Congress is trying to squeeze money out of Medicaid to pay for the tax cuts. They’ve got to come up with the trillions somewhere, why not healthcare for the low income?
Their current scheme is to take away a scheme states came up with years ago to augment the Federal money they were getting to pay for this cheap healthcare.
Remember, total Medicaid funding, Federal and State for healthy adults’ costs taxpayers about half what we spend on our health insurance coverage for our legislators. That’s because the Medicaid payments to hospitals and providers is so low.
Hospitals here in Idaho back in 2008 saw Medicaid payment cuts coming when the financial crisis sent us into recession. They suggested a solution, one many states had been doing for a while, but Idaho was slow to adopt.
“Tax us” they said. Hospitals suggested the state place a 10% tax to hospitals on every Medicaid dollar they received. This tax would then be used to spend on the states Medicaid payments to hospitals.
Why would they do that? Why would they want to pay back 10% of what they were paid, just to then have the state pay it back to them.
Here’s where the Ponzi aspect of this rears its head.
Back in 2008-2010, for every dollar the State of Idaho spent on Medicaid, the Federal government matched three. It’s currently dropped down to 2.5/1, but as you can see, we get back more than the tax takes.
Many states “assess” their hospitals at a higher rate. A few states don’t use this scheme at all. I use the term “assessment” , because that is what this is called in Idaho statute, an “assessment”.
But it’s a tax. Conservatives don’t like taxes, but assessments were just fine with the Idaho legislature.
Just like tariffs, which are taxes on us consumers, are tolerated as long as we can pretend that they aren’t a tax.
I have to admit, I didn’t like this when I found out about it in the legislature. Nursing homes pay an assessment too since they get Medicaid payments. But the hospital association said they couldn’t live without it, so I carried the renewal of this tax bill in the Idaho Senate. Makes sense, doesn’t it, an Idaho Democrat has to carry the tax bill most Republicans supported?
Written into this sleazy bill was an exception that also burned my gut. Private, for-profit hospitals lobbied to be excluded from this “assessment” and they got themselves written out of it. They claimed they didn’t get Medicaid payments. I looked into that. They were getting millions.
But congress wants to take this scheme away from states. In Idaho, we will lose about 10% of the Federal funding. For some states it’s almost a 40% cut.
There are only a couple ways to do this.
#1. Decrease enrollees = kick some folks off. The number of uninsured patients will climb, hospitals will still care for them, and they will get less money.
#2 Pay doctors and hospitals less for what they do. I’ve already told you Medicaid payment rates are the least of any payer. Hospitals cannot refuse to see Medicaid patients, but doctors can. Many already do. More will.
So, these are the choices we are making in this, our country. We enjoy the richest economy in the world. We spend by far the most per person (about 50% more than the next country spends) on healthcare of any country in the world. And we don’t have universal coverage. They do.
And we are about to send poor folks off coverage to provide somebody tax cuts.
Says something about our values, doesn’t it?