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“Particularly Shameless”: Rick Scott Lied On His Mother’s Grave — And Blew A Hole In The GOP’s Anti-ObamaCare Argument

When it comes to ObamaCare’s expansion of Medicaid, it may seem like a matter of simple logic for states to take the money that’s on offer. It would both help their most vulnerable citizens and pump lots of money into local economies.

Alas, logic and the contemporary Republican Party have little relation to each other, so most GOP-controlled statehouses have turned down the offer. But few have done so in a more clownish manner, or exposed the contradictions in the Republican position more clearly, than Florida Gov. Rick Scott.

Scott has flip-flopped on Medicaid, first opposing it, then supporting it, then opposing it again. This is bad, if not entirely unusual, political behavior. But Scott was particularly shameless, citing his recently deceased mother as his justification for suddenly embracing the expansion in 2013.

As he has now revealed, however, Scott was lying on his mother’s grave. He pretended to embrace the Medicaid expansion to secure a federal waiver for privatizing Florida’s Medicaid system, then quietly dropped his support once the waiver was granted. (The Obama administration’s decision to give the quid without first getting the quo, given who they were dealing with, was not its finest hour.)

So Scott used his deceased mother as a shield to lie about his motives in order to funnel federal taxpayer money to Florida businesses, then reneged on his part of the deal, leaving many poor Floridians to needlessly suffer and in some cases die. All par for the course for Scott, who before entering politics oversaw a massive amount of Medicare fraud as CEO of a large for-profit hospital operator.

At this point, one could say that, rank dishonesty and opportunism aside, at least Scott is standing on principle. He is turning down federal dollars to protect state sovereignty. Not a very attractive principle, but at least a principle, right?

Nope. Before the Affordable Care Act, the federal government made money available to states to create Low-Income Pools (LIP) that would reimburse hospitals that treated patients who couldn’t afford to pay for emergency services. Florida is receiving more than $1 billion a year in federal funds from LIP. The ACA, however, makes the LIP obsolete. It addresses problems of uncompensated hospitals by expanding Medicaid, greatly reducing the number of patients who cannot pay their bills.

The federal government has told Florida that it will not make the LIP funds available, pointing to the Medicaid funding which remains available. But Scott wants to have his cake and eat it, too. Not only is he demanding that the federal funding continue, he has actually filed a frivolous lawsuit arguing that the federal government is obligated to give Florida the LIP money. The Obama administration, having been burned by Scott already, is unmoved.

This lawsuit builds on the Supreme Court’s already shaky holding that allowed states to opt out of the expansion, pushing it to an extreme that would be too absurd even for the Roberts Court. It has virtually no chance of succeeding.

But the decision to file it is instructive. On the one hand, Scott is arguing that taking an extraordinarily good offer from the federal government to insure its poor citizens would be an intolerable intrusion on the sacred sovereignty of the state of Florida. On the other hand, Scott is arguing that Florida has a right to another source of federal tax dollars for health care.

There is, in other words, no actual principle involved here — not even a bad “states’ rights” one. It’s just pure partisan politics, with Florida’s poor people being punished as a result.

As Michael Hilzik of the LA Times observes, Scott’s disgraceful behavior reflects broader trends in Republican governance. The decision of Republican officials at the state level to reject the Medicaid expansion, while misleading their constituents about the dread ObamaCare, continues to have disastrous results for their citizens.

The ensuing mess in Florida — where a huge hole has been blown in the state budget because anti-ACA fanatics won’t take the Medicaid expansion — does at least provide a glimmer of hope for the longer term. Red-state legislators may not particularly care about the many poor people being needlessly denied access to medical care. But they will start to increasingly care about the medical professionals and hospitals who are also being screwed. Once Obama leaves office, it’s likely that more and more states will grudgingly take the federal money.

In the meantime, however, the consequences of misrule in these states will continue to be grim.

 

By: Scott Lemieux, The Week, May 18, 2015

May 19, 2015 Posted by | Low Income Pools, Medicaid Expansion, Obamacare, Rick Scott | , , , , , | 1 Comment

“Show Me The Medicaid Money”: Buckle Up Republicans, Obamacare Is Here To Stay

Somewhat quietly, Obamacare enrollment hit 4 million this week. Now, it’s certainly true—as critics have noted—that enrollees aren’t the same thing as people who will continue to stay with their plan for a full year. If an enrollee encounters an unexpected expense of replacing a head gasket or something like that, he might skip a payment. But even so, 4 million’s a more-than-respectable number.

Also rather quietly this week, a new tracking poll from the Kaiser Family Foundation showed support for repeal of Obamacare down to 31 percent. As Jay Bookman noted in the Atlanta Journal-Constitution, overall the poll wasn’t something the president would exactly brag about, but it did represent noticeable change, especially among independents, 57 percent of whom now support the law.

That 31 percent number made me sit up straight for one reason. The percent of Americans who identify themselves as conservative is, lately, about 38 percent, says Gallup. So 31 percent is getting down there. And consider this: As of mid-December 2013, the percentage of Americans who favored repeal was 52.3 percent in a Real Clear Politics average of numerous polls. The Affordable Care Act may not be as popular as Twelve Years a Slave, but it’s not The Lone Ranger anymore either.

