More Medicaid costs a problem

More Medicaid costs a problem

"Free" money can be awfully expensive, as in the case of the expansion of Medicaid.

The fallout from last year's decision affirming the constitutionality of Obamacare is spreading across the country, last week landing in the Illinois Senate.

The high court upheld the core of the legislation — the mandate requiring all Americans to buy insurance or pay a fine for not doing so — but it said that individual states were free to decide whether to participate in the legislation's vast expansion of Medicaid.

The Illinois Senate last week voted 40-19 to participate in the expansion. When the Illinois House follows suit, as it surely will, the legislation will be signed into law by Gov. Pat Quinn.

That's too bad. There are so many question marks about the impact of the proposed Medicaid expansion that it would be more prudent for our state to wait and see what happens elsewhere.

Right now, all 50 states are in the process of either signing up for the Medicaid expansion or not. Each state has its own reasons for acting as it does. For many, the lure of what is being described as "free money" promised by the federal government is irresistible.

Of course, the federal government doesn't have the money that is being described as free. It will borrow the necessary funds through the credit markets, substantially increasing the federal budget deficit and national debt.

The cost of the program to Illinois also will not be free, even though it is advertised as such. Critics say that the planned expansion will cost Illinois taxpayers roughly $2 billion between now and 2020. For a state already deeply in debt, that's not chump change.

Majority Democrats, who control the levers of power in this state, are undeterred by the extra costs. They characterize the Medicaid expansion as a moral imperative and ignore the price tag.

Here's the plan for Illinois.

Under Obamacare, participating states will expand Medicaid eligibility to low-income adults who have no children at home. Previously, it was limited to low-income families and the disabled.

Roughly 350,000 uninsured Illinois residents will be newly eligible under guidelines that allow enrollment for those with incomes of up to 138 percent of the federal poverty line ($15,400 for an individual and $31,800 for a family of four).

But the state also expects people currently eligible but not enrolled in Medicaid to be drawn into the program. That number is estimated to be roughly 170,000.

The federal government will pay 100 percent of the costs of the newly eligible enrollees for three years. After that, the federal government will pick up at least 90 percent of the cost for the newly eligible.

The federal government will pay 50 percent of the cost of newly enrolled people who were eligible under the old rules. That's where most of the extra cost to the state comes in.

Gov. Quinn called for the expansion, describing health coverage as a "fundamental right." He also has foolishly characterized it as a stimulus to the economy, maintaining that the expansion will create thousands of jobs.

So on the strength of this argument, Illinois once again is going to spend hundreds of millions of dollars it doesn't have. That's the same approach that has led Illinois to effective bankruptcy.

There is another problem that is not being discussed. Medicaid in Illinois is infamous both for not paying its bills on time and not reimbursing medical providers at sufficient amounts. That has prompted many medical providers not to accept Medicaid patients or not to accept additional Medicaid patients.

Illinois is about to drop an estimated 500,000-plus new Medicaid patients on the system. Will there be sufficient providers to care for them?

Despite all the talk about the dramatic Medicaid expansion, the fact is that no one can say with certainty how this will work out. Given all the questions surrounding the impact of this program, Gov. Quinn and state legislators are taking an unacceptable risk with state finances.

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SaintClarence27 wrote on March 05, 2013 at 8:03 am

Again, the NG misses out on the fact that people without health care are a drain on the system, and Medicaid is much less expensive than people without insurance.

rsp wrote on March 05, 2013 at 11:03 am

Plus there are the people who are afraid of taking a job, any kind of job, in fear it will cost them their medical coverage. Meanwhile they also collect other aid that they would give up by taking a job.

Sid Saltfork wrote on March 05, 2013 at 12:03 pm

I am going to draw the ire of many by saying this.  Medicaid should only be available to the legal citizens of Illinois.

EL YATIRI wrote on March 11, 2013 at 11:03 am
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Folks just don't seem to understand that the current system with so many uninsured is the most expensive and worst of all systems.

