published Saturday, March 8th, 2014

Expand Medicaid, Tennessee. It's a matter of life and death

It's time for Tennessee to stop playing partisan games with the Affordable Care Act because our red-state lawmakers don't like the president and the party he represents.

The games have gone far beyond rhetoric and they're hurting Tennesseans and our hospitals -- especially Erlanger, which treats the lion's share of Chattanooga's uninsured charity patients.

Many of those charity patients would have insurance if Tennessee Gov. Bill Haslam had expanded Medicaid under the ACA and accepted the 100 percent federal payment for it.

Instead, Erlanger's charity care amounts to more than $92 million this year -- up from $86 million, thanks largely to a perfect storm of health care funding changes and the state's failure to act.

The Affordable Care Act, derogatorily dubbed Obamacare by the GOP, would have gone a long way toward solving Erlanger's charity care deficit. Erlanger Health System CEO Kevin Spiegel said Tennessee foregoing the expansion means Erlanger is losing out on $35 million a year that would have been paid by insurance for people who now receive charity care.

Additionally the hospital lost out on $1.2 million in special payments the ACA cut because the law assumed states would expand Medicaid. When a U.S. Supreme Court ruling left decisions about expansion up to states, most Republican governors, including Haslam, balked.

Erlanger also lost another $1.2 million when the state canceled TennCare's CoverKids (because CoverKids did not meet ACA standards and our red-state officials opted not to upgrade the coverage). All those losses added a double whammy to the fact that Erlanger already was suffering from a four-year-long loss of $8.5 million in state disproportionate share payments intended to help defray charity care costs.

Make no mistake: Tennessee didn't refuse ACA to save itself money. In fact, expanding Medicaid under Obamacare would have paid the tab for that expansion. The federal health law provides 100 percent funding for the first three years of Medicaid expansion and 90 percent thereafter. That's tax money we've already sent to Washington, and now it's going to other states (like neighboring Kentucky and Arkansas) and hospitals where governors weren't covering GOP election bets.

"You can't just sit there and blame Obamacare for the next four years and watch all of the money leave Tennessee," Spiegel said Thursday. "At some point, it's not about red and blue, it's about green."

But Haslam and other state GOPers face re-election this year, and although GOP wins are virtually certain, they continue to play the hard-right conservative line to trash the president and Democrats at every turn.

Haslam began his grandstand act a year ago, saying he would not seek Medicaid expansion and instead would work to get federal approval for what he calls his "Tennessee Plan." He said his plan would make the expansion affordable over the long haul by allowing the state to charge recipients higher co-pays than allowed under federal rules.

Haslam, however, never submitted a formal plan to U.S. Health and Human Services Secretary Kathleen Sebelius. Last month, he tried to dump responsibility for a plan in her lap, telling the department to come up with something he can accept.

Apparently his fellow Republicans didn't trust that he would continue to tow the nonsensical, no-Obamacare line -- and, in fact, he probably won't. He can't be that illogical. Not with 54 Tennessee hospitals at risk of major cuts or closures without the expansion. Spiegel says doctor and hospital groups plan a major push after the election to persuade action.

But it already may be too late. On Thursday, the state Senate passed a bill that requires Haslam to obtain legislative approval on any deal he may cut with the Obama administration on expanding Medicaid. The House passed a similar bill last month. The effect is to tie Haslam's hands. Yes, he could veto the joint bill, but then a super majority could override his veto. Check and checkmate.

This is partisan politics at its reddest.

There's an old saying that applies here: Don't cut off your nose to spite your face. Tennessee has clearly done that.

Gov. Haslam can stop the bleeding -- if he acts right now.

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moon4kat said...

Does Haslam even have a spine? If so, now would be the time to show it. Otherwise, he's nothing more than a limp figure-head for a political party that favors -- and tries to enforce -- stupidity over knowledge. I think Haslam is smart enough to see and reject that, but he doesn't have the courage.

March 8, 2014 at 11:34 a.m.
Rickaroo said...

As ruthless and selfish as Haslam is in putting politics over doing the right thing, let's not forget that it took a lot of Tennesseeans being stupid enough to vote against their best interests to put him in office in the first place. They knew well enough where he and all Republicans stood on this and other issues. But no doubt many of those who are without health insurance today voted for this self-serving ideologue. And probably many of them will vote for him again!

Apparently they have been sufficiently brainwashed to think that they must not deserve to have health insurance if they cannot afford it, so they are willing to lay themselves on the altar of the elitist fat cats and politicians who have their little sheep convinced that those at the top of the ladder have worked hard for what they've got and therefor deserve it, while those at the bottom are moochers and takers and therefore deserve the nothing that they are getting.

I'm sorry but there really is no other word for these pitifully brainwashed people but stupid. That's just being s-t-u-p-i-d.

