We as citizens and employers are already paying for the health care of the uninsured.  We pay for the coverage today but it is hidden in our insurance premiums and reimbursements to providers.  Families USA estimated that to be at least $1,000 per family.  So expanding Medicaid to bring in more of the uninsured could be another way of paying for their coverage.  However I fear that the expansion will not lower our premiums and it will not lower reimbursements.  As I was told; “It is easy to give someone something but you can never take it back.”

There are several issues.  One is that expansion of Medicaid will not bring all of the uninsured into a health plan.  There are large numbers of uninsured who refuse available coverage. 

The second issue is that Medicaid reimburses providers significantly below the cost of providing the service.  The last numbers I saw showed that Medicaid reimbursed at around 75% of costs.  This gap between cost and reimbursement is where we as covered lives pay extra to the insurance companies and providers.  By expanding the number of lives in Medicaid the total amount of unpaid costs gets higher.  Our premiums will not go down.  The providers will ask for more money from paying patients and insurance companies to offset the gap.

Third - We cannot forget that Medicaid is a State program funded by a combination of State and Federal funds.  The funds come from our taxes.  An expansion of the program requires an increase in taxes.  As I stated at the beginning, we already pay for this care.  I do not believe the increased taxes will ever replace what we spend now in premiums because our premiums will not be adjusted.  We will be told that the monies were absorbed pay administrative costs, or inflation, or something else, we will never see our premiums go down.  We will be paying both; increased taxes and higher premiums.

As a societywe need to have a serious discussion about how we cover the poor, how it is being paid for, what should be covered, and what is a reasonable fair price for that service. 

I wrote this is response to a editorial column that appeared in the December 3rd issue of the Savannah Morning News, Georgia wins if Medicaid expands.