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The Incredible Costs of Republican Attacks on Medicaid Expansion

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Apparently if Republicans in the Montana legislature are going to agree to reauthorize Medicaid expansion at all, they’re going to demand that we put “serious sideboards” on the program, meaning that in order to be eligible to enroll, low-income folks will have to pass some sort of test, like having a job or being drug free.

There will no doubt be all sorts of righteous chest thumping about “freeloaders” and talk about who “deserves” or “truly needs” coverage, but obviously what the Republicans are really hoping for is to kick a bunch of people off the program. That way, in 2020, when they’re trying desperately to elect a Republican governor, they’ll be able to claim that they saved the taxpayers a bunch of money.

Baloney.

Right now, if a Medicaid expansion enrollee receives, say, $1000 worth of medical care, the state picks up about $100 worth of the cost and the Federal government gets the other $900. So kick this person off the program (because some Republican solon doesn’t believe he belongs there) and the taxpayers can take satisfaction in the fact that they’ve just given up $1000 worth of health care for one of their neighbors and saved $100 in the process. Hell of a deal.

But wait, there’s more!

When poor people are denied Medicaid coverage, what happens to them? Well, there are all sorts of possibilities. Some go bankrupt trying to pay the doctor bills out of their limited earnings. Some get really sick and finally end up in the emergency room, where they get expensive care they can’t possibly pay for. Some, who were receiving mental health or substance abuse care, land in jail.

And the cost of all these outcomes? Well, the human cost for the guy losing the coverage is incalculable. And the out-of-pocket costs to the public – as taxpayers or paying hospital patients or health care providers or human service agencies – are probably a damned sight more than the $1000 cost of the medical care that was taken away in the first place. So now the taxpayers can really dance in the streets. The Medicaid rolls have been reduced, their taxes are lower by $100, and they now get to pick up the pieces at a cost somewhere north of $1000.

Oh, and lest there be any doubt about it, realize that it’s the Federal government that saves the really big bucks when Medicaid is cut. And poor Donald Trump and Mitch McConnell really need that money if they’re going to cut corporate taxes and not run the Federal deficit into the stratosphere.

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About the author

Dick Barrett

Dick Barrett is a retired University of Montana economics professor who has served in the Montana legislature since 2009. He currently represents Senate District 45 in Missoula. Due to term limits, the 2019 session will be his last.

4 Comments

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  • So, if I understand this correctly, for progressives, it is okay to tax someone for ‘bad behavior’ like smoking to pay for healthcare, but not okay to make sure that people aren’t purchasing drugs when they say they cannot purchase healthcare?

    And again, it is okay to tax that behavior, but not to expect that a person have a job that contributes taxes towards funding of said healthcare?

    Rather perverse systems of incentives at work there.

  • If I understand you correctly, Andrew, people who may have an drug problem or are unemployed shouldn’t get health care, whereas someone who chooses to smoke/chew/vape shouldn’t be assessed an additional fee to help pay for Medicaid costs.

    Granted, I’d prefer a different method for funding health care, perhaps universal health care like most civilized nations have, but Medicaid expansion is a start. Incidentally, countries with some sort of universal health care system get better medical results at much less cost.

    Here’s a balanced report on universal health care throughout the world:

    https://www.thebalance.com/universal-health-care-4156211

    • That isn’t what I wrote – nowhere did I say they should have care.

      If people purchase drugs, they should not be expected to have unmitigated access to a fully taxpayer-funded health care program when they have access to funds to pay for said drugs. They should either take a mandated remediation program, or contribute to the cost of their care.

    • That isn’t what I wrote – nowhere did I say they shouldn’t have care.

      If people purchase drugs, they should not be expected to have unmitigated access to a fully taxpayer-funded health care program when they have access to funds to pay for said drugs. They should either take a mandated remediation program, or contribute to the cost of their care.

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