Showing posts with label medicaid expansion. Show all posts
Showing posts with label medicaid expansion. Show all posts

Sunday, April 26, 2020

The takers and the makers. It isn't what you think. Why?

Edited and updated: April 28, 2020
Published by Winter Park Times, May 7-8, 2020 https://winterparktimes.com/opinion/columnists/the-takers-and-the-makers-not-what-you-think/
The takers and the makers...It isn't what you or the Tea Party-like folks think. An Atlantic magazine analysis has been updated in 2017 though the analysis was first done in 2014. The red states are the takers of the blue states ' federal taxpayers' money.  Per the article, "There are various ways of thinking about what a 'state dependency' map cited in the article tells us. One approach is to shine a light on the red-states-as takers paradox: Dominated by Republican voters who profess their distaste for the federal government and its social programs, these are the very states that rank highest on the dependency index." This is how Business Insider handled the story: "As it turns out, it is red states that are overwhelmingly the Welfare Queen States. Yes, that's right. Red States—the ones governed by folks who think the government is too big and spending needs to be cut—are a net drain on the economy, taking in more federal spending than they pay out in federal taxes. They talk a good game, but stick Blue States with the bill." https://www.theatlantic.com/business/archive/2014/05/which-states-are-givers-and-which-are-takers/361668/?utm_source=facebook&utm_medium=social&utm_campaign=share&fbclid=IwAR1Scz2tEi0lNIQfem3uJawCg8TqJ-eewY9YTmOpQ25BZUATLD4QxoEMzrY
By any measure in the article, Colorado is a maker state, among the lowest tier of states taking federal taxpayer dollars.
     Why are some states takers, not makers?  Simply looking at the various maps and statistics, what pops out is that most of the taking states are red and southern.  The Atlantic conclusion is correct so far as it goes.  The Atlantic article did not go into any detail, but I agree the importance of who holds political power in Congress does play an important role. The Atlantic article places the blame on  Congress members frequently re-elected from safe seats, gaining seniority, and controlling committee chairs. True. They have brought in the pork to their home states.  I have some theories of how this has happened.  More House safe seats have been carved out by rampant gerrymandering, permitting frequent re-election of incumbents and seniority in the House. In the Senate, those from safe seats rule committees and their GOP chairs often hale from the South. For example, Kentucky is in the top ten of the taker states and it is the 4th poorest state in the union.  Ironically,  Kentucky Sen. GOP Majority leader Mitch McConnell, who controls Senate majority votes and committee chairs, is not considered an ideological friend of spending of social programs or making it easier to vote.  Also from Kentucky is Sen. Rand Paul, a libertarian who generally opposes federal spending on social programs. He is much valued in a close vote. Governance of state governments also plays a role. Regardless of ideology, it has not kept Kentucky from being in the top ten takers.  New Mexico and some others ranking high on the poverty list have high native American and Hispanic populations. Many others have large African-American populations.   Often these states are governed by legislatures and governors who are white and conservative and uneager to share power. 
      One more paradox in makers and takers comparisons,  racism is a factor, but not as the racists believe.  More white people get government assistance than any other group of minorities, including African Americans. https://www.lexingtonlaw.com/blog/finance/welfare-statistics.html
Food stamp recipients, in particular, are more white of percentage,  than of a minority race.
   Diving deeper into the issue of political control, there are some underlying factors.  The kinds of economic activity states generate may play a role. However,  with few exceptions, there is also a strong self-perpetuating connection in the South with the poverty rate of the taking states and the percentage of racial minorities, poor health care, and voter suppression. https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/     https://www.healthline.com/health-news/covid-19-affecting-people-of-color    Because of poverty, their needs exceed the will and ability of their state governments to provide so they demand and need federal help.  Many of these states have not expanded Medicaid to their poorer citizens when they had the opportunity under the provisions of Obamacare, keeping the poorer sicker and more expensive to treat. Voter suppression tactics,  making it expensive and inconvenient to register and get transportation to vote, and stringent requirements for government-issued picture IDs from non-drivers,   keep minorities at a political power disadvantage in getting their part of the economic pie. 
https://www.theatlantic.com/business/archive/2014/05/which-states-are-givers-and-which-are-takers/361668/?utm_source=facebook&utm_medium=social&utm_campaign=share&fbclid=IwAR1dykQ8kFVoryZ34mclzcjsIKx-qNX-dQMi9RoW0wg7b_lGIblYFIvLlUQ


The average gross monthly income per food stamp household is $731; The average net income is $336. 37% of participants are White, 22% are African-American, 10% are Hispanic, 2% are Asian, 4% are Native American, and 19% are of unknown race or ethnicity.    

