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COMMENTARY

A worthless sacrifice

This article was published January 9, 2013 at 5:00 a.m.

Gov. Mike Beebe met with reporters Monday and said no one had been doing a good enough job explaining the Medicaid issue.

So he commenced explaining it and took a breath maybe a quarter-hour later.

He was mildly Clintonian in his professorial instruction and in his contextual connecting of the dots.

If everyone could hear this explanation, then public opinion would change. If all legislators could hear it — and he said that he and his staff would share it with them anytime — then a three-fourths majority to appropriate the money for expansion might not seem so implausibly daunting.

So I’m going to take a shot at explaining it as he explained it, availing myself, for that purpose, of this online column so that I might blow through newsprint’s space limitations.

First, the governor said, existing Medicaid (and our deficit thereon) is an entirely separate issue from proposed Medicaid expansion.

While it’s true that Medicaid expansion would solve some of the existing deficit problems, the two issues do not overlap much in terms of service, and not at all in regard to essence.

Existing Medicaid goes overwhelmingly to asset-depleted folks housed in nursing homes — mostly helpless senior citizens — and to children’s health insurance through the ARKids First program. So we need to plug our existing shortfall to keep from having to reduce vital aid to those two needy groups.

Expansion has little to nothing to do with serving more nursing-home residents or children. Instead, it’s about extending Medicaid’s basic health-insurance coverage to a greater number of recipients — about a quarter-million adults who now work and don’t quality for Medicaid but who make so little that they can’t easily afford health insurance.

Their children probably are covered under ARKids First, but they are likely uninsured.

If they get sick now, particularly in some kind of high-dollar emergency, they probably wind up getting treated at the local hospital and are sent bills they never pay, at least in full, because they can’t.

So their costs get written off as uncompensated care, or indigent care, and the hospitals build those costs into their price structures in a way that raises health-insurance rates for all of us.

Beebe will be happy to explain to you that he formerly was on the hospital board at Searcy and knows firsthand what he’s talking about.

The essential point of so-called Obamacare, he said, was to reap long-term efficiencies for the health-care system, and eventually for all of us, by getting those kinds of patients insured.

That would mean the rest of us wouldn’t have to keep paying those costs in ever-rising medical bills and health-insurance rates.

To try to hold down the immediate explosion in the federal budget deficit, President Barack Obama and Democrats included in the Affordable Care Act a reduction in reimbursements to hospitals for Medicare — not Medicaid, but Medicare.

And to compensate hospitals for that lost revenue, the law provided for this expansion of Medicaid at hundred-percent federal funding for three years, and 90 percent federal funding thereafter.

But then the U.S. Supreme Court said states could opt of the Medicaid expansion. Then it all hit the fan.

If we opt out in Arkansas, vital hospitals — from UAMS to your nearest local one — will be in big trouble.

And if we opt out, there will be a lingering and unjust gap in health insurance in this state.

The poorest people will have health insurance on basic Medicaid. Most middle-class and upper-class people will have private insurance. Some in the lower range of middle class will be able to buy insurance through new health-care exchanges and receive some form of subsidy in their premiums. Seniors will have Medicare.

Alone without insurance would be people working and making too much to get basic Medicare, but earning less than 138 percent of poverty and thus ill-equipped to afford even subsidized care through the new exchanges.

So, as Beebe laid it out, we can expand Medicaid at federal expense and help our hospitals and our working poor people.

And we can seek to construct a new health-care culture in which costs might stop rising so much because of uncompensated care.

Beebe acknowledged that some people, understandably, believe the federal government simply can’t afford to be throwing this kind of borrowed money at states.

But, as he said, that money is going to be borrowed and spent regardless of whether Arkansas takes its relative pittance.

For us to decline the expansion would be to close some of our hospitals, conspicuously deny insurance to our working poor people and perpetuate an unsustainable system of uncompensated care.

And it would accomplish diddly in regard to the federal deficit.

If you’re still opposed, then you’re simply stubborn or I need to go back and shorten some of these words and sentences.

It’s not a matter of ideology, which, in this case, only gets in the way of profound logic.

If we in Arkansas could solve the federal deficit by sacrificing our hospitals and working poor people, then maybe there’d be some argument.

But to sacrifice them to nothing at all — that’s just wrong.

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. E-mail him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.

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johnparrish says... January 9, 2013 at 7:54 a.m.

Good explanation, its not right but good explanation. If everything were fair, there wouldnt be any crippled children or handicapped adults. Wish we could keep our Gov another 4 years......