England has a very good single payor system covering all with excellent quality and consumer satisfaction, and it costs one fourth of what the US spends per capita.

Citizen1 wrote on March 05, 2013 at 1:03 pm

Non-drug abuse citizens

Sid Saltfork wrote on March 05, 2013 at 2:03 pm

Sure.  Let's go one further.  Mandatory drug testing for Medicaid recipients, the legislators, and governor.  Many public employees already have it.  Make it required for everyone.  Mandatory drug testing for driver's licenses, FOID cards, and voter registration. 

rsp wrote on March 06, 2013 at 9:03 am

Sure, let's drug test all those kids. And the disabled. Never mind the cost and the fact that very few people on medicaid abuse drugs. It's much easier to buy the myths. 

Chapin Rose has a plan he's been trying to sell for years to cut fraud in food stamps by putting photos on the IDs. It will cost hundreds of thousands of dollars. And nobody will see the cards to see who is using them. A complete waste of money. Some of the local stores know when the cards are used illegally and look the other way. Multiple cards used on one transaction, the same card used over and over in a row, etc. They don't report it, just pocket the money. 

Why do people sell their food money? To keep the power on, have gas to get to work, get medicine for their kids. 


Sid Saltfork wrote on March 06, 2013 at 11:03 am

rsp;  That is why I said the "legislators", "governor", "FOID cards", etc.  The people clamoring for drug testing on Medicaid recipients would not be happy if they had to submit to it also.

My complaint is the use of Medicaid by illegal citizens.  I know we may disagree on that.  Millions of dollars have been cut from services to legal Illinois citizens while millions have been spent on illegal citizens.  Politicians are rewarded by votes for doing it; but the cost is coming from the legal citizens who are seeing their services cut.  I do not want to be inhumane; but the state, and country cannot continue spending on non-citizens while we have a broken immigration policy.

SaintClarence27 wrote on March 06, 2013 at 12:03 pm

Sid, I think you are missing how the NG threading works. RSP wasn't responding to you.

Specifically, the use of Medicaid for illegal aliens probably decreases the cost to the country as a whole.

Sid Saltfork wrote on March 06, 2013 at 2:03 pm

SaintClarence27;  Point taken.  It is hard to tell who is responding to who without the preface of the commenter's name.

Please explain how the use of Medicaid for illegal aliens decreases the cost to the country as a whole?  Maybe, I am mis-reading your comment.  If free medical insurance, "look the other way" employers, free education, and assisted housing did not exist; they would not come illegally.  I realize that sounds inhumane; but they would go "home".  Legal immigration based on legitimate employment skill needs, and other valid reasons would allow growth in the middle class.  The country does not need more poor people.  It needs skilled middle class people.  We have enough poor, and working poor as it is currently.  Close to 50% of the population is living below, or at the poverty line.  We do not need more illegally slipping in while we are struggling to assist our own citizens.  I do not care if the legal immigrants come from Mexico, Nigeria, Spain, Russia, or elsewhere as long as they have skills needed to rebuild the middle class.

SaintClarence27 wrote on March 06, 2013 at 2:03 pm

I understand your point (though I generally am skeptical of it) regarding illegal immigration. I'm specifically talking about medicaid. If your argument is to deny services in the hope that people will just go home, I don't think that's a reality. But for a second putting aside whether they're here or there, let's just assume that we still have 13M illegal immigrants.

The reality is that those Medicaid expenses are paid one way or another.

