Trying to understand the looming changes in our health care system and their impact on patients has been very difficult.

Hopes abound based off the promise of “affordable” care for all including “free” care for those who can’t afford any contribution toward their own care. Unfortunately, as in all other aspects of life, there is no “free lunch” in health care either.

The sad thing about the current system as laid out in The Patient Protection and Affordable Care Act, also known as “Obamacare,” is that before it gets started here in Mississippi it already apparently is underfunded.

I have gotten information from state legislators, hospital association representatives, the governor’s office, former Medicaid personnel and general news publications, and I am struck by the somewhat variable cost estimates of the approaching system we will have and also by the general consensus that: “It won’t work, but we have to do it anyway.”

First of all, Obamacare cuts out something known as Disproportionate Share Payments (DSH payments) to hospitals over the next few years under the premise that “everyone will be insured so the hospitals won’t need the money.” DSH payments are basically federal monies (our tax dollars) that hospitals receive each year to help offset some of the cost for the care of the currently uninsured patients.

Secondly, and bear with me now, we currently have approximately 400,000 people served by the Mississippi Medicaid system. Nearly $4.5 billion was spent on their care for the 2012 fiscal year. Under Obamacare, about half of the newly insured in our country will get their new insurance through an expanded Medicaid system by raising the income level a person can earn and still qualify for Medicaid to 133 percent of the federal poverty level.

This will add approximately 400,000 more people to our Medicaid rolls. Normally Medicaid is jointly funded by our state and federal taxes with Mississippi blessed to receive a generous 74 percent federal match to our 26 percent state taxpayer contribution.

However, to entice more participation, Obama has promised that for three years the feds will pay “100 percent” of the cost for the new Medicaid, but not the old Medicaid, patients. After three years taxpayers will gradually have to help fund the extra patients with 90 percent eventually still paid by our federal taxes and 10 percent from state tax collections.

According to Ed Sivac of The Mississippi Economic Policy Center, who spoke at a recent chamber of commerce event, the total extra federal taxpayer money to take care of just the extra 400,000 new Mississippi Medicaid patients will be $11 billion over seven years, and this will be matched by 1.6 billion state taxpayer money. That amounts to less than $2 billion per year to treat 400,000 new people while we are currently spending 4.5 billion to treat 400,000.

Our hospitals, which average approximately 30 percent of their money from Medicaid, our nursing homes, pharmacists, doctors, home health nurses, DME companies, etc., who are paid by Medicaid will either not get paid adequately or will have to curtail services.

The usual political response is either that they don’t expect everyone who is eligible to actually sign up, or that the new Medicaid recipients will be healthier people and won’t use the health care system, or that our new health care system will be so efficient that it won’t cost as much to care for the patients.

If these numbers are true, we are all in trouble. Changes will occur in the delivery of health care in our country.

Costs are rising faster than inflation, and we have to care for the truly needy. But we have to do it in a way that does not ruin the care that most have been comfortable with and without bankrupting our country. Perhaps programs like the one in Indiana, which has resulted in savings but in a way apparently tolerable to over 90 percent of those in the program, would be a way to go.

It seems to offer choices of different levels of insurance with state contributions to health savings accounts that are controlled by the patients who are then able to control their own health care decisions and expenses. The vast majority of Americans could handle such empowerment. We voters aren’t as stupid as the president and his technocrats think we are.

Dr. Kenneth Stubbs

Concordia parish resident and Natchez internist