The well-known inscription on the statue of liberty reads:  ”Give me your  tired your poor, Your huddled masses yearning to breath free….”  Somewhere along the way, many of those coming to the U.S., rather than seek freedom, are seeking the best benefit package-the handouts.     Just as the massive handouts in the U.S. serve as a magnet for freeloaders, is it crazy to think that individual states, having embraced Obamacare and its Medicaid expansion, may see the same sort of migration of folks to their states, seeking their imaginary “right” to health care from those states that have essentially declared that such a “right” exists.

One of the justifications for the expansion of Medicaid by the statists and crony healthcare capitalists is that tax dollars collected in a state that has refused the Obamacare Medicaid expansion, will be used to subsidize and pay for Medicaid patients in other states that have embraced Obamacare and the Medicaid expansion.  Using this argument, I think that it would be appropriate for governors in states that have rejected the Medicaid expansion to consider the mobilization of an army of school buses and send those who are supposedly left “without coverage,” for the care they would supposedly and otherwise be denied, to the states accepting the “free” federal money for their care.  Let these folks exercise their “right” to health care in states who believe in this “right.”  Obamacare states are getting paid for this care anyway, aren’t they?  These patients would be spared the bankrupting, “charge-master” billing rates of the big hospitals, as well.

The big hospitals are pushing for this Medicaid expansion, just as you would expect.  After all, it consists of providing poor folks with a credit card to be used at their hospital, the ultimate bill for which goes to the taxpayers.  Medicaid patients, those with the most moral hazard, will have the most medical credit.  This is a recipe for even more gross profits by the big hospitals and that is why they are lobbying so hard for it, bashing governors who have refused to smoke this crack and rewarding governors who have succumbed.  How about calling their bluff?  Send otherwise eligible Medicaid patients to states embracing expansion for their care while simultaneously mitigating the burden of these folks on the poor hospitals in states rejecting the expansion.  

This could be a whole new industry of Medicaid medical tourism.  Governors that have embraced Obamacare wouldn’t really have anything to say about it, as they are supposedly the beneficiaries of Medicaid funds from states rejecting the expansion, money that doesn’t belong to them anyway.  Governors of states packing the buses would be helping out the poor hospitals in their own states who just can’t bear any more non-Medicaid poor patients without going broke.  Forgive my sarcasm.

Think this could work?  You think it sounds crass?  Patients are travelling from Canada and the outskirts of the U.S. to take advantage of our pricing, escaping the areas of the country where price fixing by the medical cartel is ironclad.  Those states that have rejected the exchanges and Medicaid expansion could “ship em out” to the states that think this expansion is a good idea, getting patients to where the money is supposedly going to go for their care, anyway.  Paying for patient travel would be better for a state’s budget than paying for care, no?

What would happen?  The first thing you would hear would be the howls of the big hospital bunch.  We would hear about why forced busing is a bad idea.  That would be a public relations disaster, I think.  We would hear that “Oklahoma should take care of their own,” an argument for federalism and state’s rights that could backfire on these cronies and other statists.  What you wouldn’t hear is a sigh of relief that these hospitals no longer have to shoulder the burden of the health needs of the non-Medicaid poor.  Don’t forget-they get paid even when they don’t get paid through the uncompensated care scam, sticking the taxpayers with a bill for the difference between what they bill and what they collect and bankrupting this patient group with their “charge-master” bills.   

Advocating Medicaid medical tourism would expose their propaganda and lies, wouldn’t it?  What the hospitals really want and can’t bear the thought of is losing out on this new gravy train, this new era of  ”coverage for everyone,” an era that will be ripe for the up-coding fraud-masters that tend to infect the Medicaid world, the big hospitals being the largest offenders.  

None of this, of course, will ever happen.  But I think it’s instructive to think about what calling their bluff would look like.

G. Keith Smith, M.D.