Tag: medicaid

Yes, Florida Voters Oppose ObamaCare’s Medicaid Expansion

Bloomberg’s Josh Barro criticizes the James Madison Institute’s poll showing that 65 percent of Florida voters oppose implementing ObamaCare’s Medicaid expansion. Barro is mostly wrong. But even when he’s right, he’s still wrong. Disclosure: I helped JMI formulate their poll questions.

Barro complains that JMI conducted a “push poll.” His first complaint is:

It starts by priming respondents with questions about the national debt and the size of Florida’s existing Medicaid budget.

Then it gives an inaccurate description of the terms of the expansion. Poll respondents were told that Medicaid currently covers people earning up to 100 percent of the federal poverty line. That’s not true: In Florida, the limit for adults is 56 percent of FPL, and you must have dependent children to qualify.

Though Barro slightly mischaracterizes the poll question, he is basically correct, and the inaccuracy is my fault.

The folks who originally drafted JMI’s poll questions aren’t health care wonks, so they ran their questions by me. This question was originally worded the way Barro claims the final question was: “Medicaid coverage is currently available for those with incomes up to 100% of the poverty line.” I hurriedly emailed the JMI folks, “Florida does not offer Medicaid coverage to everyone below 100 percent of poverty. See page 2 and table 3 of this report. You might replace ‘currently’ with ‘generally.’” So that’s what JMI did. In retrospect, Barro is right. “Generally” gives the impression that Medicaid is available to more Floridians below the poverty line than is actually the case, and I should have offered a better edit. Mea culpa.

His next complaint is not accurate:

Respondents also heard that after three years, the state would be on the hook for “more than 10 percent” of the cost of newly eligible adults. That’s not true, either: The state’s share would be exactly 10 percent.

Under current law, for the first three years the feds pay for 100 percent of the cost of claims for newly eligible adults. They do not pay 100 percent of the administrative costs of covering those adults. States have to pick up much of that cost (as well as other costs related to other parts of the expansion). So the question is accurate and Barro is wrong. He’s not a health care wonk, though, so he can be forgiven for this one.

But Barro’s third complaint is the real doozy:

Rick Scott’s ObamaCare Flip-Flop

Word is that Florida Gov. Rick Scott (R) has decided to throw his support behind, or at least drop his opposition to, ObamaCare’s Medicaid expansion. His formal announcement, which may come tomorrow, will receive much attention. Scott was an early opponent of ObamaCare. He parlayed that opposition into a bid for governor in 2010, and rode the anti-ObamaCare wave into office. Shortly after becoming governor, he announced he would not lift a finger to help the federal government implement the law. I followed all this pretty closely. I served on Scott’s gubernatorial transition team, at his invitation.

Now, it appears Scott doesn’t see the point in opposing the Medicaid expansion. Never mind that – according to my colleague Jagadeesh Gokhale, whom the Social Security Administration consults when making these types of projections – the expansion will cost Florida $20 billion over the first 10 years, and add 3 million Floridians to the Medicaid rolls. Never mind that many of those Floridians currently have private health insurance. Never mind that Medicaid will provide them inferior access to care. Never mind that expanding Medicaid would make those millions of voters dependent on government for their health care, and thus would expand the constituency for more government spending and higher taxes.

There is speculation that Scott made a deal with the Obama administration: he would drop his opposition to the Medicaid expansion in exchange for HHS approving Florida’s plan to put its Medicaid enrollees in managed care plans. HHS approved Florida’s plan today. But economists have shown that moving Medicaid enrollees into managed care increases state and federal spending because it lures more people into the program. So it appears that Scott supported ObamaCare’s Medicaid expansion so that the Obama administration would support his.

Scott says he still opposes having Florida create a health insurance Exchange. Then again, he said the same thing about the Medicaid expansion. So in addition to whatever other damage his flip-flop does, he has squandered his credibility as an opponent of ObamaCare.

