via TPM, this:
The states that declined to expand Medicaid will lose out on a total of $8 billion in federal funds, have millions more residents uninsured, and spend about a billion dollars more on uncompensated care as compared to states that accept the expansion.
That’s the conclusion of a new study in Health Affairs by two RAND Corporation scholars, who model the impacts on the first 14 states that opted out of Obamacare’s Medicaid expansion, which was made optional by the Supreme Court.
In total, mathematician Carter Price and economist Christine Eibner find, the 14 states that rejected the expansion will wind up with 3.6 million more uninsured people, $8.4 billion less in federal funds, and up to $1 billion more in spending on uncompensated care in 2016.
But, but, but…FREEDOM!
I’ll add only this editorial aside: the number that really counts there are the 3.6 million more uninsured.
That’s a lot of human cost, suffering that should not happen. That it comes at a significant dollar cost to the states that so choose to put their citizens in harm’s way is only icing on the cake.
Actually, I can’t resist one more bit of editorializing. As I think about the in-your-face religiosity of a fair subset of those opposing Obamacare, I can’t help but think of what Albert Einstein said on being asked for his message to the German people in the second year of that conflict whose name should have retired the irony prize for all time, the “Great War”:
Honor your Master Jesus Christ not only in words and songs, but rather foremost by your deeds.
That is all.
Image: Jan Steen, The Sick Woman, c. 1663-66
(PS: I’m on the road with very sporadic internet for the next week+. Given my highly sporadic approach to blogging, no one is likely to notice — but if you do, that’s why.)
? Martin
You say that like they care.
They don’t.
taylormattd
Please don’t hate me *too* much for an off topic post, but I *have* to share this with you all.
This to me is an absolutely perfect encapsulation of the media:
lurkmode365.tumblr.com/post/52196203877/michelle-obama-the-heckler-what-had-happened
Cacti
Do Republicans really hate poor people that much?
Yes. Yes they do.
JGabriel
Tom Levenson @ Top:
There is no price too high to pay for the freedom to let our underpaid peons die when we have no more use for them!
Mike G
Turning away billions in free money out of spite. It’s just what Jesus would do.
Yatsuno
@Mike G: They may die, but they will die without the horrific tyranny of gubmint healthcare. And their Republican betters will damn well make sure of it.
Groucho48
The numbers are a bit confusing. It appears as though they are saying that those states will receive $8.4 billion less in Federal funds and have to pay out $1 billion more for uncompensated care.
That implies the folks that won’t be added to Medicare would have $8.4 billion in premiums and received $1 billion in health care.
What am I missing?
Suffern ACE
@Groucho48: Missing I think is the amount of uncompensated care now. Since there are millions without coverage now. Although the numbers are confusing.
Chris
@? Martin:
That’s not really true.
When I recall the standing ovation Ron Paul got when he said to a roomful of Republicans that people who weren’t insured should just die already, I find it very difficult to believe they don’t care. I think they’d be very, very upset if all that human cost and suffering weren’t happening.
Yatsuno
@Groucho48: Uncompensated care means care hospitals don’t get paid for. Saint Ronaldus Magnus made sure ERs have to take every comer regardless of ability to pay, but if the patient is uninsured the hospital has to spend a small fortune collecting. And most of the time they get zilch because the vast majority are too poor.
This part:
I don’t follow you on at all. It means the states that refused the Medicaid money don’t get the dollars set aside for the expansion.
JGabriel
@Groucho48:
That the states that accepted the Medicaid expansion will have far less on uncompensated care, and will receive $8 bn more dollars to pay for it. In other words, you’re missing that the states with Medicaid expansion will have, on average, at least $9.4 bn less in health care expenses, because the feds are paying the bill, than those states without it.
Steeplejack
@Groucho48:
First, it’s Medicaid, not Medicare.
From the linked story at TPM:
The $8.4 billion number probably represents the amount already known that the nonparticipating states will not receive from the federal government (since they have declined to participate).
