If you agree with the agenda of Medicaid reformers taking power in Washington, Democrat Gov. John Bel Edwards and his intemperate chief health bureaucrat say you're the bad guy.
With a mixture of conceit and high dudgeon, Louisiana Department of Health Secretary Rebekah Gee declared efforts to repeal Medicaid expansion “irresponsible, inhumane and ill-advised." Nor did she seem open to reform efforts that would pay for the program via block grants — a fixed, relatively unrestricted funding allotment from the federal government — or with money paid per enrollee. More circumspectly, Edwards wrote congressional leaders asking to keep Medicaid expansion in place and expressing unease with proposed funding reforms.
This makes Edwards a hypocrite, since in 2014, as a state representative, he joined overwhelming majorities in passing Act 783, sponsored by his future chief of staff, then-state Sen. Ben Nevers. This law seeks to expand Medicaid through many national reforms endorsed by Republicans like Sen. Bill Cassidy, who look likely to act upon these ideas in the near future — including use of block grants. Act 783 can provide a model for the state for the changes to come.
Reflecting a penchant for distraction and disingenuousness, Gee’s remarks show she remains enthralled with the facile notion that we cannot do better than a program that costs too much and produces no better outcomes for patients than those experienced by the uninsured, according to studies from the Oregon Health Insurance Experiment.
This year, Louisianans will pay more than $200 million in extra insurance premium taxes and hospital taxes passed along to them in order to pay for expansion. It will get worse. According to a pair of reports issued by the Jindal Administration — now out of sight at Edwards’ LDH — in the last year of Edwards’ term, expansion will put taxpayers on the hook for about $260 million more in net extra spending, requiring even more reductions in state services and/or higher taxes.
And history since shows that forecast is likely too low. Almost every state that has expanded Medicaid underestimated, often severely, enrollment levels and costs, in part as more people than expected stopped paying for insurance through the private sector and socialized their costs by signing up for Medicaid. In fact, of the nine states that have released the relevant data, their net cost overruns from expansion through the next couple of years will exceed $10 billion.
What’s more, that negative budget offset does not include the impact expansion has had on the labor force participation rate, as particularly for single and childless individuals it provides a disincentive to work. A recent study estimates that expansion reduces this rate, already the lowest nationwide in almost four decades, by 1.5 to 3 percent in participating states. This means less economic activity, thus taxable revenues, compounded by the $60 billion vacuumed up by the federal government to pay its share of expansion costs in 2015.
So, it’s laughable when Gee asserts that changing Medicaid would cause budgetary problems that threaten, for example, programs for people with disabilities. Expansion already has started the process of imploding Louisiana’s budget, which will keep tens of thousands on waiting lists for services — if not already having contributed to the federal government’s threat to sue Louisiana for insufficient home- and community-based options for the mentally ill. Although the problem goes back years, LDH’s obsession with expansion currently keeps its eyes off this ball.
But don’t worry. If expansion is left untouched, and in the future you find yourself unable to afford adequate medical care because of the higher taxes you pay to finance expansion and the reduced economic prospects you suffer from its dampening of economic growth, at least you won’t be acting irresponsibly and inhumanely.