Newsflash:
Issues ERA 3 State Strategy SC Medicaid Expansion The High Cost of Saying No
Friday, 25 April 2014 22:31

The High Cost of Saying No

Written by  Andy Brack | Free Times
Rate this item
(0 votes)

Up to eight rural hospitals across the Palmetto State are threatened with closure or outside takeover because the state is not accepting billions of federal dollars to expand Medicaid to almost 200,000 of the state’s neediest, according to health policy experts.

The head of the state agency that runs Medicaid, however, disagrees.

Experts say rural hospitals face possible closure or loss of local control due to purchases by outsiders, including hospitals in Abbeville, Allendale, Barnwell, Dillon, Edgefield, Fairfield, Florence, Hampton and Union counties.

“There will be some hospitals that will sustain such significant financial harm that they will be purchased by for-profit health systems or out-of-state, not-for-profit systems,” says health economist Lynn Bailey. “There will be a shift to more for-profit health care and out-of-state controlled facilities.”

But Tony Keck, head of the state Department of Health and Human Services, points to the $20 million-a-year state Healthy Outcomes initiative. Started in October, it is paying for free care given by 19 rural hospitals across the state as a lifeline for those hospitals, most of which have bed occupancy rates of less than 30 percent.

“Since South Carolina Medicaid has agreed to cover the uncompensated care cost of rural hospitals, we are in fact paying for the full cost of care for the uninsured that use these hospitals,” Keck tells Statehouse Report. “The primary reason rural hospitals are struggling are the significant decreases in volume they are experiencing that is (a) part of a larger national trend of decreasing admissions and (b) the result of shifting referral patterns where local residents use larger hospitals.”

Battle over Obamacare
During the 2013 legislative session, hospitals fought hard to get the General Assembly to accept billions of federal dollars to expand Medicaid to about 200,000 of the state’s poorest residents. Advocates came up short. This year, they focused their efforts on fixing a state Certificate of Need program for which Gov. Nikki Haley vetoed funding last year. Earlier in the week, the S.C. Supreme Court overturned the governor’s veto.

Caught in the middle in the battle over Obamacare are two groups: the poor and hospitals.

Because of the way the complicated Affordable Care Act (ACA) is constructed, adults who are not elderly and who are at the federal poverty level or below generally don’t qualify for any federal health insurance subsidies if a state does not accept Medicaid expansion money, projected to be $11.2 billion between 2014 and 2020. Oddly, those who are above the poverty level do qualify for subsidies up to a certain point. Since October, almost 100,000 South Carolinians have signed up for Obamacare through a federal exchange, since the state hasn’t started its own due to rejecting Medicaid expansion dollars.

Also left in the lurch are hospitals. In the past, they’ve received “disproportionate share” payments from the federal government through the state for free care they provide, such as emergency room visits by the poor for routine health needs. As a lure to encourage states to expand Medicaid, those payments are being cut off under the presumption that the funding would be covered through new health insurance provided through Medicaid. In states that didn’t expand, the payments will end, although the cutoff has been delayed in recent months.

For and Against
Those who believe it is in the state’s best interest to expand Medicaid point to a number of benefits associated with the Affordable Care Act:

Jobs. An estimated 44,000 new jobs would be created in South Carolina with a third of them outside the health care sector, according to a 2012 report by USC’s Moore School of Business for the state hospital association.

Return on investment. For a state that invests millions in luring big companies like BMW and Boeing, investing in the state’s poor would have a dramatic economic benefit statewide, according to the South Carolina Hospital Association. Expansion would generate $3.3 billion in economic output in the state by 2020 and enough tax revenue to cover the state’s 10 percent share of expanding Medicaid, according to the Moore study.

Keeps tax dollars here. Proponents say if South Carolina continues to reject the money, it will be used to pay for insurance coverage in other states. Expanding Medicaid keeps tax dollars here that are already being paid by South Carolina taxpayers.

Higher business costs. Businesses and individuals will pay higher premiums because the state won’t get the cost savings available through Obamacare. A 2013 Jackson Hewitt study showed failure to expand Medicaid could expose employers to extra payments of $30 million to $46 million.

