Hospital associations need to get tough on Medicaid expansion

Medicare was denounced as a billion-dollar boondoggle when President Lyndon Johnson pulled everything out of his bag of bare-knuckled tricks to get it through Congress nearly 50 years ago.

Johnson, nicknamed "Rufus Cornpone" by Kennedy administration insiders, could run his elbows through a knife-sharpener and fight on his own terms with the those stubborn good ol' boys who thought Medicare and Communism were one and the same.

President Barack Obama cannot afford to act like Johnson even for a nanosecond. That is why the intransigence regarding the potential trillion-dollar boondoggle otherwise known as the Affordable Care Act continues to linger. That is why so many of the Red states are refusing to participate in the exchanges and expand Medicaid. Given Arizona didn't deign to offer Medicaid coverage until 1978, it could be years, if ever, before all the states fall in line.

All those hard-headed governors say their concerns are purely fiscal, but the position they are taking is remarkably short-sighted and cruel. It could prevent millions of Americans from obtaining healthcare coverage. Multiple studies link life expectancies to access to health insurance such as Medicaid. That means that a larger proportion of those states' populations may die for purely political reasons.

Meanwhile, a new study by the Urban Institute and Kaiser Family Foundation concludes that the states could save $18 billion in uncompensated care costs with Medicaid expansion. Most of those uncompensated care costs are going to hit hospitals, which will be forced to treat patients who might otherwise have coverage if they were treated just over the border.

Unlike Obama, trade groups can afford to play tough when they feel it's the right thing for their constituents. Witness the Illinois Hospital Association, which didn't hesitate to run radio ads suggesting kiddies would be turned away from emergency rooms if a tax and charity care bill entirely favorable to them wasn't passed by the Legislature.

Now it is the time for state hospital associations to use similar tactics in those Red states where the governor or the Legislature refuses to budge. Here are some suggestions on how to best proceed:

1. The "death clock." Using a combination of studies that cite higher death rates for those without insurance, census data and levels of uninsured for each state, each hospital association should be able to calculate how many residents of their state are likely to die because of their inability to access Medicaid. This number can then be posted on their websites and updated daily ("This many people died in XXX today due to its lack of participation in the ACA. So far, XXX residents have died this year"). As a matter of face, this data can be superimposed on portraits of the more intransigent governors. For someone like Alabama Gov. Robert Bentley, it would even represent an aesthetic improvement.

2. Gather and disseminate testimonials. The state associations often do a yeoman job gathering video of clinicians and administrators or ghostwriting op-eds in their names when it comes to issues they feel so passionately about, such as fighting nurses' unions or commercial health plans. Now it's time to send those camera crews and scribes out to find individuals whose health and finances are being destroyed by not being able to obtain insurance. Their testimonials can then be placed on their websites, or submitted for publication in regional newspapers. It shouldn't be too hard to find these people, as they will likely be waiting patiently in emergency rooms.

3. Let the lawmakers know where your PAC dollars are going. Virtually every hospital association has a political action committee fund. In some of the larger states, such as California, it raises more than $1 million a year. If Indiana Gov. Mike Pence found out $150,000 was being thrown into the campaigns of his political opponents, it might actually give him pause for a second.

Of course, my suggestions may be dismissed as hard-headed and mean-spirited themselves. But keep this in mind: During the 1964 election campaign, President Johnson didn't hesitate to run a commercial suggesting Barry Goldwater would drop a nuclear bomb on little children were he in the White House. Johnson won in a landslide. Medicare was enacted the following year.

Given that program has become the financial lifeline for most hospitals in this country, perhaps its time to dust off the Johnson playbook and get ultra tough. History suggests it works. - Ron (@FierceHealth)