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Medicaid Expansion Now in States' Hands

Margaret Dick Tocknell, for HealthLeaders Media, July 6, 2012

In a blog for the National Association of Public Hospitals and Health Systems, Bruce Siegel, MD, the group's president and CEO, noted that DSH cuts were "written into the law on the assumption that states would be required to expand Medicaid, leading to fewer uninsured patients landing in the safety net…Without the financial help of an expanded Medicaid program, safety net hospitals absolutely cannot bear further cuts to DSH payments. In an earlier press statement Siegel asked that "policymakers and regulators wade through the Court's decision and clarify the gray areas left in the law, we implore them to revisit the DSH cuts and other hospital-based reductions."

For states that are so far declining to participate in the Medicaid expansion, the reasons for the decision are primarily financial. Although the federal government is committed to picking up the lion's share of the costs for 10 years, states are still cautious.

Anthony Wright, executive director of Health Access, a California advocacy group, says he doesn't understand that stance. "This is a great opportunity for states. There are very few investments that a state might make that could provide a 9:1 return to bolster its health system and economy. There is no tax cut or infrastructure project that provides a 9:1 bang for the buck."


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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3 comments on "Medicaid Expansion Now in States' Hands"


R Daniel King (7/11/2012 at 9:34 AM)
TennCare expanded Medicaid eligibility utilizing HMOs that grew into a financial crisis resulting in stricter eligibility. With no significant change in enrollment costs grew 3.5 times from $2.4 billion in 1994 to $8.5 billion in 2005. Why? Program never inspired health care efficiencies and quality. In 2003, Dirigo Health in Maine was a subsidized health care premium program that was suppose to insure 130,000 within five years. Today, less than 10,000 are under the program. Why? Never inspired health care efficiencies and quality. Hawaii employer mandated insurance started in 1974 and by 1992 all but 2% were insured. The Clinton Administration granted Hawaii "Medicaid expansion" to cover the 2% which failed after 9 years. The mandate is killing small business and Hawaii now limits its mandate to full-time employees causing an increase in part-time employees increasing the uninsured to 10%. Why? Never inspired health care efficiencies and quality. And just because someone has insurance does not mean they avoid bankruptcy since a 2007 study found 75% of bankruptcies due to health care bills had insurance! ObamaCare disciples will ignore the above failures and facts, but some governors have the courage to remember. Although ObamaCare feels good, it remains a dead program spending until the nation replaces it with a system the inspires ALL health care professionals to be in the constant pursuit of the most efficient delivery of quality universal integrated care. Meanwhile, ObamaCare will prove to be an economic coffin that many governors will rush to occupy.

Don Stumpp (7/9/2012 at 10:25 AM)
Agreed Christine! In my opinion, this is the heart of ACA - The expansion of insurance benefits to those who have no coverage. I just hope that the States who opt out do so because it is best for their citizens - NOT because they dont want to give a victory to Obama or Democrats. Put politics aside and tell me: how will your citizens be served by opting out? Let's go through it. The uninsured poor (133% FPL) either get care or they dont. If they get care, they dont pay for it, and the insured pay for it or the government thru DSH funds or other mechanisms. If they dont get care, they suffer or eventually get care when it then becomes more costly. The States need to think of Medicaid expansion not as same-ol' same-ol' FFS increases. If more people get HEALTH care we can reduce overall costs of SICK care. Let me ask - if your providers went to not extending credit to consumers and therefore one needed insurance or cash (Visa/mastercard/Discover accepted!), what would happen? If healthcare became like every other industry and expected payment at time of service, the lack of insurance would be painfully apparent. Walmart, Kroger or your local pizza place doesnt finance your purchase. Why should doctors? Even when you go to the pharmacy for your Rx - it is payment at time of service to the penny for any of 10,000 drugs on the NDC. Twitter: Iam4ACA

Christine Hankerson (7/6/2012 at 11:15 AM)
Why is there such resistance from the states? Either way the tax payers incur costs. So why not allow individuals to have healthcare under this Act, take the burden off the emergency departments, and ultimately hope for a healther country.