“Rachel” Levine is disappointed.
In June, the “17th Assistant Secretary for Health for the U.S. Department of Health and Human Services” wailed that even “after all this time” — Obamacare was signed into law on March 23, 2010 — “there are still a number of states” that refuse to expand Medicaid.
It’s a predictable perspective for someone concerned with “health equity,” not health outcomes. Fortunately, a core cohort of governors and lawmakers in the expansion-skipping states of Wisconsin, Wyoming, Kansas, Texas, Tennessee, Mississippi, Alabama, Georgia, South Carolina, and Florida possesses a firmer grip on reality.
The Foundation for Government Accountability’s latest work on the folly of Medicaid expansion offers up-to-date stats on why the ten holdouts are wiser than the 40 cash-grabbers. The FGA’s Hayden Dublois and Jonathan Ingram note that “state policymakers have been often tricked by lobbyists and activists seeking to expand Medicaid to a new class of able-bodied adults” — an augmentation permitted under Obamacare — and highlight how flawed projections continue to “grossly underestimate how many … would enroll if states expanded Medicaid and how much such an expansion would cost taxpayers.”
But let’s not get ahead of ourselves. Some history is in order.
A breathtakingly naïve product of the Great Society’s trillion-dollar blundering, Medicaid was crafted, in BusinessWeek’s description, “to help poor mothers and their children.” Almost immediately, eligibility rules widened, causing costs and caseloads to soar. By the time Barack Obama became the nation’s 44th chief executive, enrollment stood at a jaw-dropping 48 million people — 16 percent of all Americans.
While it still covered kids and parents who had fallen on hard times, a huge portion of Medicaid’s budget was now devoted to the elderly. The Wall Street Journal observed that the program wasn’t “intended as a middle-class entitlement or as inheritance protection for the children of well-off seniors.” But that’s what it became — “spend down” and get taxpayers to finance your golden-years needs. The entity that used to be known as The Henry J. Kaiser Family Foundation estimates that in 2020, “Medicaid was the primary payer” for “long-term services and supports.” It fronted “over half of all LTSS spending in in the U.S.”
The average non-disabled, non-elderly Medicaid beneficiary costs taxpayers less than the typical oldster. (Pediatrician visits, broken legs, and eye exams aren’t nearly as expensive as round-the-clock support.) But the program doesn’t offer quality and choice for children and working-age adults. Back when Paul Ryan was a major D.C. player, his reform plan for the nation’s fiscal crisis explained that Medicaid providers “are paid based on bureaucratically determined formulas that do not reflect the market,” and thus, “fewer and fewer providers are willing to participate in the program, meaning longer lines for beneficiaries, fewer operational clinics, and insufficient care.” Reason’s Peter Suderman noted that multiple researchers documented the lousy performance of socialized medicine for low-income beneficiaries: “Numerous studies show that, on an array of specific maladies, Medicaid’s health outcomes are dismal — and in some cases worse or no better than the outcomes for individuals who lack health insurance entirely.”
Runaway spending, unintended consequences, inferior value. Not a program worth expanding, right? Pish tosh. Obamacare did exactly that, by dangling enormous subsidies to the states that offered healthcare welfare to “nearly all adults with incomes up to 138% of the Federal Poverty Level.” Democratic and Republican elected officials alike scrambled for the loot.
But ten states would not comply — hence, Levine’s frustration. FGA observes that the resisters have ample cause for their intransigence:
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