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)

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