# Why are so many states not taking the Medicaid Expansion? **URL:** \ **Category:** Great Debates\ **Created:** [October 4, 2013, 7:03pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384 "2013-10-04T19:03:09Z")\ **Posts on this page:** 19\ **Page:** 4
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 11, 2013, 10:59am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/61 "2013-10-11T10:59:54Z")
> [@NotfooledbyW](#): > > Its interstate commerce. Works just like interstate common defense. The > Feds are in both to stay. Big business likes it. The Supreme Court rejected the interstate commerce justification when upholding the law. The mandate is a tax and the Medicaid expansion is optional for the states. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [October 11, 2013, 11:12am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/62 "2013-10-11T11:12:30Z")
> [@adaher](#): > > How would you prevent obesity through the health care delivery system? I wasn’t aware that you could go to a doctor to get treated for obesity. This one is personal. Due directly to the results of bloodwork and other tests, and direct advice from my doctor at annual checkups I’ve changed my lifestyle and lost a lot of weight. Anecdote, but I’ve got to believe I’m not the only one. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [October 11, 2013, 11:22am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/63 "2013-10-11T11:22:39Z")
> [@SmartAlecCat](#): > > This one is personal. Due directly to the results of bloodwork and other tests, and direct advice from my doctor at annual checkups I’ve changed my lifestyle and lost a lot of weight. Anecdote, but I’ve got to believe I’m not the only one. I’m not diminishing your accomplishment, but even though you received advice from your doctor all of the effort was on you. That’s why people don’t get thin all day every day. It takes work and a life style change, in most cases. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 11, 2013, 11:23am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/64 "2013-10-11T11:23:21Z")
But were you given any advice unique to a medical professional that you didn’t already know? I just want to be clear about the differences between health care delivery systems and general healthiness. Most of us know how to not be obese, we just usually don’t do what we’re supposed to do, and I’d imagine very few people start just because a doctor tells them. ---
**Author:** ![BrokenBriton](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@BrokenBriton](https://boards.straightdope.com/u/BrokenBriton)\ **Post date:** [October 11, 2013, 12:06pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/65 "2013-10-11T12:06:44Z")
> [@adaher](#): > > Okay, but that’s not health care spending as we understand it. It’s like calling the “Say No to Drugs” campaign part of the health care system. Just stand back for a moment and look at that statement. Fwiw, my opinion is you live in a society where health provision has been steered in the wrong direction since WW2. Consequently, it’s no surprise that, by now, how all other developed societies shape provision - what is connected and taken for granted - is absent in the US. Of course, prevention is at the heart of healthcare provision. Italso helps that it’s a non-political, financial no brainer. Drugs, however, remains a political football. > [@adaher](#): > > For the purposes of Medicaid, “preventive services” means things like mammograms, prostate screenings, etc. Services that you get from a medical provider to try to catch a problem before it becomes an emergency. Things like anti-obesity campaigns may or may not technically come out of the nation’s health care budget, but aren’t part of Medicaid’s budget, which is just used for reimbursing providers for care. Again, it’s not joined up thinking is it? It’s money-making thinking: US healthcare loves obesity. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [October 11, 2013, 6:25pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/66 "2013-10-11T18:25:08Z")
