... And he knows it.
We sent Freedom of Information Act requests to every Red State governor or legislature who refused to Expand Medicaid. Thus far, eleven red state governors and one red state legislature have responded to our requests. Of the twelve total responses received, only one respondent admitted to having any documents, whatsoever, showing how many people he or she may be killing and bankrupting because that state refuses to Expand Medicaid.
That would be Texas.
Every other state is positively incurious about the number of people they may be killing or bankrupting in their home state. So, in a perverted way, Texas Governor Greg Abbott is at least ahead of them. He has an idea how many people he may be killing. In response to our FOIA requests, which asked for any documents showing what he has done to find out how many people may be dying because he refuses Medicaid Expansion, he provided a 75-page document.
1. More Dead Than We Expected.
The document was shocking to us. We knew that there was no good reason to refuse to Expand Medicaid, and we knew that it was a decision that would either save or cost a lot of lives. We didn't realize how many. You see, we have used a Harvard Study which indicates that between 1,840 and 3,035 will needlessly die in Texas every year without Expanded Medicaid. That Harvard Study, in pertinent part, provides as follows:
"In Texas, the largest state opting out of Medicaid expansion, 2,013,025 people who would otherwise have been insured will remain uninsured due to the opt-out decision. We estimate that Medicaid expansion in that state would have resulted in 184,192 fewer depression diagnoses, 62,610 fewer individuals suffering catastrophic medical expenditures, and between 1,840 and 3,035 fewer deaths."This Harvard Study dealt with the entire nation; Greg Abbott had another study in his possession that dealt only with Texas, written by Texans, for Texans. The report, entitled Expanding Medicaid in Texas: Smart, Affordable and Fair, can be found in the files of the Governor of Texas and in its full PDF glory here. It provides as follows:
"Experience in other states indicates that failing to expand Medicaid would result in an estimated 8,400 premature deaths each year."That's a lot of dead Texans each year. A lot of people who have diabetes but cannot afford medication; who have diabetes and don't know it; who have undiagnosed but treatable heart conditions, high blood pressure or cancers. That's a lot of potential pap smears and mammograms that Texans will not receive. "The state leads the nation in the rate of people without health insurance — roughly one in four Texans." With approximately one million Texans in the "Medicaid Gap," it probably shouldn't have been a surprise to us that as many as 8,400 will die annually, and before their time, because of Governor Abbott's failure to Expand Medicaid. It's as if you wiped Liberty City, Texas right off the map. Then did it again every year:
Kind of an ironic name--Liberty City--as it represents the deadly repercussions from Texas state government thumbing its nose at the Federal Government for no good reason, while the casualties pile up each year.
2. The Only Evidence of Death and Bankruptcy Abbott Has....
The only document Governor Abbott, a former Attorney General, has to help him decide how many people will die in his state each year without Medicaid Expansion indicates the number to be 8,400. He doesn't even have another document from some Koch-funded think tank claiming that only three people will die. The only information he has to make an informed decision about how many people he is bankrupting each year is that there will be approximately 62,610 of those woebegone folks.
The Governor has not afforded his people due diligence much less due process. A person accused of murder in Texas gets better treatment than the working poor.
3. The Other Document.
We also requested documents in the possession of Governor Greg Abbott that would show how many Texans without health insurance have received treatment in Texas hospitals during the last reporting period. The Governor provided an eight-page report from the Texas Department of Health and Human Services indicating that hospitals in the state lose billions of dollars annually because of the failure to Expand Medicaid.
In 2012, Texas hospitals spent $22.538 billion on health care provided to the uninsured in that state.
To give you some perspective on that, if Greg Abbott was going to pay for all those hospital charges with his own tax payments, and he paid $104 in taxes every year, it would take him two hundred and sixteen million, seven hundred and eleven thousand, five hundred and thirty-eight and one-half years to do it.
According to the report, uncompensated hospital charges in Texas rose from $17.51 billion in 2010 to $18.312 billion in 2011. It then jumped more than five billion to $22.538 billion in 2012. The picture will soon turn even bleaker, as the Federal Government may not be helping Texas out with those deficits in the future.
4. The Obama Administration Tightens the Pressure on Florida and Texas and Other Non-Medicaid Expanding Red States.
Every year, the Federal Government provides what amounts to massive block grants to states, which the states can then use to pay to hospitals that provide services to the uninsured. This has been provided as part of the Medicaid program. In this way, hospitals would receive direct payments from Medicaid for covered individuals, and they would receive the Medicaid "subsidy" or block grant money for uncovered individuals.
Those huge block grants--in the billions of dollars each year--will stop in 2015 and 2016 because of Medicaid Expansion.
The theory was this: Once Medicaid was expanded, there would be no need for the additional block grant subsidies for hospitals, as people would either have private insurance or be covered under the Expanded Medicaid. The second document we received from Governor Abbott described the situation succinctly:
Health Care Reform Impact. One of the supplemental Medicaid payments that greatly contributes to the Medicaid surplus is the Disproportionate Share Hospital (DSH) payment. The DSH program was created to compensate hospitals that give care to a disproportionate amount of low income and uninsured individuals with a lump sum payment. Health care reform will impact DSH payments starting in 2016. The assumption is that when the individual mandate takes effect, the need for supplemental payments to cover the uninsured is less. The ACA requires HHS to reduce DSH payments.
Of course, nobody counted on Republican governors and state legislatures allowing their citizens to die or to go bankrupt for no earthly reason.
Texas and Florida and other wanna-be new-confederate states like South Carolina want the Federal Government to continue paying their hospital buddies with these block grants; they don't want the Federal Government to help the people with Expanded Medicaid. The Obama Administration has said, "Not so fast!" It has let these states know that the money to reimburse hospitals for care to the poor and working poor is there to be had--as soon as the states Expand Medicaid. One source reported:
"The Centers for Medicare and Medicaid Services indicated to Texas officials Thursday that whether the state expands Medicaid under the Affordable Care Act would factor into the renewal of a multibillion-dollar Medicaid funding stream next year, according to state officials.
Hypocritical Governors like Scott and Abbott and Haley want Federal money to pay to their buddies at the hospitals, but not a penny to provide Medicaid for their poor and working poor constituents.
NOTE: This is a community diary, which could only be written because of the efforts and activism of a number of people who belong to the Support the Dream Defenders group at Daily Kos. Their contributions are always appreciated. I am proud that they let me work with them!