Red States Need Medicaid Patch


The readers of the Loganville-Grayson Patch didn’t need an explanation, but when the story was reprinted in the Mineola Patch, it probably should have had one. Loganville and Grayson are towns in Georgia with a combined population of roughly 12,000. The city of Loganville has the slogan “where people matter” and the website proclaims that it’s a town “where a child’s education is a community commitment” and “where families call home and business prospers.” Looking at the pictures all the people of Loganville are prosperous regardless of race, and always smiling. Whatever the condition of their general health, their teeth are excellent. Loganville is “where companies are excited about opening their business” and where something exciting is always happening! The city of Loganville is a place where the headline, “Woman: Hospitals Won’t Remove Beach Ball-Sized Tumor Over Lack of Insurance” makes perfect sense. Mineola is in New York which has taken advantage of Obamacare. Loganville is in Georgia.

By now people in the blue states have gotten used to Obamacare. There are still arguments, legitimate ones about whether it’s a good law. The nature of insurance means that there will always be winners and losers, and some people are paying more for insurance under Obamacare than they did under their previous plans. Some physicians are retiring rather than continue working for reduced rates and people who were happy with their physicians may be forced to change in order to find an in network doctor. Progressives would have been happier with a single-payer plan while conservatives still want to get the government out of healthcare. But, Obamacare has settled in and we no longer expect people to be denied insurance because of pre-existing conditions.

In contrast, Georgia is one of the states where Republican legislators and governors have refused to expand Medicaid, which would cover the near poor, people too well-off to qualify under the state’s definition of Medicaid but not yet well enough off to buy insurance, even subsidized insurance, through the federal exchanges. The woman in question, a 58 year-old resident of Newton County, Ga., reported that four local hospitals had turned her away and refused to remove a non-malignant tumor the size of a beach ball – but she found a hospital in Atlanta that will perform the surgery. Hopefully the other hospitals would have performed the surgery had the tumor been cancerous.

Other Republican governors have accepted the federal funds, including Rick Snyder of Michigan, Jan Brewer of Arizona, Chris Christie of New Jersey and Terry Branstad of Iowa. When Christie made the decision to accept federal money for New Jersey, he said, “We are putting people first. Which is why, after considerable discussion and research, I have decided to participate in the Medicaid expansion under the Affordable Care Act.”

Of course Gov. Christie is the Republican governor of a blue state and his acceptance of the Medicaid expansion demonstrates his ability to cross party lines. In contrast, Georgia’s Gov. Nathan Deal not only refused to accept the money for expansion but signed a bill turning responsibility over to Georgia’s General Assembly, which effectively assures that the expansion is never going to happen.

There is one additional interesting aspect to Georgia’s decision on the Medicaid expansion. People who had read about the expansion, thousands of them, applied for Medicaid. While most of them were turned away, one report indicates that 100,000 Georgians who had been eligible for Medicaid previously, but had been unaware of it, qualified and will be added to the state roles. While Georgia has refused to take $3 billion in federal money to expand Medicaid the addition of the newly registered will cost the state an estimated $90 million in Medicaid costs.

In December 2013, the Commonwealth Fund published a report on the money lost by states refusing to expand Medicaid. Interestingly, most of the states that have refused the expansion have traditionally been net gainers in terms of federal funding, meaning that more federal money in terms of salaries and benefits come into the state than are paid by the state in federal taxes.

In this case, however, these states are subsidizing the states which have accepted the expansion. The Commonwealth Fund reports “After taking into account federal taxes paid by state residents, states with the highest net losses include Texas, which will see a net loss of $9.2 billion in 2022; Florida, which will lose $5 billion; Georgia, which will lose $2.9 billion, and Virginia, which will lose $2.8 billion.” Also, over a quarter million veterans and their families are being denied health coverage because their states refuse to expand Medicaid. From the Robert Wood Johnson Foundation: “Analysis of the 2008-2010 American Community Survey (ACS) indicates that 535,000 uninsured veterans and 174,000 uninsured spouses of veterans-or four in 10 uninsured veterans and one in four uninsured spouses-have incomes below 138% of the federal poverty level (FPL) and could qualify for Medicaid or new subsidies for coverage under the Affordable Care Act (ACA).”

For those who think there’s no difference between the two parties – isn’t this answer enough?

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y. Email

From The Progressive Populist, July 1-15, 2014

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