Expanding Medicaid is really simple math
Since its inception in 2010 the Affordable Care Act, better known as Obamacare, has either been salvation or damnation. The ACA is actually two separate pieces of legislation: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Together, Medicaid coverage was expanded to millions of low-income Americans and made improvements, according to medicaid.gov to Medicaid and the Children's Health Insurance Program (CHIP).
As of May, almost 1.8 million Georgians were enrolled in Medicaid and CHIP, an increase of more than 14 percent since the first open enrollment period in 2013. Still, Georgia made it extremely difficult for poor people to sign up for coverage and is one of 19 states that hasn’t expanded Medicaid.
The Georgia General Assembly in 2014, with the governor’s approval, went so far as to take the decision-making power of whether the state expanded the program from the chief executive while shutting down any state-run organization from operating navigator programs that assisted citizens in signing up for provisions offered by the ACA.
According to the U.S. Department of Health and Human Services, 541,080 people had acquired health insurance in Georgia through the Affordable Care Act by February 2015. However, estimates are that 600,000 Georgians remain uninsured, and that’s taking a toll on the hospitals and clinics that end up delivering services with no hope of payment.
When Gov. Nathan Deal first declared the state wouldn’t participate in the ACA in 2012, it didn’t seem to make much sense. The federal government paid 100 percent of the cost of the newly eligible through this year. By 2020 payments would drop to 90 percent and go no lower. Even before the ACA, Georgia received $2.02 for every Medicaid dollar spent, and between 2017 and 2026 the state’s bill for uncompensated care would drop an estimated $1.9 billion to $2.4 billion.
Georgia State University estimated that Medicaid expansion would support 70,000 jobs and increase annual tax revenues of $277 million. Now a new study from the Urban Institute shows that expanding Medicaid would bring Georgia $8.68 to $9.42 for ever dollar spent. So why did the state not take what was essentially free money? Why would a state that has higher than the national averages of poverty, diabetes and other health maladies such as issues of access turn its back?
State lawmakers are not alone in the “Twilight Zone.” On the federal level, dozens of votes have been taken in an attempt to repeal the ACA. The last just before Congress took a vacation. Republicans attempted to tie Zika funding to ACA defunding and Democrats didn’t bite — but Zika carrying mosquitoes are.
In Georgia some lawmakers are beginning to rethink their resistance. We can only assume that the atmosphere may be different once the lead architect of the ACA leaves office in January. However, much damage has been done. According to Becker’s Hospital Review, eight hospitals have closed their doors this year, five in states that didn’t expand their Medicaid programs.
According to a Georgia Public Health Association study, “Georgia’s Rural Hospital Closures: The Common-Good Approach to Ethical Decision-Making,” 73.5 percent of the hospital closures (50 out of 68) since 2010 occurred in states that didn’t expand Medicaid, and five were in Georgia. And if you peek over the horizon — and you don’t have to look very far — you will see hospitals all over the state, large and small, that are barely hanging on.
The Georgia hospitals that are now shuttered had a number of things in common. All five were located in counties — Hart, Stewart, Calhoun, Charlton and Wheeler — with populations with uninsured rates at or above 20 percent and poverty rates from 21 percent to almost 40 percent.
The GPHA study states: “... rural hospitals, specifically CAHs (Critical Access Hospitals), are seemingly vulnerable for future closure. Most of the population they serve, older adults and low-income residents, have greater dependency on Medicare and Medicaid.” It goes on to say what should be a warning to lawmakers, “If these hospitals are not supported by payment systems that attend to those most vulnerable financially, loss of providers and quality improvement, financial hardships, and closures will likely continue.”
As we approach the November elections, these are the types of life and death issues our state representatives need to be spending their time on. Ideology needs to stop before the emergency room door disappears. Cut the foolishness, call Obamacare something else, accept the federal money, and do what politicians do: forget you were ever against it and move on.
This story was originally published August 13, 2016 at 9:00 PM with the headline "Expanding Medicaid is really simple math."