Great Article in NY Times…and, a little more info.

The Affordable Health Care Act was upheld by the Supreme Court yesterday with each state having the option of whether to expand Medicaid or not. Many states’ Governors, including the gov. in my state, has denounced the decision and said they are each considering NOT accepting Medicaid expansion – the expansion is a requirement for the 100% financial pick up of Affordable Care Act (ACA) costs the first few years and then 90% after that. They say they cannot afford the expansion of Medicaid and it’s expansion……….nice try. This is a lot of smoke and mirrors as they pander to the most financially conservative of their state residents.

I’m not making a political statement at all so please do not mistake this for one. This is purely financial and state government knowledge. Medicaid is paid through matching funds between the state and the federal government. The state portion is determined based on the economy of the state – how well the state is doing financially. My state is one of the more financially solvent states and has not suffered as much during the recession like many other states, mostly because of our oil production. Our state’s match is about 68/32 which means that for every Medicaid dollar spent in our state – the feds pay $.68 cents and our state pays $.32 cents. So, as an economically stable state we pay 1/3 of medicaid costs – the states who are worse off economically pay even less. Another thing to consider is that those who are not currently covered, remain ill longer and then one day the MUST go to the ER or clinic or some other medical facility and then the state will have to pick up 100% of the costs.

The ACA will expand mostly waivers and those waivers target mostly the elderly and disabled of the United States. Paid at 100%. These are the most costly eligibles there are…….Hmmm…. Really? The other thing about costs that are paid 100% by the feds (Child Day Care and SNAP – formerly Food Stamps are both 100% reimbursement) is that if our state decides not to take it then other states get even more, because that money is going to go somewhere. I remember when former California Governor Schwartzenegger went into office. He fussed and fumed about how the state was broke and how he was going to cut off the “free lunch” of Food Stamps. I remember thinking that he was either the stupidiest governor ever or he had the most stupid advisers ever. And then someone explained to him how Food Stamps really work and who they REALLY benefit (grocery store owners, farmers, and trucking companies) the most. Soon he was touting the program and seeking out any and everyone in California who would qualify in order to apply for the Food Stamp Benefit.

Since ACA will work much like Food Stamps and those who will benefit the MOST will be hospitals, clinics, private physician’s offices, and health therapy facilities – I would say all this strutting and posturing of governors is just that. Either they already know this is financially sound to help their states out of the mess they are already in, or one of their advisers will get to them and educated them PDQ. Then they will release a statement saying their hands are tied, and they are forced to take the money. And then they will.

In the end, it will help the elderly and disabled the most and they ARE the most costly folks in the Medicaid system. So whatever your feelings are about the Affordable Care Act, it is coming and we should prepare for the inevitable.

You can find the NY Times article here:


2 responses to this post.

  1. As someone who has worked extensively within the Medicaid system in multiple states and also with the elderly and disabled population in the health care field my major concern with Medicaid is the amount of fraud. It is rampant!

    If there was a better way to address the issue of fraud we could provide Medicaid to even more people who legitimately need it.

    I don’t have an answer as to how to address the fraud, but I wrack my brain every day looking for ideas on the subject.

    Until the fraud is reduced we will never be able to efficiently meet the needs of the poor, the elderly, and the disabled.

    This is also not related in any way to a political opinion, but rather from a long-term observation of the inefficiency of government run programs whether they be federally or state funded, or both.

    Thank you.

    • Posted by Taylor Hooper on July 1, 2012 at 10:46 am

      I read this blog and the author has said on occasion that she works for the government in some capacity. So when I read your comment about how poorly run government programs are it seems to me that you are insulting your host here. It’s a little like going to someone’s house and telling them that they are have terrible taste. You might think it but a person with good manners would not say it.

      That being said, I disagree with your comment and this is my rebuttal:

      First, a caution about sweeping generalizations: They are often based on anecdotal evidence (if any) and while often used to support a position (most commonly by politicians in my opinion) have very little to do with the reality of any situation.
      For example: “Government Programs are inefficiently run.” Statements like this become popular over time and are often repeated by the masses as a way of venting frustration about something they don’t like such as paying taxes or because a program did not work the way they wanted it to. They often complain about fraud because the system actually did work…but to befit someone they thought was undeserving.

      You say that your major concern is the amount of fraud that is rampant. You do understand that the fraud occurs on the user side of the federal program, correct? It can be a patient, a doctor, a company, a nurse, or others who actually commit or assist in committing the fraud. The program (any government program) is designed to function in a specific way with rules and guidelines. Those who want to access it fraudulently find ways of doing so. You can hardly blame the government for this…but so many do. Fraud occurs in both the public and private sector. If there is some kind of formula to prevent fraud, the person who has it should be very rich.

      Didn’t I read on your blog (starting the dialogue) that you are a nurse? And you say here that you have extensive experience with the Medicaid system in multiple states. I can only guess that you have worked as a nurse or in some other capacity in the medical profession with the elderly and/or disabled, who access government programs such as Medicaid and/or Medicare. So, at least in part, your income was derived from these same government programs. It is entirely safe to say that the whole of the medical profession in our country is, at least in part, subsidized by the government through the administration of these programs and others.

      So, then my question to you would be: if you believed one or some of your patients were undeserving of participation in the Medicaid program (committing fraud) did you or would you give the money back to the government that you were paid to care for them, perhaps with a note reporting the fraud? If you are so disgusted with these programs why would you ever accept the portion of your pay check subsidized by the government and these programs? It all seems to be a little hypocritical to me.
      But that’s just my opinion.

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