Medicaid: To Expand or Not Expand?
Kirsten Stewart and colleague are reporting about the reluctance of Utah Republicans when it comes to the optional Medicaid expansion under ObamaCare (http://www.sltrib.com/sltrib/news/54456433-78/medicaid-state-expansion-u...):
Utah Republicans to decide Medicaid’s fate after election
Health » Utah’s GOP leaders will wait until presidential election to decide on expanding program, a path to coverage for 43% of uninsured adults.
But don’t expect any major announcements about the state’s plans for the optional parts of the law, including an expansion of the low-income insurance program Medicaid to cover 139,000 uninsured adults.
Senate President Michael Waddoups said the hope is that Mitt Romney will win the presidential election and Congress will act to repeal the law or let states off the hook from some of the mandates.
"We’ve decided there are just too many unknowns there, and the state’s position at this point is we probably won’t do anything until we know what’s coming out of Washington," Waddoups said following a meeting with the governor last week. "It’s just too volatile of an issue."
House Speaker Becky Lockhart said the concern shared by state leaders is that the expansion will commit the state to long-term funding obligations.
"Personally, I think the expansion of Medicaid under the Affordable Care Act was coercion, so I was glad it was found that way by the Supreme Court. The state cannot afford the expense as envisioned under the act, so I think we have to be very careful," she said, saying it could cost "millions or tens of millions, potentially hundreds of millions of dollars, to fund that expansion."
The high court ruled states can’t be compelled to take the expanded Medicaid funding and would forfeit the funds if they do not. However, the court said that the federal government cannot strip existing Medicaid funding from states that do not comply.
The federal government initially would pay 100 percent of the cost to expand Medicaid coverage to include those within 133 percent of the poverty level — about $30,700 for a family of four — but the federal funding would be phased down, to where it would cover 90 percent by 2020.
The Congressional Budget Office said state Medicaid costs would increase by about 2.8 percent as a result of the expansion.
The first 10 years will cost state taxpayers $240 million, said Utah Medicaid Director Michael Hales. Over the subsequent decade, the state’s tab will total $500 million.
The politics of health system reform is on full display in our state and in the entire nation. Neither side is actually talking about what will be good for patients. Both sides are making political calculations concerning the coming election. If the US were to transform health care delivery to be similar to that in other first world countries in efficiency and quality, we would spend about $1 trillion less per year (making health care affordable for families and taxpayers) while covering all citizens with close to first dollar coverage (no deductibles, co-payments, co-insurance as opposed to the plans under ObamaCare with 40% co-insurance) for all medically necessary care (no more advertisements claiming that anybody can have a powered wheelchair at Medicare expense). No tax raise would be necessary to cover this, since Americans already have taxes for health care higher than is the case in any other first world country. But our employers would not be spending ridiculous amounts of money on health benefits, and our out of pocket costs would drop to nearly zero. No one would be forced into the underfunded program now known as Medicaid, because the confusing array of government funded health programs would be subsumed into a universal program for all citizens. Meanwhile, the 180,000 or so deaths each year from preventable health care harm would be virtually eliminated.
Why are there no politicians talking about this better, alternative vision of what health care could be like in our country? Because politicians of both parties are reaping the political donations of the health care corporations who are receiving corporate welfare from state and federal governments. The health care corporations are using the profits taken from our own tax dollars to keep us in a poor quality, inefficient health care system. When it comes to health system reform, you either favor patient care or corporate welfare and profitability. The proponents of ObamaCare favor corporate welfare. They are, therefore, no different than the Republicans.
Dr. Joe Jarvis