Posted: 1:54 pm Thursday, June 19th, 2014

From Jan Jones: A counterpoint on Medicaid expansion 

By Jim Galloway

Earlier this month, this space featured a post on whether H.B. 990, which gave the Legislature the final say-so over Medicaid income thresholds, was in fact the final word on expansion.

Specifically, whether a workaround – perhaps like the ones adopted in Arkansas and elsewhere – might be possible.

Click here if you missed it.

This morning, House Speaker pro tem Jan Jones, R-Milton, sent over a thoughtful response that is well worth your time. To wit:

“I want to clarify Georgia requirements for Medicaid reform in response to a column you wrote June 11 entitled, “Lifting the lid on the debate over Medicaid expansion.

House Speaker pro tem Jan Jones, R-Milton. AJC file

House Speaker pro tem Jan Jones, R-Milton. AJC file

The Arkansas Medicaid reform plan entails a federal Section 1115 waiver. A similar or other significant reform plan cannot be implemented in Georgia without prior legislative approval. In 2006, the Georgia General Assembly passed Senate Bill 572 requiring legislative action prior to significant Medicaid reform. The relevant Georgia code section is noted below. SB 572 did not address changes to income threshold requirements for Medicaid.

I believe SB 572 passed around the time Georgia implemented a managed care system for low-income Medicaid participants.

I authored House Bill 990 in 2014 to require legislative approval specifically for an increase in the income threshold in Medicaid expansion. At the time I worked on HB 990, I was aware of the existing requirement for legislative action for significant Medicaid modification and, thus, wrote it knowing that no “loophole” would be created in its narrow construction.

HB 990 was simply an extension of existing state policy requiring broad legislative participation in significant changes to Medicaid, a program that comprises 18 percent of the state general budget. Please note that every single Democrat in the Georgia General Assembly voted FOR legislative participation in 2006 through SB 572. In 2014, every single Democrat reversed course and voted AGAINST it through HB 990.

This income threshold issue became timely with the passage of Obamacare and after the U.S. Supreme Court ruled the federal government could not force states to increase the income threshold to expand Medicaid as a condition of continuing to participate in the program.

In the years I have been in the legislature, I recall Georgia modifying the income threshold once. The state reduced the income threshold to reduce costs and bring the state more in line with surrounding states.

As an aside, I suggest Senator Jason Carter reform his gubernatorial campaign rhetoric to conform to the facts. Expanding Medicaid by increasing the income threshold for able-bodied Georgians and putting taxpayers at risk is off the table, although he has claimed otherwise.

Additionally (as noted in the aforementioned column), Carter absurdly asserted that if we don’t grab these federal dollars, our tax money will go to Medicaid expansion in other states. As a state legislator who has voted for state budget legislation, Carter should understand Medicaid is an entitlement program and, therefore, there is no fixed amount of federal Medicaid spending to be reallocated from state to state.

Unlike certain infrastructure grants, states that choose to participate do not have the opportunity to receive extra dollars when other states decline to participate. Every dollar we refuse to spend on Medicaid expansion is one dollar less that the U.S. has to borrow from China, not one dollar more that goes to another state. Georgia’s refusal to expand Medicaid does in fact help to reduce the growth in federal spending, which is yet another reason why every state should do the same.

59 comments
BillinGeorgia
BillinGeorgia

Medicaid or welfare medicine is not about the delivery of healthcare.  It is about pay-offs to Hospital corps and getting votes.  Even wonder why people on Medicaid are always complaining they don't have healthcare.

MaryElizabethSings
MaryElizabethSings

Jan Jones: "Please note that every single Democrat in the Georgia General Assembly voted FOR legislative participation in 2006 through SB 572. In 2014, every single Democrat reversed course and voted AGAINST it through HB 990."

+++++++++++++++++++++++++++++++++++++++++++++++++++++


Democrats "reversed course and voted against it through HB 990" because Democrats are tired of your spin and can see through it, and so are most Georgians with any heart.  People will die who do not have healthcare.  Can't you get that through your head, and more importantly, into your heart, Jan Jones?  If Georgians have to vote out Republicans in our General Assembly to extend Medicaid in Georgia for the working poor, then that is what is coming.  You can bank on it!


Readers, the fact that House Pro Tem Jan Jones is a member of ALEC tells me all I need to know about where her loyalties lie.  Don't be bamboozled by political spin, Georgians.  You have the heart and the vote.  Vote her and other callous, hard-hearted legislators out of Georgia's legislature and change that law so that ALL Georgians can have affordable medical insurance and ongoing medical care.



