We need return to Obamacare's original intent

In playing with political footballs, the details of the game tend to get confused, unless you slow things down and watch the replay. The newest version of trying to get health coverage for Utah's working poor, UtahAccess+, is just such a football. So here are a few clarifying points (so far left unsaid) about the winners and the losers in this life-and-death game.

As new federal money floods into Utah, the biggest winner will be the commercial insurance industry. Most of the new money will flow through the industry's hands and it will get to skim up to 20 percent off the top for administrative costs (as opposed to the 2 percent administrative costs of our state's current Medicaid program). Nice deal for the insurers, and they are not on the list of those who are being "asked" to give back.

The second winner in this plan is the Legislature's general fund. Essentially all the federal money that comes here will be spent on either wages or consumable goods (almost none for infrastructure). The state gets 5 cents income tax on every dollar spent on wages and 4.7 cents sales tax on every dollar spent on goods. Then every dollar spent in the state gets re-spent in our communities, and thus will generate another round of income taxes and sales taxes. The churning continues until those dollars get spent out of state. This tax windfall would be enough to defray the entire cost of this expansion, but these funds are also not on the list to fund the expansion. I would like to believe that this free money would finally fund our schools, but I suspect it will be earmarked for harassing the Bureau of Land Management or chasing those pesky wolves.

The third winners in this plan are the bottom-dweller minimum- wage employers (often deified as job "creators"), who get the benefit of healthier, more productive employees but again are "asked" neither to contribute to this plan nor to insure their own employees.

And, of course, the next big winner is all of us. Our community will be healthier, there will be less cost-shifting, less bankruptcy and fewer families devastated by the capriciousness of illness or injury. This is a clear benefit to all the citizens of our state.

The obvious big losers are the many small medical businesses (physicians, therapists, even optometrists) who get to pay this new business tax. As a pediatrician for 32 years, I have always served Medicaid children at a loss. The Medicaid payment has mostly been less than my overhead costs, less than it actually costs me to see these patients. I and other physicians in our state provided this care essentially for free because these people deserved that care. Our Legislature underfunded this promise to our citizens, just as it underfunds education. Despite the new tax, and the fact that all the new money will go for adult care, I will continue to care for Medicaid children.

I strongly suggest we get back to the intent of the Affordable Care Act. The funds should be sufficient to fully expand Medicaid according to the original federal plan if we quit siphoning off money to prop up our greedy insurance industry and we quit playing football with our citizens' health. This can be, and should be, a win for all.

William Cosgrove is president of the Utah chapter of the American Academy of Pediatrics.