An important aspect of last week’s Supreme Court on Obamacare is that the federal government can’t force states to expand Medicaid eligibility (by withdrawing all Medicaid funding, should states refuse). I have been asked several times whether Utah will expand its Medicaid coverage.
Background: Obamacare forces individuals to get healthcare or pay a tax. This was politically palatable for the Democrats who passed Obamacare, because most people weren’t going to have to pay for their healthcare; the Government (meaning other taxpayers) would pay for it. Part of the way the Democrats planned to have Government provide was to force states to expand Medicaid (poverty-level health insurance) to cover more individuals. With the Supreme Court’s ruling (upholding the mandate to buy insurance, but striking the Medicaid expansion provision), the working poor now will face a significant tax increase.
Discussion: Utah balances its budget every year. We have a triple-A bond rating. We are widely regarded as the best-managed state in the Nation. (Considering the competition, that might be like bragging about being the tallest building in Tooele, but, still, we do know a thing or two about budgeting and about fiscal responsibility.).
Utah has finite dollars. Medicaid already is the fastest growing part of the State’s budget, meaning that dollars are being taken away from all other areas of state government, such as education. In my 12 years in the Legislature, Medicaid has moved from commanding 10% of the budget to 20% of the budget. Do we want to expand Medicaid even more? No.
But, some might argue, the feds have agreed to pick up 90% of those costs. Remember, such promises aren’t worth the paper they’re written on. The federal government promises big Medicaid matches; the states expand coverage (because, with those matches, “it would be foolish not to!”); dependency develops for the expanded programs; the feds reduce/eliminate the match; states are left footing the entire bill.
And, if the federal government ever gets serious about balancing its budget (I know, I know), the first area the feds will look (where they’ll HAVE TO LOOK, if truly serious) is Medicaid.
So, will Utah expand Medicaid coverage to fix the tax problems created by Obamacare? No.
If you’re right, this would be one of the most foolish and ideologically driven decisions the state could make. The reality is that the efforts to decrease Utah’s uninsured have been anemic and ineffectual. Your clever wording here (“To solve the Obamacare problem”) belies the truth I know you are informed enough to know: Utah’s uninsured are YOUR problem, and it’s a problem that itself contributes greatly to the very federal spending you wring your hands over here. Basically you are describing — and discussing as if your hands are tied — a situation where Utah lawmakers exchange one form of leeching off the federal funds for another form of leeching those funds that is simply more ideologically palatable to the majority caucus. That isn’t leadership, it’s obtuse. And the fact still remains we have an abysmal record of dealing with the uninsured and those uninsured do have costs to the nation as a whole.
The Kaiser Foundation has a breakdown of state expendatures on the expansion that estimates Utah would pay an additional 3% of its budget for a 50%+ reduction in uninsured who qualify. And again, the federal government has no choice but to spend the money subsidizing the uninsured anyway (unless we just want to turn them into the streets or the current markets we already know they can’t afford). So the feds are saying “how about we spend this money with a plan that could cover more through a very effective program rather than playing catch up with emergency rooms?” and you’re going to respond: “Nope, cuz we’re tea party an’ stuff!”
Genius plan. What passes for leadership here, at times, is an embarrassment.
Jason, you’re confusing health insurance with health care again, just like the insurance companies like. They’ve apparently also suckered you into thinking that their product I’d the only way to get health care, and that’s dangerous.
Jesse, I must have been suckered in as well, because an emergency room visit cost me $2,900. I can’t afford insurance, so I am literally going into debt to save my life. So when you say there are other ways to get health care, what are you talking about?
And how come I’ve missed that memo?
Thank you Steve,
For one, I think we need to do EVERYTHING we can legally do as a state to fight the implementation of obamacare. Fundamentally, there is no amount of helping the poor through federally managed, top-down healthcare (as if it were even possible) that can ever make up for the loss of Liberty that comes from the micromanagement of healthcare delivery, or life choices in general, inherent in this law.
The basic economic truth that all of the sophisticated policy wonks out there who think this is some sort of a great idea need to realize is: obamacare adds (at last count?) 159 new bureaucratic entities that will stand between the buyer and seller of healthcare. And at what cost? Most middle men add value to a transaction, but bureaucratic machinations are parasitic drag–they suck dollars without adding any value back to the process. Since doctors won’t work at a loss, or without profit. And since bureaucrats won’t either, guess who foots the entire bill?
Perhaps this all begs the question anyway. The designers of obamacare are bright enough to know the ultimate affect of this bill on our country–and that is, it will collapse under its own weight. They have been pretty open about the fact that obamacare is designed to catapult us to single payer healthcare and destroy the private insurance markets. For all the problems of private insurance markets, command and control certainly isn’t the way to fix the problems inherent with them. Introducing competition back into the equation is the only true fix. Men must be free to trade with each other–even in the realms of health care, or our medical system is doomed to mediocrity or worse.
