The Obamacare replacement bill is dead, but Senate Majority Leader Mitch McConnell has now presented a partial repeal bill in its stead, akin to the 2015 legislation vetoed by former President Barack Obama, H.R. 3762. That bill phased out Medicaid expansion over a period of two years, and the legislation was passed by almost every Republican currently in the Senate, with the exception of Sen. Susan Collins (R-Maine) who threatened to torpedo the recent replacement legislation if Medicaid cuts remained in the bill.
Senate Republicans should stick with McConnell’s plan, which is a part of the promise to repeal they have been making to constituents for since 2010, mindful that even more Senators would be against the legislation if Medicaid expansion remained in place. Conservatives need to remind voters that Medicaid expansion is not a medical necessity, but a medical detriment, and that the current legislation would block grant the program to states. Denying citizens Medicaid expansion is not a moral evil that translates to stealing health care from citizens, comprehensive research has already proven this is far from true.
Researchers studying Medicaid have an age-old scientific problem; with human participants, you cannot perfectly replicate the control group and the experimental group because a single person can never participate in both groups. Yet in 2011, the state of Oregon had a once in a generation chance to defy this rule.
With an abundance of Medicaid requests, a randomized lottery was used to select a small group of participants eligible for the program, creating a perfect control and experimental group. While the state set out to prove the Obamacare expansion of Medicaid was a necessity, they were shocked to find just the opposite.
The experiment studied over 20,000 participants from Portland metropolitan area; half who received Medicaid by lottery and half who did not. It was hoped the study would prove Medicaid’s benefits, but it highlighted its faults instead.
The study concluded that, “Medicaid coverage generated no significant improvements in measured physical health outcomes,” making the program Congress is debating spending billions of dollars on seem entirely useless.
Moreover, the study found that while self-reported rates of depression decreased, there was no significant difference in some of the most common medical conditions such as high blood pressure, high cholesterol, or glycated hemoglobin. Even the 10-year predicted risk of a cardiovascular event was in no way different with Medicaid than without. As the health care debate heats up around the same issue once again, a reassessment of the Oregon Medicaid experiment must remind the Left that Obamacare is not the essential humanitarian cause it is portrayed to be.
However, Forbes contributor Avik Roy notes one important factor to keep in mind:
Oregon’s Medicaid program is in substantially better shape than that of the average U.S. state. In Oregon, Medicaid pays primary care physicians approximately 62 percent of what private insurers pay. That compares to the national average of 52 percent; a number of large blue states pay less than 40 percent. Because Oregon’s Medicaid program pays more, the state’s Medicaid beneficiaries have relatively better access to doctors. While 21 percent of Oregon physicians won’t take new Medicaid patients — an unacceptably high number — the national average is even worse: 31 percent.”
This is a critical point, considering a 2003 to 2007 Medicaid study by the University of Virginia found that,
Patients on Medicare were 45 percent more likely to die than those with private insurance; the uninsured were 74 percent more likely; and Medicaid patients 93 percent more likely…Medicaid reimbursement rates are so low that hospitals, on average, lose money on every Medicaid patient they treat. As a result, most doctors refuse to see Medicaid patients, forcing the poor to get care through hospital emergency rooms.”
With so few case studies on Medicaid even taking place, this provides key insight on the effectiveness of the service; the UVA study concluded along similar lines to the Oregon study that, “patients can’t get access to routine checkups and preventive care, because doctors won’t see them. That, in turn, leads to poorer health outcomes.“
Oregon may have fared better due to the state’s high reimbursement rates, but it still showed Medicaid lacked the ability to improve health outcomes. The problem will only be exacerbated if Medicaid expansion is taken nationwide, making Medicaid both inefficient and even dangerous.
That is why Medicaid expansion should be rolled back immediately, and not left for future Congresses to undo the same way 1990s entitlement reforms to Medicare were undone by the so-called Doc Fix.
Without repeal, state expansion of Medicaid is expected to cost states $8.5 billion in 2018, a $4 billion increase from 2016, according to the National Association of State Budget Offices. That, even as federal funding has expanded, from $74.1 billion in fiscal year 2016, to a projected $83.3 billion in fiscal 2018.
In the meantime, Medicaid’s expansion to able-bodied, working-age adults presents a risky situation for our nation’s seniors, who will be relying on long-term care doctors for treatment in their old age. Reform is needed to do away with Medicaid expansion and increase state flexibility immediately to address these urgent shortfalls.
In 2012, 4.4 million seniors enrolled in Medicaid, primarily for long-term nursing home and community care, according to the Medicaid and CHIP Payment and Access Commission. If seniors keep using long-term care at the same rate as 2012, then the number of patients will increase to 13 million, with about 7 million using Medicaid. By 2037, there will be 80 million seniors, with 16 million on long-term care, and about 8 million using Medicaid.
But with Medicaid’s expansion to those who might otherwise get private health coverage under the Republican plan, these seniors could have fewer resources for their long-term care because of the scarcity of resources at the state level.
Health insurance does not equal health care; and as insurance attempts to expand, care will certainly decrease, in this case, for those who need it the most — seniors with debilitating conditions like Alzheimer’s or who have suffered a stroke.
Yet, Republicans such as Ohio governor John Kasich act to expand Medicaid by claiming a moral obligation to assist the poor. These governors, along with Senate moderates, are working to delay the promised repeal and replace of Obamacare to support a system that doesn’t back up the morality it claims to uphold.
While the Oregon study found individuals on Medicaid were less burdened by “catastrophic health care expenses,” this is unsurprising considering those costs are being shifted onto entire states.
The moderates are not fulfilling an obligation to help the poor; they are dragging the rest of us down to the same level of poverty.
Conservatives like Sen. Ted Cruz (R-Texas) are applauding the Senate’s latest legislation as “significant progress,” while moderates are still holding out for the Congressional Budget Office analysis to see how many Americans will lose insurance. This is despite the reality that losing Medicaid expansion will create an opportunity for these Americans to get plans that actually meet their medical needs, rather than one that provides a false sense of security and makes it difficult for states to meet their other more pressing Medicaid needs, like seniors.
Unfortunately, Senate GOP moderates are delaying the necessary legislation to end the Obamacare death spiral, in favor of a program that doesn’t even work and forecloses effective care for seniors.
The Obamacare Medicaid expansion has consistently proven to be ineffective and fiscally irresponsible, yet Republicans with clear Senate and House majorities remain unable to roll the program back. Medicaid might make people happier but it does not make them healthier, and taxpayers cannot afford to support a system that fails to maintain its basic purpose at such a high cost and in the meantime takes resources away from where they are more needed for seniors on long-term care.
Republicans need to look to Oregon and see that health care reform is necessary, but Medicaid expansion is not; therefore, passing legislation that rolls back this program’s expansion — and having it take effect immediately. Congress has a habit of kicking the can down the road, and the legislation under consideration must ensure that does not happen here when these reforms are so urgently needed. Allowing Medicaid expansion to remain in place, along with the rest of Obamacare, is fiscally and medically irresponsible.