Tag: Barack Obama

Roy: “The Arkansas-Obamacare Medicaid Deal: Far Less Than It First Appeared”

At Forbes.com’s Apothecary blog, the Manhattan Institute’s Avik Roy is cool to the idea of states implementing ObamaCare’s Medicaid expansion by putting those new enrollees in ObamaCare’s health insurance “exchanges”: 

When Arkansas Gov. Mike Beebe (D.) first announced that he had reached a deal with the Obama administration to use the Affordable Care Act’s private insurance exchanges to expand coverage to poor Arkansans, it seemed like an important, and potentially transformative, development. The myriad ways in which the traditional Medicaid program harms the poor have been well-documented, and it looked like Beebe had come up with an attractive—albeit expensive—way to provide the poor with higher-quality private insurance. A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It’s now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along.

The first reason states should not pursue the Beebe plan is that, like a straight Medicaid expansion, it would inhibit the pursuit of low-cost health care for the poor. 

The second reason is that it would cost even more than putting those new enrollees in the traditional Medicaid program. Economist Jagadeesh Gokhale, who advises the Social Security program on how to make these sorts of projections, estimates a straight Medicaid expansion would cost Florida, Illinois, and Texas about $20 billion in the first 10 years. And that’s in the wildly unrealistic event that the feds honor their committment to cover 90 percent of the cost. President Obama has already proposed abandoning that committment. Congressional Budget Office projections suggest the “Beebe plan” would increase the cost of the expansion by 50 percent. That too should be enough reason to reject the Beebe plan. Neither the state nor the federal government have the money to expand Medicaid at all. Volunteering to make the expansion even more expensive is lunacy. 

The Beebe administration is trying to make its plan seem no more expensive than a straight Medicaid expansion. How? By simply assuming state officials would voluntarily make a straight Medicaid expansion so expensive that the Beebe plan wouldn’t cost a penny extra. The illogic goes like this. If Arkansas were to expand traditional Medicaid, the state would likely need to increase Medicaid payments to doctors and hospitals in order to secure adequate access to care for new enrollees. That would make a straight Medicaid expansion so expensive that the Beebe plan would be no more costly, and might even cost less. 

It’s true, states that implement ObamaCare’s Medicaid expansion would have to increase provider payments to give new eligibles decent access to care. The problem is that Medicaid never does that. Medicaid is notorious for paying providers so little that it access to care is lousy. Medicaid does so year after year, even if people sometimes die as a result. The Beebe administration simply assumed that state officials would magically change such behavior, increase Medicaid’s provider payments to the same levels private insurers pay, and thereby volunteer to make an already-expensive Medicaid expansion even more unaffordable. In that fantasy world, the Beebe plan would be no more expensive. As an indication of how implausible that assumption is, no one had been talking about combining a straight Medicaid expansion with higher provider payments until the Beebe administration needed to make the governor’s plan seem slightly less unaffordable. 

Roy has soured on Beebe-style plans since reading some of the terms and conditions the Obama administration issued on Friday. Yet he still imagines there might be free-market-friendly ways to implement a massive expansion of the entitlement state. Thus he counsels states only to expand Medicaid in exchange for real reforms. We’ve heard that song and dance before. Republicans said the State Children’s Health Insurance Program and Medicare Part D – two Republican initiatives – would lead to Medicaid and Medicare reform. Instead, government got bigger and reform went nowhere. Lucy is going to pull the football here, too. If it is Medicaid reform you seek, the only free-market Medicaid reforms are Medicaid cuts. Roy’s criticisms of the Beebe plan are welcome, though it’s odd to find him to the left of officials in the 15 or more states that are flatly rejecting the expansion.

Cato Responds to the State of the Union 2013

Cato Institute scholars Michael Tanner, Julian Sanchez, Alex NowrastehSimon Lester, John Samples, Pat Michaels, Jagadeesh Gokhale, Michael F. Cannon, Jim Harper, Malou Innocent, Juan Carlos Hidalgo, Ilya Shapiro, Trevor Burrus and Neal McCluskey respond to President Obama’s 2013 State of the Union Address.

Video produced by Caleb O. Brown, Austin Bragg and Lester Romero.

Sunlight Before Signing in Obama’s First Term

Sunlight Before Signing” was President Obama’s 2008 campaign promise to put all bills Congress sent him online for five days before signing them. It was a measurable promise that I’ve monitored here since the beginning of his first term, and I will continue to do so in his second.

It was the president’s first broken promise, and in the first year he broke it again with almost every new law, giving just six of the first 124 bills he signed the exposure he promised.

With his first term concluded last month, we can now assess how well the president did with Sunlight Before Signing. Compliance with the promise got better, but it’s still not great. The president gave 413 of 665 bills five days of public review (and one he acceptably did not give five days due to emergency).

The easy bills almost always got five days review—few bills to rename post offices haven’t gotten sunlight. But more important bills often didn’t. Recent examples are the controversial FISA Amendments Act Reauthorization and the “fiscal cliff” bill.