The $1 billion in “uncompensated” care is the amount calculated to be eaten by the states when they have to pay for uninsured people showing up at emergency rooms, etc.
Bruce S
I think that GOP governors are going to start falling away from this insane approach. This really is the divide between genuine assholes who have an ounce of pragmatism (Brewer, Kasich) and the utterly crazy who are obsessed with Obama as the Devil. Also, maybe there’s an issue in some cases of wanting to look like a potential hero to the base in ’16 (Jindal, who doesn’t seem like he’s this crazy and reckless without it being part of some scheme for furthering his national ambitions.) While this is terrible news for poor people in states with governors who hold out, it could be good news for Democratic pols because it’s insane policy and could open some political wedges, even in the South.
Ruckus
@Groucho48:
A lot.
There will be 3.6 million people without health insurance who would have had it had the 14 states they live in not be run by complete assholes.
These 14 states would have gotten 7.4 billion for the coverage for those additional 3.6 million people. Had they not been run by complete assholes.
Those assholes will also have to spend an additional 1 billion to cover the people they still have to cover. IOW the money(1 billion of the 8.4 billion) would also have covered some of the costs that still have to be paid even without the ACA.
MattR
@Suffern ACE: It also seems to be missing time frames. I think those numbers are projections for 2016. But you kinda need multiple years to see trendlines to judge what those 2016 numbers really mean. Personally, I think the interesting projections would be to compare the increase in uncompensated care costs due to not expanding Medicaid with the increased costs to the states to pay for that expansion once the Federal government’s portion drops to 90% in 2017. Generally speaking, that is the argument that Republicans used to reject the expansion – that it would become too costly for the state once the Federal gov’t stopped paying for all of it.
(EDIT: Obviously if a 100% subsidy in 2016 is 8.4 billion then we know that the states would have been on the hook for 840 million in that year if the feds only gave 90%. And 840 million in costs is less than the 1 billion they are projected to spend anyway on uncompensated care. But I would like to see where those numbers are trending to confirm that the Republicans are in fact lying, heartless bastards who just don’t want to provide health care to the poor even if it is cheaper)
mclaren
If the voters get sick of this shit, all they have to do is throw the bums out. Stop electing Republican governors and Republican legislators, and the problem will go away.
Bruce S
@Cacti:
Frankly, I think it’s more about hating Obama than hating poor people. They don’t give a shit about poor people, but hating Obama is an obsession.
Ruckus
@MattR:
Except that those states would be getting over 10% additional money before the fed supplied money will be reduced to 90%. IOW they would have to go back to spending a very little less than they do now. They don’t lose unless they don’t take the current increase.
That’s why you have conservative governors who can read, add and subtract actively working to take the money.
Bruce S
I love that the anti-federal government crowd won’t take the expansion because after several years the Feds are asking them to chip in 10% to help cover their people’s medical care. Of course, asking for consistency from these loons or being “shocked” by their serial hypocrisy is a fool’s errand.
MattR
@Ruckus:
Not sure I follow this. Are you referring to the money they wont have to spend on uncompensated care?
Ruckus
@MattR:
The 1 billion is more than 10% of the 8.4 billion that they would receive if they didn’t have their heads up their asses. That is money used to help enroll the additional 3.6 million people as well as offsetting the money they now spend. When the fed portion is rolled back to 90% they will still be getting slightly more than they are currently. IOW there is no loss to those states to take the money.
Groucho48
Thanks for the explanations. I’m still confused, though. Is the study saying that the folks currently uninsured, who the states are refusing to cover, are amassing 8.4 billion in health care expenses? Then, what is that other billion that would be added? Is it possibly the extra cost of health care for those uninsured folks because they have to get ER care for everything?
I guess my main question is what is that 8.4 billion in Federal payments for? Premiums? Or incurred health care expenses?