Matt: It’s all part of the scam. Insurers have spent a lot of time, effort, and money to try and make health care unaffordable without their product. (And for many people, it can be cheaper to pay cash for services rather than carry insurance.)
Jason,
Of course, if you were dictator, we’d have real leadership. Right?
If you get to know more of your neighbors, you’d learn that they believe in marketplace solutions more than governmental solutions. Don’t believe me? Please get Democrats to run on more governmental solutions!
Adding more people to government health insurance rolls doesn’t decrease the numbers of uninsured in the long-term. 1. By putting a greater tax burden on our economically-productive citizens to pay for it, we decrease economic opportunity, meaning more people will be uninsured until we further expand the programs and create an even greater burden on those who still pay the bills, on and on and on, until you run out of economically-productive citizens to pay the bills. 2. Crowd out is real. The bigger the segment of the population that Government removes from marketplace concerns, the harder it is for the private market to provide affordable products. So, Government advocates have Government step in even more to fill the holes, making it even harder on the private sector, and on and on and on, until Government is the inefficient, inept provider.
If we truly care about health insurance (instead of government control), we’d remove mandated coverage items and we’d let insurers insure across state lines. If you want something to be available to the people, let a marketplace exist. If you don’t, have government take it over.
If you could please get my Democrat opponent to publicly disagree with these points, you’d be my friend even more than you are now!
A great way to put Utah into that second-tier of American states that abandons a good chunk of their population to destitution.
Fred,
I’m not quite sure what you mean. But, I’m thinking that Utah needs to make decisions to stay in the tier of states with economic opportunity for their citizens, which is the sustainable way for citizens to avoid destitution.
“It’s all part of the scam. Insurers have spent a lot of time, effort, and money to try and make health care unaffordable without their product. (And for many people, it can be cheaper to pay cash for services rather than carry insurance.)”
Your argument is flawed, The distribution of who is effected disease and injury is unknown before the point at which the disease is contracted or the injury incurred.
I can easily say that the people who don’t get sick or hurt don’t need insurance, but this belies the problem of the argument, as nobody knows who is going to win the cancer lotto, or be hit by a truck.
Even if Utah turns down the medicaid expansion, Utah’s citizens will still pay the taxes related to Obamacare, the 2.9% medicare FICA tax increase on income over $250,000 and the 2019 implementation of the Cadillac insurance tax. However the vast majority of the PPACA is paid for by cutting over payments to Medicare advantage providers(well over $250 billion dollars worth here), And other non-benefit cuts to medicare(from lower negotiated hospital payments in medicare and drug discounts from the pharma industry from Medicare part D).
The vast majority of the PPACA is rearranging money that was already in the system to be used in a more efficient manor. The 80/85% medical lose ratio requirements have already had an effect which caused the CBO to project increased savings from lower insurance rates in the exchanges then originally projected, And Obama used that savings to have the Medicaid expansion rules written in a much more friendly manor for States being able to move people from the lower match rate standard medicaid to the expansion 90% coverage area.
If Utah opts out of the Medicaid expansion and a federally qualifying insurance exchange, The hospitals here will really feel the crunch from other changes in the law.
I will also note that the States are not necessary scott free on the Medicaid expansion due to the SCOTUS ruling, Only 3 justices joined that part of the Majority ruling(its still part of the majority ruling but this is fuzzy legal territory) so if Obama really wanted to be hard nosed about it in 2014 he could still pull funding in those States that decline the expansion and cause at least 6months to a year of major problems in those States before the SCOTUS would get around to it again.
they were gnna do. Not only is it the same old government dirty trikcs they have taken it to an all new level. Worse than that they have increased class and race warfare with their rhetoric. Lets tax milionaires and billionaires more. Not like they are the ones who own the corporations that peut people to work. I guess all the big businesses out there are owned by those folks making $50k a year. You kow those dirty rich people that vacation on Marthas Vineyard every year, oh that can’t be where rich people vacation because that is where the communist in chief is vacationing with his family right now. Again on vacation. While the middle class is struggling to pay their mortgage and put food on the table, but that’s ok cause Obama has a new jobs bill he is gonna propose after vacation. Hope it works better than the last time when they said we have to pass this in order to keep unemployment from reaching 8%. We saw how well that worked out now didn’t we?See how I did that? Went from Obamacare and turned it into unemployment. The only thing I didn’t do was blame George Bush, the Japan Tsunami and an Arab Spring on how poorly the presidents record has been so far. But as long has he has time to spend with his family, recharge, improve his golf game and of course continue to campaign and hold fund raisers, I guess it is all ok. And yes I know the economy was bad when Obama took office thanks to George Bush and a DEMOCRAT held House and Senate, but under Obama and DEMOCRAT held house and Senate they have managed to set us on a path that we may never recover from as a Nation. Perry 2012