Somebody Else's Problem Field In Action

People going without health care because red states rejected funding for Medicaid expansion is a perfect example of the "Somebody Else's Problem" effect.  But the ugly truth underneath the GOP's efforts to make sure Obamacare doesn't work in their states is that without that funding, hospitals are closing, putting the population of those states at risk.

Reports out in the last week indicate the gap between those with health care coverage is widening between states that agreed to go along with the health law’s Medicaid expansion and those generally led by Republican legislatures and GOP governors that are balking at the expansion. 

The moves against expansion are “beginning to hurt hospitals in states that opted out,” a report last week from Fitch Ratings said. The U.S. Department of Health and Human services has said Medicaid enrollment in the 26 states and the District of Columbia that agreed to go along with and implemented the expansion by the end of May “rose by 17 percent, while states that have not expanded reported only a 3 percent increase,” HHS said in an enrollment update for the Medicaid program. 

“We expect providers in states that have chosen not to participate in expanded Medicaid eligibility to face increasing financial challenges in 2014 and beyond,”Fitch said in its July 16 report. “Nonprofit hospitals and healthcare systems in states that have expanded their Medicaid coverage under the Patient Protection and Affordable Care Act have begun to realize the benefit from increased insurance coverage.” 

Already, the financial ratings agency said it has downgraded 10 health care entities so far this year and five of those were in states that have not gone along with the Medicaid expansion. Fitch didn’t specify the entities that have been hurt financially. 

“Several of those downgrades were driven by operating performance declines related to funding and reimbursement pressures, which may have been lessened by Medicaid expansion,” the Fitch report said. “Conversely, of the nine upgrades since Jan. 1, eight were hospitals in states that have expanded Medicaid.”

So yes, this is starting to affect the bottom lines of many hospital systems. That in turn affects availability of health care, and of course the economic well being of hospital employees.  If it seems like Republican governors are doing billions of dollars in damage to their own economies in order to get red state voters to blame Obama for the resulting mess, that's because this is exactly what's going on.

A report last week from the Robert Wood Johnson Foundation and the Urban Institute described the coverage difference as a “gulf in percentage of people without health insurance” that is growing larger between states that expanded Medicaid and those that did not. 

As of June, the report said 60 percent of the nation’s uninsured residents live in states that did not expand Medicaid. That figure was up from 49.7 percent in September of last year. 

Analysts expect that gap to only worsen. Unlike private coverage under the health law that is generally purchased during a specified open enrollment period, Americans can sign up for Medicaid at anytime.

“In states that expanded Medicaid, an estimated 71 percent of the uninsured likely qualify for some type of financial assistance for health insurance, compared with 44 percent of the uninsured in the states that did not expand Medicaid,” the Robert Wood Johnson Foundation and Urban Institute report said.

So these are the states that are going to have higher taxpayer costs dealing with uninsured Americans, and Republicans, instead of taking responsibility for their direct actions to keep people uninsured,  are just going to blame Obama.

And in most cases, that'll work just fine.

Hope you don't live in a red state.