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.
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.