Medicaid expansion remains deeply unpopular with Mississippi voters, as recently released polling from Mason-Dixon finds and as Tuesday’s Republican primary results certainly did not dispel.
This is perhaps surprising, given that many people don’t know much about Medicaid. This lack of knowledge has allowed politicians and others to try to sell Medicaid expansion as a cure all for many of Mississippi’s problems. To set the record straight, Medicaid is not a very good parachute for rural hospitals. It’s also not a very good way to boost the state’s economy. Medicaid is not even going to improve health care outcomes for the working poor. Medicaid expansion is going to be far more expensive than anyone predicts. It is also going to squeeze out funding for other priorities, like K-12 education and roads.
In order to understand what Medicaid is, we need to understand who benefits from it. One would think Medicaid most benefits the patients enrolled in it. The academic research indicates otherwise. To understand why, we have to acknowledge that merely holding a Medicaid insurance card does not guarantee health care. Medicaid is not health care; it is a government-subsidized health insurance plan. Compared to private insurance, however, Medicaid insurance is not very good. To begin with, it’s expensive: not for the people on Medicaid, but for the taxpayers who subsidize it. Second, many doctors don’t accept Medicaid because it pays less than private insurance and, sometimes, less than self-paying patients.
The Affordable Care Act (Obamacare) made a very expensive bet that one group, in particular, would benefit from expanding Medicaid. As it turns out, this bet was wrong. It’s instructive to realize who the ACA did not expand Medicaid coverage to. Not low-income children, who are already covered under a program called CHIP. Not disabled people, many of whom are languishing on home and community based Medicaid waiting lists. Not the elderly, who are already eligible for Medicare. Rather, the ACA expanded Medicaid to able-bodied, working-age adults earning up to 138 percent of the federal poverty level.
Every one of these people already have access to health care, thanks to a federal law called EMTALA, which requires hospitals to treat anyone who enters an emergency room, regardless of ability to pay. Substituting Medicaid coverage for EMTALA coverage will not change the quality of care for most of these patients. Thus, researchers have found that Medicaid expansion “increased the use of health-care services,” but “had no statistically significant effect on physical health outcomes.” In turn, the same team of Ivy League researchers concluded that the primary beneficiaries of Medicaid expansion are hospitals. (KF Note: There are also the regional clinics.)
Basically, Medicaid expansion is a backdoor mechanism Mississippi hospitals hope to tap into to pay for the unfunded mandate that is EMTALA. The problem for the hospitals is that Medicaid does not pay very well. Thus, their goal is to steer Medicaid patients toward lower-cost services that will provide a larger profit margin. For some hospitals, this will work. For others, it won’t. The hospitals are willing to roll the dice on Medicaid expansion, but Mississippi voters are not.
Recent polling by Mason-Dixon found that 55 percent of Mississippi Republican primary voters are less likely to support a candidate who votes for Medicaid expansion. This number soars to 70 percent when voters realize that Medicaid expansion will compete for funding with other priorities, like K-12 education, roads and bridges, and the state retirement system. I believe these voters intuit that Medicaid expansion is a bad bet – not because they don’t care about low-income adults or rural hospitals or poor children (who, again, are already covered by SCHIP!).
Mississippi voters care about all these issues, they just think there are more targeted ways to help each of these groups. Consider that the best way to help the working poor is to encourage them to obtain a good job. Yet, nationwide, more than half of Obamacare Medicaid recipients are not working.
Is it any surprise, then, that Medicaid expansion has been far more expensive than expected in the states that have tried it? According to analysis by Jonathan Ingram and Nicholas Horton, “States have consistently and grossly missed their expansion enrollment projections, already signing up more than twice as many able-bodied adults than they anticipated would sign up at any point in the future.” As a result, Medicaid is squeezing out other state budget priorities, consuming “one out of every three dollars in state budgets.” This includes Indiana, whose 2.0 “reform” cost more in year one than a traditional expansion would have cost and is forcing lawmakers to find new sources of revenue via tax and fee increases. It also includes Arkansas, whose Medicaid expansion cost almost twice as much as predicted, far more than traditional expansion, and whose attempts to rein in costs with a work requirement have been nullified in court.
