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Medicaid expansion 'cure' is worse than the disease

Medicaid expansion 'cure' is worse than the disease

Fred Birnbaum
August 8, 2018
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August 8, 2018

Remember when President Barack Obama touted the benefits of the Affordable Care Act: Families would save $2,500 annually on premiums, you could keep your doctor and, crucially, the ACA would bend the medical cost curve downward - according to the president.

Medicaid expansion is a key component of the ACA.

Now that the ACA is an unmitigated failure, Idaho's proponents of Medicaid expansion are attempting to paint opponents as the desperate party, that we keep "screaming Obamacare."

According to the worldview of expansion advocates, none of the false promises matter, perhaps because their end goal has never wavered: They want a top-down, federal-government-run taxpayer-funded health care system. Medicaid expansion is an important milestone on the road to that end goal because it would give 100 percent taxpayer-funded "free" medical care to healthy able-bodied adults.

Expansion proponents in Idaho continue to make ACA-like promises. So, let's dissect the promises one by one.

Proponents of expansion claim that it targets the working poor.

The reality: Currently, without expansion, any single adult who works full time is eligible for highly-subsidized coverage on the exchange with Advanced Premium Tax Credits. Even most part-time workers are eligible, so long as you earn at least $12,140 per year. Expansion is primarily an entitlement for the adult able-bodied, nonworking poor.

Expansion proponents claim that the Idaho Legislature rejected the federal government's "lucrative offer," as Lewiston Tribune editorialist Marty Trillhaase framed it, to pay 100 percent of expansion costs up front.

(That figure will drop to 90 percent starting in Fiscal Year 2021.)

The feds' generous cost-sharing promise is likely to be broken when the nation comes to its fiscal senses. Keep in mind the national debt stands at $21 trillion and the country will have to tackle that at some point.

Proponents claim that the ballot initiative for Medicaid expansion was a "grassroots" operation. They conveniently ignore the $500,000 plus that the out-of-state Washington, D.C.-based Fairness Project paid to professional signature gatherers.

However, the most preposterous claims concern economics: Initiative proponents claim expansion will save Idaho taxpayers millions of dollars annually. The media typically ignore the cost picture, but know this: The traditional Medicaid program continues to drain the Idaho state budget.

During the past 12 years, Idaho's population has grown about 17 percent - but the Medicaid budget has grown more than 100 percent. Thus, Medicaid spending growth has outstripped spending on public schools and roads.

Finally, expansion fans often note that only 3.3 percent of Medicaid spending goes to administrative costs. That figure is completely false. Why? Because that figure only captures state costs. The 3.3 percent number ignores federal administrative expenses and providers' administrative costs.

The initiative to expand Medicaid builds upon the failed ACA and is destined to be a cure worse than the disease. There are alternatives to expanding government-run health care that protect the doctor-patient relationship, don't require everyone to be on the same mandated plan and won't bankrupt taxpayers.

Let's insist on alternatives first.

Note: The Lewiston Tribune first published this article. You can see that post here. 

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