dr. byron schlomach - the aca in texas: do hospitals need medicaid expansion?
TRANSCRIPT
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Name
Title
MEDICAID EXPANSION:
Byron Schlomach
Director,
Center for Economic Prosperity
Just Dont Do It
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Standard Wisdom
goldwaterinstitute.org
Im opposed to Obamacare, but we have togovern in the world we live in, not the world we
wish we live in.
Missouri Senator Ryan Silvey, R-Kansas City
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Medicaid Mother Lode
goldwaterinstitute.org
$65.6 Billion over 10 years! (Urban Institute)
$6.6 Billion (2013) x 3 (multiplier) = $19.8 Billion
A Whopping 1.3 % of Texas GDP ($1,532 Billion)
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H.L. Mencken
goldwaterinstitute.org
For people in the mass soon grow used to anything,
including even being swindled. There comes a time
when the patter of the quack becomes as natural
and as indubitable to their ears as the texts of
Holy Writ, and when that time comes it is a
dreadful job debamboozling them.
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Exploding Debt with States to Blame
goldwaterinstitute.org
State governments
received 32.8 percent
of their total generalrevenues from transfers
from the federal
government in the
2012 fiscal year.
Tax Foundation
34.3 percent of Texas
current all-funds biennial
appropriation is funded by
transfers from the federal
government.
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Why Not Expand Medicaid?
goldwaterinstitute.org
1. Our debt problem is bigger than our health care
payment problem.
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Exploding Health Care Share
goldwaterinstitute.org
How much more do we need?
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Health Care's Share of the U.S. Economy
Actual
If Med Inflation = CPI
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Exploding Health Care Prices
goldwaterinstitute.org
When we debate health care policy, we seem to
jump right to the issue of who should pay the bills,
blowing past what should be the first question:
Why exactly are the bills so high?
Unlike those of almost any other area we can
think of, the dynamics of the medical
marketplace seem to be such that the advance
of technology has made medical care more
expensive, not less.
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Third Party Payers in Health Care
goldwaterinstitute.org
0.8
1.3
1.8
2.3
10% 20% 30% 40% 50%
Ra
tio:MedicalPrices/Genera
lPrices
Share Health Expenditures Paid Out-of-Pocket
Medical Prices vs. the Share of Medical PaymentsOut-of-Pocket
19601966
1972
1986
Out-of-pocket share has fallen over time
Cost
has
risen
over
time
2006
Byron Schlomach, Removing the Middleman,
Goldwater Institute
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Why Not Expand Medicaid?
goldwaterinstitute.org
2. Third Party Payers (Government and Insurance) are
the Problem NOT the Solution
1. Our debt problem is bigger than our health care
payment problem.
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Medicaids Labor Impact
goldwaterinstitute.org
Garthwaite, Gross, and Notowidigdo, Public Health
Insurance, Labor Supply, and Employment Lock,http://ldi.upenn.edu/uploads/media_items/public-health-insurance-labor-supply-and-employment-
lock.original.pdf
Dague, DeLeire, Leininger, The Effect of Public Insurance
Coverage for Childless Adults on Labor Supply, NBER working paper,
http://www.nber.org/papers/w20111
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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goldwaterinstitute.org
Why Not Expand Medicaid?
1. Our debt problem is bigger than our health care
payment problem.
2. Third Party Payers (Government and Insurance) are
the Problem NOT the Solution
3. Medicaid has a negative effect on labor supply and GDP
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Are Hospitals Really In Need?
goldwaterinstitute.org
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All the Action is in Charity Care
goldwaterinstitute.org
Most Hospitals qualify people for charity care up to
200 percent of poverty
Medicaid Expansion only covers to 138 percent of
poverty
When hospitals claim large losses that Medicaidexpansion is supposed to help with, they usually include
Bad Debt
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Truth About Hospital Charity Care
goldwaterinstitute.org
Of total revenues, charity care represents
In Arizona: 2 percent of revenue
Memorial Hermann: 4 percent of revenue
0%
10%
20%
30%
40%50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
2009 2010 2011 2012
Baylor University Medical Center - Dallas:4 percent of revenue
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Non-profit Hospital Profits
goldwaterinstitute.org
Arkansas Hospitals Annual Average Profits 2007-2011
Arkansas Children's Hospital: $33,564,420
Baptist Medical Center: $16,430,648
St. Bernard's Medical Center: $9,259,227
Piney Ridge Center: $2,566,309White County Medical Center: $12,962,605
Washington Regional Hospital: $10,230,256
Arizona Hospitals 2011 Profits
Banner Health: $296,085,406
Casa Grand Regional: $6,740,705
Yavapai Regional: $30,795,934
Yuma Regional: $34,513,648
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Non-profit Hospital Profits
goldwaterinstitute.org
-$50,000,000
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
2008 2009 2010 2011 2012
Memorial Hermann's Profits
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
2008 2009 2010 2011 2012
Baylor Univ Med Ctrs Profits
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Non-Profit Hospital CEO Pay
goldwaterinstitute.org
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
2008 2009 2010 2011 2012
Annual Pay of Memorial Hermann's CEO
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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Plenty of Money to Lobby
goldwaterinstitute.org
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8/9/2019 Dr. Byron Schlomach - The ACA in Texas: Do Hospitals Need Medicaid Expansion?
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goldwaterinstitute.org
Why Not Expand Medicaid?
1. Our debt problem is bigger than our health care
payment problem.
2. Third Party Payers (Government and Insurance) are
the Problem NOT the Solution
3. Medicaid has a negative effect on labor supply and GDP
4. Hospitals dont need the money and theyre lying
about cost shifting
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Resources: Understanding Health Care
goldwaterinstitute.org
David Goldhill, How American Health Care Killed My Father, The Atlantic,
2009, http://www.theatlantic.com/magazine/archive/2009/09/how-
american-health-care-killed-my-father/307617/
Steve Brill, Bitter Pill: Why Medical Bills Are Killing Us, Time, 2013,http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDeman
dAndGreed.pdf
Byron Schlomach, Removing the Middleman, Goldwater Institute, 2009,
http://goldwaterinstitute.org/sites/default/files/Removing%20the%20Middlem
an.pdf
http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdfhttp://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdfhttp://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdfhttp://goldwaterinstitute.org/sites/default/files/Removing%20the%20Middleman.pdfhttp://goldwaterinstitute.org/sites/default/files/Removing%20the%20Middleman.pdfhttp://goldwaterinstitute.org/sites/default/files/Removing%20the%20Middleman.pdfhttp://goldwaterinstitute.org/sites/default/files/Removing%20the%20Middleman.pdfhttp://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdfhttp://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/