> [@BrokenBriton](#): > > Just stand back for a moment and look at that statement. > > Fwiw, my opinion is you live in a society where health provision has been steered in the wrong direction since WW2. Consequently, it’s no surprise that, by now, how all other developed societies shape provision - what is connected and taken for granted - is absent in the US. > > Of course, prevention is at the heart of healthcare provision. Italso helps that it’s a non-political, financial no brainer. Drugs, however, remains a political football. > Again, it’s not joined up thinking is it? It’s money-making thinking: US healthcare loves obesity. You are wrong above everything. System wide prevention is more expensive. I have already linked to two studies that show that. Lifetime health expenditures are lower for the obese than the healthy [living](http://www.ncbi.nlm.nih.gov/pubmed/18254654). > [@](#): > > CONCLUSIONS: > Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures. Luckily for the UK government obesity has quadrupled in the last 25 years. ---
**Author:** ![BrokenBriton](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@BrokenBriton](https://boards.straightdope.com/u/BrokenBriton)\ **Post date:** [October 11, 2013, 6:54pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/67 "2013-10-11T18:54:23Z")
And, surprise surpise, on the same page a follow up from 2012 involving 41,965 participant and citing the (above) 2008 “cohort”: > [@](#): > > CONCLUSIONS: > > According to the point estimate, lifetime medical expenditure might appear to be higher for obese participants, despite their short life expectancy. With weight control, more people would enjoy their longevity with lower demands for medical care. > **[Lifetime medical costs of obesity: prevention no cure for increasing health...](https://pubmed.ncbi.nlm.nih.gov/18254654/)** > > Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and... How about that. Merry Christmas. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [October 11, 2013, 7:20pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/68 "2013-10-11T19:20:31Z")
The problem with your study is it only studied the old and middle aged. Past 70 obesity has little effect on mortality. However, for a twenty year old the effect has been estimated at 10 years, which is triple the effect your study found for women and five times the effect found for men. Most of the increased mortality is caused by heart attacks and stroke which are relatively cheap for the healthcare system. ---
**Author:** ![John\_Stamos\_Left\_Ear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_stamos_left_ear/32/3198_2.png) [@John\_Stamos\_Left\_Ear](https://boards.straightdope.com/u/John_Stamos_Left_Ear)\ **Post date:** [October 12, 2013, 7:19am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/69 "2013-10-12T07:19:02Z")
> [@Marley23](#): > > Spite. Holy shit. You posted this one-word response on 10/4. And look what [Jon Stewart said yesterday on The Dailuy Show](http://www.theatlanticwire.com/entertainment/2013/10/daily-show-wonders-why-26-states-didnt-expand-medicaid/70432/): > [@](#): > > (A)ll of those states have Republican governors and/or legislatures. > > That fact, Stewart said, “makes it really hard not to see this as just another example of that hit game show sweeping part of the nation What Do You Hate More: Poverty or Obama?” The show’s brought to you by Spite, the emotion that makes you turn down money to help the poor “because you hate the president.” > > Of course, Texas governor Rick Perry didn’t list spite as a reason for not expanding Medicaid. He compared it to putting a thousand people on the Titanic. “That’s true,” Stewart said, “if the Titanic had crashed into a hospital.” So… We found out Jon Stewart’s SD handle now! 😛 ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 13, 2013, 11:48am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/70 "2013-10-13T11:48:32Z")
Texas’ share would be $5 billion. it’s not between poverty and Obama, it’s between higher taxes and poverty. Texas has always chosen to make the tradeoff of higher poverty for better opportunity. What, did you think ACA would force them to change their basic governing philosophy? ---
**Author:** ![John\_Stamos\_Left\_Ear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_stamos_left_ear/32/3198_2.png) [@John\_Stamos\_Left\_Ear](https://boards.straightdope.com/u/John_Stamos_Left_Ear)\ **Post date:** [October 13, 2013, 11:55am UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/71 "2013-10-13T11:55:22Z")
> [@adaher](#): > > Texas’ share would be $5 billion. [citation needed] ---