      








THEATLANTIC.COM
And is that even the correct way to frame the question?

Saturday, October 18, 2014

Number of uninsured admissions drops: Report says uncompensated care will cost hospitals $5.7B less this year - Mohave Daily News: News

Number of uninsured admissions drops: Report says uncompensated care will cost hospitals $5.7B less this year - Mohave Daily News: News

This is not a local story; it is an Associated Press national story.  What it does show is that when Obamacare is implemented fully (none of this refusal to expand Medicaid as many red states have done), hospitals get stuck less with covering the expenses of the uninsured or those who cannot pay their medical bills. They cover it by raising their charges to those insured, which in turn causes insurance premiums to go up.  The estimate is that this cost shifting pre Obamacare resulted in the insured families paying $1000 more per year in health insurance premiums. The question  now becomes: will the insurers pocket the savings or will they pass it on in the form of lower premiums to the insured.

Whether the slowdown in current health care costs per family is happening now because of the recession or Obamacare is open to discussion. With less spending money and loss of employer provided insurance due to layoffs, consumers cut back or delayed health care treatment.  There for sure has been a very significant decrease in the cost of Medicare, extending its life 14 years.  The administration is claiming the per family costs have already been $1600 or more...but that is not in premium costs, but in the cost of health care in general per family.  The Washington Post gave that claim two pinocchios, but it took a lot of discussion to reach that conclusions, mostly because the impact of the recession is not figured into the equation. http://www.washingtonpost.com/blogs/fact-checker/wp/2014/10/17/

 My thought is that the impact of Obamacare is more likely to be felt more in the future since the program is not yet fully implemented, including the failure of nearly half of the states to expand Medicaid coverage and the penalties for non coverage (the mandate) will only begin to increase this next year. Cost shifting impact has not yet been fully felt yet though  medical  provider cost reduction measures had been taken a couple of years in advance of its implementation.

The challenges to covering more in Colorado and having more sign up to Obamacare were explored in an Oct. 15, report
From the report: "
Flying Solo: Why Uninsured Coloradans Go Without Health Insurance
October 15, 2014

The Colorado Health Institute released a report today analyzing the reasons given by uninsured Coloradans for not having health insurance.
"Flying Solo: Why Uninsured Coloradans Go Without Health Insurance" is based on data from the Colorado Health Access Survey (CHAS), the premier source of information about coverage across the state.
The report, written by Research Analyst Natalie Triedman, comes as Colorado prepares for the second open enrollment period under the Affordable Care Act. Beginning November 15, it will run through February 15, 2015.
The biggest barrier, by far, is cost. Four of five uninsured residents say they don’t have coverage because it costs too much. No surprises there, but it speaks to the importance of affordability, as well as communicating the value of health insurance.
The second most common reason for being insured was that a person lost their job or changed employers. This “churn” will be an important consideration moving forward.
The most dramatic change in reasons cited for being uninsured came from uninsured Coloradans who said they don’t need health insurance. The percentage more than doubled between 2009 and 2013, increasing from 11.1 percent to 24.9 percent, the biggest shift among the reasons cited. This could reflect a number of factors, including objections to “Obamacare” and its individual mandate."
https://us-mg4.mail.yahoo.com/neo/launch?.rand=26d85c6418ea5#8881185274
http://www.coloradohealthinstitute.org/blog/detail/flying-solo-why-uninsured-coloradans-go-without-health-insurance
http://www.coloradohealthinstitute.org/blog/detail/modest-price-increases-in-store-for-second-year-of-online-marketplace