Hospitals don't turn away people. People without insurance generally don't pay. Say some one stubs their toe, splits the nail, and the nail gets infected (this has happened to me). And they know they can't afford to go to the doctor for it. So they wait. And they wait. And they wait. And then an infection that could have been solved with a $60 doctor's visit and a $5 course of antibiotics becomes septic. Now it's life threatening. Now they *have* to go to the doctor. Except they've waited so long, that they can't even function. They can't drive or walk, and are in delirium. Now there's an ambulance call, and off to the ER. All of a sudden that $65 has turned into $500 before they ever get to the hospital! And now they have to stay overnight and be administered IV antibiotics. There's another $750 for the bed. And now it's looking like the toe will have to be amputated. Now we're looking at a $10,000 surgery, plus another 3 days in the hospital. By the time all is said and done, this patient has racked up over $15,000 in medical bills. He doesn't have insurance, so he won't be able to pay. That's okay, they have charity care for that! Except those costs are then pushed back onto the people who do have insurance through increased bills and premiums. Then the hospitals write off the rest of the charity care and use it to keep non-profit status and avoid paying taxes.

The cost to us now is well over $15,000, and it could have been solved with a $65 doctor visit and course of antibiotics. And don't say that hospitals should just turn away illegals - if someone has a potentially life-threatening affliction, they HAVE to be seen. It's not optional for the hospitals or doctors.  

Preventative care and early treatment is MUCH more cost effective than trauma treatment and therapy. This was just one hypothetical, and it happens on a regular basis. Most ER visits by uninsured people are as a result of lack of preventative care. People who don't get preventative care cost MORE than people who do. So, since they will be treated anyway, shouldn't we be doing it earlier, cheaper, and more humanely?

Sid Saltfork wrote on March 06, 2013 at 2:03 pm

That is up to the doctors, and hospitals.  It would their choice.  Donors to charities would have to decide also.  At least, the rest of us would not be on the hook for the costs.  There would be some outcry; but they do not have to be treated.  Things could change.  

Have you ever been injured in Mexico?  If you do not have insurance which covers you abroad, you do not get treatment.  The U.S.A. can no longer be compassionate.  It can no longer afford it.   

SaintClarence27 wrote on March 06, 2013 at 4:03 pm

That's a REALLY bad idea. Starving or injured people not getting treatment leads to destabilization of society.

Sid Saltfork wrote on March 06, 2013 at 5:03 pm

Starving or injured citizens would get treatment.  Give advance notice so the non-citizens have time to move to Wisconsin, Indiana, Texas, or Mexico.  The Illinois society would stabilize following that.

SaintClarence27 wrote on March 06, 2013 at 5:03 pm

First, I don't grant that people would just move. Second, the society would still be less stable. Third, it's unreasonable and inhumane to deny treatment, illegal citizen or not.

Sid Saltfork wrote on March 06, 2013 at 10:03 pm

How is it supposed to be paid for?  Increase taxes?  Take away benefits from legal citizens? How is the increasing cost to be paid?  I am open to suggestions that solves the problem instead of increasing the problem.  The reality is that it costs money.  The money has to come from some where.

SaintClarence27 wrote on March 07, 2013 at 12:03 pm

Sid, while I understand your point, we've come to an impasse. We've both gotten down to the two most efficient choices - refuse to treat illegal aliens entirely, or grant medicaid by income like everyone else. I will never agree with you that it's okay to not treat people who need it, no matter where their birthplace may be.


Bulldogmojo wrote on March 06, 2013 at 11:03 pm

Everything is a domino effect Wall street steals trillions, people lose equity in their homes and pensions, people lose jobs, have no money to support the local businesses, those businesses close causing more unemployment which means more uninsured people who turn up at already overburdened emergency rooms driving up insurance costs and so on and so forth.

We need to prioritize our meager healthcare resources. Personally I don't want to see any children suffer with illness regardless of their immigration status or economic status. Whatever happened to "Pay what you can" or working off some of your bill by working at the medical facility itself or community service? I don't think Ron Paul's notion of "well when I was a doctor the churches picked up the slack of the uninsured" is going to work. We better get back to the fundamentals of ethics or no plan will work. I would suggest various revenue generators but if the state can't be trusted not to steal the money what would be the point? We all need to cut out the middle man (state of Illinois) and donate a little more money directly to charities that help the uninsured.

Some clinics in India a doctor does his rounds and sees one patient who is insured or can afford the care at full price and the next patient across the hall is someone who can't pay or can only pay very little. Back and forth like that all day. It works. We don't need to come up with innovative solutions we just need to copy other ideas that work.