**Author:** ![John\_Stamos\_Left\_Ear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_stamos_left_ear/32/3198_2.png) [@John\_Stamos\_Left\_Ear](https://boards.straightdope.com/u/John_Stamos_Left_Ear)\ **Post date:** [October 13, 2013, 12:03pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/72 "2013-10-13T12:03:01Z")
And while you’re digging up that cite, here’s some reading for you: > [@](#): > > **Analysts: Texas loses big by rejecting Medicaid expansion** > > Statewide, Texas will forfeit an estimated $100 billion in federal Medicaid funds by rejecting Medicaid expansion. > > The economic advantages of participating in Medicaid expansion are profound, according to a study by the Perryman Group, a Waco-based economic and financial analysis firm. While the cost to the state general fund of making almost 1.5 million more residents eligible for Medicaid is estimated at $1.3 billion through fiscal year 2017, Texas would be eligible for an estimated $24 billion under Medicaid expansion, according to the study. > > Conversely, not participating in expansion means Texas will suffer “a significant economic downside which must be weighed against potential savings in direct State outlays,” according to the report. A large uninsured population leads to higher private insurance premiums and higher taxes to cover the cost of uncompensated care, Perryman says. > > On the other hand, more spending on health care creates economic stimulus and makes for a healthier population, fewer deaths and increased productivity, according to the study. > > A new study by the nonprofit RAND Corporation’s health policy research division, the largest in the nation, concluded that Texas and 13 other states whose governors have vowed to reject expansion, will end up paying significantly more for uncompensated care than states that do expand Medicaid. > > “Our analysis shows it’s in the best interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” lead author Carter Price said. > > [The Brownsville Herald](http://www.brownsvilleherald.com/news/local/article_caf425ee-d0ae-11e2-b684-001a4bcf6878.html) ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 13, 2013, 12:04pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/73 "2013-10-13T12:04:37Z")
> [@John\_Stamos\_Left\_Ear](#): > > And while you’re digging up that cite, here’s some reading for you: You just gave me the cite. Texas would get $100 billion. Their share is 10% after a few years. ---
**Author:** ![John\_Stamos\_Left\_Ear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_stamos_left_ear/32/3198_2.png) [@John\_Stamos\_Left\_Ear](https://boards.straightdope.com/u/John_Stamos_Left_Ear)\ **Post date:** [October 13, 2013, 12:16pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/74 "2013-10-13T12:16:45Z")
> [@adaher](#): > > You just gave me the cite. Texas would get $100 billion. Their share is 10% after a few years. You ignore the savings that Texas will have by insuring “nearly 1.5 million additional Texans living below the poverty line would have insurance by 2017” had they took the expansion. Unless you think that the medical expenses of 1.5 million uninsured people will just vanish and not be passed along to anyone in any way; is that your contention? If it is, the Texas Medical Association [disagrees with you](http://www.texmed.org/Uninsured_in_Texas/). > [@](#): > > Taxpayers, Texans with insurance, and employers who offer health benefits also pay extra for caring for the uninsured. Families USA estimated the total cost for Texas in 2005 to be more than $9.2 billion. Of that: > > - The patients and their families pay about half ($4.6 billion); > - Government health programs pay one-sixth ($1.6 billion); and > - Those with private health insurance subsidize the remaining third ($3 billion). > > In 2005, typical premiums for family health insurance coverage provided by private employers in the U.S. include an extra $922 in premiums due to the cost of care for the uninsured. In Texas, because of the very large percentage of uninsured, that figure is $1,551. By 2010, the national average will catch up to Texas’ current figure; by then, the annual cost per Texas family will soar to $2,786. These figures are from 2005. Since then, healthcare costs have only gone up and so have insurance premiums. Which means the costs are even more. Considerably more than five billion, as you can see. In fact, it was practically equal to that in one year alone, eight years ago when costs were less than they are now. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 13, 2013, 12:19pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/75 "2013-10-13T12:19:10Z")
