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What Medicaid expansion is not

By Mike Kennedy and Dan Greenberg

For the Deseret News

Published: Sunday, June 22 2014 12:00 a.m. MDT

November 20, 2013 - Utahns for the Medicaid Expansion held a rally to show Governor Herbert support in the expansion of Medicaid held in the rotunda at the Utah State Capitol.

Matt Gade, Deseret News Archives

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Patients, taxpayers and policymakers deserve straight facts about the issue of Obamacare’s Medicaid expansion. In his May 20 opinion touting expansion’s alleged merits, Scott Poppen of Doctors for America falls short of this standard.

Poppen highlights Arkansas’ Medicaid expansion, the so-called “Private Option,” challenging an Arkansas state senator who has warned his Utah peers about the dangers of replicating this strategy through the “Healthy Utah” proposal. But Poppen’s claims are entirely off the mark.

Claim: Arkansas’ Obamacare Medicaid expansion is a block grant

Truth: No Obamacare expansion is a block grant

Block grants are a strategy to run state or federal partnership programs in which Washington gives a state program without micromanaging how goals are met. They specifically require two elements: Washington funding is capped and the funding comes with administrative flexibility. But Medicaid expansions — whether by a “Private Option” or “Healthy Utah” — are entirely inflexible. Funding comes with hundreds of strings attached to ensure Medicaid expansions comply with Obamacare’s rules. Washington gives Utah orders; Utah carries them out. There’s no “flexibility.”

Claim: Utah recoups billions implementing Obamacare’s Medicaid expansion

Truth: Medicaid expansion is not an ATM card

When Poppen suggests Utah is losing hundreds of thousands of dollars every day it doesn’t expand Medicaid, he misrepresents how federal spending works. States that reject expansion aren’t rejecting money they are owed. There isn’t a lockbox or ATM reserved for Utah, Arkansas or any state. Any money spent on Medicaid expansion is money that must be printed or borrowed, adding billions to our national debt. Money is saved, not lost, when a state rejects expansion. According to the Kaiser Foundation, Medicaid expansion in Utah would cost nearly $5.3 billion over nine years. If Utah rejects Obamacare’s expansion, our national debt is $5.3 billion less.

Claim: Medicaid expansion saves lives

Truth: Evidence doesn’t confirm expansion saves lives, but it does confirm expansion jeopardizes health

Poppen cites a study out of Massachusetts claiming “health insurance coverage reduces mortality rates by 30 percent.” But his story is incomplete: The study’s authors state their conclusions are not generally applicable to other states and they cannot “directly link mortality changes to persons gaining insurance coverage.” This does not apply to Medicaid specifically, but to any type of coverage.

Factors not addressed in the study, such as Massachusetts’ world-class hospitals or the fact that the recession did not hit Massachusetts as hard, may have influenced findings. However, other studies document risks to patient health created by Medicaid expansion. A study by the Foundation for Government Accountability shows how expanding Medicaid in Utah to cover up to 150,000 nondisabled, childless, working-age adults would direct limited resources away from truly vulnerable patients already relying on Medicaid (the disabled, elderly and low-income kids), increasing access problems, wait times and doctor shortages.

Claim: Implementing Obamacare’s Medicaid expansion saves money

Truth: Medicaid expansion is financially unsustainable

Obamacare supporters argue expanding Medicaid “saves money.” Right now, Arkansas’ expansion is nearly 15 percent over budget. Arkansas officials are now considering requesting a Medicaid expansion bailout from Washington. Even if Washington rescues the Private Option this year with extra funding, Arkansas cannot count on bailouts to keep it alive indefinitely. And recent budget proposals by the Obama administration sought to shift more Medicaid costs to states.

All this leaves Arkansas taxpayers on the hook for a financially unsustainable Obamacare Medicaid expansion. Vital investments in education and public safety will be on the chopping block and tax increases seem likely as Arkansas copes with the costs of this bloated health care experiment.

The same risks apply in Utah: “Free” Washington money will evaporate and Washington will look for ways to push more costs to the state. Utah can’t afford this massive expansion of uncontrollable and unpredictable costs.

Poppen’s misguided claims about Obamacare’s Medicaid expansion are a disservice to policymakers wrestling with this issue and to the patients and taxpayers who will live with their decisions. We applaud the leaders fighting against Obamacare expansion in Utah. Medicaid expansion is a lot of things, but, despite Poppen’s assurances, it isn’t a solution.

Mike Kennedy, MD/JD, is a member of the Utah House of Representatives and the Health Reform Task Force. Dan Greenberg is a former Arkansas State Representative and current president of the Advance Arkansas Institute based in Little Rock.

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