The U.S. Senate bill addresses the threat Medicaid’s unchecked growth poses to meeting other state priorities without crushing tax increases. It would mandate measures to encourage efficiency and improved care to a program that now, through its open-ended financing, discourages states from rooting out fraud and waste. In its present form, Medicaid also gives preference to lower-income, able-bodied, working-age adults over children, the elderly, the disabled, and the truly indigent.
Reform opponents such as Gov. John Bel Edwards try to deny this reality, propagating a brazen mythology about the bill. Their emotive appeals distort — and sometimes simply ignore — the facts.
Myth: The bill cuts Medicaid spending.
Fact: The legislation doesn't cut Medicaid; it simply aims to slow its growth.
Myth: The bill threatens services to people with disabilities.
Fact: By establishing higher reimbursement rates for services to the disabled, freeing states from requirements that presently encourage cuts to disability services first, and allowing transfer of savings garnered from reforms to go to the disabled, the bill would actually allow more people with disabilities to get the help they need.
Myth: The bill boots people out of Medicaid, thereby reducing health insurance coverage.
Fact: Eligibility requirements do not change, but the bonus federal match for the expansion population, which unconscionably pays much more for lower-income, able-bodied working-age adults than for children, the elderly, and the disabled, eventually would disappear. States like Louisiana that expanded Medicaid could ask their taxpayers to pony up more to continue giving away free coverage that many expansion beneficiaries previously paid for themselves.
Myth: The bill will allow more people to die.
Fact: Having fewer people covered by Medicaid doesn't necessarily translate into greater mortality. A number of studies, as compiled by the Duke University Center for Health Policy and Inequalities Research's Chris Conover, show no significant difference in mortality risk between the uninsured and those either with private insurance or Medicaid. Perhaps the best known of these, the Oregon Health Insurance Experiment's randomized controlled design, in comparing expansion recipients to the similar uninsured population discovered that Medicaid generated no significant improvement in measured physical health outcomes, nor did it result in a statistically significant reduction in death risk.
Edwards and his ideological fellow travelers love to reel off statistics about services provided by expanded Medicaid, calling these services essential. If that's true, then Medicaid boosters should have no problem persuading Louisiana’s taxpayers to pick up the tab. But even if they can’t, the bill guarantees anybody now eligible for Medicaid coverage can enroll in an insurance plan with a premium that does not exceed two percent of their annual income, or at most about $20 a month per person. No one who makes having health care insurance a priority will lose it under this bill.
By advancing better health for the deserving without growing government and bankrupting taxpayers, the Senate bill’s Medicaid reforms make sense.
Jeff Sadow is an associate professor of political science at Louisiana State University-Shreveport, where he teaches Louisiana government. He is author of a blog about Louisiana politics, www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at www.laleglog.com. Follow him on Twitter, @jsadowadvocate or email email@example.com. His views do not necessarily express those of his employer.