STATES LOSING BILLION IN REFUSING TO EXPAND MEDICAID

Texas will lose $9.2 billion in 2022; Florida says goodbye to $5 billion; Georgia is out $4.9 billion. A new report

details just how much states are losing because they don’t want to expand Medicaid under Obamacare, and it’s

Centers for Medicare and Medicaid Services (Me...
Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

not chump change.

Red states may be sticking to their Republican beliefs in small government, but the Commonwealth Fund finds they are passing up billions in federal funding by saying no to the Medicaid expansion.

“By choosing not to participate, Texas, for example, will forgo an estimated $9.58 billion in federal funding in 2022. Taking into account federal taxes paid by Texas resi­dents, the net cost to taxpayers in the state in 2022 will be more than $9.2 billion,” the report by Sherry Glied and Stephanie Ma of New York University says.

“We find that the Medicaid expansion will be a relatively large source of federal revenue to state enter­prises,” the report adds. States expanding Medicaid will get, on average, more than twice as much in federal funding than they get in federal highway funds, they said.

It’s the latest report on what Medicaid expansion would mean on a fiscal level to states, and the timing couldn’t be better for the administration of President Barack Obama. The White House has launched a three-week drive to highlight what it says are the benefits of the 2010 Affordable Care Act, and Obama has been urging states to expand Medicaid.

The ACA was designed to transform health care in the United States, which most experts agree currently costs

English: Spending on U.S. healthcare as a perc...
English: Spending on U.S. healthcare as a percentage of gross domestic product (GDP). (Photo credit: Wikipedia)

too much and leaves far too many people without health insurance. One way to do that is through the health insurance exchanges, where people can buy private insurance and which are dominating the headlines now.

The other way was by requiring states to extend Medicaid to people earning up to about 138 percent of the federal poverty level, or about $14,800 for single people and $31,000 for a family of four.

ADAPT Medicaid Rally
ADAPT Medicaid Rally (Photo credit: SEIU International)

Medicaid is usually a cost-sharing program – the federal government pays on average about 57 percent of costs and states pay the rest. But under the expansion, the federal government  will pay 100 percent of the additional costs for the first three years. States will have to kick in a very small percentage more each year after that. By 2020, the federal government will pay 90 percent of the costs.

But after a series of challenges to the law, the U.S. Supreme Court ruled in 2012 that the Medicaid expansion requirement went too far.  States can’t be forced to add more people to Medicaid, the court ruled.

Many Republican-led states immediately said they would not be expanding Medicaid.

“As of November 2013, 20 states have decided to opt out of the Medicaid expansion,” the report said.

Glied and Ma calculated how much this would cost by 2022, and took into account states’ arguments about the so-called woodwork effect – the argument that people who were already eligible for Medicaid but had not applied would do so if they heard about the expansion. These people would still cost states the 43 percent or so of state contributions to Medicaid.

But they also calculated savings. States would not only get the direct federal money, but would save the money that taxpayers end up spending on so-called uncompensated care – when sick or injured uninsured people show up in emergency rooms seeking treatment.

Their calculations show that by 2022, Florida would lose more than $5 billion and Georgia would forgo  $4.9 billion. They also looked at what Medicaid brings to states in comparison to two other giant federal programs – federal highway funds and defense funds.

The report projects that Alabama would bring in $2.1 billion in federal funds from expanding Medicaid; $975 million in federal highway funds and $10.4 billion in defense procurement contracts. North Carolina would get $5.7 billion in Medicaid money; $1.3 billion in federal highway funds and $4.6 billion in defense contracts.

Indiana, Montana, New Hampshire and Tennessee are undecided about the expansion. Indiana would bring in nearly $2.6 billion in Medicaid money in 2022; $1.2 billion in highway funds and nearly $5.6 billion in defense contracts.

Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota,

texas our texas
texas our texas (Photo credit: jmtimages)

Texas, Utah, Virginia, Wisconsin and Wyoming are not expanding Medicaid.

The Urban Institute,  Lewin Group and Rand Corp. have also issued reports showing states will lose billions by not expanding Medicaid.

The decision not to expand Medicaid has more than financial effects. It leaves a lot of people without any inexpensive options for health insurance, because the law assumed states would expand Medicaid and doesn’t provide insurance subsidies for the very poor. 

“If adopted by all states, the Medicaid expansion is expected to provide health insurance to as many as 21.3 million Americans by 2022,” the report says.

This graph depicts gross U.S. health care spen...
This graph depicts gross U.S. health care spending from 1960 to 2008. (Photo credit: Wikipedia)

“No state would experience a positive flow of funds by choosing to reject the Medicaid expansion. Because the federal share of the Medicaid expansion is so much greater than the state share, taxpayers in non-­participating states will nonetheless bear a significant share of the overall cost of the expansion through federal tax payments—and not enjoy any of the benefits,” the report concludes.

