As Devon M. Herrick concludes his policy brief :
On paper, Medicaid coverage appears far better than what most Americans enjoy — with lower cost-sharing and unlimited benefits. But by almost all measures, Medicaid enrollees fare worse than similar patients with private insurance and often experience worse health issues than patients with no insurance. Wisconsin made a wise choice when it decided to forgo a full Medicaid expansion in favor of a smaller program that would maximize the availability of private coverage for Wisconsin’s low-income residents
Read more: Medicaid Expansion: Wisconsin Got It Right | NCPA.
More on the Medicaid ghetto here and here.
Linda Gorman of the Independence Institute writes:
Medicaid expansion would limit access to care for the significant fraction of the currently uninsured who would otherwise be eligible for federal premium subsidies under ObamaCare. It raises costs for state taxpayers, increases costs for people who are hospitalized, and prevents state insurers from collecting millions of dollars in federal subsidy money.
Read more: How Colorado’s Medicaid expansion harms patients | Complete Colorado – Page Two.
At Complete Colorado, Linda Gorman of the Independent Institute writes:
Health and Human Services has agreed that Arkansas can pay premiums for commercial insurance purchased through the state’s health insurance exchange using the federal funding that would have gone to expand Medicaid. …
For those who are not disabled, commercial insurance is more flexible than Medicaid and offers better access to health care. Medicaid reimbursement for specialist care lies far below commercial reimbursement amounts. People with Medicaid coverage often also have a difficult time accessing specialists. …
The possibility of a deal with Health and Human Services gives Colorado officials a rare chance to improve the medical care available to low-income people by shaking off the shackles of Medicaid.
Read more: Arkansas Deal with HHS on Medicaid Expansion a Model for Colorado | Complete Colorado – Page Two.
See also: “Arkansas’s unusual plan to expand Medicaid,” in the Washington Post.
Avik Roy & Grace-Marie Turner in National Review present 12 reasons Virginia, or any state (like Colorado), should not expand Medicaid:
- Virginia’s Medicaid spending will explode
- Medicaid harms the poor.
- Medicaid’s access problems will get worse as more doctors drop out.
- Claims about job creation are exaggerated.
- Claims about coverage expansion are exaggerated.
- Medicaid raises premiums for those with private insurance.
- Medicaid’s undercompensated care is a bigger problem than providing uncompensated care for the uninsured.
- Expanding Medicaid will expose [states] to immense amounts of fraud and waste.
- [States] will be exposed to higher Medicaid costs when Washington recalculates its matching payments.
- By rejecting the Medicaid expansion, Virginia encourages other states to do the same, reducing waste of taxpayer dollars.
- Medicaid will worsen the cycle of dependence and harm the economy.
- Exchanges will provide better health outcomes, far less fraud, and fiscal certainty.
Read details on each: Twelve Reasons to Say No – National Review Online.
For more on Medicaid expansion, see posts on Colorado Medicaid.
John C. Goodman writes:
The idea behind health stamps is straightforward. Like food, health is generally considered a necessity. So why not treat it the same way we treat food?
We don’t segregate grocery stores into those that sell to poor customers and those that do not. Grocery stores take all comers, and they charge the same price to each of them. … The [food stamp] program allows poverty and near-poverty families to have access to the full range of food products. Because they pay market prices, food stamp families are welcome customers at every grocery outlet. Although they live with more limited budgets, food stamp families are able to make tradeoffs in grocery choices—using food stamps in a way that meets their own preferences and needs. Competition for food stamp dollars forces stores to compete on price and, unlike healthcare, the prices are transparent. Every paper contains full-page ads in which price plays a dominant role.
This proposal makes certain that the poor have the wherewithal to pay for their healthcare not by forcing them to wait or take poorer quality, but with healthcare dollars. These healthcare dollars are full dollars to providers, insuring that the poor can complete for resources with all other buyers of care.
via Reforming Medicaid with Health Stamps | The Beacon.
In the Denver Business Journal, Ed Sealover describes the effect of Gov. Hickenlooper’s proposed Medicaid expansion on businesses:
The most direct effect of the move on general businesses could be a long-term slowing of the growth of health-insurance costs if hospitals can reduce the cost of uncompensated care for uninsured patients — which they now pass along to patients insured by employers by increasing their costs of care.
I left the following comment:
This analysis does not account for how much Medicaid, through low doctor payment rates, increases insurance premiums. This amount is much more than the amount uninsured people increase premiums when they do not pay part of all of their medical bills. For details on this, see my article: Your Health Care; Don’t Trust the Colorado Trust.
Colorado Governor John Hickenlooper wants to drag more low-income people into Medicaid, which is notorious for fraud, delivering lousy care, poor access. Instead of expanding this failed government dependency program, Colorado should look at Florida as an example of effective Medicaid reform.
Benjamin Domenech of the Heartland Institute summarizes the Florida’s pilot program involving premium support for commercial insurance. (“Premium support” differs from a voucher.) Domenech writes:
A little more than six years ago, Florida Gov. Jeb Bush established a pilot program in five large counties in Florida with a total overhaul of Medicaid. Under the pilot program, more than 300,000 Medicaid recipients—bigger than the total programs in 17 states—were given the choice of a wide variety of plans created by multiple insurers. …
In the program, Medicaid recipients get to choose among a dozen different plans with different offerings. The plans compete on benefits, copays, and provider networks, and offer risk-adjusted capitated rates, allowing for better matching of payment to risk to prevent insurers from avoiding sick people. …
The program has achieved results. According to the Florida Agency for Health Care Administration, the health outcomes are 64 percent better than under a managed care system, with 83 percent higher satisfaction from those in the program. Florida is currently saving roughly $118 million a year on Medicaid in the five counties, with better outcomes for the people in it.