Medicaid expansion raises complicated questions

By Scott Mooneyham | Feb 05, 2013

RALEIGH -- If they are true fiscal conservatives, the Republican legislators who control the North Carolina General Assembly will think long and hard before rejecting additional Medicaid money slated to come to the states as a part of the federal health care overhaul.

On the surface, it may appear that the fiscally conservative thing to do is to reject the Medicaid expansion that is part of the Affordable Care Act. States were afforded the opportunity to do just that by the U.S. Supreme Court, and about a dozen are expected to do so.

Republican rhetoric of rejecting "Obamacare" certainly serves up a good portion of red meat to the party faithful. But setting the politics aside, the pluses and minuses of Medicaid expansion are not so easily determined.

Proponents of the expansion argue that the additional federal money coming into the state (the expansion would be all federal dollars in the first three years and 90-percent federal money afterward) would be a boost to the medical economy.

One study put the additional economic activity at $1.4 billion. But spending taxpayer dollars and expanding government programs can't be justified based on how many people are employed. Taxpayer money is paying for the expansion, whether from federal taxpayers or state taxpayers.

States that accept the money also limit themselves regarding future changes to the program.

The feds don't want states to take their money, only to create eligibility restrictions that  allow them to play a shell game and swap federal and state dollars. To prevent that from happening, the feds are requiring that states make no changes to what is called their "maintenance of effort."

Those restrictions are understandable. So too is the reluctance of governors and legislators to enter into an agreement that limits their ability to change how states operate their Medicaid programs. After all, this is big bucks. Right now, Medicaid in North Carolina is about a $10 billion program, with the state paying about $3 billion of that cost.

So, legislators reluctance to expand the program should come as no surprise. But a knee-jerk reaction may not be in the best interest of taxpayers or private insurance ratepayers. One of the myths about Medicaid is that it provides health care coverage to the poor. In fact, it provides that coverage only to certain categories of the poor.

The poor who don't fit into one of those categories often end up uninsured, with the cost of their care passed on to other private payers or state and local taxpayers.

A recent N.C. Institute of Medicine study concluded that the state would save $65.4 million a year by agreeing to the Medicaid expansion. The study, though, looked at direct revenues and costs, and economic benefits.

What legislators -- even those who can justify to themselves turning away federal tax dollars -- ought to be concerned about whether they would be plugging one hole that only forces more water through another hole, drowning the taxpayer nevertheless.





Comments (1)
Posted by: Charles Zimmerman | Feb 07, 2013 15:39

   The Afordable Care Act(ACA) is the law of the land. Whether it is administered by the state or by the feds is the true question. Hopefully, it will cover the many not now covered and level the playing field. As the article above points out, too many are not being covered whereby their quality of life is lessoned & lives are shortened prematurely. Those not covered who do get care but cannot pay have the cost transfered to other sources & effectively raise everyone's cost of care. Same with undocumented.

Personaly, I only had a catastrophic type of insurance during my 30 plus years of farming. Never used. July of 1986 I fell about 8 feet off the top of a 9 tower Valley center pivot. I landed initially on the 8 inch in diameter verticle motor that drove the tower. Hit the lower right side of my back. Did a whiplash & spun around & landed face first falling another 3 feet. Sire agreed to start that system while I went to his system & put in fuel. Went to local emergency room. Filled out paperwork. Was laughed at. Filled out paperwork again. Refused service. Filled out paperwork again. Barb was furrious. Young doctor had nurse check me out. I told her I just wanted to be ex-rayed to see what I broke. She pulled up my t-shirt & looked at my back. Doctor came in & proceeded to claim that he didn't know how I had hurt myself but that my story was an outright lie especially as an older woman was there that had simply slipped on cooking grease & fallen down & broke her hip. She was employed as a cook by Dan Stanly who had brought her to the emergency room. I knew him thru 4-h & highschool. Then the doctor accussed me of trying to fleece my insurance company. I pointed out I was self-insured. He was not convinced. I told him I had 4 center pivots running & had to put in fuel or check every 4 hours & had to go. If my left arm had worked, I'd of picked him up & slammed him against the wall. But I had other priorities. I could not turn my head to the left for 1 1/2 years. Left shoulder wasn't right. Five years after fall I finnally had time(and money) to go to an austeopath(sp). His wife took the x-rays. She told him to "not touch that man". He put my charts up & said "well where should we start". It was his birthday & he thought she was paying a joke on him. I had & still have a broke rib in back, broke collar bone, shoulder blade & torn right rotator cup & knocked all 4 alignment tabs off 7th vertrebre & had fractured it. Laughingly, he said "I've seen corpses in better shape". He & his wife had done the autopsies at Ft. Wayne, Ind for many years. He told me to go on SSI & prepare to die as I would not last more than 5 years. I moped around for about 6 weeks & then realized I had work to do & got ready for harvest. Four years ago I was sitting in my 1970 KW doing paperwok at exit 39 US 75, Kentucky & my 7th vertrebra popped open. I thought that was the end I had been warned about. I laid down & rested for a couple of hours. Very carefully I drove my no power steeing KW to Homerville, Ga. & prepired to unload the two coils off my covered wagon. A very nice man that I had gotten to know had to help me. He called the company I was leased to. I had to hide out until I got home. We went to Asheville & it took 8 or 9 x-rays to get one that was visible. When the doctor saw the fracture, she jumped back & exclaimed "did you know you've got a fractured vertrebra"? I said "I told you I did yesterday." Sent me to an nueroligist. He scheduled x-rays & c-scan. Took 15 r-rays & computer enhancement to get one that worked. Seems farmers & athelethes have thick neck muscles. He prescribed a water pillow & anti-swelling pills. In two weeks I had another round of x-rays. He could not believe a gap that I could put my little finger in on the x-ray was gone. Just a line remained. He cleared me for work & back in my old KW I went.

I had to pay all costs out of pocket. I was fortunate, so to speek.             

Many cannot. Thru no fault of their own. Even though they have paid into "the system".

It is long past time this inequality is corrcted.

ACA ain't perfect. But it is a well needed start.



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