If state lawmakers want to help rural hospitals, they should craft a credible plan to do so. Likewise, there are many ideas – ranging from deregulating charity care to encouraging nonprofit hospitals to do their fair share – that could increase health care access for low-income, able-bodied adults. Throwing Medicaid money at these problems would be a lazy, foolish, and expensive gamble. Mississippi voters know better.
Dr. Jameson Taylor is Vice President for Policy at the Mississippi Center for Public Policy, the state’s non-partisan, free-market think tank.
Thursday, August 15, 2019
MCPP: The Hidden Costs of Medicaid Expansion
Subscribe to:
Post Comments (Atom)
49 comments:
Excellent read!
Another sophomoric op-ed piece/scare tactic re Medicaid expansion without the benefit of data or context as it relates to Mississippi.
Show the numbers from the other 36 states that have expanded and the projections for MS if it were implemented. You won't do it because you're a corporate whore.
Seems to be working pretty good where it's been implemented. You can paint any picture you want when you disagree. When I color 1600 Pennsylvania Ave it's pink. So I call it the Pinkhouse.
Thank you KF for breaking this down...I wondered how the Medicaid expansion sound bite worked into the campaign. So if we see a candidate for Medicaid expansion we will surely see on the list of contributors hospitals and doctors connected to hospitals. Basically anybody who would profit from hospitals. As usual, if you follow the money you can figure out most peoples intentions.....
Click bait for the blog owner
Silly article
The MS Center of Public Policy is many things. Incompetent is one. Non-partisan is not. They are nothing more than water carriers for the far right republicans.
Since the expansion will be "free" how can anyone object???
They mention Traditional Expansion twice in this article. What exactly is the difference between Medicaid Expansion and Traditional Expansion?
I have a few questions for Dr. Taylor.
" Did you take into consideration the current costs of EMTALA vs Medicaid treatment for the same services including how ER cost are eventually recovered in charges for all medical care to those who can afford insurance?"
Your argument that " no statistically significant effect on physical health outcomes" seems to hint at bias . Why should there be a different effect for the same treatment delivered in different settings ( ER vs clinic) ?
What " Ivy League" research are you referencing? Some of us like to read the research for ourselves.
Did you consider the effect in terms of productivity? This is for the working poor and lost productivity when it comes to prevention of health problems vs treatment for a more serious problem would seem to be important as well as spreading illness in the work place when workers people go into work until their virus turns into pneumonia so as not to use up sick days or hours?
Why did you ignore that Arkansas and Indiana are using a non-standard approach
or waivers so as to subsidize premiums for those with private health insurance?
This drives up costs.
Why focus on the impact of hospitals rather than patients?
Getting affordable medical care is a non-partisan issue. That health care costs are out of control is something we should all recognize. Sadly, over the past several decades those who profit from increased costs have not been the focus of why costs are out of control. Rather, there seems to be a " blame the sick" for being sick. Like death and taxes , we will all get sick even if we eat just right and exercise as suggested and don't have any bad habits. Genetics and exposures to bacteria and viruses and injuries and environmental contamination (the air we breathe is now the number 1 cause of lung cancer) happen.
Only one candidate for governor will veto an expansion of Obamacare in Mississippi, Tate Reeves.
Don't count on the legislature killing it. Many of them are bought and paid for by the hospital lobby.
This is THE reason we have to elect Tate Reeves.
This is a sophomoric column that was clearly fed to the writer by a group in Washington DC. He lost me when he said that the working poor's alternative to Medicaid was emergency room treatment. That's the very reason why health care costs to the government have skyrocketed.
Of course Medicaid is expensive, because health care is expensive. Medicaid payments are for services rendered, not insurance premiums. The money goes to the doctors, hospitals, clinics and other providers directly and not to the working poor person or family.
Normally, the state would pay one-fourth and the federal government would pay the other three fourths. However, under the expansion, Uncle Sugar will pay for most all of the first ten years of the expansion, and by then, state government should be able to find money to cover our portion of the expansion.