I would think there’s a direct correlation between these two sets of facts, no? The more people go to the web site and see that they can get insurance at a decent price (in most cases), the more they tell their co-workers and neighbors that doing so wasn’t the horror show they expected. The more people learn about some of the law’s benefits, the more opposition to it softens.

There are still a few more things the American people need to learn about the law, though, and it’s up to the Democrats to tell them, and I’m going to bang on about this until I see some action. As I wrote Wednesday, Governor Rick Perry has said no to $9 billion in free money. Texas is the largest state in the union that hasn’t accepted the Medicaid expansion money, so that’s the biggest figure, but the figures are significant in relation to the population and budget in every single state.

These figures are from a Commonwealth Foundation report from three months ago. Florida is saying no to $9.6 billion, Georgia to $4.9 billion, North Carolina to $5.7 billion. Wisconsin is passing on $1.75 billion, Virginia on $2.15 billion, and Pennsylvania on $5.5 billion (although Pennsylvania is considering the opt-in). And this report’s figure for Texas is actually $9.6 billion.

You know how states clamor for federal highway money? Well, as Commonwealth points out, in every one of these cases, the Medicaid money is more—at least double, typically, and sometimes far more—than what these states get in highway money. And yet they say they don’t want it. They say that over time, they’re going to be on the hook for vast expenditures they can’t afford, or they fret publicly that Washington might change the formula. They’re both bogus arguments.

The federal government is paying 100 percent of states’ expansion costs through 2016 and no less than 90 percent thereafter on a permanent basis. It’s a sweet deal. But okay, what about that (up to) 10 percent that states are going to have to start paying? Ten percent doesn’t sound like a lot, but in dollar terms, isn’t that real money?

The answer is, not really, in most cases. This gets complicated and involves a category of spending by the states for something called “uncompensated care,” which is just what it sounds like—health care provided for free to poor people. State and local governments typically pitch in now on uncompensated care. But as the Center on Budget and Policy Priorities explains in a 2012 report: “The Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs.” Overall, the health-care consulting firm The Lewin Group estimates a minimal increase in states’ spending obligations, around 1 or 2 percent, depending on the state.

As for the argument that some GOP governors make that they fear Washington might change the formula…well, that’s straight from Orwell or Kafka. That is: Barack Obama isn’t going to change any formula. President Hillary Clinton wouldn’t be changing any formula. A Democratically controlled Congress won’t be changing any formulas. Only Republican presidents and congresses would do that. In other words, these Republican governors are saying—yeah, the deal looks fine now, but my party might take over, and then I’d be really screwed!

The ACA is here to stay. It’s not going to be struck down. It’s not going to be repealed. That would require a Republican president and 60 GOP senators and a solid GOP House majority, and the odds are strongly against the emergence of such a confluence. It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it. And over time, the people in states like Texas and Georgia and Wisconsin are going to see that people in nearby states that took the money are in fact pretty happy with their situations.

It’s only a matter of time before these resistant governors and state legislatures start caving. Democrats have it in their power to help hasten that timetable by making this an issue. They have to have the courage not to wilt or get the vapors whenever a right-winger invokes the evil gummint or the hated Kenyan. Democrats say they’ve waited decades for this moment. Well, it’s here. Now’s not the time to run away from the fight.

 

By: Michael Tomasky, The Daily Beast, February 28, 2014

March 3, 2014 Posted by | Affordable Care Act, GOP | , , , , , , , | Leave a comment

“Obamacare And Emergency Rooms, A Bit Of Perspective Needed”: Oregon Study Doesn’t Undermine Affordable Care Act Claims

Headlines based on a study of emergency room visits by a few thousand Oregon Medicaid beneficiaries undoubtedly gave the Obama administration heartburn last week. Although the study predated the Medicaid expansion authorized by the Affordable Care Act — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicaid beneficiaries would make greater — not less — use of the ER for routine care.

I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And that’s because more Americans will finally have insurance.

Reform advocates have long suggested that getting folks out of the ranks of the uninsured should cut down on visits to the ER for noncritical medical care. Many people who lack coverage don’t have a primary care physician and all too often make trips to the ER when their illness or injury could have been treated more appropriately and inexpensively in a clinic or doctor’s office.

The Oregon study, which was published in the journal Science, would seem to disprove that theory.

In 2008, two years before the ACA was enacted, Oregon increased the number of Medicare beneficiaries in a novel way: by lottery. Many Oregonians who had been on a waiting list for the state’s Medicaid program got lucky when their names were drawn and they were added to the rolls.

The researchers who wrote the Science article studied the emergency room use of about 25,000 of the successful and unsuccessful lottery participants and found that those who won coverage actually made more trips to the ER over 18 months than those whose names were not drawn.

Headline writers were quick to draw their conclusions: Obamacare would not reduce unnecessary ER visits.

“Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday.

“Obamacare Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg.

And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Emergency Rooms, Undermining Central Rational for Obamacare.”

“For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,’ said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion.”

