For years, progressives have claimed that they are the party of science. “Our government has forced what I believe is a false choice between sound science and moral values. . . . I believe the two are not inconsistent,” said President Obama in 2009. Science is the reason we need to suppress trillions of dollars of economic activity around the world, because Al Gore — and science! — tell us that if we don’t, “our planet will experience cataclysmic warming by the end of the century.” Gore has even taken to calling conservative climate-policy skeptics “climate deniers,” a clear reference to Holocaust deniers. But there is at least one area of public policy where the Left has abandoned its rhetorical allegiance to science: health care.
On Wednesday the New England Journal published the results from year two of the Oregon project, which “showed that Medicaid coverage generated no significant improvements in measured physical health outcomes” versus being uninsured. If Medicaid were a new drug, in other words, the FDA would reject it.
The Medicaid group used about 35% more health services, but they showed no clinical differences from the identical uninsured group across basic health measures like blood pressure, blood sugar and cholesterol levels that can be improved with the right treatment. The same was true comparing subgroups such as people with chronic diseases like diabetes. Health spending was higher among the Medicaid group, despite claims that using more preventative care and less emergency room will lower costs.
Yet liberals are proclaiming the results a great success and a reason to expand Medicaid under ObamaCare. They point to a side finding that Medicaid increased economic security and led to “a reduction in financial strain,” the share of personal income going to care. “Here Medicaid shined. It hugely reduced out of pocket spending,” noted Aaron Carroll of Indiana University and Austin Frakt of Boston University.
We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.
Florida Senate Republicans Vote to Expand Obamacare and Medicaid, Rejecting House’s Free-Market Alternative – ForbesMay 1, 2013
On April 11, the GOP-controlled Florida House of Representatives passed an innovative, consumer-driven replacement for Obamacare’s Medicaid expansion, one that could be a national template for free-market health reform. But Republicans in the state Senate rejected the House plan, electing instead to expand Medicaid, as Obamacare prescribes. Senate Republicans’ inexplicable decision makes it likely that free-market reform will fail in Florida, an outcome that could easily have been avoided.
Amid signs of early snags in the federal health law, President Barack Obama on Tuesday acknowledged it could face a rocky rollout this fall but said officials are racing to get the new insurance system ready in time.
The main goal of the 2010 law is to bring health-insurance coverage to Americans who lack it, yet two of the measure’s key ways of doing this have hit obstacles.
More than half of the states are on track to sit out the law’s Medicaid-expansion goal initially—which means millions of low-income Americans won’t have access to health insurance through Medicaid as the law anticipated.
Meantime, 33 states have opted against running their own insurance exchanges, the websites where the law envisions consumers shopping for health policies and finding out whether they qualify for tax credits to help pay for them starting Oct. 1. While these residents will be able to use a federal exchange to buy policies, the federal government has had limited funding to set up the exchanges on behalf of the states and to provide consumer assistance for people trying to pick among insurance policies.
Using figures compiled by Kaiser and our own research at the state level, the Goldwater Institute estimates that the federal tab for Medicaid expansion has been reduced by more than $424 billion in new federal spending over the next eight years thanks to the 18 states that have already opted out. If the 12 still-undecided states also decide to opt out, there will be an additional $185 billion in savings.
The more than $609 billion in total savings from these 30 states would represent over 50% of the expected federal spending on the Medicaid expansion. A drop in the bucket? That’s more than seven times the $85 billion in 2013 sequester cuts and more than half the projected federal deficit for this fiscal year.
The thinkers at Advance Arkansas Institute have released a new paper entitled, “How Medicaid Expansion (and the “Private Option”) Will Lock Its Clients Into Poverty.” The paper examines, among other things, how the healthcare plan being pushed through the legislature will trap the poor:
This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.
Arkansas has attracted national attention over the possibility that the Obama administration might agree to allow Arkansas to implement Obamacare’s Medicaid expansion by enrolling these newly Medicaid-eligible patients on the ACA exchanges. This has appealed to me and others, because the exchanges, for all of their imperfections, would be a substantial improvement to the broken Medicaid program in a market-oriented direction. However, we’ve learned in recent days that what the Obama administration is offering Arkansas is not, in fact, true exchange-based insurance, but rather a kind of private-sector window-dressing upon the Medicaid program. Unless HHS agrees to revise its stance and embrace true market-oriented reforms, the Arkansas legislature should oppose the Medicaid expansion in their state.
A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It’s now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along.