Tap-dancing can't put lipstick on expansion pig

Regarding the dueling opinion pieces by female policy-makers at the opposite ends of Louisiana’s Medicaid expansion debate, more relevant to the debate is what was not written.

Last week, in the Louisiana section of The Center Square news site, Republican state Sen. Sharon Hewitt opined that politics rather than sound policy drove Democrat Gov. John Bel Edwards’ decision to expand Medicaid. She pointed out that it was rolled out hastily, that it registered at least $85 million roughly in payments to non-qualifiers, that a computer system which could have reduced that total was known to be lacking by the Edwards Administration yet expansion occurred without it, implementation of the system removed some 50,000 recipients from the system who likely cost taxpayers hundreds of millions of more inappropriately, and that as a whole gamesmanship appeared to play a role in the selection of new providers for regular and expanded Medicaid judging from the unserious reaction by administration staffers in the vetting process that led to a decision now legally challenged and threatening future provision.

In response, Edwards’s appointee to run the Department of Health, Secretary Rebekah Gee, tried to contest many of Hewitt’s points. She claimed that her department “worked hand-in-hand with the legislative auditor’s staff and the Attorney General’s Office to identify the rare cases of misuse or fraud in the program.” Also, she noted that Hewitt played an early role in the contract selection process the senator now critiqued and that “scoring of the bids was done by an independent review committee without input from politicians or political appointees.” Additionally, she defended the preparedness of the agency in the nearly six months from announcement to startup. Finally, she made a defense of Medicaid overall, including areas outside of the expanded population, and stated that expansion had resulted in “saving lives and [has] cut the state’s uninsured rate in half, while creating new jobs and economic growth in the process.”

Of note, Gee didn’t contest Hewitt’s point that she knowingly implemented expansion without adequate controls in place to prevent improper payments, which didn’t arrive for two years. Nor did Gee volunteer that she and Edwards set up the system to hemorrhage taxpayer dollars wastefully from the start.

That came courtesy of two decisions made in the implementation period. First, they rolled back more stringent eligibility controls instituted by the Republican former Gov. Bobby Jindal Administration; second, by becoming the first state to enroll automatically Supplemental Nutrition Assistance Program recipients (in her piece alluded to by Gee as an implementation  “recognized nationally as one of the most seamless”) and thus importing that program’s error rate without compensating for this. These were the genesis of an error rate that, as Hewitt observed, produced 50,000 improper enrollees of half a million at its peak, or 10 percent – a level Gee ludicrously indicated as “rare cases.” That represents $500 million in inappropriate payments, with tens of millions directly paid by Louisiana taxpayers.

Also, Gee misstates reality when she alleged close working relations with the Legislative Auditor and attorney general’s office. In fact, the Edwards Administration opposed legislation making clear that the state’s Department of Revenue had to show auditors financial information about expansion applicants, among others seeking government benefits, which would have obviated an ongoing suit filed by the Auditor to have access to that information – data which the Edwards Administration has fought tooth-and-nail to prevent releasing.

Nor does Gee adequately excuse her department’s behavior during the contracting process criticized by Hewitt. So what if it “was done by an independent review committee without input from politicians or political appointees;” Gee doesn’t contest that questionable behavior occurred during the latter stages of the process that likely tainted the outcome. Attempts at insulation don’t guarantee absence of politicization, especially in that bureaucrats can read tea leaves and the winks and nods of their politically-appointed superiors.

Of course, Gee can’t help but throw in the “greater good” defense she and Edwards typically make when faced with explaining away expansion’s waste, in her claims of better health and economic growth as a result of expansion. But claims about the former are well overblown and are nonexistent concerning the latter. Anywhere to a third to a half of expansion clients already insured themselves prior to expansion, while the remainder already had free services at the state’s charity hospitals, so access to life-saving care was hardly an issue prior to expansion. Plus, state taxpayers in the past year spent three times to pay for expansion’s estimated growth in terms of tax receipts, a figure that will rise to at least four times in 2020, and higher beyond. (Note as well how, because of these numbers, Gee no longer mimics Edwards’ claims that expansion “saves” the state money.)

Medicaid expansion largely served as an additional welfare benefit extended by Edwards to win votes. It costs the state more than it benefits it citizenry as a whole. It largely replicates, at greater taxpayer expense and wastefully, existing health care provision. Gee, who has a history of tap-dancing disingenuously around the facts, can’t do so fast enough to obscure a basic truth of Edwards policy in this area: from the word “go,” expansion has been, was designed to be, and continues to be, a politicized tool of his administration.