I tried checking the full report but it requires you register for the site and I don’t like doing that for one-offs.
MattR
@Ruckus: Gotcha. On the same page.
@Groucho48:
They are saying if the states put those 3.6 million people in the Medicaid program, they would incur 8.4 billion in health care expenses (which would be fully reimbursed by the federal government) (EDIT: If I understand this right, there are no premiums in Medicaid. It is just direct payment from the program to the doctors to cover the costs of the services rendered) (EDIT2: To clarify, that 8.4 billion is not how much they are currently spending in health care costs while uninsured, it is a projection for how much they would spend if they became insured via Medicaid)
That’s pretty much it. If those 3.6 million people are not in Medicaid, they will have no insurance so many of them will not get routine care that they need and will end up in the ER. The billion dollars is the difference between how much care they will get in the ER and how much they will actually pay (leaving the state to make up the shortfall)
Or at least I think that is it. But it is hard to tell without being able to access the full report, which as you mentioned is behing a pay wall.
David Koch
Are they any worse than the Progressive Betters™ who want to “Kill the Bill!”?
Groucho48
A very lucid explanation. Thanks! I poked around a bit and that billion dollar figure IS to deal with folks getting uncompensated care.
I’m guessing a lot of that 8.4 billion is currently being eaten by hospitals and such and by higher private insurance rates for everyone else to cover those costs. So, Republicans can just pretend it doesn’t exist.
Wally Ballou
@Mike G: Verily I say unto you, Inasmuch as ye have flipped the bird unto the least of these my brethren, ye have flipped it unto me.
El Cid
Imagine how haughty & uppity all them poors would be if’n they were to think they could go to the doctor when they needed?
This would set a terrible precedent in the toiling populations perceiving themselves as overly human.
Valdivia
@taylormattd:
thank you. Josh from TPM posted some of her tweets from the past few days it looks like even if she was sent there by that org she is a regular in the Obama can do no right crowd.
Buckyblue
Here in WI it’s even worse. A state that went for Obama and elected the first openly gay senator is not taking the Medicaid money because the dbag governor thinks he can be president. Please, God, make Scooter the republican nominee in 2016 so I can again say the fine phrase, “yes, president Clinton”. Scott Walker really thinks he can be president, which tells you all you need to know about how stupid this guy really is.
VidaLoca
@Buckyblue:
Yes. Yes it is. The Wisconsin Legislature’s Joint Finance Committee just voted to to give $30 million of state money to hospitals for uncompensated care while refusing to cover low-income people who need health care. So the people who need the care don’t get it, the taxpayers cover the costs, but at least the hospitals are off the hook.
Can you explain why people in Wisconsin should get all happy about Hillary beating Walker in 2016 when Walker will still be Governor until at least 2018 and possibly beyond?
I’ll grant you that Walker is not the brightest bulb in the marquee although for a stupid guy he’s done quite well for himself and shows no signs yet of running out of steam — our fantasies to the contrary be damned. If you want something really stupid though I’ll send you the email I got yesterday from the chairman of the Wisconsin Democratic Party. He was literally wetting himself because the DPW now has … wait for it… a billboard! To go along with their education campaign! And a spiffy new research memo! All about how Walker has failed us. Followed by the inevitable begging for money and the chance of a lifetime to get on their mailing list until hell freezes. Fuck that.
Omnes Omnibus
@Buckyblue: Yep. The WI GOP plan coming out of the budget committee will cost $119 million more and cover 85,000 fewer people than the Democratic plan. It takes a special kind of asshole to want to pay more to do less. I could understand, but not agree with, a decision to save money by covering fewer people, but this boggles the mind. Oh, yeah, voucher increases and public school cuts too.
Shakezula
I’m sure the Repuds will come up with a solution like … The Work Exchange Allowance & Lease for True Healthcare Act. An uninsured person who has medical debt will be leased to the highest bidder and work of his or her debt over a period of time.
cvstoner
It would appear that mean-spiritedness doesn’t pay, after all.
