Dysfunctional Debate Over Medicaid Expansion in Kansas City

I actually made it to the second half of the Medicaid expansion in Kansas/Missouri panel last night:

Brad DeLong: Must-See: UMKC Medicaid Panel, and Think-Tanks: “Must-See: Alas! I seem to be missing the Kathleen Sibelius panel…

…on Medicaid expansion this evening at UMKC American Public Square: Dinner at the Square A Dose of Reality: A Medicaid Status Report…

Reactions:

1. Tarren Bragdon, the President and CEO of the Foundation for Government Accountability, didn’t seem to either (a) know enough, (b) have gotten himself well enough briefed, or(c) be able to think fast enough to do anything other than regurgitate right-wing talking points. But, then, would anyone who could do (a), (b), or (c) want his job?

2. Kathleen Sibelius and MO Hospital Association Senior VP of Governmental Relations Daniel Landon said about what I expected them to–and were, by and large, accurate and on point.

3. Michael F. Cannon of the Cato Institute surprised me in a number of ways.

4. Cannon claimed that Amy Finkelstein et al.‘s Oregon Medicaid study had found “no effect of getting Medicaid on physical health”. Not “no statistically-significant effect”. Not “effects quite possibly due to sampling error, but in line with clinical expectations”. Not “effects that might have been due to chance”. Not “effects that might not pass a sensible benefit-cost test”. Instead, he said “no effect”–over and over again, a couple of times qualified as “no discernible effect”. I wonder if he would have dared to so mischaracterize the Oregon Medicaid study–which found statistically significant and substantial effects on family finances, statistically significant and clinical substantial effects on depression (which is, mind you, a physical illness: brain chemistry plus, you know), clinically substantial but statistically not significant (due to low statistical power) effects reducing unhealthy blood sugars, and clinically substantial but statistically not significant (due to low statistical power) effects reducing unhealthy blood pressure–if Amy Finkelstein or their coauthors had been in the audience or on the panel?

5. Cannon’s big argument–made over and over again–was that the Affordable Care Act was bad because it did not eliminate insurance companies’ ability to engage in adverse selection via insurance plan design, and that the regulations in the ACA to limit such simply showed that it was a serious problem. Now if you really do believe that adverse selection by insurance companies via insurance plan design is a fatal flaw in the ACA, that has consequences. Getting rid of the ACA makes adverse selection a much bigger problem, and thus a much more fatal flaw. If that is your objection to the ACA, then you are a single payer advocate. If you are intellectually consistent. Sibelius nailed him: “Now I do not understand whether you object to the ACA because it regulates insurance companies too much or too little.”

6. Cannon’s slip-up when he said “the ACA is not going to be repealed”–apparently the start of the argument that he should not be held accountable for the consequences of the ACA appeal that he advocates. He stopped in mid-sentence, however, apparently realizing that was not a road he really wanted to go down.

7. Cannon’s claim that his 48-year-old developmentally-disabled cousin in New Jersey did not deserve to have and should not have a Medicaid card because he came from “a large Irish Catholic family with lots of relatives to take care of him”. Presumably female relatives. Again, Sibelius nailed him: “New Jersey’s Republican Governor Chris Christie disagrees–he expanded Medicaid.”

8. The “should Kansas/Missouri expand Medicaid?” argument is over before it starts. Kansas’s and Missouri’s taxpayers are paying for Medicaid expansion elsewhere. The question is whether they pay the taxes and get the benefits, or pay the taxes and don’t get the benefits. Thus the only argument that can be made is that there are no benefits–hence the misrepresentation of the Oregon Medicaid study that Medicaid does no good, the claim that those who qualify for Medicaid under the expansion do not “deserve” it, attacks on overpaid health-care providers who receive Medicaid payments. Plus, most recently, Kansas’s Governor Brownback’s claim that the real purpose Obama has in mind with Medicaid expansion is to keep urban hospitals that treat Black people open. (False, by the way: the hospitals most at risk from the absence of Medicaid expansion in Kansas right now are rural hospitals that treat poor people.)