SADOW: Nevers Is Hoping The Legislature, And The People, Are Stupid

State Sen. Ben Nevers apparently needs some extra exercise, so he decided to flog the dead horse called Medicaid expansion. But he does so on the usual mistaken beliefs of its supporters and on the erroneous thinking that the voting public as a whole is actually dumber than state legislators.

That latter group would have to be pretty dumb to support the idea. The state has the choice to include individuals at 25-100 (or perhaps up to 138) percent of the poverty line in Medicaid because the Patient Protection and Affordable Care Act (“Obamacare”) to stay consistent with the Constitution cannot compel states to do this. The most reliable study done on the matter, by the state’s Department of Health and Hospitals last year, indicates rejection is the most cost-effective policy, showing that within a decade the state will pay out $92.5 million more a year than without it, by then the extra payout increasing by 15 percent a year and only going higher.

No expansion also will provide the best medical outcomes. Recently, a study in Oregon demonstrated that the worst outcomes were recorded by those utilizing Medicaid services, compared to those with private insurance and no insurance at all. Both that and why the current method of serving the uninsured through uncompensated care reimbursements saves money compared to expansion are explained by a fact of which Nevers either is unaware or won’t admit in order to advance his agenda.

As do many uninformed supporters of expansion, Nevers repeats the party line that the uninsured crowd emergency rooms because of lack of insurance that “cost all of us millions,” implying that the bulk of uncompensated care payments go to the uninsured. This is a myth; in fact, the largest proportion of users of emergency medical service are those already on Medicaid, and they had the highest rate of utilization for preventable conditions. And when Arizona expanded Medicaid voluntarily in 2002, since then uncompensated care costs have increased an average of 9 percent annually through 2010.

This in part explains why costs would be higher for Louisiana by accepting expansion (the main cause being displacement as expansion sucks in those previously using private insurance). And it doesn’t even include the extra costs to the state and federal government by having to deal with worse outcomes, and to the federal government (passed along to Louisiana taxpayers) in that Obamacare envisions cutting uncompensated care reimbursements in half when the available data show an increase would be expected and will become politically necessary, increasing costs to all taxpayers even more. Worse, emergency rooms would continue to be crowded by Medicaid users, and even more, because expansion would produce too many patients for too few doctors.

Despite these facts, no doubt Nevers and others will try to confuse decision-makers by talking about, as he has, how “In my senate district, one out of every four people does not have any health insurance. How can I turn my back on 25 percent of the population in my senate district?” Note the sleight of hand here, how not having health insurance is equated with not having health care. The implication of that transmogrification, of course, is patently false: anybody can walk into any hospital in Louisiana and get treatment at any time, and if they do not have ability to pay, any difference gets funded through uncompensated care.

The strategy contemplated by Nevers is to offer his agenda as constitutional amendments, bypassing expansion opponent Gov. Bobby Jindal. The problem is, he has to get two-thirds of each chamber of the Legislature to agree, when last year not even simple majorities could be mustered to support that view. But even if that were to happen, implying a certain level of stupidity to a large majority of legislators, as amendments then must be ratified by a majority of voters, he thinks a lot of voters are idiots as well.

As long as the facts are made known (as well as exposed the illogic of supporters’ arguments, such as expansion should occur because then state citizens’ federal tax dollars won’t go to finance expansion in other states even though their total tax bill would be higher with expansion), the voting public isn’t stupid. Expansion is redistributive and those who would be allowed to take from others would support it. But a majority would be worse off and would vote accordingly if informed.

But it’s unlikely to get that far because enough elected representatives (whom Nevers, ironically including himself, disparages as “just a handful of people”) will see the wisdom in continued rejection. Representative democracy does usually work out for the best.

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