## Saturday, January 26, 2013

### Medicaid Expansion: It’s the math, Stupid!”

Politics should be more like mathematics. Take this problem. Susie has one apple. She needs ten to make an apple pie. If Johnnie gives her nine apples, will Susie have enough? Mathematicians would say, “Yes, 1 + 9 = 10.” Whether the mathematician is a Republican or a Democrat 9 + 1 should equal 10, unless the facts are manipulated. Unlike mathematicians, politicians can equivocate and say, “I just don’t trust Johnnie to give her any of those apples.”

Forty-percent of Wyoming’s high school graduates require remedial math because they didn’t learn it well enough in high school. Before the legislature adjourns we’ll see what that percentage is among our legislators.

When Congress enacted Obamacare, it gave states some math homework. Some states have been better at the math than others depending on whether they really want to help Susie make that apple pie.

The law provides for a “mandatory expansion” of Medicaid and an “optional expansion.” Congress didn’t care whether states agreed to the optional expansion. There were some people they had to cover regardless, mainly children. That will cost Wyoming (jot down this number) 80 million dollars.

The 80 million dollar figure is critical to getting this math problem correct because the state legislature must spend that regardless of whether they like Obamacare or not. Those dollars are gone!

Then Congress added to the equation. Knowing a lot of other folks, namely the working poor, still need healthcare, Congress said that if the states choose to participate, the federal government would pay no less than 90% of the costs of covering those families.

This number is critical to the math because today Wyoming taxpayers are paying all of the costs for providing medical care to these folks. Programs created by state legislators to provide care for the uninsured cost you millions. Some of the costs are paid when uninsured people end up in hospitals and can’t pay. There’s also a cost when health insurance premiums increase dramatically because the costs of caring for the uninsured are shifted to the insured.

In addition to the millions of dollars the legislature appropriates every year for these programs, local hospitals lost 200 million dollars last year caring for folks who could be insured with Medicaid expansion.

Congress said to state mathematician/politicians, “Figure out how much of that money you could save if you expanded Medicaid insurance to cover your uninsured.”  The Wyoming Department of Health studied those costs and concluded that if legislators decide to expand Medicaid under the Affordable Care Act, there are 127 million dollars in Wyoming’s budget that could be saved. That doesn’t include the 200 million in uncompensated care at Wyoming hospitals, most of which would also be saved.  Jot down the 127 million dollar savings while keeping in mind the additional 200 million dollars (they’re your tax dollars too).

Now you are ready to do the math.

Whether legislators like it or not, we must come up with 80 million tax dollars for the mandatory expansion. Wyoming starts 80 million dollars in the hole. If legislators agree to the optional expansion, we’ll save 127 million tax dollars (plus, always remember, the hospital money). Simple math. After paying for the mandatory expansion, you’ll save 47 million dollars. That’s why the Department of Health calls Medicaid expansion a “great opportunity for savings.”

There’s another number in the formula. If Medicaid is expanded, approximately 864 million federal dollars will be added to Wyoming’s healthcare system, creating jobs, improving the state’s medical infrastructure and helping local economies.

Medicaid expansion saves tax dollars whether a Democrat or a Republican does the math. But easy math problems become complicated by partisanship. Math collides with ideology. Some governors are better mathematicians than others. Republican governors of North Dakota, Arizona, Nevada, and New Mexico opposed expansion but they did the math and decided that saving millions trumped their dislike of Obamacare.

If a majority of Wyoming’s legislators need remedial math, it’ll cost us millions.