ObamaCare & Medicaid . . . On the Road to the Great Depression

Robert Lewis Stevenson said, "Don't judge each day by the harvest you reap but by the seeds that you plant." So . . . I'm going to plant a seed.
The Arizona Osteopathic Medical Association has been asked to contribute Political Action Funds (PAC) to those congressional members supporting Arizona’s Medicaid expansion.  I seem to find myself in the physician minority as to my point of view on this subject. Do others not see the economic damage that the Affordable Care Act has caused and will cause in the future?  Does no-one see the sadness and depression on the faces of patient’s in the exam rooms? Does no-one put two and two together to see the effect that federal and state regulations imposed upon the small businesses of America have upon the average American family?  

I respect their points of view, however, I am very discouraged by the progressive position and mindset of many physicians around me.  Maybe I'm missing something? Maybe they see the world with a different set of spectacles? This kept me awake last night as I pondered the reasons. 

I recognize that the practice of medicine is, to say the least, life encompassing.  Often, it is all you can do just to keep up with the many demands upon the physician each day.  Understanding how the economy effects your practice is the last thing that many physicians want to do.  But I see it as one of the most important, especially as a physician who owns his own practice. 

Maybe this lack of interest is due to the declining physician ownership of practices. According to Becker’s Hospital Review, only 37% of physicians in 2013 have any ownership interest in their practice, down by almost 8% this year from last year.  This statistic, just over a third of physicians, seems in line with the number of physician that are opposed to expansion of Medicaid in Arizona and the Affordable Care Act or “Obamacare” in general.  

“Obamacare” and the employer mandate has made it nearly impossible to expand my practice, and the Medicaid expansion may make it worse.

How is Medicaid expansion bad?  Wayne Allen Root explains it better than I can: “Forget the 7.3 percent unemployment rate that is reported by the government. That’s pure fraud and propaganda. That figure goes down only because hundreds of thousands of Americans drop out of the workforce. In other words, if you stop looking for work, and go on food stamps and welfare, [our White House Administration] says the unemployment number just got better!

 “The only truth about unemployment is found in the Labor Force Participation Rate of 63 percent. That’s the lowest in four decades. For men it’s the lowest since record-keeping began in the 1940’s. What this means is 37 percent of the able-bodied, working age adults in America are not only not working, they’ve given up looking for work.

“Even worse, an unimaginable percentage of those who are employed have only part-time jobs. Seventy-seven percent of the new jobs created since January 1st are part-time jobs. That’s not good folks. Studies show 1-in-4 part-time workers live in poverty, while only 1-in-20 full-time workers live in poverty. So millions of Americans under Obama who show up as “employed” are merely working their way towards poverty. And millions of others who have full-time jobs are working at McDonalds, or working as waiters, or bartenders, or janitors.”  The American middle class is being moved to the intensive care unit.

“Here are the two most ironic points about this slow-motion train wreck called the Obama economy: “Obamacare” is the number one culprit destroying real jobs. Business owners are done. No smart business owner in all of America will lift a finger to create a full-time, high-paying job with benefits. It just makes no economic sense anymore. So Obama’s signature achievement has not only created a part-time economy, but all those people in part-time jobs don’t have health insurance. This should be a Saturday Night Live skit. The man has created nationalized health care so that everyone loses their jobs and no one has health care.” 

This is pure insanity . . . unless your goal is to create an entire nation dependent on government welfare.

Mr. Root continues, “Secondly, here’s the really sad, tragic, and ironic fact of the Obama economy . . .Obama’s policies are destroying the very people who elected and believed in him. It’s almost as if Obama is out to destroy his own voters. Let’s take a look at who is suffering the most from this Obama Great Depression.

“Obama won the 2012 election with a razor thin 51 percent of the vote. His biggest supporters were blacks (93 percent voted for Obama), Hispanics (71 percent), single women (67 percent), young people (60 percent), and those without a high school diploma (64 percent). This is the loyal foundation of Barack Hussein Obama. This is who made him President, without a single qualification, except being a community organizer.

“Now let’s look at how Obama repays his loyal fans. New research out just last week proves that since 2009 income for black heads of households dropped by 10.9 percent. For Hispanic heads of households it dropped by 4.5 percent. For single women head of households it dropped by 7 percent. For young people (under age 25) it dropped by 9.6 percent. For those with a high school diploma or less, income dropped by 8 percent.

“In dollar terms the numbers are even worse. Female incomes are down by $2,300 per year under Obama; black incomes are down over $4,000 per year; Hispanic incomes are down by $2,000 per year.