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Jackabbott says... January 9, 2013 at 9:03 a.m.

Good story. Existing Medicad should be saved and bolstered. But taking money from Medicare for people who paid Medicare premiums while working and retired and shifting it to others is morally wrong. This is one of the fundamental reasons older people lost favor with Obama, it is a sleigh of hand to pay for something that should have been set up in a way to pay for itself.
Social Security and Medicare are popular programs not only because they work but also because they are self-financing. Once Reagan and the other presidents and their lackeys in Congress started using SS as a giant piggy bank was ok until we traded our economy to China and Mexico and now find ourselves short.

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Pobucker says... January 9, 2013 at 10:01 a.m.

*blink*
There is always tomfoolery, let's see if we can find it.
~
ah! Here it is-
In the rape you now or rape you later catagory:
Hospital writeoffs for freeloaders = higher hospital healthcare costs for all
Moving freeloaders to exchange insurance = higher insurance healthcare costs for all

the tomfoolery? You working people are going to pay for the freeloaders any way you look at it.

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Molly44 says... January 9, 2013 at 10:51 a.m.

It's not taking any money from old people or reducing their services. Instead of paying $35 for some medical service, Medicare will pay $30. Why? Because the ER and the hospital will start receiving money for those services they used to perform for free to the uninsured sick and injured.

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Whippersnapper says... January 9, 2013 at 10:59 a.m.

Yes, in liberal world, providing more services to more people will miraculously cost less overall. Whether the tax dollars to pay for it come out of the left pocket or the right pocket, they still come out of the same pair of pants. If there is not enough money to pay for all the services today, there isn't enough money to pay for even more services for even more people tomorrow.

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JakeTidmore says... January 9, 2013 at 11:39 a.m.

And in the conservative world, they continually offer the old excuse "Am I my brother's keeper?"

Blessed are the poor because the conservatives will do everything in their power to shaft them, blame them, and demonize them. Anything other than care for them.

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Pobucker says... January 9, 2013 at 11:57 a.m.

Jake, you say all that like it is wrong. the poor you will have with you always. MY version - its like pouring money down a rat hole OR throwing good money after bad.
Freeloaders should starve to death. don't work, don't eat.

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Populist says... January 9, 2013 at 12:44 p.m.

Pobucker,

You need to read Jeffrey Sachs "The End of Poverty" and other books which discuss ways to end poverty. Some areas have much less poverty because they have higher levels of education. We can enable people to avoid poverty by making better choices in life. Birth control can allow people to plan their children so that they can adequately take care of them. Education allows people to be more skilled and produce better services or more goods more efficiently.

When emergency rooms are treating colds, we are wasting resources. Emergency rooms operate with a fear of litigation, and it costs too much to treat minor injuries there. Some people should just see a nurse at a health clinic. Indeed, medical expenses in this country could be decreased dramatically with more public recreation, exercise, and weight loss programs. We need to regulate and label lard and sugar. Supersized meals should be called "lard ass sized." We just are obese and out-of-shape as a nation.... I am going to get up and exercise.

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Whippersnapper says... January 9, 2013 at 12:56 p.m.

Populist, "poor" is and always will be a relative term. Every person in the United States today would be wealthy if the standard of 1st century palestine was applied. Numerous studies have established that the average "poor" household in the United States has a higher standard of living than many "middle class" families in Western Europe. When Jeffrey Sachs says we can eliminate poverty and Jesus Christ says we can't, I know who I am more likely to believe. "Am I my brother's keeper?" is a distinctly different question from "Is the government my keeper?" or "Is the government my brother's keeper?" Note that two of those three questions abdicate responsibility for your choices and turn liberals into Ebenezer Scrooge from "A Christmas Carol." If you believe that it is the government's responsibility, then you ask the question "Are there no prisons, no poor houses?" If you believe it is an individual responsibility, you wish you had more of your money so you could help more folks yourself. Speaking as somebody who is a conservative and gives time and money to several charitable organizations, I know who I would trust to help and act responsibly, and it's not the government.

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Reason says... January 9, 2013 at 2:01 p.m.

John explained it well.
.
Medicare and Medicaid are separate.
Medicare is payed by a payroll tax, premiums pay one-fourth and the general funds pay "the rest". "The rest" (the part that comes from the general fund) is what is saved from Medicare and used on Medicaid in Obamacare. Therefore, what was and is being paid into to Medicare is still being used for Medicare. Get it?
.

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