Medicaid expansion

Richard Roberson minces no words when he hears people argue that there’s no reason to expand Medicaid to the working poor since they can already get free medical care at hospital emergency rooms if they can’t afford to pay for it.

“That’s the most asinine, uninformed, unintelligent statement that anyone could make about how health-care services should be delivered,” said Roberson, general counsel and vice president for policy and state advocacy for the Mississippi Hospital Association.

“That is akin to saying food and clothes are available at Walmart, and we’re OK if people just walk in and take what they want without paying for it.”

Roberson, who has been promoting his association’s no-cost-to-the-state plan for adding an estimated 300,000 currently uninsured working adults to the Medicaid rolls, was responding to a recent op-ed column by Jameson Taylor opposing Medicaid expansion.

Taylor works for the Mississippi Center for Public Policy, which calls itself “the state’s nonpartisan, free-market think tank.”  Taylor claimed that expanding Medicaid, even with the federal government picking up 90 percent of the cost, is too expensive for Mississippi, will take money from other pressing needs, will only benefit hospitals and is really not necessary.

Taylor is not the only one making those arguments, or similar ones. Most of the current Republican leadership, including Gov. Phil Bryant and the person looking to succeed him, Lt. Gov. Tate Reeves, have completely closed their minds to the logic of expanding Medicaid because they believe there is more political hay to make in this conservative state by opposing anything connected with Democratic former President Barack Obama.

Even if Taylor and other Medicaid expansion opponents are correct that only hospitals will benefit, “So what?”

Since 2010, when the Obama-pushed Affordable Care Act changed the methodology by which hospitals were compensated for treating the uninsured, 125 rural hospitals in the U.S. have closed, including five in Mississippi. The majority of the closures nationwide have been in the 14 states that have refused to expand Medicaid.

Nor is the bleeding done. Another 31 of Mississippi’s rural hospitals — about half of the entire remaining total — have been deemed at risk of closing.

There are many causes for their financial troubles, but one of the biggest is they are falling under the weight of providing so much free care to patients who have neither insurance nor the money to pay their bills out of pocket. Last year alone, it’s estimated that Mississippi hospitals spent $624 million treating patients for which the hospitals were not compensated.

The Mississippi Hospital Association has projected, based on the calculations of a highly respected Texas economist, that those losses could be cut by 40 percent.

If that’s all the “good” that would come from Medicaid expansion, that’s good enough.

But it’s not all.

When people don’t have insurance, about the only place they can go for medical care is the emergency room, even for routine ailments. They often wait to seek care until their condition has gotten severe, which drives up the cost of treating them.

If they had Medicaid, they would be more likely to seek preventive care and potentially could be weaned off always going to the emergency room. Also, they wouldn’t have the stress of being dunned and their credit ruined over medical bills they can’t pay.

Taylor appears to be operating under a fallacy that all you have to do is show up at the emergency room, get treated, claim that you can’t pay for the services, and the bill is wiped clean.

That’s not how it works, Roberson said. State law prohibits publicly owned hospitals from waiving debts owed to them by patients unless the patients can demonstrate that they qualify for charity care. If they don’t provide that proof, the public hospitals are required to pursue them, including taking legal action.

I’d think that patients would much rather hand the hospital a Medicaid card than have to jump through hoops and appeal to its mercies to resolve the bill.

Then there are the jobs that a billion dollars a year in new money from the federal government would create. One study puts it at 9,000 jobs, another at 16,000. Either way, it’s a much better return for Mississippi than most of the corporate giveaways that Bryant and Reeves have fallen all over themselves to give.

Maybe the federal government, with its trillion-dollar annual deficits, can’t afford Medicaid expansion. But that’s not the question here, or in a governor’s race that has boiled down to one expansion opponent (Reeves) against two expansion proponents (Bill Waller Jr. and Jim Hood). The question is whether expansion is good for Mississippi.

Medicaid expansion will shore up rural hospitals, expand the economy, reduce stress on the working poor and conceivably improve their health.

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