Lastly, the Medicaid expansion mostly helps working poor. These are people WHO ARE WORKING and have jobs already but can't afford high insurance premiums. These are not the lazy, unemployed, don't want to work types. etc. Medicaid is the best way to get health care to the poor and working poor, and if it is expensive in Mississippi, then it is because we have so many poor and working poor people.
Just a little research discovers that not all is close to rosy with the expansion in Louisiana including flawed numbers used by LSU (flaws acknowledged by LSU) that overstated both new federal spending in the state and jobs claimed as attributable to the expansion.
I'd normally post a bunch of links -- and I do so 99% of the time -- but instead will tell the piss ant trolls here who refuse to support their BS claims with links to f'&^ off, get off their asses and use Google.
Medicaid expansion has been great for Louisiana. It will be here too.
http://gov.louisiana.gov/page/impacts-of-expansion
Interesting this non-partisan group only quotes republican polling. I wonder how medicaid expansion polls when you account for all Mississippians.
Also, the study he quotes extensively is only vaguely sourced as "...The academic research" -- what study, when was it published, who published it?
EMTALA isn't a freakin' fix! It's the reason it takes 6 hours to be taken care of in the ER. It's also the most expensive care we provide in our healthcare system. Saying 'visit an ER' to get treatment for the flu is EXACTLY what's wrong with our healthcare system.
Here's a study that refutes the, assumedly made up because it's not sourced, 'academic research'.
KFF Study that Refutes this FUD
There is hardly any evidence at all behind these statements. I could be convinced of its shortcomings if there was evidence instead of agenda-laden generalizations.
why does Medicaid suck so much? No Doctors, the few left not in these endless clinics, want to deal with it. I have a son who would benefit from Medicaid expansion, works, low pay, single and has no children. Yet I prefer he better himself and get on the costly regular plans with employers.
The cost of Rx seems more of an issue to many retirees and working poor.
Then we have the VA?
No matter what we do, healthcare and wealth cannot be separated. Our Senators and the elite will if they desire much better care than me.
I see the Jim Hood voters who masquerade here as Bill Waller voters have arrived.
Click bait for the blog owner
Silly article.
And you rose to the bait, took it, ran off some line by leaving a comment and helped pay the JJ light bill in the process. Now who, exactly, is the sucker?
Thank you for sharing!!!!!
The MHA paid social media influencers are having to work early today aren't they?
What good is having state funded research institutions if you can't get some good research reports to back your position?
Kingfish did not 'break anything down' since he didn't write the column. Pay attention.
August 15, 2019 at 9:41 AM
+10,000
"(the air we breathe is now the number 1 cause of lung cancer)"
Bullshit.
Cigarettes
Cigarettes
Cigarettes
Nothing else even comes close. I've been filling out and signing their death certificates for 30 years.
This article is beyond disingenuous
Article in today's Wall Street Journal gave evidence that the real problem with Medicaid expansion is that it covers people who aren't supposed to be covered. States rely on the Federal marketplace website to screen out by income. Most people who go to the federal website lie about their income. But the states don't have the resources to see who is lying. Louisiana was cited as 82% of the new enrollees in their Medicaid expansion were actually not eligible because they were in many cases in excess of 250% of the poverty line. People game the system, and it takes years, if ever, to root them out of the system. Different editorial also in today's WSJ cites Bernie Sanders advocating for a 20 billion dollar hospital bailout, because the hospitals in states that expanded Medicaid are going broke even faster than the non-expansion states. There is no free lunch. Hospitals who see higher revenues with Medicaid expansion will actually lose even more money since Medicaid doesn't cover the hospitals actual costs to provide the care.
The real argument in the article starts by equating federally mandated emergency room admittance to ACA-insurance coverage for standard medical care? Those two things aren't remotely comparable.
10:31 Ultimately Mississippi will stand alone. Some people are comfortable with that and love any argument justifying it. We should be used to it by now.
