Second, they believe that the federal government will honor its commitment to continue to cover virtually all of the Medicaid expansion in their states. This is wishful thinking. No estimate of spending by the federal government has ever been accurate. Just remember that Medicare was never supposed to cost more than $10 Billion annually when it was first passed. And when we face another fiscal cliff or sequester, the first cuts to be made will be the Medicaid dollars to the states, and they will be left holding the bag. Governor Brewer has said that if the money stops coming in, that the expansion will stop, but by that time, it will be too late. The genie will be out of the bottle.
Third, there has been an enormous amount of pressure placed on these governors to accept this deal, by interests who stand to gain the most – the hospitals. Medicaid expansion means more patients and more dollars flowing to them. The American Hospital Association- the powerful lobby that represents the hospitals in America, has spent an enormous amount of money to get provisions that favor them written into the ACA, and they have continued to put pressure on the Governors in their respective states to accept this money. The Governors who have been swayed by the special interests, have demonstrated a deficit of backbone and conviction.
Yet some GOP governors have been unwavering, which should give some reason for hope. Gov. Pat McCrory (NC) has correctly stated that Medicaid is a broken system to begin with, so why expand it? Medicaid patients have the worst outcomes in numerous studies reported in the medical literature- even worse than patients who do not have any health insurance. The waste in the Medicaid system is out of control. Patients who are enrolled in Medicaid are the worst abusers of medical resources, such as using emergency rooms for non-urgent care. As far as access to care is concerned- only 30% of physicians currently see Medicaid patients, and this number is certain to plummet when reimbursement for medical services are slashed as have been proposed.
In Wisconsin, Governor Scott Walker has sternly rebuked the notion of a Medicaid expansion on the federal government’s terms. The Medicaid expansion as part of the ACA will be overseen by the Department of HHS, which takes away the control of this program from the state. He intends to run Badgercare- the Wisconsin Medicaid program – in a way that is best suited for Wisconsonites.
Hopefully, the falling dominoes will cease and other Governors will realize that signing onto this Medicaid expansion is a huge miscalculation. The deal may seem sweet right now, but the dollars will likely be temporary, not be as much as had been promised and come with strings attached. Above all, we cannot afford this. These governors are abetting the implementation of the ACA, which will ultimately tear apart our healthcare system, hurt our country financially, and will ultimately come to harm each of them politically.
Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.
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