It goes like this: states tax hospitals (who are begging to be taxed), use those funds to qualify for federal Medicaid funds, and then turn around and give the hospitals back the money — now legally laundered — and then some. The losers? Federal taxpayers, who shell out Medicaid bucks without even the slight restraint of a small state funding requirement, and Medicaid patients themselves, trapped in substandard health care.
According to Obama, prohibiting these bed taxes or “provider taxes” to cover state obligations under Medicaid would save $21.8 billion. And Obama has vociferous agreement from the right on this issue. As the Wall Street Journal editorial board put it: “This is real waste, fraud and abuse, not the talking-point version.”
The problem is getting worse. Arizona is using the scam to finance a massive expansion of its Medicaid program — even after leading the charge to the Supreme Court to successfully secure its legal right to opt-out.
The political pitch? This won’t cost Arizona taxpayers a penny. Which would be wonderful, except that Arizona taxpayers are also federal taxpayers. Republican governors who are keen on expanding Medicaid are almost certain to follow Arizona’s lead and use this trickery to put the entire cost on the back of federal taxpayers.
At a minimum, states should not be allowed to use the bed tax scam to avoid paying even their legally required 7 percent share of the Obamacare Medicaid expansion. Think about it; if a state is unwilling to spend even 7 percent, why should federal taxpayers pay 93 percent? Or 100 percent via the bed tax scam?
The saddest thing about the expansion of Medicaid, which will cost federal taxpayers at least half a trillion dollars over the next decade, is that it isn’t likely to improve health outcomes for new enrollees.
Medicaid pays doctors below-market reimbursements and burdens them with extensive paperwork and bureaucracy. Adding 12 million people to Medicaid rolls, which is CBO’s current projection of the impact of the expansion, will only exacerbate the shortage of primary care physicians and specialists who can afford to take Medicaid patients and add significantly to emergency rooms’ workload.
While the question of whether or not to expand Medicaid is intensely polarized politically, the issue of ending the bed tax scam is not. President Obama proposed closing the loophole. He’s right, and Republicans should take him up on the offer in the next package of spending cuts they pass.
The Medicaid expansion in Georgia will cover roughly half a million of Georgia's two million uninsured working people.
Multiple research projects show that acquiring insurance improves physical and mental health, increases longevity, and significantly reduces financial distress. The real danger of injury and disease today is bankruptcy.
Regarding cost, we are sure there is $700 billion in inefficiency in the $2.8 trillion medical/health industry. CBO's just released Budget and Economic Outlook for 2013 - 2022, projects that the Medicaid and insurance expansion will reduce the national debt by $60 billion over ten years while covering around 32 million now uninsured. Spend less money; cover more Americans.
This will bring $33 billion into Georgia over the decade. By reducing uncompensated care, it will prevent private insurance premiums rising.
On the issue of market rates of pay, there is considerable evidence that the high prices are the result of inefficiency in medical delivery, fragmentation in communication, and lack of accountability by medical providers. Extreme variations by geographic region domestically and internationally indicate price distortions rooted in local treatment preferences rather than effectiveness. See the three decades of data and research produced at Dartmouth Medical School at the Dartmouth Medical Atlas for evidence.
To balance the power of an industry that large and constrain costs, the power of the government is necessary.
As the last cottage industry, physicians have long resisted the use of information technology. The ACA has funded major initiatives in this area and leading medical centers have pioneered in the cost savings to be gained from adopting the same technology that Hardees uses.
We have an oversupply of specialists and undersupply of primary care providers for multiple reasons. The most critical are low pay for general practitioners and low prestige for primary care providers. As the ACA's incentives in medical education and delivery take hold, more people will move into the role of primary care and treatment co-ordinator; hopefully, there will be fewer specialists.
Here in Rome you must have noticed our dueling Emergency Rooms. Billboards with 'waiting time clocks"??? Emergency rooms are a door to attract paying patients and a screen to exclude the poor. That is why they are advertised.
Please don't believe that Emergency Room treatment is anything other than determining that a person cannot pay and instructing them to see their doctor, which uninsured people don't have. My experience as a board member of a clinic for uninsured and working women who have been to both Rome's Emergency Rooms has been consistent over time.
Your work on the bed-tax scam was good. Please look further into the actual provisions of the ACA as well as the business model of the medical and insurance industries before consigning Georgia's two million uninsured to the category of "surplus population."
Mike L. Reynolds
Rome, Ga