“How about actual unemployment figures for Obama’s fans? We see the same results. Reported unemployment (a bogus figure) is 7.3 percent. But among blacks (who voted 93 percent for Obama) it is an unimaginable 13.3 percent. Among Hispanics it’s 9.4 percent. Among black youth it’s 20.9 percent. Among teens it’s 23.7 percent.

“The black middle class is being destroyed. Black home ownership has slipped to the lowest level in decades.

“But perhaps the worst statistic of all is the unemployment plus under-employment rate for college graduates under age 25: 18.3 percent. That means new college graduates (also big supporters of Obama) not only can’t find a decent full-time job in the Obama economy, at the same time they are saddled with the highest student debt in history. That could be why we have the highest student loan default rates in history.”

The Medicaid Expansion in Arizona will just speed up the process already occurring across the country.  Our “lemming-like” acceptance of this expansion as physicians is leading to the further destruction of Arizona’s and America’s economy. Contributing PAC funds is like putting the proverbial nail in my businesses coffin. For the reasons above, I cannot in good conscience support the expansion of Medicaid in Arizona.  

Arizona Entitlements...To Expand or Not to Expand?

I had the wonderful pleasure of visiting the Arizona State Capital yesterday and meeting with a number of our state senators and representatives.  The big "hula-ballou" was that Governor Jan Brewer was also holding a press conference about her proposal for Medicaid, Arizona Health Care Cost Containment System (AHCCCS), expansion for our state. This has had a significant amount of media coverage, as Gov. Brewer a fiscal conservative, has decided to expand Arizona's entitlements by leveraging federal funds. Her press conference was held on the same morning the Arizona Osteopathic Medical Association (AOMA) was meeting with our state legislative representatives.  I was interviewed by News Channel 3's Dennis Welch, but only three seconds of my three minute interview was aired and it was taken completely out of context.
Here is what I tried to explain and my position on the issue. At first appearance, it seems that Gov. Brewer sprouted "progressive" tendencies and has given in to the Affordable Care Act ("ObamaCare") to which she has been historically and strongly opposed.  However, this is a very sticky problem, and it is important to understand the back ground on this issue to understand why this proposal has arisen.
It started in1982 when Arizona voted to enter the Medicaid program.  Arizona was the last state in the union to enter into Medicaid.  This brought on a number of budgetary challenges, and to solve this problem, the state "privatized" Medicaid, allowing a number of insurance companies to compete for and oversee the distribution of the care and funding in 1987 called the Arizona Health Care Cost Containment System (AHCCCS) and lovingly termed "access."  This allowed for tighter control and efficient use of the Medicaid funds.

Bigger challenges arose with the voter passage of Proposition 204 in 1995 and then re-voted upon in 2000, amending the Arizona constitution to mandate state health coverage of those residents up to 100% of the federal poverty level.  This means that no matter what, Arizona is constitutionally required to pay for and participate in Medicaid.  Part of the health care dollars have been paid for by an Arizona Sales Tax which was set to expire on December 31, 2013.  The renew of the sales tax was voted down at the end of 2012 and these funds will no longer be available.
Currently, the federal government matches Arizona's contribution to Medicaid at a 2:1 ratio. Because of budgetary AHCCCS enrollment freezes, childless adults that will not be covered, mandated changes to the plan required by the ACA, and the loss of revenue from the sales tax, AHCCCS will cost Arizona an additional $450 million dollars per year that will be required to come from the State's general fund.  This makes it impossible to balance the state's budget in 2014.
Because Medicaid coverage at a minimum of 100% of the federal poverty level is required by the state constitution, Governor Brewer is stuck with a difficult problem.  Services have already been notably reduced and reimbursement to providers has already been cut by 10% over the last few years.  Further cuts would cause providers and hospitals to drop the program like a rock.
The proposal, therefore, is to accept the Federal 9:1 match of funds by expanding Medicaid to 133% of the federal poverty level. This would actually allow coverage of an additional 60,000 Arizonians and would save the state $325 million dollars per year.
From the perspective of Health Care Policy, it is important to look at any policy in regards to cost, quality and access.  Governor Brewers proposal will allow her to balance the budget much easier, however, this proposal will not improved quality and only partially improves access.  The liberal side of the community is excited about the expansion of entitlements; however, the strong conservative side of the community is concerned that we are adding to the federal debt to balance the state's budget and strapping our children with today's burdens.  Because of increased access to services (modest as they may be), most physician and health care organizations have thrown their support behind Governor Brewer.
Will federal income tax increase in the future because of this?  Will the federal government actually have the funds to move the ACA forward? If the federal government fails with it's commitment, will that leave Arizona in a financial bind?  Does this affect our states sovereignty? These are questions that have not been answered.
I agree that something must be done, but is there another way to balance Arizona's budget without increasing  our state's dependence upon federal funds?