By J.D. Davidson, director of the Center for Health Care
Policy at the Texas Public Policy Foundation in Austin, TX., via NRO
* * *
To many state officials, the feds’ contribution...
* THE FEDERAL GOVERNMENT "CONTRIBUTES" ONLY
WHAT THEY TAX OR BORROW... GET THAT THROUGH YOUR HEADS...
...to Medicaid looks too good to turn down. It isn’t.
* IT SHOULDN'T BE... BUT POLITICIANS BEING SCUMBAGS...
WE'LL SEE...
In the wake of Louisiana governor John Bel Edwards’...
* A DEMOCRAT, OF COURSE...
...announcement last week that his state would expand
Medicaid under ObamaCare, the White House rolled out a new scheme to persuade
the 19 states that are still holding out to fall into line and expand their
programs: throw more money at them.
The offer, which Obama will include as a legislative
proposal in his 2017 budget, is that any state that expands Medicaid will get
the first three years of expansion free — paid for entirely by the federal
government.
* YEAH... (*SNORT*)... "FREE..."
(*JUST SHAKING MY HEAD*)
As written, the law says that Medicaid expansion in a
given state will be paid by the feds...
* AGAIN... WHERE DO "THE FEDS" GET
"THEIR" MONEY FROM? Hmm?
...for the first three years, beginning in 2014, and
after that the state gradually picks up an increasing share of the tab until by
2020 the federal government will be paying "only" 90%.
* "ONLY 90%..."
* Er... AND PUTTING ASIDE THE FEDERAL
"CONTRIBUTION" AND WHERE THAT MONEY COMES FROM... WHERE EXACTLY ARE
THE STATES SUPPOSED TO GET "THEIR" 10% FROM?
* Hmm... I WONDER... WOULD A BUMPER STICKER READING
"THE ONLY GOOD POLITICIAN IS A DEAD POLITICIAN" PASS LEGAL MUSTER?
(*PONDERING*)
Obama is proposing to extend the three years of full
federal funding to states regardless of when they expand, which means those 19
non-expansion states are still eligible for 100% federal funding should they
follow Louisiana’s lead. The purpose of this little twist on the Medicaid
expansion deal is to give President Obama a fighting chance to claim victory
for his otherwise failing healthcare law. Full federal funding for three years
would mean potentially billions of federal taxpayer dollars for holdout states
like Texas and Florida, where large numbers of poor, uninsured adults enrolling
in Medicaid would mean a revenue windfall for Medicaid providers and
managed-care organizations. Those special interests, the White House no doubt
realizes, will now redouble their efforts to persuade state lawmakers and
governors to cave.
But these state officials should resist the temptation,
for at least three reasons:
First and most obvious is that expansion states have all
experienced the same thing - more people signed up than expected, and it blew a
hole in the states’ budgets.
Jonathan Ingram and Nicholas Horton of the Foundation for
Government Accountability studied this trend and found that expansion states
routinely underestimated the number of people who would sign up in 2014, such
that after one year of expansion, “several states have already seen more adults
sign up for Medicaid welfare than they thought would ever sign up or even be
eligible.” The numbers are staggering. In Colorado, officials thought only
61,000 people would sign up in FY 2014, and an additional 100,000 by the end of
FY 2015. But by March more than 210,000 people had already enrolled, and the
total was more than 307,000 by year’s end. To varying degrees, the same thing
happened in Arkansas, California — where 2 million enrolled in 2014, nearly
three times what was projected — Illinois, Kentucky, Michigan, Ohio,
Washington, West Virginia, and every other expansion state. Those extra
enrollees cost states money, even with 100% federal funding, because many of
them were “previously eligible,” meaning they aren’t part of the Medicaid
expansion group and states must pay for about 43%, on average, of the cost of
covering them. That works out to billions of state tax dollars.
* IF YOU'RE STILL READING... PAT YOURSELF ON THE BACK. I
KNOW THAT THE VAST MAJORITY OF AMERICANS ARE TOO DAMNED LAZY AND IRRESPONSIBLE
TO PUT THE TIME INTO EDUCATING THEMSELVES, EVEN WHEN I SPOON-FEED IT TO THEM
FROM A SILVER PLATTER.
In Ohio, the Medicaid program went $1.5 billion over
budget in the first 18 months.
In Illinois, $800 million.
In Kentucky, $1.8 billion.
Washington State increased its biennial budget by $2.3
billion just to deal with expansion costs.
(*SIGH*)
The second reason is that there’s no such thing as “free”
federal dollars.
* YA THINK...?!?!
