Medicaid expansion defenses again mislead

You always can tell when a response to an opinion column comes from Louisiana’s Health Secretary Rebekah Gee, for these ignore the points made by the authors and distract from the validity of these through dubious and non sequitur assertions.

Readers of the Baton Rouge Advocate received two doses of that last week in separate letters published. The first came after a column by state Sen. Sharon Hewitt. In that, Hewitt made the points that the state pays $500 per person enrolled in Medicaid every month and a third of those able-bodied Louisianans enrolled reported earning no income. Further, fewer than 17 percent of those enrolled are actually using the physician services provided through expansion. These numbers buttressed her larger point that the state could use work requirements or substitutes for able-bodied adults to receive Medicaid, as other states are pursuing.

A week later, in a letter Gee belittled that view, even though she tangentially at best addressed the twin issue of non-working able-bodied adults getting free Medicaid and large-scale underuse of Medicaid. She claimed work criteria should not apply to the majority of Medicaid recipients who are children or disabled – but Hewitt never proposed they should be.

Of those not earning income, she noted most of them “are either[sic] disabled or too ill to work (36 percent), homemakers, family caregivers (30 percent), or in school (15 percent).” Of the remaining 19 percent, she argued that less than half could find work but chose not to, which she said requirements should target.

Notice how she grants a blanket exemption to roughly 90 percent of nonworking Medicaid recipients – 15 percent about which Hewitt agrees, those in school. But should being a “caregiver” qualify? For example, how about a single mother able to work as opposed to someone caring for a person with disability? And how do you define “disabled or too ill to work” – undoubtedly using receipt of Supplemental Security Disability Income or a hospice diagnosis as the criterion would pare that 36 percent number substantially, as opposed to reliance on self-reporting.

In this way, Gee tries to trivialize Hewitt’s point. She also outright tries to distract from it with her favorite tactic in these situations, through spouting off statistics about services rendered through expanded Medicaid. The problem with that as a means of justifying expansion is we have no way of knowing if those services would have been performed without expansion. That is, would these have occurred anyway through uncompensated care, out-of-pocket spending, or on private insurance?

In my Jan. 21 column, I make the point that private insurance would have covered many of these, instead of socializing such costs onto the public, when I note that the latest data available show that, after Medicaid expansion in Louisiana, the proportion of the population with non-public insurance decreased the exact amount of the increase of those on Medicaid, with the uninsured rate staying the same. Aggregate data like these can’t show individual-level changes, but it seems clear that some significant portion of the insured population dropped their nongovernment-provided insurance for Medicaid, shifting costs onto taxpayers.

Additionally, I noted that expansion caused at least one major provider to curtail services and it triggered a huge tax increase to pay for it. Further, costs would continue to escalate as the state’s share owed increased over the next three fiscal years. Finally, the low level of utilization Hewitt noted demonstrates doubt that expansion would encourage people to engage in regular checkups and preventive care that theoretically would save taxpayer dollars in the long run, as Gee often asserts.

Predictably, Gee’s response ignored my points about substitution of public payment for private, that expansion did not seem to reduce the uninsured rate, and its impact on providers, although she did dip into the playbook again to talk about services rendered, this time adding in a couple of personalized examples. (I can do the same concerning health law changes Gee supported, such as after those changes one person whose necessary expensive medicine tripled in price and another whose premiums rose and deductible soared to $10,000 with reduced coverage.)

Even more shamefully, she disregarded the fact of tax increases paying for expansion, and outright fibbed again (as she had done in her Hewitt letter) in writing that Louisiana “saved more than $184 million state tax dollars from expansion” last fiscal year. Expansion didn’t do that, but the tax hikes attached to it did. Nor did she address the fact that this convoluted excuse of hers would disappear in the next three years as by then even the higher taxes won’t cover the extra costs imposed upon the people by Medicaid expansion.

Gee may think the public inattentive or stupid enough to keep buying her flawed argumentation trying to justify Medicaid expansion. That her boss Gov. John Bel Edwards claims he now explores work and patient responsibility criteria for Medicaid in reality indicates they fear the public is starting to catch on to their confidence game.