SouthGeorgiareader
SouthGeorgiareader

She's spinning facts and avoiding the basic question of whether we want to insure the uninsured at no state cost for three years and small state outlays after that.  She's also avoiding the issue of saving small, rural hospitals from closing.  Spin, spin, spin...

Jke
Jke

A new study projects that large cities could see the number of uninsured drop almost 60 percent under ObamaCare’s Medicaid expansion.

The report by the Robert Wood Johnson Foundation and the Urban Institute looked at numbers for 14 major cities and estimated the percentage of uninsured would drop by an average of 57 percent in 2016 if states that have adopted the Medicaid expansion.

Those cities studied in the report are Chicago, Columbus, Denver, Detroit, Los Angeles, Phoenix and Seattle.

By comparison, cities in states that have not adopted the provision are still likely to see a drop in the uninsured, but only by an average of 30 percent.

Those cities include Atlanta, Charlotte, Houston, Indianapolis, Memphis, Miami and Philadelphia.

“Medicaid expansion helped those who needed it the most, low and moderate income people,” noted John Lumpkin, senior vice president at the Robert Wood Johnson Foundation.

The drop in uninsured in cities where Medicaid has been expanded is expected to range from 49 percent in Denver and 66 percent in Detroit.

The federal cost of covering more people would also range from $4.1 billion in Seattle to $27 billion in Los Angeles by 2023.

The report says if Medicaid was expanded to the non-participating cities in their analysis, the drop in uninsured would average 52 percent.

However, that would also mean federal spending would increase between $4.8 billion in Atlanta and $16.4 billion in Houston from 2014 to 2023.

The study’s authors say cities that don’t expand Medicaid are likely to face more economic hardship.

“Cities in states not expanding Medicaid would face other challenges in addition to having more uninsured residents and foregoing additional revenue,” they said.

“There will be reductions in Medicare reimbursement and Medicare and Medicaid disproportionate share hospital payments under the ACA, which could be particularly difficult for urban safety-net providers serving uninsured people across a wider region.”

A number of Republican governors have rejected the Medicaid expansion, arguing that while the federal government will provide funds initially, the long term burden of the program will drain state budgets. 



Read more: http://thehill.com/policy/healthcare/209913-study-urban-uninsured-would-drop-60-percent-with-medicaid-expansion#ixzz35BK0R2az

Ralph-43
Ralph-43

Borrow the money from China?  This (?) woman is making things up.  Who elected (?) her.  (Female impersonators should not wear shoulder pads.)  We all know that U.S. taxes are collected in all 50 states and 100 percent of the Medicaid expansion will be paid from them for 3 years during which time each state will determine how to pay its 5-10 percent share in the future.  Physician reimbursements and hospital profits will increase, the Georgia state 'Bed Tax' will be eliminated, and the healthcare industry will be in the black and self-supporting.  Healthy low income wage earners, (diabetes, hypertension, angina pectoris, hyperlipidemia, tobacco smoking, etc. now controlled) will return to work full time eliminating food stamps, unemployment, and disability payments.  New construction and infrastructure maintenance will soar.  Send Jan back to her sorority house, or maybe a trip to China for re-education if the sorority girls finally realize what a mistake they made. But - do NOT re-elect this incompetent hateful female impersonator. 

The_Centrist
The_Centrist

Eustis posted "Georgia seems eager to take Federal money for about anything except healthcare.Why's that?"

Because the port will help Georgia's economy and increase revenue.  The federal money associated with Medicaid expansion shrinks leaving state taxpayers and our budget with unfunded claims.  Opposite results.  A concept liberals refuse to acknowledge.
 

RoadScholar
RoadScholar

"...Carter should understand Medicaid is an entitlement program and, therefore, there is no fixed amount of federal Medicaid spending to be reallocated from state to state."

The ampount to Georgia is zero...goose egg...nada!

AvailableName
AvailableName

It's good to know that Rep. Jones continues to be a condescending elitist, who wants everyone to know that the GOP plan to screw the working poor in Georgia is going to work (cue horror movie laugh). Silly Democrats, you think we're going to let you do something to provide health care and add jobs?

Eustis
Eustis

"Unlike certain infrastructure grants, states that choose to participate do not have the opportunity to receive extra dollars when other states decline to participate"

Maybe true, but it makes it easier for the Feds to provide money to the participating States. 

"Georgia’s refusal to expand Medicaid does in fact help to reduce the growth in federal spending, which is yet another reason why every state should do the same"

Wonder what her opinion of he Savannah port project is? Georgia seems eager to take Federal money for about anything except healthcare.Why's that?

