Tag: Medicaid

Must-Read: Aaron Carroll: So What Did the Medicaid Expansion Actually Do?

Posted on by Brad DeLong

Must-Read: Aaron Carroll: So What Did the Medicaid Expansion Actually Do?: “In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults…

…Laura Wherry and Sarah Miller…. By the second half of 2014, adults in the expansion states had seen their health insurance coverage increase 7.4%; Medicaid coverage increased 10.5%. This isn’t surprising, as increased coverage was the main intent of the Affordable Care Act. Coverage was found to have ‘improved’ as well (7.1%)…. In Medicaid expansion states, there were increased in physician visits (6.6%), hospital stays (2.4%), rates of diagnoses of diabetes (5.2%) and high cholesterol (5.7%). Of course, this is an observational study…. Insurance coverage is just the first step in improving access. What this study adds are some data showing that expanding Medicaid through the ACA resulted in increased coverage, improved coverage, more physician visits, and more disease diagnosed…

Must-Read: Ezra Klein: Republicans Think America Is Doing Terribly, but It Isn’t

Posted on by Brad DeLong
Journalist, columnist, and blogger Ezra Klein. (AP Photo/Charles Dharapak)

Must-Read: America looks bright today primarily from the perspective of the rich, the techie, and those who have benefitted from ObamaCare’s coverage expansion. That is not most Republicans. The lived experience of most non-poor–and many poor–Republicans in the Bush 43 and Obama years is not of participating in the second tech bubble, or even benefitting greatly from ObamaCare because their local political rulers and masters have not implemented it. And they couldn’t care less that Greece and Italy and France and Britain are doing even worse:

Ezra Klein: Republicans Think America Is Doing Terribly, but It Isn’t: “Anyone watching the fourth Republican debate would be excused…

…for thinking America is mired in a deep recession–that the economy is shrinking, foreign competitors are outpacing us, more Americans are uninsured, and innovators can’t bring their ideas to market…. They would be surprised to find that unemployment is at 5 percent, America’s recovery from the financial crisis has outpaced that of other developed nations, the percentage of uninsured Americans has been plummeting even as Obamacare has cost less than expected, and there’s so much money flowing into new ideas and firms in the tech industry that observers are worried about a second tech bubble.

This beats even the markers the Republican Party established. In 2011, for instance, Mitt Romney made headlines when he promised that ‘after a period of four years, by virtue of the policies we’d put in place, we’d get the unemployment rate down to 6 percent–perhaps a little lower.’ We’re now quite a bit lower than 6 percent, and in less than four years…. The economy simply isn’t as bad as they’re making it out to be….

[And] Republicans are increasingly focused on economic problems they don’t really know how to solve, and don’t have much credibility to say they will solve…. Republican tax plans will sharply increase after-tax inequality, and they will do so in the most obvious and mechanical of fashions…. Republicans have entered into a disastrous arms race of ever more expensive tax plans that they have no way to pay for…. Republicans are stuck between a description of the economy that seems increasingly detached from the reality of the recovery and a set of economic plans that actually worsen many of the problems Republicans say they want to solve. It’s a pickle.

Must-Read: Kevin Drum: Red States Spent $2 Billion in 2015 to S—- the Poor

Posted on by Brad DeLong

Must-Read: Nobody is saying anymore that states’ rejecting Medicaid expansion is a way of raising the chances of repealing-and-replacing ObamaCare with something better. Only true dead-enders–cough, Michael F. Cannon–are claiming that Medicaid is ineffective. And more and more evidence piles up that Medicaid expansion lowers rather than raising state-level health spending even in the short run. The remarkable thing is that the anti-Medicaid expansion zombies just keep on going–and it’s not just the poor, it’s the disabled, it’s the elderly whom Medicare copays have made poor, and its the hospitals and doctors and nurses who treat the poor:

Kevin Drum: Red States Spent $2 Billion in 2015 to S—- the Poor: “In 2015… spending by states that refused to expand Medicaid…

…grew by 6.9 percent. That’s pretty close to the historical average. However, spending by states that accepted Medicaid expansion grew by only 3.4 percent. Obamacare may have increased total Medicaid enrollment and spending, but the feds picked up most of the tab. At the state level, it actually reined in the rate of growth…. The states that have refused the expansion are… willing to shell out money just to demonstrate their implacable hatred of Obamacare. How much money? Well, the expansion-refusing states spent $61 billion of their own money on Medicaid in 2014. If that had grown at 3.4 percent instead of 6.9 percent, they would have saved about $2 billion this year… denying health care to the needy and paying about $2 billion for the privilege. Try to comprehend the kind of people who do this….

The residents of every state pay taxes to fund Obamacare, whether they like it or not. Residents of the states that refuse to expand Medicaid are paying… Obamacare taxes… about $20 billion of that is for Medicaid expansion…. So they’re willing to let $20 billion go down a black hole and pay $2 billion extra [a year] in order to prevent Obamacare from helping the needy. It’s hard to fathom, isn’t it?

Dysfunctional Debate Over Medicaid Expansion in Kansas City

Posted on by Brad DeLong

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.)

Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical

Posted on by Brad DeLong

Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical: “Oregon’s mass homicide sparked the usual debate about whether guns or mental health is the best focus in preventing atrocities…

…Given this stark frame, the centrality of gun policy is hard to deny. Compared with other wealthy democracies, America has surprisingly similar rates of car theft, aggravated assault, and other forms of nonlethal violence. Our gun homicide rate is about three times the average…. Gun policy measures such as improved background checks included in the nearly-passed, bipartisan, post-Newtown Manchin-Toomey bill would certainly be helpful. Many conservatives place greater emphasis on the mental health system. In some ways, this rhetoric is misplaced. The fraction of American violence attributable to severe mental illness is… on the order of five percent. We must also avoid reinforcing cruel stereotypes….

Still, it’s always wise to consider how our mental health systems could treat people more effectively, and more-reliably keep weapons away from dangerous individuals… expand the power of police and mental health professionals to temporarily confiscate guns from individuals whose behavior raises real concerns, but who do not meet the stringent criteria required to justify involuntary commitment…. Texas Senator John Cornyn has proposed… [to] expand states’ provision of mental health information to the National Instant Criminal Background Check System…. The potential impact of such data-sharing remains unclear…. Cornyn’s proposal does not address the most glaring issue in American mental health policy: the Affordable Care Act’s Medicaid expansion… the public health cornerstone of ACA…. Medicaid expansion provides financial stability to the whole network of safety-net medical, psychiatric, and addiction care…. In 2013, the National Alliance on Mental Illness (NAMI) released a report endorsing Medicaid expansion…. Addressing the connection between mental illness and violence, NAMI concluded:

In the aftermath of Newtown, many politicians and policy makers have promised to take steps to fix America’s broken mental health system. Expanding Medicaid in all states would represent a significant step towards keeping those promises.

Senator Cornyn is an implacable opponent of Medicaid expansion. Indeed he rallied at the Texas state capitol to oppose it…. Addiction and psychiatric disorders within the population of Texans deliberately left uninsured… 140,000… with addiction disorders… 54,000 live with severe mental illness… indigent criminal offenders and those seeking care at addiction treatment centers and stressed safety-net facilities that have lost billions of dollars because Texas has declined Medicaid. Leaving aside the human consequences for the uninsured, this is very poor violence prevention policy. If any other politician suggests that mental health rather than gun policy is central to reducing mass homicides, ask where they stand on Medicaid expansion. Their answer will be clarifying.