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Medicaid expansion – waiting for the alternatives

Lost in the political arguments over whether or not to accept federal dollars to expand Medicaid is a rather basic question – what happens if you don’t expand Medicaid?

This is especially important in states such as Florida and Texas, Louisiana and New Mexico, states where over a quarter of the working-age population don’t have health insurance.

If these states don’t expand Medicaid, those people will remain uninsured, safety-net providers will not be able to provide care for them, and hospitals’ financials will deteriorate, some drastically.

In Texas, Louisiana, and Florida, there’s little chance that Medicaid will be expanded, yet there are no alternative solutions proffered by opponents. The politicians in opposition seem content to allow hospitals to fail and people to suffer and die.  Some do this in the name of freedom, others fiscal prudence, yet the result is the same in both cases.

People who can’t afford or can’t get health insurance need solutions, yet all they are getting from expansion opponents are sound bites.  Where’s the leadership, the courage, the bold and innovative solutions?

I’m pretty sure “freedom” to a single mother with kids suffering from asthma and diabetes means freedom from worry, from the gnawing fear that she’ll have to quit her job because she earns too much to qualify for Medicaid in Texas/Louisiana/Florida.  But it’s either that, or go bankrupt when her kids need care.

What does this mean to you?

Depends on your concern about others and your definition of freedom.


4 thoughts on “Medicaid expansion – waiting for the alternatives”

  1. Joe, I share your dismay about Southern stinginess. When a Rick Perry brags that Texas has no state income tax, I think of the working poor who have no health coverage and I despise Rick Perry.

    However, I do not quite see why hospitals will fail, or fail any faster than they would anyways.

    The number of working age persons who need hospital care is not enormous, maybe 2-4 per cent of the population, and most hospitals in the US give out uncompensated care without going broke. I believe that the total amount of uncompensated care is $30 billion, and some of that is cushioned by Medicare subsidies.
    Hospitals are a $600 billion industry, so even if the $30 billion was pure loss they would not all fail.

  2. Joe, this is nothing more, and nothing less than re-packaged Puritanism, where hatred of the poor is fueled by a belief that poverty is a character flaw, and the well-off are the “elect”, proof that God favors them. And, it is social Darwinian genocide being perpetrated by a party that does not believe in Darwinism. During the GOP primary, Ron Paul said someone who can’t buy health insurance should die, and the audience cheered him. They were not just being callous, they were being contemptuous of anyone who cannot play the Capitalism game, i.e., has money to take care of themselves, instead of becoming a burden on everyone else. It is this Ayn Randian vision of society that Paul Ryan, Rand Paul and many others believe is the right way to run a society. It is selfish and self-absorbed, and out of character in a modern state.

  3. I think California has a pretty high uninsured rate yet the generous people of California pay higher Taxes than anyone but those generous folks on Wall Street .

  4. Strikes me that the debate on the expansion of Medicaid in states like Texas is dominated by the mythology surrounding capitalism!

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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