Back in April, Jim Galloway reported that Democrats and Republicans have developed different language for what essentially amounts to the same thing – Medicaid expansion. Whether you call it a Medicaid waiver or Medicaid expansion, they’re both ways to cover folks that have been in the coverage gap in Georgia since the Patient Protection and Affordable Care Act (PPACA, ACA, Obamacare) became law eight and a half years ago. Sure, I’ll concede some differences, but either way, the Republicans in the Georgia General Assembly have yet to come to terms with the fact that their compatriots in the U.S. House and Senate, even though in control of both houses, are unable to pass a replacement or even a stand alone repeal. Love it or hate it, PPACA is the system we live under, and it seems it will continue to be so for the foreseeable future.
Georgetown University’s Center for Children and Families and the University of North Carolina’s NC Rural Health Research Program released a study this week that details yet again the reasons for exploring Medicaid expansion or a waiver in order to shore up rural health care in the state. Nationally, 10.7% of Americans under the age of 65 are uninsured. The percentage of uninsured is much higher in rural communities, particularly in the seventeen states that have not expanded Medicaid in some form. Overall in these states, the uninsured population is 32%. In Georgia, it’s 30% of adults in urban areas and 38% in rural areas. Add to this that Georgia has seen four rural hospitals close and come very close to losing several others, and it becomes apparent that the status quo isn’t working.
The folks in the Georgia General Assembly are worried about the hospital closures, and the lack of access to care, and the economic situation in rural Georgia overall, so much so that the House and Senate developed different committees/councils to study and report on these issues. I’d like to tell you that some of the things they’ve done to try to shore up the hospitals have worked, but it’s been more like applying a bandaid to a broken arm. That’s because the cost of delivering health care is enormous, and providing the care that hospitals are required to provide to ensure they meet EMTALA requirements is impossible if over a third of patients are being treated with no means to recoup costs. Because let’s be real, no one barely scraping above the federal poverty line (expansion is to 138% FPL, which is an annual salary of $16,753 in 2018) is able to pay enough out of pocket to put a dent in the cost of their care in an emergency room, and it’s one of the major reasons why those of us with private insurance are charged insane amounts for our stays, like the infamous $500 Tylenol.
The Georgetown/UNC study is one in a long line of studies that have found that expanding Medicaid will not only cut down the number of uninsured (not to mention give these people more of a sense of security than they currently have), but also will shore up finances amongst the rural hospitals in the form of reimbursements for services. Studies by The Urban Institute, the Georgia Budget & Policy Institute, the Henry J. Kaiser Family Foundation, and Healthcare Georgia Foundation/Georgia State University, to name a few, have found similar conclusions. Dr. Keith Mueller’s final report to the governor’s Health Care Reform Task Force clearly danced around the issue, but look at note 3 on page 3. It’s even there, albeit gingerly addressed.
But, Medicaid expansion is budget-busting, right? After all, the Republican stance for these past eight and a half years has been and continues to be in non-expansion states that Medicaid expansion is expensive and will break the bank, even with the federal government shouldering 90% (currently 95%) of the costs. According to The New York Times, 77 unique studies had been published on Medicaid expansion as of July, not including the new Georgetown/UNC study. Only three — 4% — found negative effects, and at least one of them has since been discredited. The Brookings Institute looked into whether any states regretted their decisions to expand Medicaid and found none did. The Henry J. Kaiser Family Foundation also found that states that expanded Medicaid saw a smaller increase in Medicaid spending than states that had elected not to expand in 2015-2016 (3.4% vs. 6.1%). Michigan, Montana, and Louisiana have reduced Medicaid spending since implementing expansions in their states. So, perhaps it’s not so budget-busting.
Georgians currently fund 95% of the cost of Medicaid expansion through our federal taxes, but as of today, we’re only paying for folks in other states while 360,000 Georgians who live between 100% and 138% FPL gamble with no insurance coverage. We know PPACA isn’t going away, and it isn’t being replaced. This is the health care system we operate under, and opposing Medicaid expansion on the principle of hating the law in spite of the current needs of real Georgians doesn’t make sense and is no longer acceptable. Absolutely, I’d oppose expansion if it were breaking the bank, but that has proven not to be the case. Will we continue to shoulder the higher costs for uncompensated care in Georgia and cross our fingers that rural hospitals can tough it out with tax breaks, refusing to expand insurance coverage to low-income Georgians, whilst helping to fund expansions in other parts of the country? That seems extremely foolish, wasteful, and petty.