Obamacare: physicians have a big pay cut - States do not want to expand Medicaid and get stuck with the bill!

Physicians will have a huge pay cut! States will have to pay for the increase in Medicaid costs.....Ah....where will they get the money?

 

H/T PNJ.com

WASHINGTON — It’s health care brinksmanship, with hundreds of billions of dollars and the well-being of millions of people at stake.

President Barack Obama’s health care law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal.

Turn it down, and governor’s risk coming off as callous toward their neediest residents. Not to mention the likely second-guessing for walking away from a pot of federal dollars estimated at nearly $1 trillion nationally over a decade.

If the Obama administration were to compromise, say by sweetening the offer to woo a reluctant state, such as Florida has been under Gov. Rick Scott, it would face immediate demands from 49 others for similar deals that could run up the tab by tens of billions of dollars.

As state legislatures look ahead to their 2013 sessions, the calculating and the lobbying have already begun.

Conservative opponents of the health care law are leaning on lawmakers to turn down the Medicaid money. Hospitals, doctors groups, advocates for the poor, and some business associations are pressing them to accept it.

“Here’s the big thing: The state does not want to expand Medicaid and get stuck with the bill,” said Dr. Bill Hazel, Virginia’s health secretary.

Medicaid covers nearly 60 million low-income and disabled people but differs significantly from state to state. Under the health care law, Medicaid would be expanded on Jan. 1, 2014, to cover people making up to 138 percent of the federal poverty line, or about $15,400 a year for an individual.

In Florida, where Scott says he is rethinking his opposition, the state could end up saving money through the Medicaid expansion, said Joan Alker, executive director of the Georgetown University Center for Children and Families, which studied the financing.

The reason is Florida would spend less on a state program for people with catastrophic medical bills.

Florida has an estimated 3,952,000 uninsured residents. Alabama, which has no plans to expand Medicaid, has 696,000 uninsured residents.

About half the 30 million people gaining coverage under the law would do so through Medicaid. Most of the new beneficiaries would be childless adults, but about 2.7 million would be parents with children at home. The federal government would pay the full cost of the first three years of the expansion, gradually phasing down to a 90 percent share.

The Supreme Court said states can turn down the Medicaid expansion. But if a state does so, many of its poorest residents would have no other way to get health insurance.

The subsidized private coverage also available under Obama’s law is only for people making more than the poverty level, $11,170 for an individual. For the poor, Medicaid is the only option.

So far, eight states have said they will turn down the expansion, while 13 states plus the District of Columbia have indicated they will accept it. The eight declining are Alabama, Georgia, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, and Texas.

Nearly 2.8 million people would remain uninsured in those states, according to Urban Institute estimates, with Texas alone accounting for close to half the total.

Health and Human Services Secretary Kathleen Sebelius says states can take all the time they need to decide. They can even sign up for the first three years of the expansion and dropping out later.

But she hasn’t answered the one question that many states have: Would the Obama administration allow them to expand Medicaid just part way, taking in only people below the poverty line?

That means other low-income people currently eligible would be covered entirely on the federal government’s dime, and they would be getting private coverage, which is costlier than Medicaid.