Guess what, when people have insurance, care gets paid for. Amazing concept.
Kaiser on the Cleveland Clinic:
The Cleveland Clinic, one of the largest hospitals in the country, has cut its charity care spending — or the cost of free care provided to patients who can’t afford to pay — to $101 million in 2014 compared with $171 million in 2013…..
The economy got slightly better in 2014 then 2013, but the big driver here is the Affordable Care Act. Medicaid expansion in Ohio was supported by the Republican governor and as projected by anyone who can count to eleven with their shoes on, unpaid care decreased significantly because quite a few poor people who had no health insurance in 2013 now had health insurance in 2014. The Exchanges most likely played a secondary role in reducing charity care as most hospitals have charity care programs up to 200% or 300% Federal Poverty Line, and subsidized Exchange policies are now avaialable to people who make too much for Medicaid but could not get affordable insurance previously and therefore relied on some charity care.
The counterbalance is that most hospitals are seeing some of their charity care cost reductions being balanced by an increase in deductible debts. The high deductible plan design mania to keep premium costs low means that a person hit by a car or diagnosed with cancer may not be able to come up with $4,000 on the spot, and some of that debt will never be paid. However, in the diagnosed with cancer scenario, the hospital might be out $4,000 but collect $25,000 from the insurer instead of eating the entire cost on charity care so it is still a massive net win.
This basic dynamic is why so many analysts (myself included) had thought that Southern and Great Plain state hospital associations would go to war with the Teabaggers to get Medicaid expansion passed as there is way too much money on the table. So far most of the hospital associations have not funded primaries or (gasp) Democrats against Teabaggers, but that is the way forward for most of the remaining hold out states to get Medicaid expansion. I think the incentive to go to the mattresses will increase as Disproportionate Share Hospital payments begin to get cut in the near future. That won’t on net hurt hospitals in Medicaid expansion states, but it will kill rural hospitals in the sadist states.
currants
“go to the mattresses”? Is that the same as “go to the mat”? (which for some reason I always thought was a wrestling term, but maybe not?)
currants
[But to your main point, Richard, yes, this is another big deal, one that was predicted–and good to see come to fruition. Glad so many people have that much more stability, even though still poor.]
WereBear
So they will ultimately kill their own most loyal voters.
Sister Rail Gun of Warm Humanitarianism
@currants: It’s a Godfather reference.
rikyrah
thank you for this post.
the Hospital Associations better step up to the plate.
patrick II
Of course the best hope for the sadist states to actually take the steps necessary to keep their citizens healthy is a financial reason, not a health reason. If people die it is o.k., as long as the state’s profit making centers stay solvent.
Mike J
@currants: http://www.phrases.org.uk/meanings/159900.html
raven
@currants: If they don’t get their shit together they’s gonna sleep with the fishes!
Major Major Major Major
Sky blue, water wet, social insurance programs save money in the long run, not to mention lives.
If only we could get more than 40% of the country to grok that. I’d be surprised if that many were even capable of “sky blue, water wet.”
MomSense
The poor rural hospitals in Maine could seriously use the infusion of Medicaid funds and the poor people in places like Washington County could absolutely use some medical care.
It has been under the radar of the national media but our governor is fixing to bring his fight to kick low income young adults off Medicaid to the SCOTUS. The messaging they are doing is infuriating. It boils down to they should get a job and then we can give that money to the elderly and besides we are tired of having to follow the whims of eebil gubmint.
boatboy_srq
At least some of this comes from underestimating the resistance. The widespread refusal by Red states to adopt Medicaid expansion was not generally expected. One would hope that, now that the stakes are so obvious in both the public health results and the hospitals’ balance sheets, that the healthcare provider sector will finally get on board. We’ve already seen what happens when business opposes wingnuttery (in Indiana and Arkansas): all that’s needed here is the healthcare equivalent of those actions.
Violet
If hospital associations don’t get on board are hospital beds going to have horse heads in them?
