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    costing lives

    Subverting Democracy by Corrupting Truth

    by | 5 | Apr 14, 2015

    Source: WhiteHouse.gov

    “None of my friends can afford Obamacare, either,” Meghan said indignantly, “it should be repealed.”

    We were in the South Carolina Lowcountry. Meghan is a mid-to-late-thirties single mother who is balancing raising her child, her relationship and job while still working on her degree.

    She was telling us about the hospital where she works. Like so many rural hospitals across the South, her hospital has a significant number of uninsured patients coming through the emergency room for treatment. Federal law (EMTALA) requires all hospitals with an emergency department that receive Medicare to screen, treat, stabilize or transfer anyone requesting treatment regardless of ability to pay.

    Meghan told us that her hospital had to cut back staff, which backed up her ER waiting room even more. She told us that the hospital could not afford to treat really sick uninsured patients and mostly their doctors patched up the uninsured sick the best they could, gave the patients some medicine and sent them on their way with a prescription knowing the prescriptions were unaffordable and the patients would be back. Meghan blamed Obamacare for all of it.

    That is when I chimed in and told her that things at her hospital were going to get worse. The Affordable Care Act (ACA, aka: Obamacare) is complicated and when passed, assumed every state would expand Medicaid. With almost everyone having insurance, there would be fewer uninsured at the ER and hospital costs would go down. With lower costs, federal Medicare reimbursements are being reduced each year.

    That’s when Meghan said that Obamacare was too expensive and should be repealed. And that is when I told her that she had been lied to. That for people earning up to 138% of the poverty level, Obamacare was should have been free and is in free in 28 states. But that her state government decided that the fate of 340,000 South Carolinians was to bankrupt, go to the ER or die.

    I wasn’t sure which one of us was going to scream or cry first. Meghan seemed bewildered and said, “It isn’t Obama’s fault that I don’t have health insurance, but it is the states? The state did this? None of my friends know that. All we hear is that it has to be repealed. This is terrible. Why would they do that to us?”

    Then I told her about the money. The more than $15.8 billion that her state would have gotten from Washington that was to pay for 100% of Medicaid expansion. Money they will never get. Money that would have created many tens of thousands of good permanent jobs, saved countless bankruptcies, saved lives and made lives better. Money that South Carolina taxpayers are sending to other states.

    It gets even worse as the states have to make up the difference for indigent care and the decrease in Medicare reimbursements – money needed to keep hospitals like Meghan’s open. The Robert Wood Johnson Foundation and the Urban Institute put that number at $167.8 billion for all the states not expanding Medicaid from 2013-2022 – for instance, Georgia will lose $1.2 billion in Medicare reimbursements in 2016– more than twice the cost of expanding Medicaid. Stupid and mean.

    Despite this, there is good news even in the states which haven’t expanded Medicaid. The online marketplace makes it easier to enroll and determine eligibility. South Carolina, for example, had about 300,000 people who already qualified, but had never enrolled in Medicaid. Using HealthCare.gov, South Carolina has already added over 150,000 of them.

    In fairness, there is a cost to the states to accept the expanded Medicaid money. States must provide basic benefits and offer it to all of their citizens below the poverty level, not just women with children. According to the Urban Institute and McClatchyDC.com, South Carolina’s 10-year cost to expand would have been about $1.2 billion – a lot of money, but not much to get $15.8 billion in return. For Georgia to get $33.7 billion, would cost $2.5 billion over 10-years (which could be funded by the governor’s discretionary budget) – one other note on Georgia – five rural hospitals closed since 2012 and more and six more are at risk (USA Today). Here’s a chart for other states.

    Suggested reading: What Is the Result of States Not Expanding Medicaid?

    ###
    • Editor’s Note: Meghan is not her real name and I might have fudged a few of her life details to preserve her anonymity or to make a better a story.
    Lee Leslie

    Lee Leslie

    I’m just a plateaued-out plain person with too much time on his hands fighting the never ending lingual battle with windmills for truth, justice and the American way or something like that. Here are some reader comments on my writing: “Enough with the cynicism. One doesn’t have to be Pollyanna to reject the sky is falling fatalism of Lee Leslie’s posts.” “You moron.” “Again, another example of your simple-minded, scare-mongering, label-baiting method of argumentation that supports the angry left’s position.” “Ah, Lee, you traffic in the most predictable, hackneyed leftist rhetoric that brought us to the current state of political leadership.” “You negative SOB! You destroyed all my hope, aspiration, desperation, even.” “Don’t you LIBERALS realize what this COMMIE is talking about is SOCIALISM?!?!?!” “Thank you for wonderful nasty artful toxic antidote to this stupidity in the name of individual rights.” “I trust you meant “bastard” in the truest father-less sense of the word.” “That’s the first time I ran out of breath just from reading!” “You helped me hold my head a little higher today.” “Makes me cry every time I read it.” “Thanks for the article. I needed something to make me laugh this mourning.” “If it weren’t so sad I would laugh.” "... the man who for fun and personal growth (not to mention rage assuagion) can skin a whale of bullshit and rack all the meat (and rot) in the larder replete with charts and graphs and a kindness..."“Amen, brother.”

     

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    • tom ferguson

      The resistance of course is ideological… what if the Affordable Care Act worked? and was popular? why the people might begin to question the “free market” ideology that presently rules… they might even entertain, gasp, single payer health care!

      • hannah

        The state “match” serves to sustain the illusion that dollars originate with whoever had it in his possession last. So we’ve got “state dollars,” and “tax dollars,” and “education dollars,” and “lottery dollars,” etc. There’s a lot of effort that goes into maintaining a myth. I’m old enough to remember when money was not supposed to be even mentioned in “polite company.” Money was the “last taboo.” Women weren’t supposed to have any and “bread” was something to be “won.” Funny how the sequence of letters/sounds affects meaning: won, own, owe, now.

    • Trevor Irvin

      The map perfectly delineates the borders of American stupidity, and not just due to rejecting the ACA. Ironically Bizzarkansaw is the lone standout in a sea of stupid.
      Regards,
      T

    • Nancy Melton

      It’s a shame that we had to take this convoluted path to single payer. There was an elegantly simple system in place that only needed to be expanded. Instead we ended up with a hard to understand, impossible to administer plan that does nothing to address health care costs. Eventually the system can be adjusted to a real functioning single payer but the Bickersons in charge will have to die off first.

      • hannah

        Ultimately, since we use a single currency, issued by the U.S. Treasury under the supervision of Congress, there is a single “payer.” The question is how many hands a dollar passes through on its way from the Treasury to the provider of a real good and service. Finance and commerce prefer a dollar to pass through their hands (accounts) first so they can take a “cut” of the action for just handling it. In a sense, the direct deposit of federal pensions into bank accounts is a sop to that desire. But, the banks are not satisfied with the fees the are able to collect for their various services. What the financial industry prefers is that dollars not only flow into their coffers first, but that they get to decide on who, and for how much, gets to use it next.
        Why is there so much reluctance to admit the above is the route our currency takes? Because Congress perceives its ability to ration the currency and turn the spigot on and off as the locus of its power. Why do our agents of government in congress seek power? Because the position of public servant holds much less appeal, especially for people who have few, in any, practical skills.
        Would you trust anyone on Capitol Hill to give you a shave and a haircut?

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