Medicaid: Will Gov. Deal do what is right…or what is political?

One Georgian and one Alabamian, one Republican and one Democrat, make their cases for state expansion of national health program

Special to the Ledger-EnquirerMarch 17, 2013 

According to a Kaiser poll, the majority of the country (56%) wants the GOP, my party, to get out of the way and permit the 2009 Affordable Care Act (ACA, Obamacare) to be smoothly implemented. The voters are rightly tired of the constant bickering and partisanship that typified the last election and Congress.

Voter disillusionment with political theater is why the 31st vote for repeal in the Republican House last year was counterproductive ... as were Gov. Deal's announcement at the Republican National Convention that he would not endorse the expansion of Medicaid in Georgia and his more recent ideological pronouncement that he would not set up a state insurance exchange.

The feds will just set up the exchange, but Medicaid is another story.

Per the recent Supreme Court ruling, the Medicaid expansion provision of the Affordable Care Act is now voluntary for each state. The feds cover 100% of the expansion expense for the first three years, falling to 90% permanently after a few more years.

Not surprisingly, expansion is being resisted by the "red" tea party states where many of our poorest citizens without coverage reside. These are the very areas that need expanded coverage the most. Georgia, for example, has 22% of its population uninsured, per Gallup. Nearly half of our 1.5 million currently uninsured Georgians would be covered if we accept the federal government's money to expand Medicaid.

The head of health policy for the Georgia Budget and Policy Institute said that Georgia's $19 billion budget would increase only 2% by expanding Medicaid coverage under the ACA.

Is this too much of an expense? Not when you consider that our hospitals' expensive ERs are already seeing many of these lower income patients "for free." Well, not really for free; the expense is just transferred to those of us with insurance who do pay the hospital bills. And to Georgia's taxpayers who pay for indigent care at their local public hospital through their ever-increasing county property taxes. But when did fiscal rationality enter into politics?

Many of the governors turning down the Medicaid money are simply ideologues. They were so self-deceived that before the election they predicted an imminent Republican health care revolution through Medicare vouchers and Medicaid block grants via Romney/Ryan. Even if a Republican president had been elected, these are merely governmental budgetary tools and would have been unpopular with the public if their true impact were known. Neither vouchers nor block grants address needed systemic changes in health care delivery related to total cost and quality.

Medicare vouchers, promoted by Ryan, just dump the cost increases onto the patient versus the government. Medicaid block grants, advocated by a Deal spokesperson, simply provide a way for states to cut services and beneficiaries, negatively impacting healthcare delivery to the poor who already have the worst health status of all Americans. And 55% of the patients served by Children's Healthcare of Atlanta are on Medicaid. Do you want to see them suffer due to fiscal cutbacks?

In any case, because of the election, there is virtually no chance that the Affordable Care Act will be repealed or dramatically changed. So it is high time that we get with the program and evaluate the true costs and benefits of Medicaid expansion in Georgia.

Dr. Bill Cutler of Georgia State University did just that in a report issued earlier. Dr. Cutler found that from 2014-2043 our state would get more than $40 billion in federal funds through Medicaid expansion. And the economic activity related to the expansion would generate $275 million each year in local and state sales taxes. This is understandable when you examine the new jobs created, over 70,000 statewide. Over 3,000 of these jobs would be in the Columbus (River Valley) region.

Gov. Deal says that our share of the Medicaid expansion averages $400 million a year. Understandably, this upsets the single-issue "no new taxes for any reason" tea partiers. And that entails a political risk.

But when you look at the benefits … the money coming into our state, the jobs created and the taxes brought in … the right choice should be obvious to our governor. Let's hope he does the right thing and not the political thing.

Jack Bernard, a Jasper County commissioner and former chairman of the Jasper County Republican Party, is a retired executive of for-profit health care services. He is now a private consultant for small business.

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