Major Major Major Major
@boatboy_srq: I don’t know about that. The whole point of the 2012 decision was that the “use it or lose it” part of the Medicaid expansion funding was unconstitutional coercion, no? That would imply that the law was attempting a carrot and stick approach, and while I usually wouldn’t trust a word Roberts writes, I seem to recall the same approach being the basic theory behind the way the expansion was drafted.
Frankensteinbeck
@Major Major Major Major:
They do grok that. They know what they’re doing and are getting the results they want. Their values are not the same as ours. The Unworthy suffering is a good thing by their standards.
@boatboy_srq:
Have we? I am reminded of the debt ceiling crisis. Business won, with the aid of everyone who wasn’t fucking insane also declaring their anger, but it was a pyrrhic victory where the downgrade hurt business. These forces are more evenly matched than you think, and only because when business throws in against the Tea Jerks, it’s because absolutely everyone else has thrown in.
JCJ
Good morning Richard!
Just saw a gentleman yesterday with a primary cancer of the tonsil with involved lymph nodes. He has had the enlarged lymph nodes in his neck for seven months but just recently got insurance so he decided to find out what the problem was. Pending further evaluation it appears to be a curable lesion, although the upcoming radiation combined with chemotherapy he will undergo is certainly a grueling course of treatment. At least the insurance coverage should keep him from being bankrupted.
azlib
At least in Arizona the hospital asscoations got their way with Medicaid expansion. It was one of the few things our former governor (a Republican) did right. I even sent here a thank you note.
Snarki, child of Loki
I’d bet that if you set up a SuperPAC, the kind that doesn’t disclose donors, specifically for opposing politicians that roadblock the Medicaid expansion, then those hospitals might find a way to send along some funding.
Make it so they stick a knife in the back of insane TeaBaggers, without leaving fingerprints.
kindness
Yea and no. I suspect some owners of Hospital chains will let a couple straglers die because the owners are ‘upstanding’ conservatives who won’t let facts get in the way of their narrative. The smaller single Hospital type place will just have to take the punches as they don’t have the political heft to do much against the native culture.
Sucks but let us not forget this isn’t a debate based on reason.
Jeffro
So far most of the hospital associations have not funded primaries or (gasp) Democrats against Teabaggers, but that is the way forward for most of the remaining hold out states to get Medicaid expansion.
I think it’ll be fascinating to see if these associations & insurance companies, along with businesses big & small dealing with Indiana-style anti-LGBT laws, start shifting their donations and other support over to the Dems. “GOP: Bad for Your Health, Bad for Business” isn’t such a bad overarching theme for Democratic campaigns through 2040 and beyond.
The US really is going to look like two fundamentally different countries by that point. New Mexico better annex an access corridor over to California, and quickly.
Someone in the industry
I’ve had this conversation with a number of trade association people. The GOP politicians are telling them that Obamacare is so toxic to the base in their states that signing on to the Medicaid expansion will result in an immediate, well-funded Tea Party primary challenger. They say that they’d rather not have the hospitals’ money than have it and be primaried — they can probably survive the first but not the second.
boatboy_srq
@Frankensteinbeck: If you’re going to quote me out of context, then of course there’s going to be difficulty agreeing with the point. I said ” We’ve already seen what happens when business opposes wingnuttery (in Indiana and Arkansas)” – meaning that we’ve watched Cummins, NCAA, Wal*Mart and others stomp all over grotesque Teahadist legislation and the bills’ wingnut backers backpedal faster than Cnut’s advisors at high tide. We haven’t seen anything like that from the healthcare sector, and likely in no small part because there are still a boatload of folks like Rick Scott (who could not care less if half his state’s population died of preventable conditions so long as HCA and his wife’s testing business got paid) still running those entities. The debt ceiling crises after the first one were predictable once the GOTea Obummer-rabies pandemic became visible, but the first one was equivalently shocking to anyone not directly in tune with the RWNM. The point was that we see good responses when business takes notice of the scr3wing they’re getting in the name of Freedumb™ and Religiousistic Liberty™: if that could be applied to healthcare we would probably see the wingnuts back off nearly as quickly as they’ve just done with RFRAs.
pseudonymous in nc
Not in situations where the state district map is gerrymandered, and primaries are tests of ideological purity. The governors are perhaps a bigger and easier target than legislators, but they only come up for re-election every four years.