Competitiveness. Experts also say if South Carolina doesn’t accept Medicaid money and another state in the region does, then it will be more competitive to businesses interested in relocating. In other words, regardless of any tax incentives, the state’s failure to embrace Obamacare will make it less competitive and it won’t achieve the economic growth it could.

Increased productivity. Bailey, the economist, adds that the state would become more productive if more people had health insurance. She quotes from a soon-to-be-published study that says: “In addition to the economic activity associated with Medicaid expansion, about 500,000 South Carolinians would gain health insurance coverage, leading to improvement in their health status and improved labor productivity.”

Those who don’t want to accept Medicaid expansion money offer several reasons:

Mandate. They don’t like the program being thrust down their throats as a kind of federal mandate. The first half of this year’s session in the state Senate found many conservative senators trying to figure out a way to nullify or bypass Obamacare.

We can handle it. Opponents also say the state can handle its own health insurance needs without a state-run exchange. They point to the Health Outcomes initiative as a response.

Federal exchange is there. They also say the federal exchange remains an option for those who want insurance. Keck has said that about half of 433,000 eligible for subsidized health insurance would sign up within three years, but that number actually might cripple hospitals because they were sicker and had expensive pre-existing conditions.

Match is too much. Opponents also say they worry the long-term costs to the state will be too much because there’s no guarantee of the level of the required state match, which will be 10 percent (to the feds’ 90 percent) in 2020. Expansion calls for no state match until 2017, when it will phase in over four years to 10 percent, which is one-third of what the match is for all other federal Medicaid funds administered by the state.

The Cost of Saying No
In all the hubbub about whether to take billions of federal money to expand Medicaid, there’s been relatively little attention paid to the costs — particularly to taxpayers — of not expanding the program. In other words, if the state doesn’t take the federal money, will it incur other costs that could actually be more than the 10 percent match required by expansion?

Here are some of those costs:

State health plan. Almost 450,000 state residents get their health insurance through the state health plan administered by the Public Employee Benefit Authority. Because the state isn’t accepting expansion dollars, it is not expected to get the cost savings generated through Obamacare, which means that insurance costs will continue to rise for the state. In 2015, costs are projected to rise 4.5 percent, which means that state will have to spend $83 million to meet increased costs, or $61 million if it makes those on the health plan pay more, according to PEBA figures.

Rural hospital spending. The Healthy Outcomes program costs $20 million in the current year and is projected to cost $25 million next year. This money likely wouldn’t have to be spent if Medicaid expansion dollars were accepted.

Uncompensated costs. A June 2013 RAND study in the Health Affairs journal estimates the 14 states that do not expand will have to pay $1 billion more to health care providers who treat uninsured patients. A basic extrapolation for South Carolina reveals the uncompensated costs would be about $56 million. Subtracting the rural hospital spending above leaves about $36 million in more uncompensated costs that the state would have to pay. A July 2013 study by the Urban Institute suggests a similar annual overall amount of $61.2 million averaged over 10 years in net spending to pay for indigent care.

Lost tax revenue. The Moore study suggested the state would lose $45.6 million in income, sales and other tax revenue from not generating expansion’s new jobs in 2014. By 2020, that loss would grow to $105.7 million.

Hospital funding. Not only will disproportionate share funding be cut off in two years but hospitals in states that don’t expand Medicaid face losses of future Medicare fee-for-service rate increases, according to the Urban Institute study. In South Carolina, that translates to a whopping $6.7 billion in federal and state Medicaid payments from 2013-2022.

What’s Next?
In the 2015 legislative session, Medicaid expansion advocates are expected to ramp up efforts to pressure the state legislature to accept the federal dollars to cover the South Carolina’s poorest.

But if Haley remains governor, she is not expected to change her position of being against Obamacare, despite some who wonder whether there will be a “January surprise” — a sudden post-election deal that will find the state in a position to accept the money.

“We’ve said that we can and should get care to people in need, but we don’t need ACA Medicaid expansion to do that,” Keck says. “We are rearranging our current financing for the uninsured ($500+ million) to cover people in need more effectively than currently and will be applying for ACA, waivers which begin in 2017.”

“There will be no January surprise,” Keck says.

Link to original article from Free Times

Read 1093 times

ERA Articles

  • Take What is Yours, Ladies
    Take What is Yours, Ladies Sojourner Truth said “If women want rights more than they got, why don’t they just take them, and not be talking about it.” It looks like we will have to do just that. August 26th is Women’s Equality Day across our nation. Not so much for the women of North Carolina. 94 years ago in 1920, women won the right to vote after decades of fighting for the 19th Amendment. Women of color had to fight within the fight, and then fight on to realize that right in full.
    Written on Tuesday, 26 August 2014 16:33 Read more...
  • ERA isn't Nostalgia in Nevada
    ERA isn't Nostalgia in Nevada CARSON CITY — Mention the Equal Rights Amendment today and it might bring back memories of the 1970s, from huge protest marches to ”ERA Yes” buttons. But the proposed constitutional amendment, which fell three states short of the 38 needed to win ratification by a 1979 deadline that Congress later extended to 1982, is not a relic in Nevada. An effort is underway to get the amendment ratified by the Nevada Legislature in 2015.
    Written on Tuesday, 19 August 2014 09:44 Read more...
  • 90 years on, push for ERA ratification continues
    90 years on, push for ERA ratification continues

    Drafted by a suffragette in 1923, the Equal Rights Amendment has been stirring up controversy ever since. Many opponents considered it dead when a 10-year ratification push failed in 1982, yet its backers on Capitol Hill, in the Illinois statehouse and elsewhere are making clear this summer that the fight is far from over.

    Written on Monday, 11 August 2014 22:49 Read more...
  • The Big Banging “F” Word and Millennials
    The Big Banging “F” Word and Millennials The week before last, near the steps of the U.S. Supreme Court, a whole lot of the “F” word was thrown around at a rally. I heartily approve and you don’t know “F” if you don’t. This is where I’m supposed to reassure you that I’m not going all potty-mouthed to make a point and offer comfort that you’re not alone in your ignorance. Yes and no.
    Written on Friday, 08 August 2014 15:36 Read more...
  • ERA Enters 2014 Gubernatorial Campaign

    Last week, State Senator Heather Steans (D-Chicago) bulldozed the measure, Senate Joint Resolution Constitutional Amendment 75, through the upper chamber 39-11-06, a vote that included two Republicans - Kirk Dillard and Minority Leader Christine Radogno.

    Written on Friday, 30 May 2014 16:03 Read more...
  • Senate Democrats look to revive dormant Equal Rights Amendment
    Senate Democrats look to revive dormant Equal Rights Amendment

    SPRINGFIELD-Senate Democrats plan to make an end-of-session push this week to “rectify an historical wrong” -- and perhaps give women a strong reason to go to the polls this fall -- by putting Illinois on record in support of an Equal Rights Amendment to the U.S. Constitution.

    Written on Monday, 19 May 2014 23:16 Read more...
  • Pilgrimage
    Pilgrimage

    Each step I take brings me closer to fulfilling my promise to help pass the Equal Rights Amendment. It’s a promise I made a decade ago to my late mother-in-law, the Rev. Katrina Swanson. (Katrina was one of the “Philadelphia Eleven,” the first group of women to be ordained as priests in these modern times in the U.S., after the Anglican Church of China.) A promise made by my husband and me to her in her last year of life. A promise, indeed a vow, and now a dream moving to reality we will resurrect and see enacted the Equal Rights Amendment.

    Written on Friday, 25 April 2014 00:00 Read more...
  • Congresswoman Speier: The Deadline for Ratification of the Equal Rights Amendment Should be Removed
    Congresswoman Speier: The Deadline for Ratification of the Equal Rights Amendment Should be Removed

    Congresswomen Jackie Speier (D-San Francisco/San Mateo/Redwood City) issued the following statement today after offering a joint resolution to remove the deadline for the ratification of the Equal Rights Amendment. The ERA was introduced into every Congress between 1923 and 1972, when it finally passed and was sent to the states for ratification upon three/fourths approval. Congresswoman Speier’s joint resolution has 109 original co-sponsors.

    Written on Friday, 28 March 2014 02:59 Read more...
  • Group wants ERA ratified
    Group wants ERA ratified

    State Sen. Nina Turner said Saturday that she supports efforts to ratify the Equal Rights Amendment but noted that more work is ahead in reaching equality. The Cleveland-based Democrat was one of several political candidates in attendance during an event hosted by the Progressive Democrats of America at the Adena Mansion & Gardens Visitors Center, where Turner gave a fiery speech to a full crowd about the need to support such a change.

    Written on Monday, 24 March 2014 22:03 Read more...
  • Progressive Democrats to kick off ERA ratification push in Chillicothe
    Progressive Democrats to kick off ERA ratification push in Chillicothe

    A group of Progressive Democrats plans to push for ratification of the Equal Rights Amendment with an event here later this month. State Sen. Nina Turner, D-Cleveland, will be the keynote speaker. Turner is the minority whip in the Ohio Senate.

    The group, which also is conducting the event to defend voter rights, also will honor a local woman with an award at the event.

    Written on Wednesday, 12 March 2014 13:35 Read more...
  • Lehigh Valley feminists waged campaign in schools, prison
    Lehigh Valley feminists waged campaign in schools, prison

    One of Mary Larkin's prized possessions is a beat-up, old, wooden cutting board in the shape of a mushroom, but you can't tell by looking at it that it is the product of a revolution.

    It was made by Larkin's daughter Debbie, who was one of the first girls to take shop in Parkland schools after the district relented in the mid-1970s to allow them to forgo home economics and do woodworking instead.

    Written on Tuesday, 11 March 2014 02:52 Read more...
  • Will Virginia be the First State to Ratify Equal Rights Amendment in the 21st Century?
    Will Virginia be the First State to Ratify Equal Rights Amendment in the 21st Century?

    Today SJ 78, a bill to ratify the stalled Equal Rights Amendment, was placed on the docket of the Elections subcommittee in the Virginia House. Could this signal GOP support for Constitutional pay equity? Even in the 21st century corporations continue to pay women less because they are women. Last week we learned that General Motors offered their first female CEO a salary 50% less than her male predecessors (the usual female pay discount is only 8%).

    Written on Tuesday, 25 February 2014 01:00 Read more...
  • Deadline Looms: ERA Ratification Assigned to Judiciary Committee in AZ Legislature
    Deadline Looms: ERA Ratification Assigned to Judiciary Committee in AZ Legislature

    Rep. Victoria Steele’s (D-9) bill to ratify the Equal Rights Amendment (HCR2016) was assigned to the House Judiciary Committee late last week. (You’ll remember that mid-week, I reported it was languishing on the desk of House Speaker Andy Tobin.)

    Written on Tuesday, 18 February 2014 01:56 Read more...
  • Uphill Battle: Rep. Victoria Steele Introduces Bill to Extend ERA Ratification Deadline
    Uphill Battle: Rep. Victoria Steele Introduces Bill to Extend ERA Ratification Deadline

    There is an ideological perfect storm brewing in the Arizona Legislature. A memorandum supporting extension of the ratification deadline for the Equal Rights Amendment (ERA) has been assigned to a committee where five out of seven members have pledged to protect and fight for the rights of fetuses over the rights of women.

    Written on Thursday, 13 February 2014 14:37 Read more...
  • America the Beautiful is Not a Movie
    America the Beautiful is Not a Movie

    What I know about sports, I learned watching movies, but what I know about fair play and equality, I learned watching my parents.  Although movies Based on a true story, have evolved closer to reality since William Bendix played Babe Ruth, the brain damage of inequality requires more than A Hail Mary Pass at equal economic opportunity and Justice for All to tackle an Equal Rights Amendment fumbled by a deadline for ratification.

    Written on Monday, 10 February 2014 20:51 Read more...
  • Alice Paul: Honoring The Birthday Of An American Heroine
    Alice Paul: Honoring The Birthday Of An American Heroine

    In November 2014, Americans will be heading to the polls to vote in the midterm elections.

    Women will be voting.

    If Alice Paul had not been alive to fight for that right, women still might not have the opportunity to make their voices heard in the United States of America.

    January 11, 1885 was the day this great American woman was born and it is on this day that everyone should take a moment to recognize and celebrate her brave and progressive life.

    Written on Sunday, 12 January 2014 00:11 Read more...
  • Signature gathering drive underway for state equal-rights amendment
    Signature gathering drive underway for state equal-rights amendment

    People are out collecting signatures to get the Oregon’s Equal Rights Amendment (ERA) for women on the November 2014 ballot. This could mean a change to the state constitution to include language that specifically protects women.

    Oregon’s ERA for women has been out there several times before now, most recently before the legislative session in 2013, but it didn't pass.

    Written on Wednesday, 01 January 2014 22:30 Read more...
  • ERA December Update
    ERA December Update

    Congratulations Rhode Island!
    Rhode Island is the first state to have 100% of their Federal delegation supporting our legislation. A special thanks to Senator Sheldon Whitehouse, Senator Jack Reed, Rep. David Cicilline and Rep. James Langevin. We appreciate your support.

    Written on Thursday, 12 December 2013 01:19 Read more...
  • JFK'S Contribution to Women's Rights -- and What He Might Want Us to Do Next
    JFK'S Contribution to Women's Rights -- and What He Might Want Us to Do Next

    Just a few weeks before his death, on October 11, 1963, President Kennedy received the final report of the President's Commission on the Status of Women. A direct line runs between the work of this commission and the establishment of the National Organization for Women.

    Written on Saturday, 23 November 2013 21:02 Read more...
  • Debate over Equal Rights Amendment

    If an Equal Rights Amendment were to pass, women would have the written support of the Constitution. Instead of women having to prove that they were being discriminated against, violators of the amendment would face a harsher reality, having to prove their innocence.

    The benefits of ratifying the amendment are fairly simple. By passing the Equal Rights Amendment, the government would not only open doors of opportunity for women in the country, but also open them all around the world.

    Written on Wednesday, 20 November 2013 02:58 Read more...
  • Progressive Push - First Stop California
    Progressive Push - First Stop California

    UPDATE: Linda Sanchez and Louise Roybal-Allard are now cosponsors of HJ Res 43. As Progressives we should all be outraged that of the 15 members of the Progressive Caucus from California, there are 5 (3) who have not co-sponsored Representative Rob Andrews legislation, HJ Res 43, removing the deadline for the ratification of the Equal Rights Amendment. Unacceptable. They are well aware of the legislation and we must alert them to this fact.

    Written on Thursday, 07 November 2013 00:00 Read more...
  • The ERA and the NCGA 2013
    The ERA and the NCGA 2013

    Targeting women’s right to vote may be the undoing of extreme governance and an opportunity to take care of constitutionally unfinished business for women – an Equal Rights Amendment (ERA). The newly declared war on the right of women in NC to vote looks to be the match to the fuse in the renewed push for passing an ERA.

    Written on Tuesday, 05 November 2013 00:00 Read more...
  • Senator Elizabeth Warren Signs On to SJ Res 15
    Senator Elizabeth Warren Signs On to SJ Res 15

    A Major Victory for ERA (Equal Rights Amendment) advocates happened today as Senator Elizabeth Warren becomes the 32nd co-sponsor on Senator Ben Cardin’s bi-partisan bill, SJRES15 to remove the deadline to ratify the ERA.

    Written on Thursday, 31 October 2013 16:47 Read more...
  • Monday Vintage Demonstrations on Equal Rights Amendment
    Monday Vintage Demonstrations on Equal Rights Amendment

    In the spirit of Moral Mondays the Onslow County Democratic Party announced that this Monday’s demonstration on  October 28th  will focus on pushing back against the wave of legislation negatively impacting  women’s rights to include the targeting of their voting rights. Demonstrators are civilly rallying from 5:00 pm to 6:00 pm outside the Jacksonville City Hall at 815 New Bridge Street to support the passage of an Equal Rights Amendment (ERA) checking state laws that are eroding women’s rights.

    Written on Thursday, 24 October 2013 17:46 Read more...
  • “Welcome to Ohio: Set Your Clocks Back 50 Years!”
    “Welcome to Ohio:  Set Your Clocks Back 50 Years!”

    “Seems like old times,” was former ODP chair, David Leland’s comment when we exchanged greetings at the Statehouse, October 2nd. Indeed it did. About 1000 enthusiastic women and men showed up for a rally entitled, “We Won’t Go Back: Stand Strong with Ohio’s Women!”

    Written on Thursday, 03 October 2013 13:49 Read more...
  • Poverty, Hunger, Inequality, Violence: American Women Are Being Screwed
    Poverty, Hunger, Inequality, Violence: American Women Are Being Screwed

    Women earn less than men. Compared to white men, Latinas earn 59 cents for every dollar earned by a white man, black women earn 68 cents on the dollar, white women earn 81 cents on the dollar, and Asian women earn 88 cents on the dollar

    Written on Thursday, 29 August 2013 00:43 Read more...
  • ERA 2013 Action Campaign Gains Momentum - White House Petition Passes 20,000 Signature Mark
    ERA 2013 Action Campaign Gains Momentum - White House Petition Passes 20,000 Signature Mark

    The new push to ratify the Equal Rights Amendment (ERA) continues to grow as word spreads about the effort to get the Obama Administration to take a stand on the issue of equal rights for women. The ERA 2013 Action Campaign and its partner, ERA NOW, seek to gather 25,000 signatures on an official White House petition to trigger an official response from the Obama Administration, now needs only 4600 signatures by February 9th.

    Written on Tuesday, 05 February 2013 17:58 Read more...

ERA Legislation in your State

Unratified states Gold - Ratified States Purple

Sign the Petition - Sen. Sanders Run as a Democrat in 2016

Button-SandersPetition

Sign the TPP Fast Track Petitions

MoveOn.org Petition - Congress Don't Renew Fast Track

Public Citizen Petition - Congress Must Reject Fast Track Authority

MoveOn.org Petition - Stop the Trans Pacific Partnership

CREDO Petition - Stop the Massive Corporate Power Grab

 

ERA - January 15th Round Table

Find Your Elected Officials

Enter your zip+4 and find your elected officials. This link provides name, address and phone number

ButtonFindElectedOfficials

Click on your state in the list to find out if your Senators and Representative are cosponsors of the Equal Rights Amendment. Then call and either Thank Them or ask them to support the legislation.

Sample scripts are below.

ERA Call Scripts

Thank You Script
I am a voter in your district and the Equal Rights Amendment is very important to me and all my friends. Thank you for supporting equal rights.

Request Support
I am a voter in your district and the Equal Rights Amendment is very important to me and all my friends. Equality is a human rights issue. The Equal Rights Amendment has been stalled and we believe removing the ratification deadline will most the process forward. Please cosponsor SJ Res 15 (for Senators) HJ Res 43 (for your Representative)

Writer a Letter to the Editor about the ERA

We need to add the Equal Rights Amendment to the National conversation. Use our tool to send a letter to the editor of your local paper.

  1. Enter your zip code to select a list of local papers
  2. Select the paper
  3. Use our talking points and/or write your own letter

button-LettertoEditor

Hand Deliver a Letter to your Senators or Representative

If your Senator(s) and/or Representative is not currently a supporter, they may not be aware that the legislation exists. Nothing sends a stronger message to a Congressional member than a personal visit to a district office by a voter with a written request for support. Phone calls and emails are incredibly important but nothing gets attention like a personal visit. Our Educate Congress page has information and a sample letter. Print the letter, sign it, deliver it.

Button-HandDeliver

Email Your Senators and Representatives

There is no faster way to send a message to your Congress members than using our Email Advocacy Tool.

  1. Enter your Zip +4
  2. Use our letter or feel free to edit and create your own

button-emailyourrep

Like ERA Action on Facebook!

ERA Videos

VA State Legislature

Marena Groll
Moral Monday - Fayetteville

January 15th Progressive Round Table

Tea with Friends of Alice - Chillicothe, Ohio

  • Sen. Nina Turner and Cathy White
    Sen. Nina Turner and Cathy White
  • Queen Nester and Sen. Nina Turner
    Queen Nester and Sen. Nina Turner
  • Awardees
    Dr. Jean Kerney, Senator Nina Turner and Portia A. Boulger Awardees
  • Sen. Nina Turner and Cathy White
  • Queen Nester and Sen. Nina Turner
  • Awardees