Political Animal


July 03, 2012 12:49 PM Hospitals Versus Ideologues

By Ed Kilgore

Jeffrey Young of HuffPost has a good primer on the potential impact on hospitals of any state refusals to implement the Affordable Care Act’s Medicaid expansion mandate, and of preliminary plans by hospitals to pressure Republican lawmakers to stand down on their threats of obstruction. While Young provides data on Florida and Arizona as well, it’s the Texas numbers that are stunning:

Getting the Medicaid expansion in place has already become the “number one priority” for the Texas Hospital Association, said John Hawkins, the senior vice president for advocacy and public policy at the organization. “It’s the kind of thing that hits our members right on the margin when they’re trying to digest other payment cuts,” he said.
Twenty-seven percent of working-age Texans, or more than 6.1 million people, were uninsured in 2010, according to the Kaiser Family Foundation. That’s the highest rate in the nation and the second-highest number to California’s 7 million people. Under the Medicaid expansion, 2.5 million Texans would qualify, the Urban Institute estimates.
But Texas Gov. Rick Perry (R) has been a staunch opponent of health care reform and his administration has indicated a willingness to opt out of the Medicaid expansion. For Texas hospitals, which absorbed $4.6 billion in unpaid bills and charity care in 2010, that’s a problem, Hawkins said.

I should think so. Presumably hospitals and their associations in all the estimated fifteen states where Republican governors and/or legislators are already rattling sabers against the Medicaid expansion are making plans not only to lobby, but to inform the public of how the costs of uncompensated emergency care are shared with everyone else. The fiscal realities of the Medicaid expansion, with its extraordinarily high “super-match” of federal funds (beginning at 100% and dropping gradually to 90%), will also be thoroughly aired in response to vague alarms from conservatives that the expansion will overwhelm state budgets.

This won’t matter much to the Tea Folk who will use their own leverage to oppose the expansion, and whose response to the quandary of hospitals might well be a blithe suggestion that Congress repeal the federal law requiring emergency care for everyone (let ‘em be more responsible!), even though it was signed by none other than Ronald Reagan. The debate won’t be between two different accounts of the policy implications and fiscal consequences of accepting or rejecting the Medicaid expansion, but between care-givers and ideologues speaking very different languages.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • stormskies on July 03, 2012 12:57 PM:

    Yep all these Repiglican governors are simply sadistic pigs who allegiance to their delusional ideology is more important that allowing millions in their own states to have health insurance .. sadistic pigs indeed

  • Daniel Kim on July 03, 2012 1:11 PM:

    The hospital industry may well try "to inform the public of how the costs of uncompensated emergency care are shared with everyone else." in order to drum up support for Medicaid expansion, but there should be some expectation that hospital fees will go down for everyone when the expansion is implemented. If the argument is made that hospitals must charge everyone more because of indigent care, then expanded coverage ought to bring some small relief to patients with coverage.

    Can we expect such a thing to occur? Will Medicare expansion money shift the burden of payment away from those with coverage onto the federal government's funds, or will the money just go toward higher salaries and bonuses for executives of health-provision companies?

  • Ron Byers on July 03, 2012 1:16 PM:

    I generally use the "follow the money" principle to figure out how politicians are going to jump. Who stands to make money if Rick Perry and the rest don't let their states join up?

  • boatboy_srq on July 03, 2012 1:19 PM:

    Scary how the same people can insist that healthcare coverage is somehow "socialism" and "government control" and "out-of-control spending" but they can still advocate for spending billions to violate pregnant women just so they can get their jollies and shame the sluts.

    Has anyone else read the comments at thehill.com? The wingnut is in full froth over this. I can't help but wonder how many of the wingnuts posting there are on the payroll of ALEC or AFP.

  • boatboy_srq on July 03, 2012 1:21 PM:

    @Ron Byers: Texas is probably a valid question, but in FL it's obvious that the one making money will be First Lady Bellatrix Lestrange.

  • gaardvark on July 03, 2012 1:28 PM:

    Jobs! Jobs! Jobs!

    Any state that refuses the Medicaid expansion should be called out for their "Job Killing" policies.

  • Mimikatz on July 03, 2012 1:28 PM:

    As I predicted would happen if the Supremes invalidated the Affordable Care Act, there is going to be a push to repeal the law that requires hospitals to treat the uninsured at least in emergency rooms. The decline and even demonization of empathy in our society is really striking. It is interesting that this fight will highlight the free rider problem among the uninsured as well, as they also add to the costs of everyone else.

    Fortunately the ideologues are less than 40% of our society, although they are very vocal. But the rest of the populace is busy going about their lives and may not realize what is happening.

    Meanwhile, the public health implications of climate change are slowly becoming apparent to those with eyes to see.

  • Skip on July 03, 2012 3:36 PM:

    Texas citizens should "opt out" of Perry's governorship.

    It can't be just the Texans hopped up on the conservative caffeine in their kool-aide who lift up signs and protest.

  • Crissa on July 04, 2012 5:26 AM:

    In the US, 1 in 9 are without insurance...

    But in Texas it's 1 in 4 and in California it's 1 in 5. I'm sorry, I missed the rest of the article by these astounding facts.

    It's actually kinda heartening to know the rest of the nation isn't as bad off as I and my friends, even while it's astounding to know the state as a whole is, too.