The money comes with conditions, which effectively shifts
policymaking from the receiving state’s legislature and governor to a distant
federal bureaucracy (in this case, the Centers for Medicare & Medicaid
Services), which dictates how states must spend federal Medicaid funds.
The so-called “cooperative federalism” scheme under which
programs like Medicaid operate is designed for one purpose: to transfer as much
federal funding to states as possible in order to impose uncompetitive liberal
policies in those states.
Medicaid now soaks up about a quarter of most state
budgets, and any increase in total Medicaid expenditures will increase that
share, making state governments even more in thrall to federal bureaucrats.
(*PURSED LIPS*)
The third reason is less abstract: Medicaid will harm
those it’s meant to help.
Often lost in the expansion debate is that Medicaid is
the worst form of health coverage in the country. The people who were enrolled
in Medicaid prior to the Affordable Care Act had — and still have — a hard time
finding doctors who will accept it because it pays far less than either
Medicare or private insurance. Nothing in ObamaCare addressed this problem,
aside from a temporary boost in federal reimbursement rates for primary-care
physicians, which expired in 2014 — leaving states with the choice of letting
rates slip back to pre-ObamaCare levels or maintaining them with state funds.
Not being able to find a doctor when you need one is no
small thing. That’s one reason Medicaid patients use the emergency room more
than the uninsured or those on private insurance. But an ER visit is no
substitute for a “medical home” and a doctor who can help manage a chronic
condition and prevent hospitalization. There’s a reason why Medicaid patients
are more likely to die after surgery than any other group, including the
uninsured: namely, that they don’t have access to routine and preventive care.
There’s a difference between coverage and care...
* AND THE STUPID... STUPID... STUPID SHEEPLE... INCLUDING
MOST COLLEGE-EDUCATED SHEEPLE... JUST CAN'T WRAP THEIR SUB-PAR MINDS AROUND
THIS SIMPLE TRUTH AND ACCEPT IT AS SUCH!
(*TAKING MY BLOOD PRESSURE PILL*)
...and although enrollment in Medicaid technically means
a person is “covered,” something the Obama administration never tires of
bragging about, it doesn’t mean he’ll be able to get health care when he needs
it.
* YEP...!
Expansion will make this problem worse. Enrolling every
person with a household income of less than 133% of the federal poverty level
(about $32,000 for a family of four) in a health-insurance program originally
designed to cover specific groups like the indigent elderly, poor pregnant
women and their infant children, and the disabled is a radical change to
Medicaid. It means covering a huge group of people — for the most part, non-disabled
and childless adults — that Medicaid simply wasn’t designed to cover.
The ObamaCare mandate to expand the program or lose all
federal funds was so extreme that the Supreme Court in 2012 struck down that
part of the law. The expansion, the Court ruled, amounted to the creation of an
entirely new program to which the states never agreed when they decided to
participate in Medicaid. Forcing them to expand therefore amounted to coercion
— “a gun to the head,” in Chief Justice John Roberts’s memorable phrase.
Flooding Medicaid with this new group will mean more
patients competing for too few providers. It will be even harder for those
previously enrolled to find a doctor.
* YOU DON'T THINK OBAMA KNOWS THIS? YOU DON'T THINK THE
DEMOCRATS IN THE HOUSE AND SENATE KNOW THIS? THEY'RE CORRUPT AND VENAL -
THEY'RE NOT IDIOTS! FOLKS... THEY KNOW THEY'RE DESTROYING THE SYSTEM! THAT'S
THEIR GOAL! DESTROY IT AND REMAKE IT AS A FULLY SOCIALIZE MEDICINE SYSTEM!
CREATE A CRISIS... AND THEN EXPLOIT THAT CRISIS!
And next year, when states must begin paying for part of
the expansion population, the law’s perverse incentives will come into play.
States on average receive about $1.32 for every dollar
they spend on a traditional, pre-ACA Medicaid patient. But the expansion
population, from a state’s perspective, offers a much better deal: For every
dollar it spends on an expansion patient next year, it will get $19 from the
feds. When it comes time, as it surely will, to make cuts to Medicaid, where do
you think state lawmakers will look first?
Because expansion promises an initial flood of federal
dollars into a state’s budget, it might turn out to be an offer state lawmakers
and governors won’t refuse. But they can and should refuse if they care at all
about their states’ long-term fiscal health and, more importantly, the health
of their current Medicaid patients.
* I'M NOT HOLDING MY BREATH...
* SERIOUSLY... THOSE OF YOU WHO READ THIS PIECE TO THE
END... GOOD JOB! YOUR FELLOW CITIZENS ARE MOSTLY... MORONS. YOU'RE NOT!
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