To reclaim any credibility on this issue, Scott would have to file an Oklahoma-style lawsuit to block the illegal taxes that the Obama administration is trying to impose on employers in Florida and the other 33 states that have opted for a federal Exchange. Or will he sell out Florida’s job creators too?

ObamaCare’s Priceless Warm Glow

Ed Kilgore says ObamaCare opponents don’t care about cost-benefit analyses:

many of them just can’t bring themselves to even notice that…Obamacare with its Medicaid expansion, health care exchanges, and regulatory mandates [does] actually provide health coverage to people in exchange for the money and the “liberty” surrendered.

Speaking of, what is the exchange rate between liberty and “liberty”?

But about those benefits. What benefits do broad-based expansions of health insurance, like ObamaCare, actually provide? Aside from giving Kilgore a warm glow, that is.

It turns out there has been only one—one!—scientifically rigorous study of that question. The Oregon Health Insurance Experiment found Medicaid coverage confers modest improvements in self-reported health and financial security. The first batch of that study’s results appeared more than a year after Congress enacted ObamaCare. And there remains to this day absolutely zero evidence that Medicaid or other broad-based expansions of health insurance buy us the most health and financial security per dollar spent.

Then again, the Oregon Health Insurance Experiment did not attempt to measure the value of the warm glow that Kilgore and others derive from Medicaid and ObamaCare, one that appears to be worth trillions of dollars of other people’s money.

On ObamaCare’s Discriminatory Subsidies, Brewer Bows When Arizona Should Keep Slugging

Arizona Gov. Jan Brewer (R) recently set aside her vociferous opposition to ObamaCare’s costly Medicaid expansion by announcing she will support implementing that expansion in Arizona. A significant factor in her reversal, she claimed, was that if Arizona did not expand its Medicaid program, then some legal immigrants would receive government subsidies while U.S. citizens would get nothing.

Brewer’s analysis of this “immigration glitch,” and her remedy for it, are faulty. Fortunately, she, Arizona’s legislature, and its attorney general have better options for stopping it.

An odd and unforeseen result of the Supreme Court’s decision upholding ObamaCare is that, in certain circumstances, the law will now subsidize legal immigrants but not citizens. What triggers this inequity is a state’s decision to implement an Exchange – not the decision to opt out of the Medicaid expansion. (Even if a state implements both provisions, legal immigrants would still receive more valuable subsidies than citizens.) The good news is that states can therefore prevent this inequity simply by not establishing an Exchange. If Brewer wants to avoid this “immigration glitch,” there is no need to expand Medicaid. She already blocked it when she refused to establish an Exchange.

The bad news is that the Obama administration is trying to take away the power Congress granted states to block those discriminatory subsidies, and the punitive taxes that accompany them. Contrary to both the statute and congressional intent, the IRS has announced it will impose that witch’s brew in all states, even in the 32 that have refused to establish an Exchange.

Oklahoma attorney general Scott Pruitt has filed suit to stop that stunning power grab. If Brewer is serious about stopping the “immigration glitch,” the way to do it is by filing a lawsuit similar to Oklahoma’s, while adding a complaint that the Obama administration’s illegal subsidies also violate the Equal Protection clause.

Estimate: Massachusetts Diverts 99% of Tobacco Money to Other Causes

From this weekend’s Lawrence (Mass.) Eagle-Tribune
Millions of dollars originally intended for smoking cessation programs in Massachusetts have been diverted to offset budget deficits, leaving the state struggling to fund quit-smoking hotlines, treatment programs and anti-tobacco advertising, the New England Center for Investigative Reporting has found. … 
 
“Roughly 99 percent of all the tobacco dollars that come into the state are used for something else,” said Stephen Shestakofsky, recently retired executive director of Tobacco Free Massachusetts, an anti-tobacco advocacy group. He was referring to the nearly $254 million in tobacco-related legal awards given to Massachusetts in 2012. More than $561 million in tobacco taxes was also collected, bringing the state’s total tobacco tally to just over $815 million, the CDC reports.
On the one hand, it’s not as if I’d urge the state of Massachusetts to sink vast sums into the paternalist project of hectoring its citizens to quit, especially not at a time when its taxpayers are already having to foot a steep tab for its RomneyCare health insurance experiment. On the other hand, we can now see that it was the purest pretense for attorneys general in states like Massachusetts to have portrayed the Great Tobacco Robbery settlement of some years back as motivated by a supposed need for new “public health” outlays, as opposed to sheer plunder and the interests of the various lawyers involved.  
 