> [@John\_Stamos\_Left\_Ear](#): > > You ignore the savings that Texas will have by insuring “nearly 1.5 million additional Texans living below the poverty line would have insurance by 2017” had they took the expansion. Ah, dynamic scoring.🙂 > [@](#): > > Unless you think that the medical expenses of 1.5 million uninsured people will just vanish and not be passed along to anyone in any way; is that your contention? Under Medicaid, they are being passed along. That’s the whole point of Medicaid, taxpayer provision of medical care to the poor. Are you arguing that Medicaid is cheaper than emergency room care? ---
**Author:** ![John\_Stamos\_Left\_Ear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_stamos_left_ear/32/3198_2.png) [@John\_Stamos\_Left\_Ear](https://boards.straightdope.com/u/John_Stamos_Left_Ear)\ **Post date:** [October 13, 2013, 12:33pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/76 "2013-10-13T12:33:46Z")
> [@adaher](#): > > Under Medicaid, they are being passed along. That’s the whole point of Medicaid, taxpayer provision of medical care to the poor. Which doesn’t address that the uninsured (poor or otherwise) are still a financial drain to the system that someone has to pay for - as I cited, this means taxpayers and the insured. Where do those costs go? Be specific. > [@](#): > > Are you arguing that Medicaid is cheaper than emergency room care? Why would I need to do that when the The Texas Medical Association does it for me to rebuke your buddy Ted Cruz: > [@](#): > > The doctors’ lobby in Texas has rebuked Republican Senate hopeful Ted Cruz for proclaiming in a televised debate this week that “it is much cheaper to provide emergency care than it is to expand Medicaid and to expand the rolls.” > > “Ted Cruz thinks it’s cheaper for uninsured patients to go to the emergency room than to receive care in a doctor’s office. He’s wrong,” said Houston emergency room doctor Arlo Weltge, the PAC’s membership chairman. “If it’s the cheapest solution you’re after, Mr. Cruz, why don’t you just let the poor people die in the streets?” > > [Dallas News](http://trailblazersblog.dallasnews.com/2012/07/doctors-group-scolds-cruz-for-saying-er-care-cheaper-than-adding-uninsured-texans-to-medicaid.html/) ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 13, 2013, 6:09pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/77 "2013-10-13T18:09:18Z")
> [@John\_Stamos\_Left\_Ear](#): > > Which doesn’t address that the uninsured (poor or otherwise) are still a financial drain to the system that someone has to pay for - as I cited, this means taxpayers and the insured. Where do those costs go? Be specific. To taxpayers, of course. Which was my point. Medicaid doesn’t save taxpayers money, it’s just a different way of paying providers. The advantage isn’t to taxpayers, but to providers since it provides them with more certainty. > [@](#): > > Why would I need to do that when the The Texas Medical Association does it for me to rebuke your buddy Ted Cruz: Notice they didn’t disagree that it was cheaper. Texas understands the tradeoffs very well and they accept them. You come to Texas to find work and opportunities, not a handout. ---
**Author:** ![neilzero](https://avatars.discourse-cdn.com/v4/letter/n/fbc32d/32.png) [@neilzero](https://boards.straightdope.com/u/neilzero)\ **Post date:** [October 13, 2013, 7:28pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/78 "2013-10-13T19:28:43Z")
> [@John\_Stamos\_Left\_Ear](#): > > Is there evidence that they have reason to worry? Has the USA told states they would get funds for something and then reneged? Recently? Perhaps not directly. I have provided transportation to free food places for poor folks for about ten years. The quantity of department of agriculture surplus decreased by about ten times, and the quantity of the food given from other sources has diminished to the point that it is hardly worth the time and car expenses to go get it. Most of the new food pantries are not seeking federal finding. I would conclude, defacto renig. Also: Quality of health care seems to be declining in anticipation of Obama care. Neil ---
**Author:** ![EverwonderWhy](https://avatars.discourse-cdn.com/v4/letter/e/ee59a6/32.png) [@EverwonderWhy](https://boards.straightdope.com/u/EverwonderWhy)\ **Post date:** [October 13, 2013, 7:40pm UTC](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384/79 "2013-10-13T19:40:42Z")
> [@neilzero](#): > > Also: Quality of health care seems to be declining in anticipation of Obama care. Neil Cite? From a reputable peer reviewed source, please. [Previous page](https://boards.straightdope.com/t/why-are-so-many-states-not-taking-the-medicaid-expansion/670384.md?page=3)