With the presidential election finally arriving, healthcare providers will know in about a week if the Affordable Care Act survives mostly intact or will either be repealed outright or chiseled away via the reconciliation process.
As I've said before, either is highly improbable. Polling data consistently shows the Democrats will hold a slim majority in the Senate after the elections. And every time a Todd Akin or a Richard Mourdock shares their quaint views on female reproductive rights with voters, their opponents breathe a little easier. Moreover, in this totally polarized environment, I doubt even a single blue dog Democrat would cross the aisle on this issue.
The ACA has been demonized with claims of it launching death panels or its GOP origins swiftly replaced with those of European socialism.
But there also have been far slyer attacks of the ACA. One of them is going on in Ohio. Republican Gov. John Kasich released an actuarial report earlier this month forecasting how many residents are expected to be added to the Medicaid rolls once its expands in 2014 as part of the ACA. The result was a little bit of a stunner: 400,000 lives, or nearly 4 percent of the state's entire population. In all, Kasich expects half of those who qualify for the new Medicaid guidelines to sign up.
However, that's at odds with actuarial reports in nearby Indiana and Michigan, as well as research performed by the Urban Institute and Michigan Center for Healthcare Research and Transformation. They project take-up rates of about 15 percent. If Ohio had similar rates, only about 120,000 people would be signing up.
Ohio isn't ginning up these numbers out of optimism; it is almost certainly doing so due to politics. At that projected enrollment rate, Kasich claims expanding Medicaid would cost taxpayers close to $1 billion a year, versus the few hundred million that might be at stake if the uptake estimates were closer to reality. And Kasich has upped his cost estimates considerably in the last year.
Those numbers really don't make a difference in Indiana or Michigan. Mitt Romney has a comfortable lead in the former, while President Barack Obama enjoys the same in the latter.
But Ohio is where the Electoral College vote will almost certainly be decided. Obama clings to a small lead in the polls--somewhere between two and three points, according to the polling data--and has held stubbornly for weeks now. With the clock running down, the GOP is using just about any tactic to reverse those numbers. They are therefore not past cooking some data on Medicaid to convince the electorate that the ACA is a pricey boondoggle--one from which their man will provide salvation.
Moreover, should Romney squeak through a victory, it could provide enough impetus for Republican governors such as Kasich not to expand Medicaid at all. Having inflated cost figures at hand would more than help his case.
Even though the entire structure of the ACA was created by Romney in Massachusetts, he has done everything in his power to disown it during this election campaign. His solution: Americans without insurance can get their healthcare in emergency rooms.
The problem is, someone still has to pay for those emergency rooms. The hospital operators that will be potentially left holding the bag need to speak up and try to correct the misinformation being peddled for data in the Buckeye State. - Ron (@FierceHealth)