WSJ: Obamacaid, America's Worst Insurance Policy
Earlier this month, the Wall Street Journal published an opinion piece on Medicaid, making the case why so many states, including Florida, are right to reject Medicaid expansion under Obamacare. The author starts by pointing out the program has already expanded far beyond what it was originally intended to be:
Medicaid, the joint state-federal safety net intended for the poor, already covers more than one of five Americans and pays for two of five U.S. births. And that’s before ObamaCare dumps up to 20 million new dependents onto its rolls. Liberals are still somehow evoking Little Nell and the blacking factory because 26 Governors or legislatures or both are so far declining to expand. Their hysterics would benefit from a fact or two.
But the author continues with a litany of facts and figures about the current Medicaid program that make it clear — Medicaid is the worst insurance policy in America and we should not be trying to find ways to relegate more people into it. If you are still on the fence about Medicaid expansion continue reading…
The feds are dangling the promise of paying for all the costs of the new beneficiaries, at least for the next three years. This subsidy honeypot can’t last forever, and Governors are right to worry about taking on fiscal obligations that will increase 13% on average in 2014 under new Medicaid, according to a Kaiser Family Foundation state budget survey.
The Beltway boys and their allies in the hospital industry that are ravenous for more federal revenue are stunned that their bribery failed. So the new line of assault is to declare that the 26 conscientious objector states must hate poor people, or racial minorities, or Saint Peter and Christianity itself.
In reality, Medicaid is now mostly a middle-class entitlement for nursing homes. Almost two-thirds of Medicaid spending flows to the elderly, and 60% of people in long-term care institutions are on the program.
Some 20% of the people under 65 who are eligible for the program today also haven’t signed up. One reason might be the scandalously poor quality of care as states squeeze down provider reimbursements. Only this May an important randomized, controlled trial in Oregon concluded that the program generates no discernible improvement in health compared to being uninsured.
If the sojourners for Medicaid were serious about helping the least fortunate, they’d try to repair its current dysfunctions. Start by prioritizing spending, and then give Governors waivers to manage case loads and make operations more efficient.
But the truth is that liberals view Medicaid as a national model, not a national disgrace. Coverage on ObamaCare’s nominally private exchanges largely clones Medicaid’s narrow networks of doctors and hospitals, low reimbursements, limited patient choice and heavy federal regulation. It might be more accurate to call it Obamacaid.
Meanwhile, the Administration is closing off state Medicaid experimentation with “maintenance of effort” rules that guarantee state costs are higher than they need to be. Most Governors, even Republicans, are pragmatic about living with Medicaid, but the White House’s control-freak instincts are making it impossible for them to participate.
What all this suggests is the real concern among Democrats isn’t the well-being of the poor but their own in 2014. They’ll run against Republicans as ideologues who won’t even accept free money from Washington, and who by the way are mean-spirited and cruel. This election gambit has a certain political logic, or at least more than pretending the Medicaid status quo is a great success and packing more of the poor into an unreformed system.