In states that expanded Medicaid doing so has not stopped rural hospitals from closing. It has only slowed the rate of closures. The expansion of Medicaid only delays the closings because in the final analysis the rural hospital business model is broken. Rural America is losing population. They lose those with the financial means to leave and the young. That means they're losing actual taxpayers in their prime earning years and future taxpayers. Rural area are therefore left with the elderly, the impoverished and the uneducated. That simply is not a customer base that, even with Medicaid expansion, can keep all the rural hospitals open and financially solvent.
The "Hospital" plan being pushed by Waller, Hood and others is economically not a viable plan. It is a trap that eventually will put state taxpayers on the hook to pay for the expansion. There is not enough money to pay for it all the spending and not enough capacity in our existing tax base to shoulder the burden.
Medicaid expansion is nothing but more mandatory redistribution of wealth.
11:18 If that's the case it's not very effective. In those states implementing in one form or another I don't think the very wealthy have lost anything. In fact I'll be they've gotten richer. But if it makes you feel
better...
I doubt that there would be any Medicaid fraud in the Bible belt of Mississippi, right? Right? Right? Bueller?
First of all, I don't wish to take a position either FOR or AGAINST expansion, but I DO take a position against ignorance. While Dr. Taylor might be an educated man, he appears it have a complete lack of understanding of the financing model of the American healthcare system, and the regulations that govern such. One "for instance" is, "Every one of these people already have access to health care, thanks to a federal law called EMTALA, which requires hospitals to treat anyone who enters an emergency room, regardless of ability to pay." That IS NOT what EMTALA requires. EMTALA requires that a hospital treat an EMERGENCY condition regardless of a person's ability to pay, if such services are within the scope of services generally provided by the hospital. For those non-emergency conditions, a hospital is only required to provide an "appropriate transfer". Dr. Taylor's next statement, "Substituting Medicaid coverage for EMTALA coverage will not change the quality of care for most of these patients", shows his complete lack of understand of the healthcare system, as Medicaid coverage does NOT substitute for EMTALA! I could go on, but suffice it to say, Dr. Taylor should adequately educate himself before penning such nonsense.
Interesting how those opposing the article fail to offer any factual support for their criticisms. Medicaid expansion to include those well above the poverty line is just another scheme (successfully implemented in other states) to force the structure of Obamacare into the states' budgets and policies. Take a look at the budget-busting effect this will have on states that took the carrot and are about to be whacked with the stick.
The level of understanding on this issue is beyond poor. And, it allows for deceit by groups ideologically opposed to the program. Whether we as a state like the ACA or not, it has been law for 10 years. It is not going away. Right now, all Mississippians' federal taxes are paying for expansion populations in New York, California, Louisiana, Arkansas and Indiana - a total of THIRTY-FOUR other states. But, we won't accept federal money - our own taxes sent to Washington - at a match rate of NINETY PERCENT.
There have been, FOR YEARS, supplemental reimbursement programs that hospitals pay for with taxes - not the state of MS. Basically, hospitals put up a quarter, and the Federal Government sends back 75 cents. With expansion, there is an even better match rate, the state would need to put up a dime, and the Federal Government will send back 90 cents. Now, you can argue this is bad policy at the national level. But, at the state level, it is a complete and total no-brainer. Hospitals have proposed a plan for recipients to pay premiums (some skin in the game and personal responsibility) and for the hospitals to pay taxes to fund the 10% for the state. So, the state would not be putting up any money from its budget. Plus, the state would then get the benefit of the 3% premium tax on $1 billion in premium payments this would generate, or $30 million. Plus, $1 billion would circulate through the state's economy generating taxes as that money circulates. This plan would not crowd out money for other state needs. It would add money to the state budget!
There are all sorts of ridiculous arguments that are thrown up against expansion. But, they just don't hold water and are pretty easily debunked. And, let's ignore talk of helping of hospitals. This helps PEOPLE, most are people who are working low wage jobs trying to better themselves. If they weren't working, they would already be on Medicaid. This is your twenty something dad with a small family that roofs buildings, or works as an employee in a small business that can't provide healthcare. There are a ton of such businesses in MS. You think an employer might like it if his employees could get care and be at work?