Local Yocal wrote on March 07, 2013 at 9:03 am
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TIME Magazine did a cover story a while back that asks the key question that no one ever asks: Why is health care so expensive? 

We all have been led to believe that it's the damn lazy poor who suck up all this "entitlement" money by having the audacity to get sick and injured and then show up at the emergency room uninsured.

IN FACT, for decades, the makers and suppliers of the medical equipment and supplies, the makers of the prescription drugs, the builders and administrators of hospitals,..........are........ ....ready?... PRICE GOUGING to make insurance look like a deal, and PRICE GOUGING the government so many times beyond cost, it staggers the imagination. Throughout this so-called recession, the one industry doing just fine, thank you very much, is the health care industry. 

And ironically, the only ones within this industry not making money are those that deliver the actual care: doctors and nurses. 

But instead, the analysis among the landed gentry up in Countess Cathedral editorialize once again that the buffoons in Springfield are coddling the damn, lazy poor people with more unnecessary goodies, like health care for christ's-sakes, at the expense of the poor taxpayers who own homes and show up for work. Talk about your class warfare. Their Catholic Jesus would be so proud of these smarty pants looking down from the cross. 

I will do the Editorial Staff a favor and next time I'm injured, I'll conveniently bleed all over their entry way on Main Street so as not to trouble their tax bill. Gosh, if they're really lucky, I might even die on their doorstep, a sensible Final Solution toward ridding ourselves of these 50 million "tax takers." 

rsp wrote on March 07, 2013 at 12:03 pm

I read a story about MRIs and how expensive the machines are, and the software they use. It seems the software doesn't come with them. The company still owns it, so they get a fee every time it's used. And you know how they have to keep upgrading it and everything. That's why all those tests are so expensive. 

SaintClarence27 wrote on March 07, 2013 at 12:03 pm

There's more to it than that. The explosion of health insurance costs over the last 12 years had a lot to do with the stock market as well. Remember, all of your money isn't just sitting there waiting for you to use it. It's placed into huge securities, stocks, portfolios. When the stock market takes a dive, insurance prices go up so the company can recover.

Of course, that doesn't explain why insurance costs haven't gone back down...

serf wrote on March 07, 2013 at 8:03 pm

While I'm sure that both of you are making valid points, I think that Local's point needs to be reiterated.  

If you have ever been in the hospital, go back and try to find the itemized bill from the stay.  The charges are ridiculously overpriced.  $15 for two ibuprofen, $20 for a plastic bedpan, and so on.  

That's the price that the hospitals start negotiating with the insurance companies at.  So when the insurance companies negotiate a 50% reduction in prices, they are only paying $7.50 for two ibuprofen (what a steal!).  Meanwhile, the uninsured have no way to bargain for the same rates and therefore they end up paying full price (not always, but sometime).

Half the bankruptcies in this country are are at least partially attributable to medical bills.  


Local Yocal wrote on March 07, 2013 at 4:03 pm
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For those interested in the expose on how medical bills are determined, looky here:

increvable wrote on March 11, 2013 at 10:03 pm

Health care is one confusing, incredibly elaborate mess. It's pretty clear that here in the US, we spend way more money per capita than other industrialized countries, and for that spending our health is worse and not everyone can go to the doctor.

I don't have any insight to contribute here. I like Atul Gawande's essays in the New Yorker. When I read them, I feel like there's some practical steps we could take to getting this problem in hand, but then I think about how dysfunctional Washington is and how so many different groups have an interest in keeping things the way they are and I lose all hope again.

Brownman07 wrote on March 12, 2013 at 1:03 am

I think that "TheChiefRules" is moonpie's other username. Always spewing hate and blaming everything on liberals. He's just a troll who feeds off the energy of others. He's quick to criticize other opinions although he only does so by addressing his own opinions. His biggest flaw is that he doesn't seem to get that his comments are indeed his opinions, and not facts.