Local newspaper coverage of the regional hospital behemoth is often problematic: as the largest private employer, with a lot of money to throw around, the paper often pulls its punches. However, the paper just began a long strand of reporting on the hospital, and the stuff that comes with obvious corporate approval is the demand for Medicaid expansion.
NCSteve
The left’s continuing delusion that the physical or economic well-being of anyone other than the top .1% is capable affecting the slightest change in a policy dictated by the hardened dogma of the right is quaint. We just can’t seem to let go of this notion that the GOP is still a normal political party in the American sense of the word.
And we continue to believe this despite watching, time and again, as the House Republicans drop their pants and shit on the heads of the Chamber of Commerce and even Wall Street and the MIC and suffer no consequences.
The only people capable of affecting Republican ideas are the Koch-aligned neo-feudalists whose ideological ambition is to destroy government and reduce the nation to economic warlordism and, bizarrely, given how it’s ability to move the dial in an election has waned under Wayne, the NRA. Crumbs will be thrown to other constituents in the GOP tent when absolutely necessary to keep them on board. But CoC, Big Finance, Big Pharma/Healthcare, and Big Everyone Else have, three elections running, cut off Democrats and rewarded Republicans for shitting on them, and, in any case, demonstrated that they’re incapable of donating the kind of money the Kochtopus Empire is putting into politics.
raven
@NCSteve: lions and tigers and bears, oh my!
gene108
From what I’ve read, it is already happening in sadist states.
The question is how long before total extinction?
catclub
@boatboy_srq: All true. But also if this were decisive, GM would have been in favor of nationalized healthcare for decades. It has not been because of the tribal effect that rich white powerful groups in the US have decided that they do not do national healthcare – in spite of whatever benefits it might have for those rich white tribe members.
(For GM those are huge – all its unfinded laibilities for retiree healthcare goes away.)
Likewise for hospital directors. So far, they are staying awfully quiet. I have no idea if they will ever develop any voice in favor of medicaid expansion.
BruceFromOhio
Slightly OT but related: a back-handed reason to kill ACA (warning, embedded video auto-start).
“Sadist states,” man that is pretty frosty, if accurate.
Frankensteinbeck
@boatboy_srq:
But I’m not sure we would. Maybe if all the different business groups lined up, but the medical community already really wants it. The Teabaggers don’t give a fuck, and they do the voting, not the 1% business community. Joe Redneck wants the niggers to hurt, and demands that Obama’s name be wiped from history, a failure who accomplished nothing.
Tenar Darell
After reading about the Louisiana local hospital closures, I could not help but note that people would definitely die if they couldn’t get to care quickly enough. Based on the continued resistance to “free money!” as Charlie Pierce says, I suspect that quite a few 1% are going to have to die from sudden onset illnesses before some states accept Medicaid after this long, sustained, fact free disinformation campaign. There’s too much pressure against the ACA to enable politicians and their local backers to publically change their minds without the multiple tragedies or people which local media will actually pay attention to. (Boy that makes me sick; the anti-ACA forces now have me thinking that they think like this).
currants
@Sister Rail Gun of Warm Humanitarianism: Ah. Thanks for the clue. I’m hopeless on most pop culture…movies generally, and music post-2008 especially.
Brett
It can take a while for them to wear down resistance to reforms like this. It took them, what, 17 years to finally get Arizona to accept Medicaid in the first place?
chris9059
@WereBear:
yes, just as their plan to destroy the US Post Office will harm rural (predominately right-wing) residents far more than urban residents.