Periodically, his administration breathlessly
announces with positive spin some new factoid about the program, which has put
approaching a half million more Louisianans on the public dole. The latest
comes from a survey
that extrapolates the adult uninsured rate in the state has fallen by just
about half from six months prior to expansion through 2017.
Fixating only on insured status does miss the
larger point of access to health care. Perhaps less than in any other state,
because of Louisiana’s archaic public hospital system, does the lack of
insurance translate into no health care; plenty of those uninsured people had
access to health care – for free – prior to expansion.
And on the other side of the coin, having Medicaid now doesn’t guarantee timely access, if at all, to health care. The survey captures this in that 28 percent said they delayed medical care because they couldn’t get an appointment, a 14-fold increase over data from the 2015 version. That may not all be imputed to expansion, but no doubt a healthy chunk of it can be from expansion signups overwhelming the system.
(NOTE: The error noted below in the strikethroughs has been corrected by the authors, although the copy posted by the state in the link above contains the original erroneous text.)
The survey also noted that almost 9 percent of the
decrease came from the lowest income individuals, defined at the 19 24 percent or
less federal poverty level. But they already qualified for Medicaid, so
expansion had nothing to do with their gaining insurance. The same is true, although
the researchers didn’t create categories to capture it, for the 20 to 25
percent group, so this “woodwork effect” (as researchers call it) overstates
the impact of expansion by perhaps 10 percent. So, the "woodwork effect" (as researchers call it) overstates the impact of expansion by this much.
Then there are data the Edwards Administration
hopes observers gloss over. Specifically, adjusting for the fact that the
presented statistics totaled to more than 100 percent because of individuals
with multiple sources of insurance, Medicaid proportions increased only 8.5
percent in the two years, which doesn’t account for the all of 11.3 percent
drop in the uninsured. That and more came from increases in Medicare enrollments
(likely a combination of an aging population and the woodwork effect
transferred from publicity about expansion), military insurance, and in that
purchased.
Together, these accounted for more than the gap,
because other categories saw declines. Former employers saw a drop, probably
due to the aging population shifting into Medicare. But, most significantly,
employer plan participation dropped by nearly a percent. Much of the amount must
have come from people dropping plans that cost them money and entering Medicaid
where they had to pay nothing.
This transfer of private responsibility to
taxpayers becomes confirmed among the beneficiaries of expansion, at the 138
percent and less FPL. While from 2015 to 2017 40,000 fewer people had employer
insurance, 10,000 fewer bought it on their own, 23,000 fewer paid in to a plan
from a former employer, 11,000 fewer received it from the military, and 6,000
fewer had it paid for by someone outside the household (almost exclusively
younger folks), 12,000 more had signed up for Medicare and a staggering 142,000
more were on Medicaid.
Put it another way, assuming the Medicare increase
took care of half the drop for retirees, 67,000 (assuming all with military
insurance don’t pay premiums) or 47 percent of the Medicaid increase came from
people paying for their insurance either partially or entirely who now make the
taxpayer pick up the tab. At an average
cost of $500 a month, that’s a staggering $402 million extra a year
Louisianans pay for people likely not previously uninsured (although any double counts,
which in this income group likely are few, would lower that number). And that
doesn’t include those in the military or separated with benefits that, for
whatever reason, might have abandoned that for Medicaid.
That’s why ratepayers, taxpayers (because Louisiana
Medicaid is now run for all but waiver programs as a managed care regime), and
many hospital patients saw a tax increase in excess of $200 million dollars
passed on to them upon Medicaid expansion to pay for all of this. Plus,
although the Edwards Administration commissioned a study, flawed
as it turned out, to try to argue expansion caused net economic benefits
that translated into more government revenues than without it, a more valid conclusion
is that expansion is a net drain on both government coffers and the state’s
economy – and only will escalate in magnitude in the coming years.
Edwards can cheerlead all he wants on the issue, but
all it amounts to is a massive transfer of wealth from middle income and above
to lower income individuals that, at least in terms of outcomes, has yet to pay off.
Louisiana continues to be worse off for him having expanded Medicaid.
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