Tag Archives: medicaid

Billions Left on the Table

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North Carolina is one of the states that didn’t expand its Medicaid program after the passage Obamacare. According to this little item from the Wonkblog there are a BUNCH of states that are reconsidering their decisions to opt out:

Money talks: Medicaid expansion makes headway in Republican states. “Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania’s deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms.” David Morgan in Reuters.

According to the Reuters article referenced above, North Carolina is one of the states looking at what it can do:

Some states with Republican governors, such as Indiana, are negotiating with Washington for agreements that could pass political muster with conservatives back home. Others such as North Carolina, South Dakota and Wyoming are exploring options.

One of the reasons that North Carolina’s leaders said they didn’t want to opt for expansion is that they feared the Feds wouldn’t pick up the vast majority of the cost as they’d promised (I’m paraphrasing). Now that they’re seeing what kind of money they’re leaving on the table they seem to be second guessing their decision, but they’re likely going to slow-play their hand because things might change in November.

According to the Reuters article if the Democrats lose control of the Senate then the wave of Republican states reconsidering their Medicaid expansions might ebb. Here’s the irony for North Carolina Republicans, many of whom might benefit from Medicaid expansion: on this particular issue they might be better off if Dem. Senator Kay Hagan wins reelection. And if you think the only Republicans who might benefit are those who are eligible for Medicaid then you’re forgetting all the Republicans who work in the health care industry. Just look at the projections for Pennsylvania:

A study by the RAND Corp predicted a $3 billion economic boost and the creation of 35,000 jobs – big advantages for a state that has struggled for decades to make up for jobs lost from the decline of the coal and steel industries.

Unfortunately for the Democrats this kind of issue is far too complex to make an effective campaign tactic. After all, this is a country full of people who said things like “Keep the government’s hands off my Medicare” when Obamacare was being debated. You can’t possibly expect them to back a candidate out of enlightened self interest when they don’t even know what their self interest is.

North Carolina’s $51 Billion Gamble

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Brad DeLong has some thoughts about Obamacare and here in NC this one bites:

The willingness of state-level Republican politicians to hurt their own people–those eligible for the Medicaid expansion, those who would benefit from a little insurance counseling to figure out how to take advantage of subsidies, those hospitals who need the Medicaid expansion to balance their finances, those doctors who would ultimately receive the subsidy dollars–is, as John Gruber says, “awesome in its evilness”. The federal government has raised the money, and all the state has to do in order to get it spent is to say “yes”. Especially in contrast with the extraordinary efforts state-level politicians routinely go through in order to attract other spending into their state, whether a BMW plant or a Social Security processing center, this demonstrates an extraordinary contempt for a large tranche of their own citizens. And when I reflect that a good third of that tranche reliably pull the lever for the Republican Party year after year…

To that point, here’s some encouraging news about North Carolina’s non-participation in Medicaid expansion:

North Carolina’s decision not to expand Medicaid coverage as part of Obamacare will cost the state nearly $51 billion in federal funding and reimbursements by 2022, according to research funded by theRobert Wood Johnson Foundation…

It notes that North Carolina stands to lose $39.6 billion in federal funding between 2013 and 2022…

“States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies,” says Kathy Hempstead of the Robert Wood Johnson Foundation.

The report notes that for every $1 a state invests in Medicaid, it will receive $13.41 in federal funds.

And here’s the real kicker:

The decision not to expand Medicaid coverage will leave 6.7 million U.S. residents uninsured in 2016. That includes 414,000 people in North Carolina.

Of course Obamacare isn’t perfect and Medicaid isn’t the end-all, be-all of health care insurance — DeLong himself says in his thoughts about Obamacare that “Where the Medicaid expansion has been allowed to take effect, it has taken effect. People are going to the doctor more, people are finding doctors to go to, and the only minus is one that we already knew: that Medicaid is not a terribly good way to spend our money in treating people with chronic conditions” — but it is still a better option than nothing and an improvement over the Emergency Room as primary care provider system that we’ve had.

What’s truly frightening to consider is where we’ll go from here. Without the funds our doctors and hospitals will be missing out on literally billions of dollars of reimbursement, almost 1/2 million citizens will be uninsured and will continue to use the emergency room as their primary caregiver, the hospitals will have to eat the cost and downward we spiral.

The Red State ACA Donut Holes

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North Carolina, like many states controlled by Republicans, opted out of the Medicaid-expansion component of the Affordable Care Act. A New York Times article explores the practical effect it's having on those states' citizens:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states…

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

We're going to be hearing a LOT about the ACA, aka Obamacare, rollout over the next few months. The program opened for enrollment on Tuesday (Oct 1) with a start date set for January and the traffic to the website was heavy enough that it slowed to a crawl.  Like any new program, especially one of this scale, there will be issues but it will be interesting to see if the overall benefits outweigh the problems enough that people will eventually say "Keep the government's hands off my ACA!"

If that does happen it will be with folks like the self-employed who couldn't get on a regular insurance plan that was anywhere near affordable, the employees working for small employers who stopped offering health insurance long ago because they couldn't afford to provide coverage and weren't legally required to, and the folks with preexisting conditions who couldn't get any coverage no matter how much they were willing to spend. Sadly it seems that a huge chunk of the working poor will fall in the "not poor enough" donut hole created by states' refusal to expand Medicaid and won't have access to a program that was most definitely intended for them.

As you can likely tell I'm one of those who is truly hoping that ACA is a step in the right direction for our country. I don't believe it's a silver bullet or that it truly fixes anything, but I'm hoping that it's a step in the direction of a comprehensive, effective reform of our health care system. It's still way too early to see what the end result of ACA is going to be, but quite frankly it would be hard to go backwards from where we've been in the recent past so I'm pretty confident it will be a net benefit for society. On the other hand I seriously doubt it's enough on its own and I hope we continue to look for ways to make sure the neediest have some form of health coverage without bankrupting the rest of us in the process.

The Unfortunate 14

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North Carolina is one of 14 states that has opted out of the new Medicaid funds linked to Obamacare. What does that mean? According to a new Rand Corporation study it means those states are sailing into a stiff healthcare wind:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

It’s a truism of health-care politics that the uninsured are impossible to organize. But Obamacare creates an extraordinarily unusual situation. The Affordable Care Act will implemented in states that reject Medicaid. There will be huge mobilization efforts in those states, too, as well as lots of press coverage of the new law. The campaign to tell people making between 133 and 400 percent of poverty that they can get some help buying insurance will catch quite a few people making less than that in its net. And then those people will be told that they would get health insurance entirely for free but for an act of their governor and/or state legislature.

North Carolina is already seeing political activism spearheaded by the state's NAACP chapter against policies of the Republican legislature. Just yesterday the NAACP's ongoing "Moral Monday" campaign led to more than 150 arrests at the state capitol. Quite frankly that action is easy for a lot of people to dismiss as just more of the same from a group trying to justify its existence (when doesn't the NAACP protest?), but if people who normally sit on the sidelines are suddenly spurred to action because their government denied them the opportunity for cheaper (or free!) health coverage then things could get very interesting for the next election cycle here in the Tarheel state.

(h/t to Fec for the link to the story).