in tow. Most of them are on cell phones with nice rides in the parking lot. I've witnessed it many times. Go see for yourself.

Taking care of the infirm, elderly and retired who are without funds is an obligation of churches, family and, yes, the community (taxes). The rest, nope.

We are the nation's poorest state and we have the highest incidence of baby-mommas with no marital affiliation. Most are non-working and on this program. And they are raising a family that will be on this program for a long time. And the cycle has continued since '64. It is well known that a high percentage of us are on this program and many more have qualification as a goal. Medicaid and disability are taught as goals in our homes, schools and churches.

Anonymous said...

If you watch late night TV you can see some of the problems we have with medical treatment.
Look at how many companies advertise different products that Medicaid will pay for if you just let them know. They will fill out the paperwork for you. Want a mobilized wheel chair, any kind of braces, special bed, and even medication. You don't have to have a reason for needing it, just wanting it is enough to get the ball moving.
If you fail at getting these free toys there are always the lawyers that will get you benefits. Just let them know.
Imagine all of the people who call these companies and lawyers. It must work or there wouldn't be all of the commercials.

Anonymous said...

10:40 AM Can you name a church, even one, in Mississippi who pays $1 million, $2 million, $5 million medical bills for people with serious health problems?

Anonymous said...

The monthly benefit is each newborn is $37. Not a big incentive.

I have seen a case where the mother is worth >$8million and the unwed child still qualified for medicaid.

Anonymous said...

12:27, most children are unwed. In most states, if not all, a person has to be an adult to get married.

The Ghost of LBJ said...

"10:40 AM Can you name a church, even one, in Mississippi who pays $1 million, $2 million, $5 million medical bills for people with serious health problems?"

I know of none and I suggested none. I did, however, that it is an obligation of the family, the church and the community to provide for those who can't care for themselves (and in that order). This doesn't include those able to work. The 'community' in this case, is the gubment. Try to keep up.

All these baby-mommas (of all races) have GOT to be required to either get off their backs and work or provide some kind of MEANINGFUL community service. It only makes sense. But, not to democrats.

The fact that a newborn only adds $37 to the monthly check (if accurate) is a red-herring. That's only the bottom point of the funnel. That's a pittance. I guess the WIC subsidy is a pittance too, and so is the welfare budget and the medical expenses paid by Medicaid. Not to mention a lifetime of sucking the tit of the taxpayer.

Anonymous said...

Add that $37 to additional food stamps, additional housing benefits, WIC, doctor's care, day care, free schooling, etc and it adds up to a good size amount. Multiply that by 6-8 and see what it adds up to.

Gubment Teat said...

And in the case where it might cost me almost $7000 a month for my family to keep me in a nursing home, the cost to a family on medicaid is zilch, nada. And if you think these baby-mommas gonna drive the Mustang down to that building on 55 North and sit in that waiting room with three youngans for an additional $37 per month, you're nuts.

Medicaid, like unemployment insurance should be available only as a stop gap measure to help out during job search between periods of employment, unless the individual is physically or mentally disabled or otherwise legitimately unable to work.

As it is, it's a goal, a way of life, a lifestyle.

Anonymous said...

@ August 7, 2016 at 7:50 PM

If Mississippians could depend on the church, we wouldn't need state government considering the number of churches we have this state.

The I don't care what denomination you are many people form churches in Mississippi, to get over on the government better than a ponzi scheme. They have been become nothing but methods for tax free paydays and free living quarters for many shade tree preachers. But that's an argument for another day.

Medicaid expansion is a good thing, it should have been done years ago.

Anonymous said...

I can remember what one church in Florence had to say to the people needing a place to stay during Katrina. "They are dirty and we don't want them messing up our church."

Anonymous said...

7:50 PM You are confusing Medicaid and Medicaid expansion. Medicaid expansion covers the hundreds of thousand of people who work every day at jobs that do no offer health insurance and do not make enough money to qualify for ACA.

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