“None of my friends can afford Obamacare, either,” Meghan said indignantly, “it should be repealed.”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That’s when Meghan said that Obamacare was too expensive and should be repealed.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 All we hear is that it has to be repealed.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?