March 8, 2014 at 12:21 p.m.
soakya said...

just because republicans control the state doesn't make it conservative. there is little difference between the roos, alrovas, haslams and fleishmans.

what this country needs is the direction and leadership of the Milton freidmans.

March 8, 2014 at 2:27 p.m.
Rickaroo said...

Everybody knows that Tennessee is a red state, fool. It has voted Republican for years now. You put your idiocy on display every time you peck at your keyboard.

As for Friedman... his supply-side economics has worked out really well for us, hasn't it? If it worked at all it would be working right now. Taxes on the rich are practically the lowest they have ever been, so why are those filthy rich "job creators" not creating jobs?? They have more money than they have ever had and they are making more and more money every year. So where are the jobs?? Friedman's economic theories (delusions) need to be pronounced dead like him and put to rest once and for all.

March 8, 2014 at 2:56 p.m.
librul said...

Hear! Hear! Rickaroo!

Milton Friedman was, along with that devil Ronald Reagan, the architect of some of the worst and most despicable economic policy known to man. The 'Chicago Boys' with their covert intrusions into Central American attempts at self rule led to assassinations, murder, mayhem, negation of open popular elections and establishment of neo-liberal capitalist colonialism which our spook works are still today busily fomenting unrest to re-establish in Venezuela.

See John Pilger's film "A War On Democracy" for yet another reason to despise the foreign policy disasters that make America hated in the world.

March 8, 2014 at 3:13 p.m.
Rickaroo said...

You're right, librul. The havoc that his influence he has wreaked on this country is just part of the overall picture. His vile half-baked economic policies and our political leaders who have bought into them hook-line-and-sinker have been responsible for making us the imperialistic, greed-centered, terrorist nation that we are and have been for decades.

I have not see this film you supplied a link to. I'll check it out.

March 8, 2014 at 4:07 p.m.
soakya said...

ok mr. dense as a rock and sharp as a bowling ball. I didn't say tn wasn't red I said it isn't conservative. big difference. we haven't seen free market capitalism the kind freidman talks about in decades if not a century.

March 8, 2014 at 4:08 p.m.
Plato said...

Great editorial. The bills the legislature passed were probably at the request of Haslam. If they become law it gives the governor the political cover he needs to fend of the critics of his inaction. It's a political win/win for him. On the one hand the wingnuts are satisfied, but on the other hand, has a ready made excuse for the moderates.

March 9, 2014 at 11:05 a.m.
Plato said...

Rickaroo - It's not just the fools without health care coverage that voted against their own interest, it's the fools that have insurance as well, who now will have to pick up the tab for Erlangers $92 Million charity care expense, and every other hospital with similar expenses, which have to be passed on to those of us that pay for our insurance. That of course also includes businesses that pay for their employees insurance or a portion of it. Nice work by the "pro business" party.

Health Care in Tennessee is so nice, we pay for it twice, thanks to Governor Dumbass.

March 9, 2014 at 11:15 a.m.
gypsylady said...

True, true, true Plato. Thanks for pointing that out.

March 9, 2014 at 6:16 p.m.
TheCommander said...

Plato said:

"who now will have to pick up the tab for Erlangers $92 Million charity care expense, and every other hospital with similar expenses, which have to be passed on to those of us"

What do you mean by "now"? How would complying to the demands of Obamacare evaporate that cost into thin air so that we don't have to "pick up the tab"? I guess there are a lot of people on this forum who still believe that Washington is the true source of our national wealth that is still yet untapped.

March 10, 2014 at 9:22 p.m.
TheCommander said...

Obamacare will operate much like the history of NYC rent control:

I remember driving through the Bronx everyday as a kid on the Cross Bronx Expressway wondering why all the buildings were burned down? Years later I learned the answer from Milton Friedman:

Rent caps on apartments made it impossible to own, operate and maintain apartment buildings there. The owners had buildings in which they could not turn a profit so it was better to burn them to the ground.

Liberals do not and I believe cannot understand that there is a difference between price and cost but I'll try one more time:

Legislating price caps will make the crowds cheer because their prices will seemingly go down or at least be frozen, but the true cost does not evaporate; it remains. This only results in scarcity. It results in reduced supply; reduced services offered. ECON 101

March 10, 2014 at 9:49 p.m.
Plato said...

TheCommander said...

What do you mean by "now"? How would complying to the demands of Obamacare evaporate that cost into thin air so that we don't have to "pick up the tab"? I guess there are a lot of people on this forum who still believe that Washington is the true source of our national wealth that is still yet untapped.


That's nonsensical Tea Party rhetoric. No one is talking about Washington being a "source of wealth" and only a true full mooner would refer to a the government paying for the lions share of the state's medicaid expenses as "complying with their demands". Taxpayers send their money to Washington and they have a right to receive benefit for it.