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PatAgonica

Soy el Dr. Gastón Alejandro Saint Martin (ARDMS. RVT. RPVI eligible, MD. CCPM). Medico patagónico; me gradué en la UNBA (Universidad Nacional de Buenos Aires, en 1961) Recién graduado y casado fui a hacer mi entrenamiento en la Universidad de Louisville, (UdeL) Kentucky, USA, la mas antigua Universidad Municipal de La Unión; pobre, pero de excelente nivel académico; con una pequeña escuela de medicina. Louisville está en la margen izquierda del rio Ohio (afluente del Mississippi) Elegí a UdeL por estar entre los rio Ohio y Tennessee, que era la zona mas subdesarrollada de La Unión, (cuna de los "Hillbillies") montañeses pobres, poco ilustrados, casi analfabetos pero gente honrada, noble y muy trabajadora; donde era de esperar encontrar problemas de patología medica y socio económicos similares a los de la población rural patagónica indigente. Los médicos residentes de la Universidad de Louisville atendíamos al Louisville General Hospital y al Children’s Hospital of Louisville. Finalizado mi entrenamiento, y al tener yo visa de emigrante, me pude quedar en USA, donde los abogados jueces y los médicos con residencias de entrenamiento completas, teníamos un brillante futuro económico, estabilidad y brillo social. La tentación para quedarse fue muy grande, pero cumplimos mi plan regresando a casa; Argentina (No a Buenos. Aires.) sino a La Patagonia (Gral. Roca, Rio Negro), donde trabajé intensamente, no solo en medicina asistencial sino en política. Para el inicio, recluté un pequeño grupo de médicos argentinos jóvenes entrenados en USA y Canadá con quienes creamos al Instituto Medico del Comahue, el pequeño hospital austral privado pionero en medicina asistencial moderna. Construimos el edificio por esfuerzo propio, y por administración, con la dirección técnica de mi padre (Ingeniero Prospero Saint Martin). Tuvimos muchos éxitos y fracasos. Nos integramos al Colegio Medico de General Roca, donde fui el primer organizador de la primer biblioteca medica patagónica. De nuestros Colegas Veteranos aprendimos la Filosofía Ético Moral Medica Hipocrática) y a ser médicos humanistas, antes que corporativos." Allí, practicando, aprendimos las normas básicas de cortesía entre colegas y pacientes. No fue fácil la convivencia y el pasaje armonico de lo (clásico) antiguo a lo (bueno) moderno, pero ¡lo logramos ... y muy Bien! En el ano 2000/2002 La Anarquía establecida Argentina desde el 10 de Septiembre de 1930 estalló y ya “no pude tolerar al criminal anárquico mamarracho republicano Argentino" que culminó con el "Robo Legalizado" (Google "The Legalized Theft" by Steve Hanke - CATO Instituto and/or Johns Hopkins economist) Como muchos de los argentinos ordenados, responsables, con importante capital de trabajo sin deudas, con algunos ahorros PERDIMOS TODO! Yo no perdí mis edificios, mi casa, mi Consultorio Radiológico) ni mi costoso instrumental diagnostico pero al quedar fuera de corporaciones medicas-hospitalarias corruptas, y fuera de los canales de facturación y cobro ... me encontré despojado de uno de los derechos humanos mas importantes “EL DERECHO A TRABAJAR” , del que depende mi “DERECHO A LA PROPIEDAD” y derecho a de “VIVIR en LIBERTAD” como me de la gana y sin pedir nada a nadie (¡LIBRE ALBEDRIO!) Por ello decidimos volver (ya estando jubilados) por segunda vez a USA. Hoy tengo otra residencia legal en Chicago (Oak Park, 60301) Mi mentor (en USA y Argentina) ha sido el Dr. Rene Favaloro (pionero del bypass coronario), con quien (cada uno por su lado) hemos compartido los mismos dilemas, para decidir volver, y para adaptarnos a esta ANARQUÍA Argentina (ver www.29deJulio.wordpress.com ) – La ANARQUÍA en la que cayó La Republica Argentina el 10 de Septiembre de 1930, fue causado por errores garrafales del GOBIERNO DE LOS ESTADOS UNIDOS DE NORTEAMÉRICA. (Presidente Herbert Hoover (POTUS 31) ...MAS... errores garrafales en la "ACORDADA UNÁNIME de LA TOTALIDAD DE LOS JUECES DE LA CORTE DE JUSTICIA ARGENTINA" ...MAS... errores garrafales del Gobierno del Reino Unido de Gran Bretaña (UK) ...MAS... el error de un soldadito con grado de General y cáncer de estomago Gral. Félix Uriburo) que no se atrevio a desobedecer al Jefe de su jefe cuando le ordenaron "violar a La Constitucio ... "en nombre de ella??) y asi TODOS ELLOS JUNTOS, en un contubernio internacional, por primera vez en la historia de La Republica Argentina depusieron a un Presidente Constitucional, (Presidente Hipólito Yrigoyen) electo dos veces (en periodos NO consecutivos), por el voto popular, y depuesto con la absurda e ignorante excusa (si no fue mentirosa) de ser "ser viejo e inoperante..."

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