That’s the only reasonable conclusion one can draw from yesterday’s Rev & Fisc vote on HB 72 by Rep. Tony Bacala, which would give the state legislative auditor the power to cross-check tax records against applications for Medicaid and food stamp eligibility. The committee voted 5-3 to kill the bill, which was a surprise to practically nobody.
Medicaid wastes more than $100 million per year in benefits distributed to people who are not eligible for the program. Last year there were more than 1,600 people with six-figure incomes drawing Medicaid, an absurd result which begs the question why anybody with that much money would even want to be on the Medicaid rolls given how crappy a health insurance plan Medicaid actually is. And just last week it came out that a fresh round of 17,000 people were found to be signed up for the program who weren’t eligible – this after some 40,000 others had previously been found out.
It’s an absolute joke. Meanwhile, Gov. John Bel Edwards has traveled the state boasting about all the good he’s done by signing up a half-million people for his Medicaid expansion, with nary a thought toward insuring those people were actually eligible for it. What we don’t know is how many people on private insurance were siphoned out of it and put on the government dole, because no particularly credible official study was ever done on that number. We think it’s at least 200,000 people, and the Pelican Institute has done a good amount of research on the subject – with less-than-complimentary judgements on offer:
To assess the breadth of Louisiana’s Medicaid crowd out, a term which refers to residents who have dropped their existing coverage to enroll in Medicaid expansion, the Pelican Institute filed a public records request with the Louisiana Department of Health. The data from LDH showed that for much of 2016 and 2017, several thousand individuals per month dropped their existing coverage for Medicaid expansion, which makes up a significant portion of the average 15,000 individuals per month enrolling in the program in 2017.
In 2015, the Legislative Fiscal Office assumed that the cost to the state to cover individuals with prior coverage would fall between $900 million and $1.3 billion. Recent testimony from LDH staff indicated that current spending on the average expansion enrollee is approximately $6,286.20 per year. This means that Louisianans who dropped private coverage for Medicaid expansion could be costing state and federal taxpayers $461.6 million in this fiscal year alone.
A key issue arises from the methodology being used by the state to calculate the percentage of the crowd out population. In August 2017, instead of calculating crowd out to equal the percentage of Medicaid enrollees who dropped their private coverage to enroll, LDH divided the number of Medicaid expansion enrollees whose private coverage policies ended within 60 days of their enrollment by the total expansion enrollment population of 442,674. This yielded a crowd out rate of 1.3 percent. However, an accurate calculation would divide the number of new enrollees who dropped private coverage in a given month by the total of new enrollees in that same month.
Using LDH data, the Pelican Institute found that in August 2017, 13,955 individuals enrolled in expansion and of that, 4,957 individuals had dropped private coverage in the prior 30 days. Dividing these numbers equates to a potential crowd out rate of 35.5 percent, which is far higher than the one-to-two percent figure cited by LDH.
The state portion of Medicaid is going to cost the citizens of Louisiana $100 million per year more each year, in compounding fashion. Private health insurance isn’t the only thing it’s crowding out – it’s going to crowd out roads, higher education, coastal restoration, K-12 education, law enforcement and lots of other things as it continues impinging on the state’s budget.
This is known. It’s not some crackpot conspiracy theory or some Chicken Little political ploy by Republicans who hate John Bel Edwards. It’s simple math. The legislative auditor finds tens of millions of dollars in waste every time he digs into the Medicaid mess. You would think squeezing out the waste and holding back the amount Medicaid and other giveaway programs run away with the state’s budget would be a top bipartisan issue.
But you’d be wrong.
The reason this happened yesterday is that Rev & Fisc was built to insure no bills imposing fiscal restraint on the Louisiana budget would ever make the Senate floor and therefore Edwards would never have to veto any of those bills. That’s why you have seven Democrats and four Republicans on that committee, in a Senate which has a 25-14 Republican edge. And that’s why J.P. Morrell, one of the most left-wing Democrats in a Republican-dominated Senate, chairs that committee.
Morrell might not even be the worst of that bunch. He has lots of help in destroying any chance of fiscal reform and governmental accountability on that committee. The six other Dems in Rev & Fisc are Gerald Boudreaux, Troy Carter, Yvonne Colomb, Jay Luneau, Karen Carter Peterson and Gary Smith. Against that wall of fiscal incontinence, the four Republicans – Dale Erdey, Neil Riser, Eddie Lambert and John R. Smith haven’t a chance.
There’s nothing which can be done about this until this fall’s elections. But if the voters actually do want to rein in the out-of-control Medicaid program, they’ll get rid of Edwards and put either Ralph Abraham or Eddie Rispone in the governor’s mansion, and they’ll make some major changes in legislative elections – particularly on the Senate side. And then they’ll demand that a Republican-majority Senate doesn’t just hand over such an important committee as Rev & Fisc to the most left-wing Democrats imaginable.
After all, enough damage has already been done over the past four years to last us a lifetime. This committee is probably the single biggest reason Louisiana’s budget is almost $10 billion larger than it was four years ago with no discernible benefit for the vast majority of the state’s population.
UPDATE: A quick postscript to show just how awful the Rev & Fisc committee is – here’s a snippet of the debate on HB 72 that the LAGOP pulled yesterday to show Jay Luneau’s grandstanding incompetence. He’s telling Bacala his bill isn’t needed because Luneau – whose face is nearly the color of boiled crawfish at this point – had already passed a bill last year purporting to provide fiscal accountability. And Bacala answers by noting that the Louisiana Department of Health isn’t following the law on Luneau’s bill.
Such interactions in that committee are typical, particularly of Luneau, who is a bloviating dunce on a scale uncommon even among Louisiana politicians. This can’t go on.