Note: There are folks who would prefer we don’t have this discussion, and who will try to confuse the issue or deflect attention to the messenger instead of the message, etc. Whatever. What I’ve written can stand on its merits, and if you see it attacked on some other basis, draw your conclusions accordingly.
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A lot of well-funded interests want you to be misinformed about what constitutes an expansion of Medicaid under Obamacare. Here’s what to look for in any so-called alternative plan.
There are a few different approaches to expanding Medicaid that are being given serious consideration in Richmond. Although there are other reforms that are being talked about in lieu of Medicaid expansion, these are not really being given serious consideration by anyone in the General Assembly in the budget showdown, as they don’t scratch the $7 billion itch that’s driving Democrats and the hospital chains absolutely bananas. Don’t allow yourself to be confused on which is which, and don’t think that just because someone says it’s a “private option” or a “free market alternative” that it actually is. See Justin Higgins for a good dissection of this kind of dissembling involving the Chamber of Commerce and the hospital industry’s attempt to cloak the Senate’s Medicaid plan in free market garb. Last time I checked, free markets don’t rely on the forcible redistribution of other people’s money.
There is still a good chance that the discussion of alternative plans becomes moot. The House GOP under Speaker Bill Howell continue to signal strengthening resolve in opposing Medicaid expansion, so we may find ourselves in a really long stalemate (i.e., none of the rumored deals gets done). If that happens, keep an eye on the Governor, who just may be desperate enough to go around the legislature and implement Medicaid expansion on his own. In that case, it all ends up in court. (See the bottom half of this post for more detail).
In the meantime, here’s what you need to know to spot an expansion plan masquerading as something more palatable:
- Federal Funding. The only existing federal funding for increased access to health insurance coverage or healthcare access is that which has been authorized by the inaptly-named Patient Protection and Affordable Care Act (aka Obamacare). If a plan proposes to use this funding—under the same appropriation as standard Medicaid expansion would—it is Medicaid expansion under a different name.
- Expansion of the Medicaid Rolls. If a plan results in the federal Center for Medicare and Medicaid Studies classifying enrollees as new Medicaid beneficiaries, it is Medicaid expansion under a different name. This, according to the House GOP Caucus, is what the “private option” plan embedded in the Senate’s “Marketplace Virginia” plan does. See also item #1 above.
- The “Coverage Gap.” Expansion proponents are all a-Twitter with hashtags reminiscent of the Obama administration’s #GetCovered. In this case, it’s #CloseTheGap, with the gap being between those offered coverage by standard subsidized Obamacare exchanges and people who already qualify for Medicaid and/or Medicare. Medicaid expansion was designed provide coverage for that group, estimated to consist of roughly 400,000 Virginians. Is there anything wrong with a truly free market approach to helping those 400,000 have health insurance or better access to health delivery? Absolutely not, and some people (at least ostensibly) have been addressing this with really good common sense reforms, but in the context of debate around Medicaid expansion, beware of the hashtag catchphrase. As the House GOP Caucus puts it, “We’ve heard about the ‘coverage gap’ and we’ve heard about the ‘private option,’ but the truth is we’re talking about Medicaid Expansion.” See also item #1 above.
- “Returning Virginia Tax Dollars.” See item #1 above.
- “Leaving Money on the Table.” See item #1 above.
- Protecting Against Future Reductions in Federal Funding. See item #1 above.
All that said, it is very much a true statement that some of the alternative proposals beat the pants off the traditional Medicaid model in terms of delivering better quality product at a lower cost to taxpayers. Without a doubt, injecting some “free market-style” reforms can save money and improve quality. So, if you’re interested in a less costly expansion of Medicaid under Obamacare, some of the alternative proposals are for you. Ultimately, though, Speaker Bill Howell hits the nail on the head for the rest of us:
On Medicaid expansion… There is no such thing as a bigger government program that costs less, works better and creates jobs. #Bridge4Sale
— William J. Howell (@SpeakerHowell) December 4, 2013
For that, we need to look to true free market proposals that do not drive up federal spending for generations; that do help encourage availability of coverage for those that need it; that drive down overall costs; that encourage competition among insurers and providers; and that reward individual thrift, hard work, and personal responsibility. Health Savings Accounts, tort reform to lower liability insurance premiums for healthcare providers, allowing for the sale of insurance across state lines, tying healthcare spending to individual price-motivated consumer choices—all of these kinds of things and more should be a part of an overall healthcare solution.
But the starting point for these reforms is the repeal of Obamacare, not the entrenchment of it via the expansion of Medicaid.
Do not be swayed by hashtags and hoopla. Stand for real free market principles.
Do not be confused by obfuscation or distracted by lots of excited, well-paid arm waving. Stand for transparency and accountability.
Do not be worn down or tired out by the monied interests seeking their slice of the federal pie. Stand with the Speaker and the House Republicans and oppose Medicaid expansion.
And stand with Republicans in Washington and Richmond who will repeal Obamacare, not make it permanent for future generations.