There is more than a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can’t pay for their ER care. That’s because the hospital shifts the cost of that “uncompensated care” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn’t have to occur.

Bringing uninsured people into coverage eliminates much of that cost shifting. And that’s a good thing, considering that the vast majority of Americans with health coverage — even after the Medicaid expansion — get it through private insurance companies, either at work or on their own.

The actual increase in the number of visits per person among the newly insured in Oregon via the Medicaid lottery was 0.41. In other words, each new enrollee made 0.41 visits more on average during the 18 months than the 1.02 ER visits made by those who remained uninsured.

When you look at it from the perspective of those numbers, and the actual amount Oregon spent per person, as University of Chicago health policy expert Harold Pollack did in a healthinsurance.org post, this is far from a “sky is falling” disaster in the making. And it is actually reducing the cost shifting.

Also, as Pollack pointed out, “the emergency departments will be reliably paid for care they provide … (With coverage expansion) providers don’t have to fear the burdens or uncompensated care, and…they don’t need to cruelly pursue low-income patients over bad debts.

It’s also important to keep in mind that private insurers now manage most of the states’ Medicaid populations, and they will be vigilant in their efforts to steer their new Medicaid enrollees away from the ERs and to more appropriate and cost-effective settings. WellPoint subsidiary Amerigroup described in a recent policy brief, for example, how its efforts to reduce primary care-treatable ER visits among Medicaid beneficiaries resulted in a savings of more than 50 percent.

Rather than rushing to conclusions, let’s see how the Medicaid expansion under Obamacare actually plays out in the years ahead.

 

By: Wendell Potter, The Center for Public Integrity, January 6, 2014

January 8, 2014 Posted by | Affordable Care Act, Health Care Costs, Medicaid Expansion | , , , , , , | Leave a comment

“It’s All Or Nothing”: The Obama Administration Plays Hardball On Medicaid

When the Supreme Court upheld the Affordable Care Act, it also gave Republican states a gift by saying they could opt out of what may be the ACA’s most important part, the dramatic expansion of Medicaid that will give insurance to millions of people who don’t now have it. While right now each state decides on eligibility rules—meaning that if you live in a state governed by Republicans, if you make enough to have a roof over your head and give your kids one or two meals a day, you’re probably considered too rich for Medicaid and are ineligible—starting in 2014 anyone at up to 133 percent of the federal poverty level will be eligible. That means an individual earning up to $14,856 or a family of four earning up to $30,657 could get Medicaid.

Republican governors and legislatures don’t like the Medicaid expansion, which is why nine states—South Dakota, plus the Southern states running from South Carolina through Texas—have said they’ll refuse to expand Medicaid (many other states have not yet said whether they’ll do it). But some states asked the Obama administration whether they could expand Medicaid a bit—maybe not cover everyone up to 133 percent like the law says, but add a few people to the rolls. And yesterday, the administration said no. It’s all or nothing: either you expand Medicaid up to 133 percent, or you get none of the new money. Was that the right thing to do? Well first, let’s talk about that money.

These Republican states offer worries about cost as their reason for rejecting the Medicaid expansion. But in truth, it’s an incredibly sweet deal for them. Right now, the federal government generally pays half of the cost of Medicaid, with the state picking up the other half. But the federal government will pay 100 percent of the cost of new Medicaid recipients signed up because of the expansion between 2014 and 2016. After that the federal contribution will step down to 90 percent by 2020, where it will stay forever more. So the state gets to insure a whole bunch of its citizens for nothing at first, and eventually for only 10 cents on the dollar. And in return they get reduced costs for uncompensated care, and a healthier, more productive citizenry with more money to spend. Some studies have projected that states will more than make up for their 10 percent contribution with health care savings they’ll get from an insured population; that’s likely to be particularly true among those states whose Medicaid eligibility standards are currently the stingiest, who not coincidentally have the highest rates of uninsured citizens (and, also not coincidentally, are precisely those states where the Republican leadership is refusing to accept the expansion).

And yet, the most conservative among them won’t take the deal. The federal government is saying to the states, Here is a bunch of free money for you to give health insurance to your uninsured poor citizens. And these states are saying, No way! Their justification of budget worries is so unpersuasive that it’s impossible to avoid the conclusion that they would rather see people have no insurance, and thus be poorer, sicker, and die sooner, than get Medicaid via Obamacare. It’s truly a moral abomination.

By playing a little bit of hardball and not letting states get away with a partial expansion, the administration is betting that before long the states will find all this free money to insure their citizens irresistible. And they may be right. That’s what happened when Medicaid was established in 1965; few states signed up at first, but before long they all did. Right now these governments are being pressured by some powerful interests to take the expansion, particularly the hospitals who have to deal with patients with no way to pay their bills. If they expanded Medicaid a little but not fully, that pressure wouldn’t be as intense and they could claim they expanded coverage. This way they won’t be able to hide behind a partial expansion and claim they did the right thing. Let’s hope the administration is right, because millions of Americans’ futures depend on it.

 

By: Paul Waldman, Contributing Editor, The American Prospect, December 11, 2012

December 12, 2012 Posted by | Health Care | , , , , , , , , | 1 Comment

   

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