Legislators and Medical Professionals Eye Medicaid Expansion
Oskaloosa, Iowa – The Affordable Care Act and the Medicaid expansion and how that will impact Iowan’s has been another topic gaining steam at the Iowa statehouse.
At Eggs and Issues, the questions about Medicaid are the same as those at the Iowa Capitol and even at Mahaska Health Partnership. How will this impact us?
The re-election of President Obama and with it his signature legislation is still being fought out by the nations Republican governors. Nearly a dozen Republican governors haven’t said if their states will take part in the Medicaid expansion, while others, like Iowa’s governor, Terry Branstad (R), have rejected the idea of expanding Medicaid – citing the potential cost to the Iowa taxpayer, saying in his weekly press conference that he doesn’t trust the federal government to keep its financial commitments.
Senator Ken Rozenboom (R-Oskaloosa) parroted those thoughts as well. “The problem is this. The federal government, the past few years, is spending one dollar and forty cents for every dollar in revenue they get. By anyone’s measure, that is not sustainable. It simply isn’t. You can’t keep doing it. None of us do that in our households, none of us do it in our businesses, but the federal government is bent on doing that. So, the short sighted view is hey, their paying for it. It has to be tempered with a more – what I consider to be a bit more long term view, a question about sustainability. One person has termed it like this, ‘ Do we want to put one-hundred and fifty-thousand more people on the titanic?”
Mahaska Health Partnership CEO Jay Christensen thinks that Medicaid expansion does make sense, and points out that, for 3 years, the federal government will cover 100% of the cost for the additional Medicaid coverage.
“Medicaid expansion really is a piece of the Affordable Care Act we affectionately call Obamacare. From a providers standpoint, it’s the piece that makes it work mathematically. It doesn’t really matter if you like the Act or not, it doesn’t work for providers without all of the pieces. And I’ll kind of explain. 158 billion dollars of the cost of Obamacare are provided by provider cuts. So, 158 billion dollars nationally over the next 10 years comes away from the hospitals and physicians to help pay for that. Well, the promise we got on the front end was, there would be Medicaid expansion that would not increase individual payments but cover more people, and so, we should net. It wasn’t going to be a financial gain, but it wasn’t going to be a big financial loss, with the real potential advantage being with people being covered, maybe more of their care would be done in a primary care setting, which is a lot less expensive than having it done in the emergency room, which we know is the highest price point in health care; it just is. And so, on our end, to take that payment cut, and particularly a significant piece of our Medicaid volume, is mental health, which also struggles to pay its costs; and to then say, we’re not going to honor the other piece of that, is a little bit frustrating. On the one hand, I appreciate Governor Branstad’s position saying we’re taking a stance on national taxes. My other is, honestly nobody there cares if Iowa’s in or not. They’ll take the money and they’ll fund someplace else. I don’t know that it’s fair to say to 118 hospitals in Iowa, this is your burden to take.”
Rep. Guy Vander Linden (R-Oskaloosa) added, ” The thought seems to be that there’s a lot of people out there who are uninsured and are clogging up our emergency rooms, and that’s very expensive in emergency rooms and why don’t we insure those people. The reason we don’t is because it would be extremely expensive and we would be relying on the federal government to continue to fund Medicaid at the current level and there’s every indication that they are not going to do that and, in fact, they have cut their support of Medicaid in the past. So the issue is… Can we afford it? And frankly, I don’t know yet. But if we do not expand Medicaid, we will certainly consider some other method to get more of these people into the system because we recognize that certainly is a problem for hospitals and all of the health care industry.”
Christensen thinks that getting people coverage will help lower the amount of patients seeking medical coverage in the emergency room, where the cost is highest. “It’s really about trying to get better care to people at the right level. And for us, just staying whole. It’s not about more money, it’s about staying whole. Our bad debt and charity care, the non-paid that aren’t write-offs because of Medicare and Medicaid. These are the ones, where actually people who didn’t pay the bill or didn’t have any resources on the front end, went up 650 thousand dollars from fiscal year 2011 to 2012. And a lot of it is exactly this, there’s more people without insurance coverage. I can’t equate how much of that’s in the ER.”
Christensen added that if Medicaid isn’t expanded, it could cost the consumer, or possibly the property tax payer, even more. “When you look at a facility… well like ours, because we’re a county facility, your options to offset that are, you raise your rates to those who still pay that difference. Now, because so much of our market’s driven by Medicare, Medicaid and Wellmark which all have fairly fixed payment systems for us, there aren’t very many people left to pass that on to. So then your option becomes… Alright, do you look at philanthropy? Do you look at property taxes? What do you look at? Nobody likes those answers, and so for us, it just makes sense it’s more of a national issue, because it really is created nationally.”
Christensen said that they are committed to their promise not to raise property taxes that could be used to help fill a budget gap that could potentially happen if Medicaid funding isn’t settled.
Vander Linden says that the current legislation is still in Human Services Committee, while currently some Republican governors are starting to adjust their position on Medicaid expansion, like Michigan’s Governor Rick Snyder who is now proposing expansion of his states Medicaid.