Derwin0
Derwin0

H.B. 990 wasn't required in the first place.  The governor can not approve the additional spending that medicare expansion requires after 3 years in the first place, as the general assembly is constitutionally required to approve new spending.

Skeetercat
Skeetercat

The unemployment rate in Georgia has ticked up once again; tuition rates are skyrocketing; 9,000 teachers have left the profession in the last five years; more and more students are packed into classrooms; hospitals, in rural areas, are closing and this not only effects the poor but veterans as well; and the list goes on and on and on.  The solution to this chaos is to vote the bums out, beginning with "shady" (devious) Deal!

The_Centrist
The_Centrist

Education spending makes up 52% of the GA budget, healthcare is next at 21%, followed by criminal justice at 9%.  Remaining categories are debt service on bonds, transportation, general government, human services, and judicial (in that order of percentages).

Carter says he will not yet ask the legislature to raise taxes.  To pay for his proposed added educational spending and expanded Medicaid he says we will have undefined "difficult budgeting decisions" and "tough choices".  Even liberal Jim Galloway says: "He can, and should, be required to point to the areas of government he would shrink in order to pay for his priorities." AJC Political Insider 6-17-2014

PoliticalOutsider
PoliticalOutsider

I actually had one of Jan Jones' colleagues repeat the same GOP talking points to me the other day, with one added twist. To quote:"By expanding Medicaid, we are only creating a new class of people who are dependent upon the government for their livelihood". This is healthcare for Christ's sake! Sort of a basic human need.

Now remember, the GOP are the loudest bible thumpers out there, yet they are the first ones to turn their back on the poor and needy. Seems like I remember Jesus spent his entire time on the Earth healing the sick and helping the needy. I guess Jesus was a Democrat.

And best of all, my Legislator did not seem to comprehend the fact that just because these dreaded "poor people" don't have access to healthcare, they don't stop getting sick. They simply walk into an already over worked ER and get treated, and the hospital and tax payers pick up the bill. It never occurred to my Legislator that if Medicaid were expanded, at least the hospitals would get some reimbursement for their services. The response from my Legislator??? "We are just creating more government depended people." WWJD?

DS
DS

Four hospitals in Georgia have closed in the past two years, and as many as 15 more may be closing their doors in the coming months. That’s according to Hometown Health, a trade association representing 56 rural hospitals in Georgia.

The hospitals have been fiscally stressed for years, due to the large number of indigent patients they treat. Many have been operating in the red.

The Macon Telegraph noted some of the possible solutions to the problem, including the most obvious: Medicaid expansion under the Affordable Care Act, which would “help rural hospitals by turning many of their uninsured patients into paying patients.”

Polls show that 60% of Georgia likely voters support Medicaid expansion.

How many Georgians whose local hospital has closed will die unnecessarily before our stubborn politicians accept Medicaid expansion?

Baumer_1
Baumer_1

Wasn't the 2006 bill the same one that created a state health insurance exchange?

Oh yeah, you conservatives didn't know GA passed a law authorizing the creation of a health insurance exchange? That was way back before you guys opposed the idea because it was embraced by a black Democratic president.

GaBlue
GaBlue

@Ralph-43


That was harsh, but well-deserved. I'm tired of posers in our legislature pretending they're doing the taxpayers a favor by holding poor people down. Never mind how well dressed or groomed they are; their insides are ugly. 

honested
honested

@Ralph-43 

It's a shame that being condescending, hateful and an ability to recite wrong-wing talking points is considered equivalent to leadership in some circles.

PoliticalOutsider
PoliticalOutsider

IF it were truly the choice (and it is NOT), between borrowing money from China and letting poor people die due to a lack of healthcare, put me down for borrowing from China. IF the USA were to default( which it will not), the damage to China's economy will be far worse than the damage to the USA economy.

Anybody ever bankrupted against you? I have plenty of times. I usually get ZERO, and the debtor walks free and clear.

Skeetercat
Skeetercat

@Ralph-43 I love it!  Especially the words:  "do NOT re-elect this incompetent hateful female impersonator."  My thoughts exactly.

Wascatlady
Wascatlady

@The_Centrist Port expansion will enrich SOME people (who likely already get tax writeoffs).  Medicaid expansion, while not free, helps the common people, hospitals, and trained medical auxiilliary services, besides saves all of us the costs of paying for ER care for those in need.  


Other examples of willingness to belly up to the federal hog trough or teat when it suits the governor:  RT3, CC (Initially), federal aid for flooding and storms.


It is really indefensible to NOT take care of Georgians, especially the common folk (and we know God loves the common folk because He made so many of them!)

honested
honested

@The_Centrist 

There is absolutely no reason to assume that 'the port' will help Georgia's economy and increase revenue.

