Make no mistake about it- the Obama administration’s Medicaid expansion plan at the state level is not about providing healthcare insurance coverage to those who do not currently have it, and it certainly has nothing to do with compassion. It is about control and dependency. It is about expanding the rolls of Americans who rely on government subsidized healthcare. It is about moving forward with the Affordable Care Act which will ultimately touch every American but will be controlled from Washington DC.
The timing of this Medicaid expansion is curious. 33 Governors had decided not to set up the state run health insurance exchanges by the December 14 deadline. The exchanges are the requisite piece needed to move forward with Obamacare but the resistance at the state level creates a major snag. The Governors mostly agreed that their states could not afford to set up and maintain these new bureaucracies. They could not afford to devote more of their state budgets to healthcare.
These same governors who disagreed so emphatically with Obamacare, when presented with the promise of “free money” from the federal government to grow the number of patients on Medicaid, have little problem with this. The “hook” is that the federal government will fund 100% of the Medicaid expansion for 3 years, and then 90% thereafter, but these Governors have not learned from the lessons of the past when dealing with the federal government’s promises.
First Governors Jan Brewer (AZ), John Kasich (OH), Brian Sandoval (NV), Susana Martinez (NM) and Jack Dalrymple (ND) jumped aboard, followed by Rick Snyder (MI). The latest defector is Rick Scott (FL), who launched his political career opposing Obamacare. How times have changed.
The reason for this political about face is understandable. First, these governors see that some states are getting money and they don’t want to miss out on this “opportunity”. Unfortunately this is money that does not exist. We cannot afford this expansion of Medicaid. Simply printing more money to cover these new entitlements drives us further down the road to insolvency.
Second, they believe that the federal government will honor its commitment to continue to cover virtually all of the Medicaid expansion in their states. This is wishful thinking. No estimate of spending by the federal government has ever been accurate. Just remember that Medicare was never supposed to cost more than $10 Billion annually when it was first passed. And when we face another fiscal cliff or sequester, the first cuts to be made will be the Medicaid dollars to the states, and they will be left holding the bag. Governor Brewer has said that if the money stops coming in, that the expansion will stop, but by that time, it will be too late. The genie will be out of the bottle.
Third, there has been an enormous amount of pressure placed on these governors to accept this deal, by interests who stand to gain the most – the hospitals. Medicaid expansion means more patients and more dollars flowing to them. The American Hospital Association- the powerful lobby that represents the hospitals in America, has spent an enormous amount of money to get provisions that favor them written into the ACA, and they have continued to put pressure on the Governors in their respective states to accept this money. The Governors who have been swayed by the special interests, have demonstrated a deficit of backbone and conviction.
Yet some GOP governors have been unwavering, which should give some reason for hope. Gov. Pat McCrory (NC) has correctly stated that Medicaid is a broken system to begin with, so why expand it? Medicaid patients have the worst outcomes in numerous studies reported in the medical literature- even worse than patients who do not have any health insurance. The waste in the Medicaid system is out of control. Patients who are enrolled in Medicaid are the worst abusers of medical resources, such as using emergency rooms for non-urgent care. As far as access to care is concerned- only 30% of physicians currently see Medicaid patients, and this number is certain to plummet when reimbursement for medical services are slashed as have been proposed.
In Wisconsin, Governor Scott Walker has sternly rebuked the notion of a Medicaid expansion on the federal government’s terms. The Medicaid expansion as part of the ACA will be overseen by the Department of HHS, which takes away the control of this program from the state. He intends to run Badgercare- the Wisconsin Medicaid program – in a way that is best suited for Wisconsonites.
Hopefully, the falling dominoes will cease and other Governors will realize that signing onto this Medicaid expansion is a huge miscalculation. The deal may seem sweet right now, but the dollars will likely be temporary, not be as much as had been promised and come with strings attached. Above all, we cannot afford this. These governors are abetting the implementation of the ACA, which will ultimately tear apart our healthcare system, hurt our country financially, and will ultimately come to harm each of them politically.
Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.