That’s worth remembering next time you hear a proposal to extract large sums from the food industry (either through taxation or, as some in the legal profession would like, by suing them for it under some creative theory) with the promise that funds will then be earmarked for anti-obesity efforts. In practice, after voters’ attention wanders, funds ordinarily get earmarked for the advancement of the political interests of those in power.  
 
More on the late-1990s Medicaid-tobacco settlement from Cato chairman Robert Levy here, here, here, and in his book Shakedown, and from me here, here, and in my book The Rule of Lawyers

Might the Washington Post Be Partial to ObamaCare?

Here’s a poor, unsuccessful letter I sent to the editor of the Washington Post:

Thirty-two states have issued a stunning vote of no confidence in President Obama’s health care law by refusing to finance and operate the new regulatory bureaucracies (“exchanges”) at its core. This development threatens to delay implementation of the law, at the very least.

Post readers learned of this once-unimaginable rebuke in an article that gave top billing to those states’ critics [“Critics Slam GOP States over Health Exchanges,” Dec. 14, A1]. The article further claimed, “there’s no question that federal officials will wield substantially more power” in those states, when in fact that highly disputed opinion is at the center of the entire debate.

This followed an article hailing an Obama administration decision to abandon a measure designed to reduce federal Medicaid spending as a “silver lining” [“A Supreme Court Silver Lining?: How Medicaid Dodged the Deficit Debate,” Dec. 12]. The article quoted six sources who supported the administration’s move, but none of the administration’s critics.

Post readers would be better served by less partial health policy coverage.

‘There Isn’t a Single Honest Health Economist Who Agrees with the LA Times’ on IPAB

I blogged previously about Mitt Romney’s claim that ObamaCare creates “an unelected board that’s going to tell people ultimately what kind of treatments they can have.” President Obama conceded the point when he responded that the Independent Payment Advisory Board “basically identifies best practices and says, let’s use the purchasing power of Medicare and Medicaid to help to institutionalize all these good things that we do.” The president admitted the whole point of IPAB is to let a bunch of experts decide what practices are “best,” and to stop paying for what isn’t.

I am not aware of a single fact-checker who has grasped that basic point. Not PolitiFact, not the Associated Press, not FactCheck.org, not The Washington Post’s Fact-Checker, not this Washington Post health reporter. The Los Angeles Times called Romney’s claim “erroneous” and writes:

This is a myth advanced repeatedly by critics of the Affordable Care Act and debunked consistently by independent fact-checkers…the panel is explicitly prohibited from cutting benefits for people on Medicare. And there is no provision in the law that empowers the advisory board to make any decisions about what treatments doctors may provide for their patients.

Jay Bhattacharya, a professor of medicine and economics at Stanford University, responds:

The media “fact check” business is incredibly tiresome given how pedantic and downright inaccurate it is, but I wanted to weigh in on this one before it hardens.  The LA Times somehow thinks that the ACA (aka Obamacare) will have no effect on determining what care patients can get, and consequently dings Romney for saying it will.  There isn’t a single honest health economist out there who agrees with the LA Times on this one.

Bhattacharya explains that IPAB will be able to influence care by cutting payments to providers. But that’s not the half of it. IPAB has the power to do exactly what the fact-checkers think it can’t: deny specific treatments to Medicare enrollees. It can even raise taxes and do other things the fact-checkers think it cannot.

I explain why the fact-checkers are wrong at this Cato Institute policy forum at noon on Thursday (October 11). Join us. Pre-register now at that link.