The disastrous Medicaid Expansion – an update

My original comments yesterday are here. In this post I’ll add some additional information – new data, but no new conclusions, just more confirmation of the harm the ObamaCare Medicaid Expansion has caused.

For background, please read Fact check: ObamaCare does hurt our neediest neighbors. The take-away there is that for traditional Medicaid the states are reimbursed by the Feds at 55% and the Expansion at 100% originally, now 95% this year. So if a state is running out of money, which program do you think it would cut? You don’t need to be familiar with public-choice theory to know that government takes care of itself first. My last post shows that the truly needy were left out in Ohio, despite the Governor’s preening moralism.

More from Ohio. As of May 2017 it had added more than 725,000 able-bodied, childless, and working-age people to the state’s Medicaid Expansion rolls. The budget called for no more than 450,000 enrollees. Expenditures are now nearly $7 billion over budget. All this at a cost of more than 34,000 ABD (aged, blind, or disabled) who no longer qualify under guidelines revised to cope with fiscal pressures. Ohio’s response to the crisis is to stop enrolling new people into the Expansion as of May 2018. Until then, of course, things will continue to get worse and more ABD will suffer. The cynical Democrats who crafted ObamaCare callously wanted to get as far to “single-payer” as they could, the cost in human suffering and death be damned.

In Arkansas things are no different. In early 2015 when the New Republican governor, Asa Hutchinson, took office following the Democrat who allowed Medicaid Expansion, Expansion rolls stood at 250,000. Barely two years later they stand at a budget-busting 325,000. Nearly half of the able-bodied, working-age, childless enrollees do not work. It appears that Arkansas will adopt a work requirement, but freezing new Expansion enrollment has failed in the state Senate. More details here.

Finally a few of the ‘moderate’ Democrats in the Senate are defending their support of the Expansion by dissembling that it helps curb the opioid epidemic. Skeptics will note that free access to prescribed opioids is not always helpful. According to the executive director of Physicians Responsible for Opioid Prescribing, “overprescribing of opioids is fueling the epidemic.” No surprise that Ohio is facing a huge increase in opioid deaths. “The CDC’s own study of Washington State showed that a person on Medicaid was 5.7 times more likely to die an opioid-related death than someone not on Medicaid.” (Sources of quotations here.)    

Troglo (L. H. Kevil)

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Republican ‘health care’ proposals: the addiction stumbling block

This addiction, found in voters and politicians alike, is not medical, but still a critical public health issue. The addicts are not harmed, but the malady is transferred to the public. The Patient Protection and Affordable Care Act was deliberately designed to be nearly irrevocable. Feeding the addiction for free money is one of the hooks making repeal nearly impossible. The dependence of state politicians on Federal Medicaid money is the real question upon which turns the Senate debate.

The diabolical construction of Medicaid Expansion has created the most difficult stumbling block. Medicaid was originally designed to help the truly poor with children, not able-bodied adults with no dependents. To induce the states to consent to Medicaid Expansion the Federal government like a pusher offered to pay the states three to ten times more per person than for traditional Medicaid recipients. Thus the rush to accept this ’free money,’ risking financial peril a few years thence, since the states were then obligated to pay an increasing share of the bill. The problem is that even states with Republican governors accepted expansion. More than 80% of the national net increase in ObamaCare health insurance enrollment resulted from Medicaid Expansion. This Federal commitment unfortunately is an open-ended entitlement, encouraging the states to entrap as many people as possible and increasing the Federal deficit. The current House and Senate proposals would limit Federal money through various means, bringing the era of increasing free money to a gradual decline at some future point. However, the politics are such that limiting the growth is considered a cut. There are of course no actual cuts in any current proposal.

The Congressional and Senatorial representatives of most profligate and addicted states are now screaming bloody murder for relief from their states’ own greedy errors. As states face increasing financial pinches, new Medicaid enrollments have to stop or be slowed down. This means that the truly poor who qualify for traditional Medicaid are blocked out because so many able-bodied just above the poverty line and without children were let in. Good intentions are no excuse, given government’s inability to avoid disastrous unintended (but foreseeable) consequences and unwillingness to shut off the public teat to those who do not truly need it. (Witness the enormous growth in disability under Obama.) In the meantime the states that wisely refused Medicaid Expansion are in the position of having to share financially in the bailing out of the states that did.

Ohio provides a great object lesson. After accepting Medicaid Expansion the state’s share of Medicaid costs has been running 143% over budget. Consequently nearly 60,000 poor who qualify for traditional Medicaid have been put on a waiting list. Early estimates were that Medicaid Expansion would lead to 365,000 new enrollments. The actual number was 650, 000 leading to $2.7 billion in cost overruns in two years. (Ohioans like free money too.) Thus Senator Portman and the insufferable governor Kasich are screaming for more Federal money from the ‘repeal,’ since the able-bodied newly on Medicaid, just as addicted to government money as they are, would react in a ballot-unfriendly way if their Medicaid benefits were reduced or stopped. Republican Governor Kasich self-righteously bullied Ohio into accepting Medicare Expansion as a moral imperative, claiming he would get credit for helping the poor “when I get to the pearly gates.” But the morality play here is different: Kasich has hurt the truly poor to benefit the able-bodied, not to speak of the state generally. Ohio for example is financially unable to offer clinical services to opioid addicts. I remind the pious Governor of the moral imperative found in 2 Thessalonians 3:1 and 3: 10-11.    

Troglo (L. H. Kevil)