SADOW: They Don’t Want You To Know This, But Medicaid Expansion Is Actually The Worst Way To Full Coverage

With little fanfare, earlier this month Louisiana released its plan to have health care insurance provided to all citizens. With even less fanfare, the state’s media ignored it because it did not fit their preferred narrative of bigger, more redistributive government.

The report only got mentioned as an aside this week in the New Orleans Times-Picayune – which until then never even acknowledged the existence of the law or the bill that became it despite its potential far-reaching impact because editorially the newspaper supports the alternative of Medicaid expansion under the Patient Protection and Affordable Care Act (“Obamacare”) – in an article that in part continues that outlet’s campaign to expand Medicaid. The law required the Department of Health and Hospitals to issue a report about what policies had to be enacted at all levels of government in order to expand insurance to all citizens using market-based rather than government- and politically-based principles.

DHH already has issued two reports explicating why Medicaid expansion is inferior and undesirable policy. Rigorous methodology showed that, under four different scenarios with differing assumptions, within a decade the state would be paying hundreds of millions of dollars more annually for care under expansion than under the current uncompensated care system. In addition, but not covered by these reports, are the results from academic research known as the “Oregon Experiment” that demonstrated people eligible for Medicaid but without health insurance have no worse and even better health outcomes than those utilizing Medicaid, and follow-ups that noted even when the previously uninsured begin using Medicaid they continued to utilize emergency room services for their primary care at significantly higher rates than the population – disproving a key Obamacare selling point that primary care would be more efficiently delivered if more of the uninsured were insured by Medicaid or other form of provision.

Given that expansion would cost the state more and, if anything, prevent better care outcomes, it’s a no-brainer to reject Medicaid expansion under Obamacare. However, Gov. Bobby Jindal had presented the outlines of a plan at the national level to extend health care insurance to all using radically different principles, and one frustrated member of the minority expansion crowd in the Legislature, state Sen. Ben Nevers, decided to see what of that could be adapted at the state level. His bill, now Act 783, mandated this reporting (even as he now, reverting to form, discounts this product).

Not surprisingly, it revealed that hundreds of federal laws and regulations, many having to do with Obamacare, act as impediments on implementing this. In conjunction with that, it also details how Obamacare generally has failed to fulfill, if not actually cause the opposite of, what Obamacare was sold on. Nevertheless, it does provide some answers as to what the state could do unilaterally to make for lower health care costs both for families and the state, which include tax deductions for insurance in the individual market to match those in the group market, improving transparency on pricing, allowing for increased pooling capacity for insurance purposes, authorizing cross-state purchasing of insurance (known as “portability”), and broadening the scope of practice for some health professionals, such as nurse practitioners.

Still, for substantial progress to be made, changes at the federal government level would have to occur, and with a stubborn ideologue in the White House who seems more interested in wealth redistribution rather than in improving health outcomes and undoubtedly would use his veto power to prove it, that seems unlikely for the next couple of years. But at least Louisiana could make some progress by doing what it can, as according to the report.

Thus, the state faces three choices in moving forward on broadening health care insurance provision: expand within an unreformed Medicaid system and make matters worse, do nothing and do no harm, or embark upon the report’s recommendations and create some improvement. The last of these choices is the obvious one to make.

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