Republican Governor Chris Christie of New Jersey set a new standard for ridiculousness yesterday when he explained that he was on the fence about whether to expand Medicaid under Obamacare but that his advisers were still considering "the most efficient way to do it from a cost perspective." There's not much for his advisers to consider: Expanding Medicaid is free to the states under the Affordable Care Act.
Christie was not the only Republican to distinguish himself by his deep knowledge of health care reform. Texas Governor Rick Perry compared expanding Medicaid to "adding a thousand people to the Titanic," a comparison that the 1.8 million Texans who stand to get coverage through Medicaid in his state surely don't agree with. Right now, 25 percent of Texans lack insurance coverage -- the highest percentage of uninsured people of any state. When this was pointed out to the governor, he "bristled" and said, "People come from all over the globe to the state of Texas for their health care." It's terrific that Texas is such a global draw for medical excellence, but I bet the people who actually live there would like to get in on some of that great health care, too.
Meanwhile, Maine Governor Paul LePage apparently was unaware of the unspoken rule in politics that Holocaust analogies are seriously offensive -- and also really stupid -- when he called the U.S. Internal Revenue Service the "Gestapo" while criticizing the health care law. Equating the IRS with Hitler's Nazi secret police obviously went way too far.
All of this foolishness by Republican governors in the wake of the Supreme Court's decision upholding Obamacare is matched -- no, exceeded by -- the decision of Republican leaders in the U.S. House of Representatives to repeal Obamacare on Wednesday. It will be the 31st repeal vote held by the Republicans. Like all the other repeal votes, this one will die in the Senate. Calling it a political stunt and a waste of time is charitable. House Republicans have abandoned even the pretense of doing anything to make health care more affordable for families and businesses. But they have set out to be a do-nothing congress and it turns out that they're over-achievers in that regard.
The problem, of course, is that there is real work to do - important things like creating jobs and rebuilding the middle class. But helping seniors, working families and small businesses isn't on the Republican agenda. They want to eliminate Medicare as we know it and dismantle Medicaid to make sure the super-rich get massive tax breaks they don't need -- and that many don't even want.
Since House Republicans don't have a health care plan, they've adopted a new political metaphor instead. According to Speaker of the House John Boehner, Obamacare must be "ripped out by its roots" and replaced with, well, something, someday. Or not. Says Boehner: "It has to be ripped out and we need to start over." So two years after enactment of the Affordable Care Act, the best the Republicans have come up with is a tough-talking new metaphor. That's a stunning display of policy and public health malpractice.
The Republicans are, however, focused on what they want to take away from people.
The Republican repeal plan would eliminate every single consumer protection and benefit in the law. That means taking away the $3.7 billion that 5.3 million seniors in the Medicare prescription drug "donut hole" have already saved; taking away coverage for 6.6 million people under 26 years old who are now on their parents' insurance plans; taking away health insurance tax credits for small businesses; and making it legal again for insurance companies to overcharge or deny coverage to people with pre-existing conditions like diabetes, high blood pressure and asthma.
The ACA is already making health care better for 100 million people. Fully implemented, it will stop insurance companies from price-gouging us and denying our care. It will expand coverage to more than 30 million uninsured Americans, hit the brakes on skyrocketing health costs, improve the quality of care and eliminate the worst insurance company abuses.
These things are so objectionable that House Republican leaders are staging a pointless, partisan House vote on Wednesday to make sure we know where they stand. We do. They stand with the insurance companies, not consumers. And they stand for inaction. Never before has the House of Representatives taken so much pride in doing so little.
In my lifetime I have never seen worse House of Representatives and worse House Majority Leader.
Add to that the societal problems caused by the uninsured (their medical bills are the largest single source of bankruptcies in the US). Throw in the lost productivity from workers who temporarily, or permanently lose their ability to work because of what started off as a fairly simple problem, which was left untreated because they couldn't afford to go to a doctor's office.
I don't know how the ACA will individually impact federal, state and hospital budgets, but in overall terms it should reduce costs unless you believe that better health care doesn't have an economic benefit.
What is our percentage of our state's current Medicaid bill (usually about 43%).
What is our state's current total Medicaid bill?
Will the Medicaid expansion result in a more than 4-fold increase in that total bill by the time our portion rises to 10% of the total?
Now, I know people will wonder where in the world I get the more than 4-fold increase. I am going to use some simple hypothetical (and totally overblown in the case of the total Medicaid bill!) numbers.
Lets say that some state has a total Medicaid bill of $100 million. (this is the overblown part - the total, according to the Kaiser Foundation, for 2010, was under $400M).
Now, at 40%, that state's responsibility would be $40M. Without the expansion, that number will probably rise by, oh, maybe 10% by 2020. Could be more, could be less - hopefully less, with more people working and not being eligible. With the expansion, lets be silly and say that state's total bill rises to $200M by 2020 - a 100% increase. With the expansion, in 2020, their portion of the bill would be HALF of what it is today - $20M.
To put that in perspective, Florida's total bill, of which they pay 43%, was $21.3M.