Tag Archives: ACA

The Chase for Amazon

The rendering of the Amazon building in the Denny Regrade neighborhood of Seattle is fro NBBJ.comIt has been hard to ignore the buzz created by the chase for Amazon’s second headquarters. Five billion dollars in construction costs and 50,000 “high-paying” jobs. 238 proposals have been submitted to Amazon from all across North America. Of course there were.

While all the proposals were made in secret, it is safe to assume that no incentive was left out. For instance, New Jersey announced it offered $7 billion in tax breaks to get Amazon to chose Newark. Details of Atlanta’s bid weren’t released, but it is also safe to assume that Nathan Deal opened Georgia’s checkbook offering billions of tax incentives. It is exciting to imagine the impact of winning.

Did you know there is another offer out there that would bring more than ten times the Amazon investment to Georgia? That right, this one offers almost $60 billion in direct investment over ten years and increasing each year after that. Were Georgia to win this deal, it is estimated that more than 35,000 new “high-paying” jobs would be created in the first year and increasing after that. Unlike the Amazon deal for Atlanta, this one includes all of Georgia.

Then there are all to little things that would come along with it that are unimaginable for a typical industrial development development:

  • hundreds of thousands of Georgia residents would be lifted out of poverty;
  • cost of living for all Georgians would be reduced;
  • life expectancy would be increase;
  • even the number of Georgians in mental health facilities would be reduced.

What does it cost to win this? Georgia would have to offer an incentive of $254 million a year. That’s a lot, but 18% of what a typical Georgia industrial development tax incentive is – chump-change compared to cost of getting Amazon. When you consider the amount of state taxes collected on the new jobs and that state spending would actually be reduced, the net spending by the state is way less than zero. Consider that for a moment. All these new jobs and great benefits with none of the downsides, such as lost tax revenues starving our schools.

Sounds so good, you’d think we would be all over it. Nope. Georgia said no. The only states in the South that went after the deal were Louisiana, Arkansas, Kentucky, West Virginia and Maryland.

Seems idiotic, doesn’t it. Seems our elected leaders would be thrown out of office for ignoring the offer and lying about it to us. You’d think our business community would be going nuts for it. Nope. Not going to happen. Forget about it.

There is good news, though: one Irish bookie has Atlanta an early 2-1 favorite to win Amazon. I wish them luck. We need it.

Oh, the deal? Surely you have guessed by now. Expanding Medicaid.

Sources (it isn’t fake news, it isn’t even news):

Subverting Democracy by Corrupting Truth

States Not Expanding Medicaid

Source: WhiteHouse.gov

“None of my friends can afford Obamacare, either,” Meghan said indignantly, “it should be repealed.”

We were in the South Carolina Lowcountry. Meghan is a mid-to-late-thirties single mother who is balancing raising her child, her relationship and job while still working on her degree.

She was telling us about the hospital where she works. Like so many rural hospitals across the South, her hospital has a significant number of uninsured patients coming through the emergency room for treatment. Federal law (EMTALA) requires all hospitals with an emergency department that receive Medicare to screen, treat, stabilize or transfer anyone requesting treatment regardless of ability to pay.

Meghan told us that her hospital had to cut back staff, which backed up her ER waiting room even more. She told us that the hospital could not afford to treat really sick uninsured patients and mostly their doctors patched up the uninsured sick the best they could, gave the patients some medicine and sent them on their way with a prescription knowing the prescriptions were unaffordable and the patients would be back. Meghan blamed Obamacare for all of it.

That is when I chimed in and told her that things at her hospital were going to get worse. The Affordable Care Act (ACA, aka: Obamacare) is complicated and when passed, assumed every state would expand Medicaid. With almost everyone having insurance, there would be fewer uninsured at the ER and hospital costs would go down. With lower costs, federal Medicare reimbursements are being reduced each year.

That’s when Meghan said that Obamacare was too expensive and should be repealed. And that is when I told her that she had been lied to. That for people earning up to 138% of the poverty level, Obamacare was should have been free and is in free in 28 states. But that her state government decided that the fate of 340,000 South Carolinians was to bankrupt, go to the ER or die.

I wasn’t sure which one of us was going to scream or cry first. Meghan seemed bewildered and said, “It isn’t Obama’s fault that I don’t have health insurance, but it is the states? The state did this? None of my friends know that. All we hear is that it has to be repealed. This is terrible. Why would they do that to us?”

Then I told her about the money. The more than $15.8 billion that her state would have gotten from Washington that was to pay for 100% of Medicaid expansion. Money they will never get. Money that would have created many tens of thousands of good permanent jobs, saved countless bankruptcies, saved lives and made lives better. Money that South Carolina taxpayers are sending to other states.

It gets even worse as the states have to make up the difference for indigent care and the decrease in Medicare reimbursements – money needed to keep hospitals like Meghan’s open. The Robert Wood Johnson Foundation and the Urban Institute put that number at $167.8 billion for all the states not expanding Medicaid from 2013-2022 – for instance, Georgia will lose $1.2 billion in Medicare reimbursements in 2016– more than twice the cost of expanding Medicaid. Stupid and mean.

Despite this, there is good news even in the states which haven’t expanded Medicaid. The online marketplace makes it easier to enroll and determine eligibility. South Carolina, for example, had about 300,000 people who already qualified, but had never enrolled in Medicaid. Using HealthCare.gov, South Carolina has already added over 150,000 of them.

In fairness, there is a cost to the states to accept the expanded Medicaid money. States must provide basic benefits and offer it to all of their citizens below the poverty level, not just women with children. According to the Urban Institute and McClatchyDC.com, South Carolina’s 10-year cost to expand would have been about $1.2 billion – a lot of money, but not much to get $15.8 billion in return. For Georgia to get $33.7 billion, would cost $2.5 billion over 10-years (which could be funded by the governor’s discretionary budget) – one other note on Georgia – five rural hospitals closed since 2012 and more and six more are at risk (USA Today). Here’s a chart for other states.

Suggested reading: What Is the Result of States Not Expanding Medicaid?

Note: this story also published at LikeTheDew.com