Dissecting the case for Medicaid expansion

Free money for Obamacare comes with strings attached


by Jane Orient

Source: The Washington Times

Republicans are accused of “sheer spite” for opposing Obamacare’s expansion of Medicaid. Grasping for money, in this context, has become a sign of prudence and caring. Turning down money seems inexplicable, at least to liberal economists, unless it is a tantrum over the triumph of Obamacare.

Arizona’s Republican governor, Jan Brewer, used hardball tactics to ram the expansion through the Arizona Legislature, claiming it was the “fiscally conservative” thing to do. The idea was to bring $2 billion to “our state.” Stripped of the noble phrases, the idea was to get the free federal money before New Mexico or some other state did.

“Rejectionist” states would lose $8 billion in “aid” for our “most vulnerable citizens,” plus putting themselves “on the hook for roughly $1 billion more to cover the losses hospitals incur when treating the uninsured,” according to economist Paul Krugman.

A free $9 billion sounds like a deal that is too good to turn down — the kind that needs a really careful look.

First, the aid is temporary. It works like bait to tempt states to expand a program that is already bankrupting them. If the states don’t expand Medicaid to 133 percent of federal poverty level, those vulnerable people are supposed to be able to get federal subsidies to buy private insurance on the new exchanges, according to John Goodman of the National Center for Policy Analysis. That would bring more than twice as much as $9 billion of federal aid into the state. So how is money for Medicaid better than twice the amount for private insurance for the same people?

Of course, there are conditions and caveats for getting the exchange money. They are complicated enough to baffle even a Nobel laureate economist. There’s an even more basic question: If hospitals lose only $1 billion caring for the uninsured, then where will the $8 billion from Washington go? If the $1 billion loss is calculated on the basis of grossly inflated hospital chargemaster rates, the true loss may be more like $200 million.

How much of the hospitals’ losses come from the federal government’s unfunded mandate requiring that illegal aliens be treated free of charge? Obamacare does nothing to solve that problem. If the Border Patrol arrested all illegals who went to a hospital, the federal government would have to pay the bill.

Even though hard-luck stories from real people are used to promote Medicaid expansion, none of the Medicaid or exchange subsidies go to vulnerable people. All the money goes to the crony capitalists who lobbied for Obamacare. What trickles down to actual care creates more dependency, assuring continued political support.

It is claimed that “Medicaid rejectionism will deny health coverage to roughly 3.6 million Americans,” resulting in 19,000 preventable deaths.

Will Obamacare exchanges reject them? Or is this a strategy to make them the states’ responsibility once the extra Medicaid payments end, instead of a permanent federal responsibility?

Does possession of a Medicaid card ward off the Grim Reaper? Evidence shows that Medicaid beneficiaries may do worse than the uninsured. Coverage often delays, obstructs or denies care. Then there is rejectionism of Medicaid by physicians because of miserable pay and worse hassles. Patients reject it, too — about one-third of people who are eligible don’t bother to enroll. What will happen to the already teetering system when flooded with millions of new enrollees, many of them pushed out of their current arrangements by Obamacare?

Why are advocates of Medicaid expansion content to stop at 133 percent of poverty? Are people less vulnerable at 133.1 percent? Do preventable deaths decline as Medicaid eligibility expands? Is there a level of Medicaid coverage at which preventable deaths would be zero? Perhaps that’s the endgame: Once we have Medicaid for (almost) all — and some suspect that may be the progressives’ ideal — death may be redefined from preventable to inevitable, and care would be futile.

In fact, we already see that happening at a hospital near you, especially for Medicare patients.

Progressives want Republicans to “accept defeat” on health care. Obamacare means certain defeat for American medicine, the American economy and all Americans who are not part of our new ruling class.

Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons.