It is easy to hate Obamacare.
The scale and complexity of the behemoth Affordable Care Act — also called Obamacare — is staggering.
The federal law is a maze of hidden fees, taxes, penalties, cost-shifts and mandates.
It is being called the biggest federal project ever undertaken and promises to radically change health care as we know it today.
That’s enough to make anyone a little uneasy.
It could, as many predict, drive up the cost of health care which is in stark contrast to President Obama’s goal of decreasing how much our nation’s spends on health care.
But Obamacare will reduce the number of uninsured in our country which is its primary goal and a laudable one when you consider the exorbitant costs of treating those who do not have insurance.
One of the ways the federal health care law achieves that goal is by mandating that states expand their Medicaid programs by 2014. The law does so by requiring states to expand Medicaid to adults earning up to 138 percent of the federal poverty level or about $32,000 annually for a family of four.
The U.S. Supreme Court limited Congress’ power to enforce that mandate when it ruled last year that states could opt out of the provision. But the decision left in place a powerful financial incentive — the federal government will pay for all of the expansion through 2016. The states’ share will gradually increase to 10 percent by 2020.
The court’s ruling put states in a quandary: Should they embrace Medicaid expansion and the influx of federal dollars that will benefit some of their neediest citizens, or should they refuse on the grounds that it will eventually add to their budgets beginning in 2017?
Initially, the debate among the states was largely political. States with Republican governors and legislatures rejected any notion of Medicaid expansion and were cool to anything that appeared to legitimize Obamacare.
Missouri falls into that category. Last week the Missouri House rejected a Democratic-led effort to expand Medicaid.
But over time, perhaps bolstered by the reality that Obamacare isn’t going to be overturned, opposition by GOP governors and state lawmakers across the country is softening.
One of the reasons for that is because of the economic case being made by public and nonprofit hospitals that they can’t afford to continue treating the uninsured when they start to lose federal reimbursements later this year.
That argument is being made in Missouri and it is starting to gain traction.
Last week, the Washington Chamber of Commerce Board of Directors joined a growing number of other chambers and business groups across the state in endorsing Medicaid expansion.
The decision here came after a presentation by a representative of Mercy Health Systems who explained the addition of federal dollars under Medicaid expansion was critical to its operations because they would offset future federal spending cuts called for under the cost shifts of the new health care law and because of the impact of recent sequestration cuts.
By law, hospitals can’t turn people away who need care. They are the primary safety net that provides health care for the uninsured.
In 2011, Missouri hospitals provided $1,109,262,049 in uncompensated health care services — up 22.5 percent in one year. This illustrates the magnitude of the problem and why expanding Medicaid to reverse this trend is critical to our state’s future.
More people on Medicaid would mean fewer patients with unpaid bills. It is simple economics for hospitals.
Without help, some smaller rural hospitals are at risk of closing under the new federal health care funding dynamics. While that is not the case with Mercy in Washington, it should be a concern for all Missourians. Those patients will have to be absorbed somewhere.
The benefits that hospitals provide to their communities go beyond providing care for those who do not have insurance. They are economic engines that create jobs which is another of the reasons why business groups want to ensure they remain viable.
If you take politics out of the equation, expanding Medicaid makes business sense.