ACA hospitals and doctors part MMMMMMCCCLXXXV

Here Matt Yglesias runs into my ACA squeezes hospitals nursing homes and home health are agencies obsession and I comment (againnnnnnn)

Oh I note the URL http://www.slate.com/blogs/moneybox/2012/08/24/obama_s_medicare_cuts_they_don_t_slash_benefits_but_may_hurt_beneficiaries.html#article_co
doesn't correspond to the current title

Cutting Medicare Provider Payments Will Probably Hurt Some Patients

One will probably be embarrassed more often if one writes "Will Probably" instead of "May." and one may even regret it. "Might" makes right.  Be gay write "May." (in the sense of cheerful and worry free not that there's anything wrong with it).

OK my comment.

I kinda sorta semi disagree.  I mean I agree that "nothing to worry about" is implausible (never say "never" and most claims including "nothing" are worth approximately that).

But your discussion overlooks a key difference between the Medicaid stinginess which hurts the poor and the ACA stinginess.  the ACA squeezes hospitals nursing homes and home health care agencies not doctors with office practices.

I think this distinction is fundamental.  The argument that squeezing providers will hurt patients always includes the key word "doctor" which means office practices (which means Medicare plan B not Medicare plan A).  The ACA totally absurd forecast of labor productivity growth equal to that of the economy in general (which is really just a way to say we will squeeze you) applies only to plan A not plan B.

So the question I asked myself is are there any hospitals who refuse to see Medicaid patients (note this means they get no money for taking care of Medicare patients either -- the deal the CMS offers is take all of them or leave all of the cash with us).  I googled for about half an hour and found nothing (except a decade old claim about an un-named hospital somewhere in I would guess Rochester NY).
I will link only to my google self search because I have made this claim so many times http://bit.ly/SybVmC

Basically even if silly accounting (which distributes sunk costs over procedures) says hospitals will lose money taking care of Medicare patients, they won't be able to turn them alll away without laying off half of their staff, selling half of their equipment and renting out half of their rooms as apartments.  In contrast the decision to sink costs (build new hospitals and wings of hospitals) depends on overall returns where the Medicare cuts are balanced by the reduction is losses from care of the uninsured.

Also hospitals have to provide emergency care.  If an elderly person shows up in  non-Medicare participating hospital's emergency room, he or she can't be released until he or she is stabilized.  Then he or she can't be billed.   If Mitt Romney shows up with an emergency in the emergency room of a hospital which doesn't participate in Medicare, that hospital would have to give him care for free (no matter how little he likes that).

And nursing homes come on, they get most of their income from the CMS.  They aren't refusing Medicaid patients.

I think the ACA was written with full consideration of the doctors not taking Medicaid patients problem and designed so that it would lead to almost no refusals to see Medicare/aid patients.  If there are any, they will be the very top hospitals without active emergency rooms who can fill their beds with patients with private insurance (as in the Mayo Clinic, Stanford U Medical center and *not* the MGH or Johns Hopkins).