Medicaid expansions undertaken by New York, Arizona, Maine and Oregon may give clues as to how a similar decision would play out in Georgia and other states under federal health reform, two leading researchers said Friday at an Atlanta forum.
The decision whether to expand Medicaid looms as hugely important for the states, assuming that the 2010 reform law remains intact after the upcoming elections. Medicaid expansion is not only a health issue, but a political and economic one as well.
In June, the U.S. Supreme Court upheld the reform law, known as the Affordable Care Act (ACA). But in the same ruling, the court reinstated much of the states’ flexibility on whether to expand their Medicaid programs for the poor and disabled. That added an unforeseen complication to how health reform will unfold nationwide.
How has Medicaid expansion worked out before the passage of the ACA? In New York, Arizona and Maine, each of which expanded Medicaid between 2000 and 2005, rates of uninsured residents dropped, access to care improved, and more people reported being in very good or excellent health, according to a recent Harvard study that compared these states to neighboring states without expansion.
Mortality rates fell as well, Dr. Benjamin Sommers of the Harvard School of Public Health said at a Carter Center health policy forum sponsored by the Georgia Budget and Policy Institute.
The new coverage saved a total of 2,840 lives per year in the three states, Sommers said. A comparable number would be saved in Georgia under expansion if it plays out here as it did in those three states, he said.
Medicaid expansion, though, has powerful opponents in Georgia, including Gov. Nathan Deal. He came out in opposition to the idea in August. Later, through a spokesman, Deal qualified his stand a bit, saying the state might be willing to consider expansion if the Medicaid program is converted to a block grant, giving states more flexibility on how to run it.
If a state expands Medicaid, 100 percent of the cost would be picked up by the federal government for the first three years, and 90 percent thereafter.
Deal, in a recent AJC editorial, voiced skepticism about the ability of the federal government to follow through on that promise.
“Washington’s new costs in Georgia alone will amount to $40 billion over 10 years,’’ Deal said in the editorial. “Even if it does live up to its end of the bargain, there’s no money in state treasuries to cover our part of the bill.’’
State House Speaker David Ralston, who like Deal is a Republican, agreed with the governor’s argument in an AJC article.
“The costs are enormous, and there is little faith that the federal government will live up to the funding requirements of Obamacare as it stands now,” Ralston said in a statement.
Changes to Medicaid will cost about $4.5 billion in additional state tax dollars over 10 years, Deal said.
“States, Georgia included, will have to choose between job-killing tax hikes and immense cuts that will dramatically affect public education and public safety,’’ the governor added.
Republican governors in other Southern states — including Florida, South Carolina and Louisiana — have rejected expansion. GOP leaders in Mississippi also recently weighed in against such action, citing costs to the state.
“While some people say Obamacare will come as an economic boost with `free’ money, the reality is simple: No money is free,” said Republican Gov. Phil Bryant of Mississippi in an AP article.
Medicaid, jointly financed by the state and federal governments, currently covers 1.5 million poor and disabled Georgians.
If the state expands its Medicaid program, more than 600,000 lower-income people will become eligible for coverage.
The AJC and WABE recently reported that a poll found a slight plurality of Georgia voters support Medicaid expansion.
Winning the lottery
Sommers argued Friday that rejecting expansion would have an adverse impact on the health of vulnerable populations in a state.
New York, Arizona and Maine found a decline in the death rates for non-whites, older adults and people in poorer areas.
Oregon tried an unusual, experimental form of Medicaid expansion. It created a lottery whereby 10,000 randomly chosen working-age uninsured people received Medicaid coverage in 2008. A study compared them to those who were not selected.
Heidi Allen of the Columbia University School of Social Work, who collaborated on a study of the Oregon expansion over its first year, told the Carter Center audience that access to care improved in the state, as did use of preventive services and prescription drugs.
Outpatient and hospital inpatient visits went up for the new Oregon Medicaid beneficiaries vs. the uninsured group, Allen said.
She also noted that spending per beneficiary was $777 more than for those who did not win the lottery.
There was no change in emergency room use, the study found.
Still, Allen said Oregon lottery winners reported that their financial worries eased. There was a significant drop in medical collections. And there were big improvements in self-reported physical and mental health.
“It was a game-changer for many people.’’ Allen said.
Making an economic argument, Allen said that if the state expands Medicaid, “people in Georgia will have much more money in their pockets to spend.’’ There will be more jobs as well, she added.
Another objection to Medicaid expansion is the strain it would put on the already overburdened health care system in the state, which has a shortage of medical providers.
Sommers noted that Massachusetts’ health system felt overburdened after it implemented health reform. But he also said access to care improved there.
The expansion issue shapes up as a crucial issue as the 2013 General Assembly session nears.
The Georgia Academy of Family Physicians recently wrote the governor to support the idea of increasing the Medicaid rolls.
“A lack of expansion will create an economic wave that will wash over patients, hospitals and, ultimately, everyone in Georgia, both insured and uninsured,’’ said the letter from the academy’s president, Dr. Beulette Y. Hooks.
Deciding not to expand Medicaid, she wrote, would mean that all Georgia residents will pay — albeit indirectly — for the care of Georgia’s 1.9 million uninsured.
“Faced with continued need among the uninsured, and struggling with reduced support for the free care they provide, hospitals and other health care providers will distribute their growing financial losses to their paying customers. It means insurers will likely raise premiums to make up for the higher charges it receives,” Hooks said.