It will probably cut shipping costs for the Chinese, but that is unlikely to be passed on to American consumers!

Eustis
Eustis

"The Medicaid program is jointly funded by the state and the Federal government. In the existing Medicaid
program, Federal government matches state expenditures at a rate determined by the ratio of the state’s per
capita income to the national per capita income. In Georgia, the Federal government contributed 66.16% of
the cost of Medicaid in 2012.
If the state expands, the Federal government will pay 100 percent of the cost of newly-eligible up to 133
percent of the FPL for calendar years 2014 through 2016. In 2017, the matching rate will be 95 percent; in
2018, it will be 94 percent; in 2019, it will be 93 percent; and in 2020 and future years, it will be 90 percent"

Pretty smart Jan. We are now reimbursed 66.16% while the rate under medicaid expansion would be no less than 90%.

Any projections on how much Georgia would spend on Medicaid in 2020 under the existing program vs. the expanded program? 

AvailableName
AvailableName

Without doing the research for a citation, I think Medicaid expansion will add more permanent jobs than the harbor dredging.

And regardless of the 10% reduction in federal funding over time, the jobs continue, people are healthier. And not insignificantly, we will have done the right thing - there's some value in that, just hard to quantify.

DS
DS

Studies have shown that Medicaid expansion boosts the economy, adds jobs and increases tax collections too.

I also think we need to be mindful of the plight of hospitals across Georgia. This is a really serious problem. Medicaid expansion would be the most effective way to help them survive.

honested
honested

@Eustis 

Using money to ruin an estuary for ships that will never come.....

It's the gop way!!

honested
honested

@Derwin0 

So allocate the MUCH SMALLER amount necessary to keep up with Medicaid and eliminate the HUGE amount currently used for reimbursement or squeezed out of municipalities.

There simply is not a legitimate argument for either HB 990 or the continued, pigheaded refusal to expand Medicaid.

honested
honested

@The_Centrist 

Then it is our job to encourage the NEXT GOVERNOR to raise the taxes necessary and stop the madness.

I realize conserrrrrrrrrrrrvatives view such an action as treason, but there is substantial evidence to prove their 'plans' don't work!!

DontTread
DontTread

@PoliticalOutsider  "Now remember, the GOP are the loudest bible thumpers out there, yet they are the first ones to turn their back on the poor and needy."


Nevermind the fact that Arthur Brooks (you may recall him as someone who actually did some research on the subject instead of pulling stuff out of his butt) found that people who reject the idea that "government has a responsibility to reduce income inequality" give 4x more to charity than people who accept this idea.


In the same study:  Conservatives give 30% more to charity than liberals do.


The purpose for government is to protect the rights of individuals, not play the role of Mommy and Daddy to (supposed) adults who can and should be supporting themselves.  While I'm all for helping people who fall on hard times through no fault of their own, people who repeatedly make bad decisions and expect someone else to pay for them (and blame other people for those decisions to boot) need to be the ones suffering the consequences, not the taxpayer.


PS: when some politicians decide to forcibly take money from people and give it to someone else, it's not "charity" any more...it's vote buying.

GaBlue
GaBlue

@PoliticalOutsider


I also was discussing this with a state legislator and a d-bag who was running for office. I said, "Have you ever sat with someone while they died from cancer because they didn't have insurance and didn't get diagnosed in time? I have." 


The d-bag (he lost, yay) said, "Do you really want the government to PICK WINNERS AND LOSERS?"  Then he handed me his little flyer boasting how he and his family are involved in their Christian church.  Yuuuuuuuuck. 

GaBlue
GaBlue

@DS


Also, hospitals = JOBS.  Employing people to provide necessary services is better for the economy in a community and our state than closing the doors on an empty building while people wonder how they're going to pay their bills next month. 

honested
honested

@DS 

But doing so would actually HELP PEOPLE and that might make them stop hating the President!

Can you think of anything more awful?

Shar1
Shar1

@GaBlue @Ralph-43 Jan Jones has been the only woman that Republicans can trot out to front for them in support of their endless policy attacks on women and children.  She sold her female (?) body to the good ol' boys a long time ago, and all that is left is a hateful, screeching desperate hack who keeps trying to increase her value to that same Old White Guy club by selling herself more and more.  Someone should tell her that overexposure degrades the product.

Wascatlady
Wascatlady

@AvailableName But to our Governor, it doesn't make it right to do it for the poor and needy--just your family and rich friends!

DS
DS

@AvailableName, you are correct, Medicaid expansion would add more jobs (70,000) than expanding the Savannah Port (5,000, plus the risk of losing 21,000 existing jobs if we don't expand).

