SADOW: Could The T-P Please Shut Up About Medicaid Expansion?

If you are feeling a bit like Sisyphus or Phil Connors when perusing the editorial page of the New Orleans Times-Picayune, you’re not alone. There’s a reason why you keep reading again and again what seems to be the same editorial touting that Louisiana should expand Medicaid eligibility courtesy of the Patient Protection and (Un)Affordable Care Act (“Obamacare”) – ideological intransigence in the service of trying to save this law that its editorial writers worship.

No fewer than seven times, about once a month since April, has the T-P regurgitated the same thing, that the state, if not the Legislature then Gov. Bobby Jindal, should take the option to expand Medicaid eligibility. A U.S. Supreme Court ruling declared invalid the part of the law that the federal government could force states into expanding it, leaving that as a state-by-state option. The law also allows for the federal government to pay for the entire expansion starting in 2014 and next couple of years, and then the state begins picking up a share until it levels off in 2020 at 10 percent (far less than the roughly 40 percent or so that changes annually under the current, more stringent eligibility requirements).

The basic argument remains the same: so much federal money flowing in, it’s “free” for the first few years, the moderately poor should have it instead of depending upon uncompensated care, hundreds of thousands could benefit, ad nauseam. It appears to continue belting out one of these rehashes each lunar cycle because Jindal never complies.

And with good reason, for also consistent among each of these is the neglect of facts that destroy its pro-acceptance plea – some known around the time the very first of them were written while others appeared not long after. Simply, the most reliable and valid study of the issue, from the state’s Department of Health and Hospitals, shows that, in the most optimistic scenario, as soon as the federal subsidies go down to 90 percent in 2020, the state begins paying more than it would under its present system where the majority of the costs for uncompensated care (that comprise about two percent of all health care spending) foot the bill for these individuals. By 2023, that extra tab is $92.5 million, having grown 15 percent over the previous year. (And the report did not even take into account some other factors that would increase state costs as well, but is consistent with research that shows almost every state will pay extra.)

Further, the most recent, best health outcomes research shows that people who used Medicaid have no better, and likely worse, of these than people who have no insurance at all. Thus, pushing more people into Medicaid likely would cause an overall decline in health care quality. Add up the extra cost, and it’s a no-brainer to reject expansion.

But you would never know about these if you confined yourself to reading T-P editorials on the matter. Yet it continues to provide the same selective information leading to the same faulty conclusion (even as Jindal and rafts of comments attached to the Internet versions of the pieces remind it of the inconvenient facts it ignores).

Oh, it tries to throw in a new wrinkle here and there, such as in its latest version where it drags in a previous point of reference, a flawed study that produces a suspect figure for job creation through acceptance, and tries out a new one from the universal health care-sympathetic Commonwealth Fund, a group with a track record of sloppy, distorted research. This tries to run an similar argument that all the additional federal spending induced into states will create wealth enough to pay for expansion (it won’t, as the DHH and other reports showed and also fails to take into account the extra money removed from the private sector that would kill economic growth needed to fund the extra commitment) and distracts with all sorts of red herrings by making cost comparisons with other policy choices (the inherent inferiority of expansion in an absolute, not relative, phenomenon independent of other policy choices). But despite the demonstrably bad policy that expansion is, the T-P doggedly continues to pimp for it.

This persistence begs for understanding why it continues with the same obviously wrong direction, time and again when there’s nothing really new revealed about the issue with its constantly relabeling new labels onto old wine. The answer lies in the key role that expansion plays with the entire law itself that mandates that every American be insured or pay a penalty, one that promised Americans could keep insurance they liked.

Well, turns out they can’t. And its premiums and deductibles are costing far more than expected by the public. And where Medicaid has been expanded, fewer people than predicted are signing up for the private sector plans. And it’s only going to get much, much worse. All of which serve to enroll fewer and fewer low-cost people into private sector plans.

Obamacare was sold on the idea that expanding the private sector insurance market, especially by bringing in groups least needy of provision but who contribute their premiums, would keep the system afloat financially. Thus, all of these trends make it more likely than ever that Obamacare will crash and burn financially – skyrocketing government costs for Medicaid, absurdly higher premiums and deductibles for many through the private sector, with massive wealth redistribution occurring to the favor of those buying policies for free or cheaply because of taxpayer subsidies – enraging the public and stimulating policy-makers to make change dramatically or to dump the whole thing.

This the T-P editorialists desperately do not want to see happen. Even as they close their eyes and try to wish way the inconvenient facts, they very much are cognizant of this one. And this explains their constant revisiting of the subject: expansion to them captures and pumps more resources into the system to prop up the whole insane idea, to give it a better chance of survival.

Thus, they write tirelessly and tritely on the subject, in the hopes that somehow they can contribute to a cause in which they have invested heavily psychologically. And in the never-ending process of flogging this dead horse they bore readers who are not low-information voters to absolute tears.



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