Puff piece on LA Medicaid expansion serves poorly

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.