The political alchemy continues coming
from Democrats through tactics of distraction and distortion to make the Patient
Protection and Affordable Care Act (“Obamacare”) not serve as a liability to
its midterm election candidates – and, in the case of Louisiana, aided by at
least one media outlet.
Yesterday, the Pres. Barack Obama
Administration’s Council of Economic Advisers released a document
purporting to show the impact of states not accepting expansion of Medicaid,
listing how many of the indigent as a result do not have health care coverage,
procedures they could receive with it, and alleging that it would create jobs.
Louisiana is one of the almost half of all states that have refused to do this.
Naturally, the slanted
information produces a cornucopia of omissions and selective use of data, with
the last assertion of job creation being the easiest shibboleth to demolish.
Theoretically, it fails because the reasoning used – more government spending creates
more jobs – would mean then we should proceed immediately to end-stage Soviet
communism by eliminating the private sector to achieve full employment and
maximal economic growth through making government the only economic producer,
and we know well that worked out in practice. The argument also fails
analytically because it does not take into account the jobs destroyed by
taking more of what people earn that they could use through their own market-based
decisions to create wealth and jobs.
But that’s not the only shortcoming
of the report. In terms of an example of the preventive kinds of medicine it
named that would be covered – where the theory here is that by encouraging people
to utilize these through giving them easy insured access to them they can catch
potential health problems early and thereby hold down later spending by
obviating the need for more intense medicine – it mentioned how many more
mammograms for women could be performed that could cut down on incidences of
advanced cancer. Yet remarkably that over six years into office, Obama still
doesn’t know what the federal government does, for there already is a federal government program that provides mammograms for women
that would be covered by Medicaid expansion. It’s called the National Breast and
Cervical Cancer Early Detection Program, designed for women ages 40-64 at
250 percent or below poverty line income, at no or little cost. In other words,
even as the report touts expansion would provide this benefit, it already is being
provided without it so for this benefit expansion
would do nothing more, if not duplicate, what the federal government does
anyway.
And, of course, the report ignores
inconvenient truths, such as the data from the “Oregon Experiment” that shows that
Medicaid utilizers’ health outcomes are no better than, if not worse than, comparable
uninsured individuals, and that they use compared to the uninsured emergency
medicine services disproportionately even with access to primary care through
Medicaid. These data reveal as false the notion propagandized by expansion
supporters that Medicaid in its current form will save money and produce better
outcomes if simply more people were on its rolls.
Yet the biggest omission comes
from not including how much extra the suffering taxpayer would have to fork
over to float the scheme. In response to the report, Gov. Bobby
Jindal reported that it would cost state taxpayers an extra $1.7 billion
over the next decade. Actually, that’s dated information – the Department of
Health and Hospitals updated
this figure this spring (for the most pessimistic scenario only; others show
lower costs to taxpayers but costs in every instance) so that it’s actually about
$2.1 billion.
That’s the cost above and beyond
the current method of providing health care to the indigent, which is to pay
hospitals to treat them through uncompensated care costs – also something the report
neglects to mention in trying to conflate “health care” with “health insurance.”
They are not the same thing; the law (after Supreme Court interpretation) gives
states the option to expand eligibility of the government health insurance program
Medicaid, but does not provide health care to the indigent who already legally must receive it on demand,
paid by the states.
The Emergency
Medical Treatment and Labor Act of 1986 mandates that if somebody shows
up at an emergency room, they are to be treated or sent to a facility that can
do so regardless of ability to pay. The facility then, if the patient does not
have ability to pay, bills a state’s uncompensated care cost Medicaid program
as usually the procedures done are covered. And this is the vehicle by which
many indigent access primary health care services (even if reactively, not
proactively through preventative medicine), and even for some care after the
visit (if an admission is needed to meet the law’s requirement to stabilize the
patient’s condition).
So expansion has nothing to do
with providing any or more or better health care to the indigent. It has
everything to do with stuffing more people into Medicaid that then likely would
produce worse outcomes and at higher costs to taxpayers.
However, perhaps the most
misleading aspect about the report, even as its text does not make the link, is
in elites trying to connect expansion’s imaginary benefits to Obamacare in an
attempt to shore up support for the reviled law. But expansion has nothing to
do with Obamacare’s odious requirements like the individual mandate,
redistribution of wealth through subsidizing some people’s premiums by raiding
the wallets of others, and creating policy tiers and inclusion requirements that
escalate health care insurance costs for the large majority. Medicaid is
government insurance for the indigent; Obamacare forces purchase of
nongovernment insurance. The only connection between the two is the same law
that created Obamacare also presented expansion as an option. The Obama/Democrat
political strategy is to posit that expansion brings “benefits” (while ignoring
their costs and duplicative efforts like NBCCED, EMTALA, etc.), therefore “expansion”
equals “good,” and that “expansion” equals “Obamacare,” thus all of “Obamacare”
equals “good.”
It’s a lie, one that Sen. Mary Landrieu is willing to propagate in
order to save
her flagging reelection chances, and one she is willing to supplement. In her
comments about the report, she repeated the fib that rejection of the
Medicaid expansion means that state taxpayers are paying for health care for
residents of other states. There’s no
truth to that: expansion is to an entitlement program. Thus, states pay
only for the services billed in their state, and if one state doesn’t expand,
the money stays in the federal coffers (or reduces the amount Washington must
borrow). Other states by expanding may force the federal tax or debt burden for
a Louisianan to increase, but it’s asinine to declare therefore this justifies
expansion in Louisiana to “get back” at the other states by increasing their
citizens’ tax burden and simultaneously the state tax burden of Louisianans.
And these omissions, distortions,
and outright whoppers seem not to pique the interest of New Orleans Times-Picayune reporter Bruce Alpert who filed a story
tying the report into the state political scene – and, following the T-P trend, then continues to miss the
bigger, more important story by pretending that untold one doesn’t exist. Alpert
mentions Jindal’s refusal to accept expansion and mentions that Indiana Gov. Mike Pence has talked
of expansion under a different guise and Sen. David Vitter has said (relevant
to his quest to succeed Jindal) he’s
open to the same – but never mentions, in keeping with the T-P’s embargo on the whole thing, that a
similar plan supported by Jindal already
has begun its first steps to possible implementation in Louisiana.
Act
783 of 2014 instructs the state in the next couple of months to come up
with a plan to provide health care insurance to the indigent already not
covered. The parameters included differ dramatically from the fee-for-service,
one-size-fits-all philosophy behind Medicaid. They were derived from ideas
Jindal has about a federal government health insurance program that would
supplant Obamacare.
In other words, it expands indigent
health care insurance, just like Medicaid expansion would, without using
Medicaid. Meanwhile, Pence’s enlargement of an existing Indiana program and
Vitter’s musings posit taking existing Medicaid and warping it into an
almost-unrecognizable form – one very close to what Act 783 asks be put down on
paper. There’s much more sematic difference between the two than substantive
difference, even as Jindal disavows Pence’s idea.
That kind of comparing and
contrasting would make for a pretty good news story, and trying to get at why
Jindal rejects Pence’s action even though it largely follows the principles he articulated
as desirable for health care provision to the indigent would make for extremely
interesting and informative reading. Instead, what we get for now from the T-P is ignoring the existence of Act 783
before and after it became law, a puff piece on Medicaid expansion that is
almost all stenography with almost no effort to present the context and nuances
of the larger issue, and in it little valid information presented for the
public to understand the issue comprehensively. If media are going to report on
these complex issues, they need to do it right or not at all.
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