You would think that, just for sake of self preservation, that the people in these states would vote these yahoos out. But they won’t.
cvstoner
@Omnes Omnibus: Yes, but the flip side of that is getting paid more to do less, which is what the people who fund the Repubs want.
vhh
My guess is some of the GOP governators think that the poor can be made to move to states with better health insurance. Sort of like ethnic cleansing.
ranchandsyrup
@vhh: One of my colleagues from TX said that just yesterday. “the Mexicans will move to CA for healthcare and the businesses will move to TX”. Failing upwards!
karen
@Chris:
Yes they get of on it and if the people are blah, double hard-on.
This is legal murder period and the feature of this plan is the death of poor people.
karen
@Shakezula:
Since there are already calls to repeal the Child Labor Laws, I figure the next logical thing would be that the poor people’s children would become “comfort children” until they paid off their parent’s medical debt.
Or we could always go the “Repo Men” route where you get your organs taken away if you can’t pay your death.
Tom_B
@mclaren: “If the voters get sick of this shit, all they have to do is throw the bums out.” Hard to do, given the large number of low-information-voter filled rural congressional districts in most states. I wonder if citizens, though, might not be able to sue their governments for fiscal malfeasance if they turn down the expansion.
cleek
fixed it.
Bruce S
@David Koch:
Yes, you blithering idiot. They are far, far worse than the handful of “who the fuck are you talking abouts?’ because they actually have political power and represent a significant margin of voters that turn out and fuck shit up.
You’re an obsessive moron. Totally ridiculous – not to mention tiresome – in your crank obsession with phantom “Progressives” who mostly live in your mind. Why don’t you join the Tea Party and tune into Glenn Beck if you think some cabal of “Progressives” conjured from your paranoia are such a danger to America. You come off as that crazy! Christ – what a fucking idiot.
Go see a psychiatrist because Glenn Greenwald does not, in fact, live under your bed.
? Martin
@Groucho48:
Not just higher private rates but higher public rates as well. The low resistance path, if you can manage it, is to get those costs covered through Medicare/Medicaid reimbursement. The feds don’t yet have the authority of an IPAB but every insurer sure as hell does.
Elie
@Yatsuno:
Yes, that is what it LOOKS like, but in truth, they are trapped there by Obama. If they all go along with implementing the expansion without hesitation, then they basically affirm the whole government works idea and it gives people the idea that they are entitled to government that works. This way, they keep it broken – even at risk of the millions they and the providers in their states loose. They know that once people get used to this huge successful example of how government helps the little guy — their whole rationale for existence of their party. That is why they hate Obama. He is “making them” hurt themselves and he knows they can’t stop it and survive standing for what they do. Yes,he happens to be black, which adds to the pain, but the core issue is that he is making them hurt themselves and they have no response except to try to hurt him as best they can at every small and large turn. Anyway, that is my take
Another Halocene Human
@Groucho48: People who die without treatment? The Malthusian solution.
boatboy_srq
@mclaren: There’s more than one way for the problem to “go away:”
1) the Teahadists can secede, and inherit all their Small Gubmint (Drownable in a Bathtub) idiocy, at which point it won’t be the US’ problem, and all the US federal dollars bleeding into Red States can be stanched and put to better use;
2) all those uninsured can kick quickly, at which point the cheapskates in the Red States can reap the benefit of increased (managed) immigration and work permits to pay the bottom 40% even less – all without “genocide” written all over the process.
boatboy_srq
@ranchandsyrup: Interesting, given that so many “Mexicans” are going to TX for work – and so many Teahadists are paying them under-the-table…
boatboy_srq
@ranchandsyrup: Interesting, given that so many “Mexicans” are going to TX for work – and so many Teahadists are paying them under-the-table…
phil
They’re just hoping that the poor will leave their states, when they see that grass is really greener elsewhere.