I support expanding the Savannah port anyway, regardless of the jobs impact. We need to do it to accommodate the larger ships that will be used once the Panama Canal expansion is complete. It's a useful and worthwhile infrastructure investment, I think.

I also think it would be disastrous to let 15 more hospitals shut down unnecessarily. Let's expand Medicaid, help our hospitals survive, boost our economy, and keep Georgians healthier.

dcdcdc
dcdcdc

@DS And those same studies completely ignored the shrinking of the economy that happened due to the "taking" of the money from others to fund that medicaid expansion.  Seriously....does any sane person really believe that govt spending, in the end, expands the economy?  If so, why wouldn't we just spend our way to prosperity. 



There's a pretty simple fact.  It if doesn't work in your personal household, it won't work over time w/ the govt.  So, unless the expenditure is focused on an investment that makes us more productive, then it's simply moving money around (with of course the govt skimming of their "take" off the top).

The_Centrist
The_Centrist

@DS - Obviously those studies do not show enough to overcome the huge added welfare liability, or a majority of our legislators and Governor would be in favor.  Just saying this is effective does not make it so.  It isn't going to happen, so well past time to move on.

PoliticalOutsider
PoliticalOutsider

ReTread

But what you tin foil hats can't understand is that it is NOT just the ones who "make bad choices" who suffer the consequences. It's the hospital ER's and those with health insurance like YOURSELF who suffer the consequences by having to pick up the tab!

So, let's forget the people who "make bad choices" for a moment. Would you agree that we should expand Medicaid for those poor people who make "good choices" in life and still find themselves to be needy?

DS
DS

True, Medicaid expansion would help all Georgians, not just those who would become eligible.

The_Centrist
The_Centrist

@DS - "Damn the torpedoes, full speed ahead" does not work in budgeting.

Wascatlady
Wascatlady

@dcdcdc And Medicaid explansion DOES make the sick more productive!

DS
DS

@dcdcdc, you do realize that we're paying most of the cost of Medicaid expansion already? That was included in the PPACA legislation that went into effect four years ago.

Why don't we bring some of those tax dollars back to Georgia?

PoliticalOutsider
PoliticalOutsider

Great Idea! Like the $19M for Arthur Blank's parking deck? Like the $70+M for tax exempt parts for Gulfstream jets? Like making the construction materials exempt from sales tax for the World of Coke and the Georgia Aquarium? Corporate welfare is rampant in the GOP while their "Holier Than Thou" Legislators look for another needy person to kick in the groin.

The_Centrist
The_Centrist

@RoadScholar - Ah, the old magic bullet.  How about "tax the rich" too?  Never mind the numbers don't work - just sounds so good.

Maybe Jason Carter will try such populism poppycock, but then the numbers get trotted out to show what bogus B.S. it is.  He is smarter than that. As he said, no increased taxes - now, and there must be "tough choices" and "difficult budgeting decisions" ahead.

DS
DS

@The_Centrist, I agree with you. But 26 other states have managed to fit Medicaid expansion into their budget. They looked at the costs vs benefits and decided it was something they wanted.

If we have the political will for Medicaid expansion, then we can too.

The_Centrist
The_Centrist

@DS - No tax dollars.  Just added debt now and even more just for Georgia taxpayers in the future if it were adopted.  Explained well in the blog item above.

Oh yea, foreclosed and not going to happen in Georgia.
  Moot point.

honested
honested

@The_Centrist 

Howsabout we just give 'tax the rich' a try and see what happens.

After all, falling for laffer madness was supposed to improve life for all (at least that's what the U.of.Chicago 'numbers' said) and we all see what happened.

The_Centrist
The_Centrist

@DS - And 24 states could not manage to fit it their budgets - Georgia being one of them.  Of those 26 states, some will undoubtedly run into trouble and beg for a federal bailout, or have to make some very painful cuts somewhere else.  Blue and purple states have a better chance of getting that federal bailout under a Democratic administration.  Remember all of those Obamacare waivers for friends of Barack?
 

honested
honested

@The_Centrist 

Invented sure.

Explained, no.

Making stuff up does not pass as an explanation.

honested
honested

@The_Centrist 

And there is the only pertinent point.

Refusing Medicaid expansion demonstrates a fealty to those who awaken each morning with no goal greater than demonstrating their hatred of the Elected President of the United States.

Reread 1984 and compare the attitude toward 'Goldstein'.

DS
DS

@The_Centrist, the states that refused Medicaid expansion did so because of partisan politics. The budget excuse is a smoke screen.