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.
The Denver Post reports:
Colorado plans to expand Medicaid coverage next year to cover more than 160,000 additional low-income adults, aided by cost-control savings of more than $280 million over the next 10 years, Gov. John Hickenlooper announced Thursday.
“This is a step toward what we have talked about for a couple of years: How can we make sure we’re making Colorado the single healthiest state in America?” Hickenlooper said.
Apparently the governor is not familiar with how lousy medical care is for people stuck in the Medicaid ghetto.
The article continues:
The state’s ability to embrace the health-care expansion draws on “a relentless focus on how to control costs,” Hickenlooper said. The Department of Health Care Policy and Financing zeroed in on several areas of projected savings, largely by rewarding value over volume.
The article then quotes from Linda Gorman of the Independence Institute on why these savings are unlikely and that Medicaid expansion is a bad deal for the poor. A better policy, she said would provide them access to commercial insurance.
Read Gorman’s comments: Colorado governor proposes Medicaid expansion – The Denver Post.
On December 30, Michael Booth of the Denver Post writes:
Free money now, untold costs later.
That’s the dilemma facing Gov. John Hickenlooper, state officials and legislators in 2013 as they contemplate one of the biggest questions in Colorado’s health future: Should we jump into the historic expansion of Medicaid that is a key element of health-care reform?
Read more: Will Colorado go all-out to broaden Medicaid pool?
Health economist John C. Goodman summarizes the poor medical outcomes on people enrolled in Medicaid, compared to those with commercial insurance or the uninsured. He notes:
[Austin] Frakt points to some studies finding that Medicaid makes a positive difference over being uninsured. But the results would probably have been just as good or better if we spent the money giving free care to vulnerable populations. Moreover, even with their Medicaid cards, enrollees turn to emergency rooms for their care twice as often as the privately insured and the uninsured.
Read Goodman’s whole post: How Bad Is Care under Medicaid?
Last week, the Denver Post reported:
The Obama administration in effect told states such as Colorado on Monday they must “go big or go home” on the controversial Medicaid expansion if they want full federal funding.
At Forbes, Merrill Matthews provides seven reasons that Colorado should not expand Medicaid:
- Medicaid Is Bad Coverage
- The Exploding Medicaid Population
- The Woodwork and Crowd-Out Effects — Those Medicaid growth projections are likely low, as eligible people “come out of the woodwork” to join the program.
- The Cost to State Budgets
- Federal Controls
- Rampant Fraud
- Loss of State Sovereignty
Read the whole article for explanations of each: Seven Reasons States Should Just Say No To Medicaid Expansion – Forbes.
See also Linda Gorman: Colorado Medicaid expansion: lousy health care for the poor, big bill for taxpayers.
Linda Gorman of the Independence Institute explains:
The act makes commercial insurance widely available for both working and nonworking people at all income levels. If it works as advertised, the federally subsidized commercial health coverage offered through the Affordable Care Act health benefits exchange will provide better health coverage for the basically healthy adults and children who make up the largest part of the Colorado Medicaid caseload. It will do this at no cost to the state, provided the state Medicaid program is changed to make those who would benefit from commercial policies ineligible for Medicaid. Under the act, individuals eligible for exchange insurance subsidies cannot access them unless they are ineligible for Medicaid.
Commercial coverage historically has provided better access to care than Medicaid. Commercial policies have reimbursed at significantly higher rates, making it easier to find a physician and to arrange for timely care. …
Under the Affordable Care Act, annual premiums for commercial coverage for people at 100 percent of the federal poverty level ($11,170 in income in 2012) are limited to $217 for a single person. … According to the 2010 Consumer Expenditure Survey, people in spending groups with under $10,000 a year in pre-tax money income spent about $1,000 on entertainment, $1,000 on food away from home and more than $2,000 on private vehicle transportation. …
Even if the Affordable Care Act didn’t offer the opportunity to make many Medicaid clients better off by switching them to private insurance plans, Medicaid expansion makes little fiscal sense given Colorado’s difficult budget circumstances.
Read more: Medicaid expansion may be more costly than advertised | Health Policy Solutions.