(Note also that MS has the Restore Hope Act from 2017 which tightens eligibility verification for Medicaid. So, it better ensures only those that qualify get Medicaid. This could be sued for the Expansion population.)
The whole point of getting people on health insurance is so they see the doctor before they have to go to an emergency room. Yes, ERs have to treat whoever walks in the door, but with Medicaid expansion many of those people can see a doctor to take care of their health issues before they get to that severity, which costs everyone much less in the long run and results in better health outcomes.
This is basic stuff. It's insulting not even to try to address it.
Oh. I See. So providing more healthcare does not actually help people get healthcare.
This article is just an argument—and a silly one.
The Mike Pence medicaid expansion in Indiana has been a complete disaster. Hope no one falls for this fake scheme.
4:09 - While you parenthetically alluded to the feds, what you cleverly leave out of your lofty analysis is this: When the feds realize they can't pay this 90 cent on a dime match, the only alternative is revamping the tax code.
That means either raising federal income taxes on those who work, eliminating some deductibles or both. And both of those alternatives only, as always, apply to those of us who are pulling the wagon.
When more and more people climb up on the wagon, those pulling it will be whipped more severely. Prove me wrong.
Dr. Taylor overlooks that not all Medicaid expansion plans are the same.
He should have asked Vice President Pence who approved the expansion plan that Bill Waller is supporting when Pence was Governor.
In that plan, the working poor pay a $20 monthly premium and $100 for nonemergency ER visits. That plan DOES NOT RELY ON STATE TAX FUNDS>
Rather than the $200 million a year Reeves claims , it would ( according to our own IHL research), it would cost $159000 a year by 2025 for a straightforward expansion (not the Pence/Waller version).
IHL also estimated 9000 new jobs in the State and $96 million more in our coffers by 2015.
Dr. Taylor also ignored that Indiana, Arkansas and Louisiana not only increased the number of people in their States who now have health care coverage by hundreds of thousands, their economic growth significantly improved where ours did not.
So 300000 Mississippians who are the working poor without health coverage and those who are paying hundreds a month in premiums they can't afford but who would be eligible would be foolish to vote against their economic self-interest but that's how we roll in Mississippi.
Dr. Taylor must have started with a bias against expansion and only looked for information he thought would support his bias and thus ended up making comparisons that weren't valid...that apples and oranges thing...not all States are the same demographically or economically nor is there just one method of expansion.
My 7th grade teacher warned her class about accounting for bias before you believe someone. She also warned us about recognizing our own biases before we formed an opinion.
@ August 15, 2019 at 4:09 PM
Thank you!!! Well stated and spot on!
@ August 16, 2019 at 6:39 AM
When the feds realize they can't pay this 90 cent on a dime match, the only alternative is revamping the tax code.
You are talking as if Mississippi is not living off the Feds right now? You do realize a majority of the states annual budget comes from federal dollars to begin with.
Even if they were to "revamp" the annual tax code, it would hurt people in in states like Illinois, California, and New York more, than in Mississippi.
Medicaid expansion in Mississippi is an idea only a fool would turn down; simply because they do not understand the program and how it would benefit the state in the long run.
@ 6:39
I'm not trying to ignore taxes. There is just a difference between the state and federal level. You file a state and federal tax return each year, right? This program will not cost the state anything so it will not increase Mississippians state taxes.
There are a whole lot of problems with the Federal budget right now. But, the current and foreseeable future is a world in which the ACA is the law of the land. The President and House and Senate just passed an increase in the debt ceiling with significant new spending. Where were the howls of outrage? Where was the government shutdown to keep from funding "Obamacare"? ACA is going to be around and is not going to change unless there is some serious change in the status quo in DC.
Mississippians federal taxes are paying for expansion in other states. It is beyond ridiculous, if the state match can be accounted for by beneficiary premiums and hospital taxes, that MS would not get with the program. I am not aware that MS turns down any other source of federal money - just this one.
And, MS can easily deal with a decreased federal match by simply setting any statutory approval for expansion to sunset should the federal match go down.