It's really not a hard concept to understand. A system that provides ERs as the only option results in little or no preventive care and a large portion of the population being served in the least efficient and most expensive delivery system you could possibly design.

Unless we decide as a society that we will let people die like dogs in the street we are going to pay for health care one way or the other. We can do it smart or we can do it stupid.

March 11, 2014 at 6:14 p.m.
TheCommander said...

Answer me this question:

Is "Taxpayers send(ing) their money to Washington" and then demanding they have a "right to receive benefit for it" the "smart" or the "stupid" way to do it?

Show me ANY ONE area that the government delivers a product or service more cost effectively and with more universal access than the private market? To illustrate let's apply your principles in another area that is even more critical than healthcare: let's scrap our current food distribution system in America, send a standard amount of food money to Washington every year and then declare food a universal right in legislation.

How will that workout? You can scream Tea Party !! Tea Party !! all you want but government involvement in any and all areas leads to a loss of personal freedom and scarcity of the very thing it declares to you to be a right. If it worked, I would be for it. We just have too much human history that clearly tells us that government needs to be limited to its basic functions and run just those basics as poorly as we all expect they would.

March 11, 2014 at 9:14 p.m.
Plato said...

^Washington DC does not design, or administer Tennessee's, or any other state's Medicaid program. The states design, administer and fund their own programs. What this is about is the expansion of Medicaid through federal funding offered to states under the ACA which will allow uninsured people, most of who are employed, to have access to health care. It's a huge benefit to the states as it will relieve hospitals of much of the burden of providing "free" care for the uninsured. Only a fool or a political hack would turn down the money and put more burden on the citizens of the state. The remainder of health care coverage under the ACA IS provided by the private sector - BLue Cross Blue Shield, United Health Care, Aetna etc.

You may wish for an Ayn Rand style of "every dog for himself" when it comes to health care but that isn't the law of the land. As a civilized country we, like all other civilized countries have made the choice that we won't let people die from untreated diseases or accidents simply becasue they don't have the money, despite what you and a small minority of whackos who idolize the 50 year old writings of a Russian immigrant, would have us do.

Given the system we have these are the choices, take the money or leave it. Either way the bill still comes due.

March 11, 2014 at 9:42 p.m.
TheCommander said...

I know nothing of Ayn Rand. My problem is this once again: "it's a huge benefit to the states". You cannot have a benefit without cost. Whether the benefit comes directly from Washington to us or it comes through two layers (federal and then state) the ultimate costs rest on us directly in taxation. Liberals do not understand this one principle: government spending IS taxation. When they spend, you are taxed. If you are not taxed enough directly, then borrowing and printing makes up the difference which drives inflation which acts as a tax as well.

You are right about one thing for sure: I am a total fool by your definition. I e-mail my local politicians often about them running our state, counties and cities using so-called federal dollars. Haslam has mastered the art of coming to town with a new state or federal grant in his hand for the local mayor to show off. The results are huge increases in debt and massive growth in local government almost universally which we will leave to our kids.

I am a fool because I absolutely and consistently say "turn it down"!! If you really care about those who need healthcare, offer to pay someones bill at a walk-in clinic. it might sooth your conscience. The more we legislate rights, it is those very things that start as universal rights that become the object of allocation programs due to scarcity of resources. Did Ayn Rand say all that?

March 11, 2014 at 10:23 p.m.
Plato said...

^You could have written the book.

All this spewing of ideology and "rights" is interesting but the bottom line is at does nothing to put 30 million people into the system and stop being a burden on society. And your proposed solution of achieving that through charity is ludicrous

March 11, 2014 at 10:39 p.m.
soakya said...

isn't it charity when government provides it via taxes when you receive more in benefits than you pay in? tell us plato you care so much about your fellow man who's healthcare are you providing besides your own family. if I was a betting man i would bet you and roo are just as charitable as biden. if the commander idea is ludicrous it is only because of folks like you who demand such rights but refuse to do anything on your own. why don't you just do your part.

Benjamin Franklin warned "When the people find they can vote themselves money, that will herald the end of the republic."

March 12, 2014 at 2:21 p.m.
soakya said...

plato, aren't you going to answer the commanders question about sending money to Washington and then demanding it back being the stupid or smart way?

March 12, 2014 at 2:48 p.m.
Plato said...

soakya said: "if I was a betting man i would bet you and roo are just as charitable as biden. if the commander idea is ludicrous it is only because of folks like you who demand such rights but refuse to do anything on your own. why don't you just do your part."

I send 4 figure contributions to at least 3 charities a year and I guarantee you I send more money to the federal government in a year than you earn. But what I give is moot. No one but a right wing loon would actually think there is enough excess income that could result in charitable contributions significant enough to support the health care costs of 30-40 million uninsured people a year. Not to mention how absurd is it to expect a regular number of working class people to pass the hat and hope someone fills it enough so that they might live instead of die.