  Number of Bills Emergency Bills Bills Posted Five Days %
2009 124 0 6 4.8%
2010 258 1 186 72.4%
2011 90 0 55 61.1%
2012 193 0 166 86.0%
Overall 665 1 413 62.3%

Would five days of public review have magically produced transparent government? Of course not. But imagine if the president had implemented and enforced his five-day promise from the beginning, and with every law.

Prez to Double Down on pre-Kindergarten Flop?

According to the latest buzz, President Obama may suggest dramatically expanding federal government preschool programs in his State of the Union address next week. That, at any rate, is the recommendation of a new report from an institute closely associated with the admnistration.

There are just two problems with this plan: 1) it’s already been tried; 2) it doesn’t work.

We now have 45 years of experience with, and two top-quality randomized studies of, the national Head Start pre-school program, and the results are disappointing. Head Start was meant to close the gap in student achievement between the children of advantaged and disadvantaged families. But, at the end of high school, the gap in achievement between the children of college graduates and those of high school dropouts has remained essentially unchanged since the program was introduced. We have even more direct evidence from two large national studies of the program commissioned by the very agency that administers it: the Department of Health and Human Services. These studies find no significant benefits to Head Start at the end of the third grade–or even at the end of the first.

So why double-down on a failed program? The most plausible (and charitable) explanation is a bad case of wishful thinking. Many people make the mistake of improperly generalizing from two or three tiny pre-school programs of earlier decades which did show some lasting benefits. Sadly the federal government’s nationwide Head Start program has not replicated those benefits despite generations of unrelenting effort. And there is no reason to imagine that it will suddenly start doing so if expanded even further.

Trying to fix failed federal preschool programs by dumping more money on them is like trying to make up per-unit losses by increasing sales volume. Sadly, that’s about the level of economic acumen demonstrated by recent administrations.

Drug Warriors Wrong on Marijuana Ballot Initiatives

Three states’ ballot initiatives might legalize the recreational use of marijuana this year. To the displeasure of some current and former drug warriors, the Obama Department of Justice is silent on the matter.

Those urging the feds to weigh in, unfortunately, rest their case on some bad reasoning:

But their claim is just not true. Here’s why. Let’s say the feds have a law banning the use of sugar in iced tea. An example of a state law that conflicts with this federal law would be one that requires the use of sugar in iced tea, not a state law that simply permits the use of sugar. A failure to adopt a law that prohibits the same thing the feds prohibit is simply not a conflict.

Another reason the Justice Department may be silent on these state ballot initiatives? President Obama is less popular nationwide than marijuana legalization.

In today’s Cato Daily Podcast, Tim Lynch goes through some of the other reasons why these drug warriors are confused on the facts.

Obama, Romney Avoiding a Serious Discussion on China

Mitt Romney attempted to refine his foreign policy platform in a speech at the Virginia Military Institute on Monday, but he was again long on rhetoric and short on strategy. What passed for substance in the speech was largely focused on the Middle East. Predictably, most of the reactions to the speech also focused on the Middle East, mainly President Obama’s policy toward Iran’s nuclear program and his response to the attack on the U.S. consulate in Benghazi, Libya, last month.

Notably absent from the media coverage and the speech itself was China. In fact, Romney mentioned China only once. This is discouraging since the U.S.-China relationship will likely be the most important foreign policy issue over the next few decades.

In today’s Cato Podcast, Justin Logan, director of foreign policy studies, discusses America’s China policy and the presidential candidates’ lack of focus on the issue. Obama and Romney have each spent time demagoguing China on their currency and other trade issues. But this political rhetoric has been at the expense of any serious effort to discuss at length how the candidates disagree when it comes to the U.S.-China relationship. Instead, the foreign-policy debate has centered on the greater Middle East, where U.S. interests are much smaller. The candidates exemplify a bipartisan obsession with the Middle East when in large part the consequential issues that the United States will face in the years to come will be much further to the east.

‘I Haven’t Raised Taxes’

Why am I only hearing about President Obama’s gob-smacking “I haven’t raised taxes” claim today, and from Reason?

On CBS News’s “60 Minutes” Sunday night, President Obama said, “Taxes are lower on families than they’ve been probably in the last 50 years. So I haven’t raised taxes.”

As of Monday morning, neither the Washington Post’s Pinocchio-awarding Fact-Checker, nor the Annenberg Public Policy Center’s FactCheck.org, nor the Tampa Bay Times’ Pulitzer-Prize-winning Politifact.com had risen to this opportunity…

Unbelievable. I just checked those websites, and they still haven’t.

Fortunately, Ira Stoll has. He leaves out a number of taxes President Obama has enacted, though, including raising the Medicare payroll tax on high-income earners, applying the Medicare payroll tax to non-payroll income for high-income earners, limiting the tax exclusion for flexible spending accounts, increasing the penalties on certain health savings account withdrawals, the “Cadillac tax” on high-cost health plans…