You live in the world as it is now, not what might could possibly maybe happen with the federal government in the future. MS expansion would simply be a rounding error to the federal government. And, state taxes will not be affected at all if the state match is funded by premiums and hospitals.
So, therefore, @10:14 you would be perfectly fine with an expansion agreement that clearly spells out when the hospitals (and the vaunted "premiums" they'll collect that you keep chortling about) decide they can no longer 100% finance the expansion Mississippi will be under no obligation to provide continuance funding and free to fully reverse the expansion?
Reeves is correct on this. This is a bait and switch.
@10:26
As I said, you live in the world that you are currently in. Hospitals have pitched a plan that they would provide taxes and beneficiaries would pay premiums to cover the portion the state has to put up for a demonstration project that includes covering more lives. As long as the match rate is 90% and as long as the plans are sound from an actuarial perspective (as required now), I don't see why the state portion would ever be an issue in the proposed plan.
I don't understand what you mean by bait and switch? Are you suggesting hospitals will push a plan and then not pay the state portion? It will be written in the code just like the current hospital taxes are written in code. If beneficiaries don't pay premiums, it's just like private insurance, their coverage would end. I don't understand what is so hard to understand.
As for bait and switch, my personal opinion is that if Tate is elected governor, there will be expansion before his term ends. The reason? His largest corporate donors, the current managed care organizations, have too much invested in him to not push for that to happen. Oh sure, he has said he is against "Obamacare expansion" to prevent attacks from the right and because he thinks it is the best path politically to the governors office. And, when the time for expansion comes, he will say he was forced to by Washington or the libruls in the MS legislature. But, my opinion is that time will be coming. It's too much business for his corporate donors not to press him on. With him administratively in charge of Medicaid at that point, they would be very happy with that outcome. I mean yesterday we saw Chris McDaniel of all people flip to support Tate after years of battle. Tate will flip on this issue.
@10:26
I see now what you are referring to as bait and switch. I understand this to mean that you think hospitals would not be comfortable with a provision reversing expansion, if the match rate changes. My opinion is that would be fine. It makes sense if funding changes, the program needs to change. So, short answer, yes.
Mississippi Center for Public Policy is non-partisan? REALLY? I haven't laughed so hard in YEARS... It's just another far-right propaganda machine.
My daughter works for rural clinics in NE Arkansas. Under the program the working poor pay a small premium for their insurance, plus a co-pay. They go to these rural clinics for non-emergency care, before, they would drive to Batesville AR for ER treatment. The Arkansas program kept the doors open to the main hospital.
Perhaps we need to look at who really gives a shit about the people of MS and
it sure as hell isn't Tater.
Something needs to be done. The current status quo (Barbour, Bryant and Reeves) have allowed the access to medical care to diminish for the citizens of Mississippi. Unfortunately many Mississippi citizens are poverty stricken. The low wages paid, lack of insurance provided by employers and the high cost of insurance with deductibles that ensure the insurance company never have to pay, is the reason for our current situation. Medicaid expansion would only be a temporary solution for the most poverty stricken and doesn't address the middle class. Maybe the answer is to bring back the Charity Hospitals. It would solve the problem with doctors having to treat patients that don't pay their bill. Charity Hospitals would provide access to Medical Care for all classes of Mississippians. It would reduce the amount of bankruptcies over medical bills. Most of all it will provide competition for the current over priced Medical Care providers and Health Care Facilities. Once competition is established our system will become a "You get what you pay for system" instead of a "You get what you get or nothing at all system." Something needs to be done because the status quo is unsustainable.
10:14 I believe your anecdotal experience but you apparently haven't kept up with the research. Read the CDC research. And, have you not heard your colleagues discuss " good guy lung cancer"?
I would remind you that there are fewer smokers in the world and less exposure.
And, I would also suggest to you that the WWII veterans who were actually given cigarettes and got hooked did not all die of lung cancer or die young or even die of a smoking related problem. Might should have studied that group. You do know that carcinogens were added to cigarettes after WWII, right? You do know that Mormons and other groups that never smoke get lung cancer, right?
Post a Comment