Why don't you two numbnuts put your heads together and come up with a plan that will keep Erlanger from having to pass on 92 Million a year to everyone that has insurance. I'm not holding my breath.

March 12, 2014 at 3:46 p.m.
Plato said...

soakya said...

"plato, aren't you going to answer the commanders question about sending money to Washington and then demanding it back being the stupid or smart way?"

Well the answer is obvious - not funding Medicaid and sending people to the ERs where they will pay $500 to $1000 for services they could have gotten from a doctor, a nurse practitioner or private clinic for $50-$100 if they had insurance is "smart". Getting people in the system so they can get preventative care like blood pressure meds at a cost of $50/month instead of paying $300,000 one time for heart surgery at the expense of the rest of us is "dumb". Gee I guess you guys win.

March 12, 2014 at 3:56 p.m.
soakya said...

not enough excess income? unless the government takes it in the form of taxes. maybe you can explain how that works because roo can't. you two are brilliant.

March 12, 2014 at 4:35 p.m.
soakya said...

progressives hide behind a veil of deceit claiming they want to help the poor when in reality all they want is power. Arthur Brooks former Syracuse professor in his book Who really Cares showed that religious, conservatives out gave the progressives. $2,210 for the conservative compared to $642 for the progressive.

FDR just liken biden gave a meager 2.5% of his salary of $75,000 to charity. progressives love to take from others but don't want to take it out of their own pocket. yeah plato you're the exception, not.

March 12, 2014 at 5:37 p.m.
TheCommander said...

Plato, I am not calling you a liar. However, you just repeated the greatest liberal lie in the entire healthcare debate in your statement:

"not funding Medicaid and sending people to the ERs"

I believe your numbers on Erlanger's losses but you believe that the uninsured flood the emergency rooms and then don't pay. That is factually incorrect. Medicaid drives people to the emergency room !!!

Don't believe me. Don't believe Ayn Rand. Don't believe Tea Party Patriots. How about a study by Harvard in the state of Oregon:

90,000 people. 30,000 were given medicaid by lottery. The results: the 30,000 with medicaid went to the ER 40% more than the other 60,000!!!

Medicaid expansion will drive even more to Erlanger, the price caps force the hospital to operate at a loss on each and every patient. Erlanger's financial results will get even worse the more you expand medicaid. Again, go back to my rent control example in NYC if you want to see the future.

Here is the link to the study:

BTW, how can you make the claim with certainty that the uninsured don't pay anything? Any documentation? If you have info, I would like to see it.

March 12, 2014 at 7:31 p.m.
Plato said...

^Let me give you and example of out of control billings. I had a simple test done a few years ago at North Park. The entire procedure took less that one hour from the time I walked into the waiting room until the time I walked out. When I got the bill I was alarmed - the billing for just the room in the hospital that the doctor used was over $4,000 for one hour! That was just the room, not the doc or the lab or anything else. I reported it to BCBS and they negotiated with the hospital and got it reduced to $2500. I understand the hospital has to try to make up for their losses on those with insurance, but I'm also damn glad insurance companies and Medicare/Medicaid are attempting to put the brakes on some of these ridiculous charges. Perhaps if the hospital didn't have to serve so many uninsured patients they wouldn't have to try and gouge the rest of it to make up for the losses. Your side is always harping about ran away costs and government waste, yet when the government or private insurers attempt to mitigate costs you complain again. Handing health care providers a blank check is a foolish policy by any measure of financial reason. I do agree that the costs need to be fair and reasonable.

Medicaid IS Insurance. If people with Medicaid go to the ER than at least some (if not all) of that is paid and the individual is responsible for the rest. Will the Medicaid expansion under the ACA wipe out all of Erlanger's 92 million in unpaid services? of course not but it will make a healthy dent into it and every dollar that is saved is one dollar less those of us with insurance will have to pick up. And yes there are other ways to mitigate cost such as requiring people with minor injuries to first see a resident Nurse Practitioner before being admitted to the ER, but that isn't the topic of the editorial. The editorial is pointing out the benefit of the Medicaid expansion dollars and the foolish decision the Governor is making by not accepting the funds (which by all rights belong to the taxpayers of Tennessee).

Do people without insurance pay for some of their medical services? - yes. It's also true that the vast majority of bankruptcies in this country are due to unpaid medical bills many by honest hard working citizens who had no other choice. The point is Erlanger had $92 Million worth of such services that they provided that WAS NOT paid for, not by the individual and not by any insurer, private or government and that's just ONE hospital.

So far you have not answered the question of what would you do about these 30-40 million people without coverage? I assume you either want to continue to see them served in by far the most expensive and inefficient manner possible, or you simple think that only those that can afford to pay for services or insurance deserve the help they need. Therefore I see why you don't want to answer the question.

March 12, 2014 at 8:48 p.m.
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