Medicaid Expansion
Well, now we know.
Repeal is a long shot.
The debate isn’t over.
supreme court
 Ruled 5-4 on June 28,
2012 to uphold law
 Individual mandate,
exchanges, insurance
rules and other
programs still stand
 Medicaid expansion is
now optional for each
state
 Subsidies are available
to individuals from
100% FPL and above if
a state does not opt in
The political question: what will states do?
some background
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January 1966. Only six
states originally participated
when the program launched:
Hawaii, Illinois, Minnesota,
North Dakota, Oklahoma,
Pennsylvania
20 states signed on later
that year
11 states joined in 1967
13 more states (southern)
joined in 1968-1972
Arizona last to join in 1982
Eventually all states
participated in basic
program and SCHIP
(enacted in 1997)
why are states reluctant?
 Oppose Obama…… Oppose ObamaCare
 States Rights
 Administrative burden
 10 percent is still a big commitment
 Fear the federal government will not keep its financial
commitment
 The “woodwork” effect
who isn’t participating?
who will benefit?
how much will the medicaid expansion cost sc?
Year
State
Federal
2014
0
$796m
2015
0
$1.64b
2016
0
$1.69b
2017
$44m
$1.72b
2018
$101m
$1.74b
2019
$125m
$1.80b
2020
$171m
$1.84b
Totals
$442m
$11.24b
state impact reports
$2,038,205,270
No matter what decision the state makes on Medicaid
expansion, our state will see this reduction in
Medicare reimbursement from 2014 to 2020.
$735,400,000
Hospitals in South Carolina will also see this reduction
in Medicaid DSH funds from 2014 to 2020 with or
without Medicaid expansion.
$2,773,605,270
The total cost of statewide cuts in Medicare
reimbursement and Medicaid and Medicare DSH funds
to South Carolina's hospitals from 2014-2020 with or
without Medicaid expansion.
$11,682,500,000
The total amount our state would receive in federal
funding from 2014 to 2020 if South Carolina decides
to expand Medicaid.
economic impact in sc
USC economic impact report
 SCDHHS estimates $11.2 billion in new
federal funding will be generated between
2014 and 2020 due to newly eligible
enrollees.
 By 2020, the annual economic impact will
total $3.3 billion in annual economic output,
nearly 44,000 jobs, and approximately $1.5
billion in labor income.
 This will translate into additional spending,
leading to increases in SC general funds
totaling $105.6 million by 2020.
USC economic impact report
 This increased tax revenue will completely
offset the required state costs over the
first seven years and generate a $9 million
net surplus.
 From 2020 forward after the federal match
rate caps at $9 federal to every $1 state,
new tax dollars will generate enough to
cover 53% of the state required Medicaid
match.
what you can do?
 Communicate with legislators
 Engage local chambers of
commerce, businesses and civic
organizations
 Write letters to editor
despite the concerns, these facts remain:
 SC hospitals will continue to
care for uninsured patients;
federal law requires them
to do so.
 The cost of that care must
be paid by someone, and
there are two options:
 We can let the other
states help pay 90% of it
(they are offering to do
so through Medicaid), or
 We can absorb 100% of
the costs within our
borders.
Which strategy will make SC more competitive?
Strategic imperative:
Enhance South Carolina’s economic
competitiveness by improving health
status, improving health care delivery, and
lowering the per capita cost of care
In order to
lower health
care costs,
SC needs
better health
and better
health care
America ranks dead last in health status
Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by
the Institute of Medicine
America ranks dead last, continued
Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by
the Institute of Medicine
In the least healthy developed nation:
South Carolina
ranked 46th out of
50 states in 2012
(The Palmetto State
ranked 45th in 2011)
Source: America’s Health Rankings, published by the United Health Foundation
What’s driving our low health status?
Factor
1. Diabetes
2. Children in Poverty
3. Low Birth weight
4. High School Graduation Rate
5. Violent Crime
6. Lack of Health Insurance
7. Obesity
8. Premature Death
9. Infant Mortality
10.Smoking
Rank
49
48
47
47
46
45
42
42
40
39
Source: America’s Health Rankings, published by the United Health Foundation
Weight
Low
Medium
Medium
Medium
Medium
Medium
Medium
Medium
Medium
High
Better Health
 Health is the result of our behaviors,
genetics, and environment combined
with the clinical care we receive and the
policies of our health care, government,
and other prevention systems.
 SC is one of the least healthy states in
the least healthy developed nation. We
need a comprehensive, data-driven plan
to make SC one of the healthiest states
in America.
 Our plan must address the primary
factors driving our poor health status.
Better Health Care
 We all care about quality of life. One of
the major contributors to a high quality
of life is access to excellent health care.
 SC has been recognized in recent years
as a national leader in patient safety
and quality of care, but there’s much
more to be done.
 Health care in America must become as
reliable as commercial aviation and
nuclear power; SC is poised to be the
lead state in building highly reliable
systems of care.
Lower Cost
 The fundamental complaint about
America’s health care system is the high
(and ever-increasing) cost of care.
 There are two contributing factors, both
of which must be addressed
simultaneously. The first is the cost of
health services, and the second is the
frequency with which those services are
utilized.
 It’s not enough to reduce the cost of
health care; we must improve our
health so we won’t have to purchase so
many health care services.