BY: B. Keith Plunkett @Keithplunkett
The Democrats offered their alternative to Medicaid expansion yesterday by proposing a bastardized version of ObamaCare for Mississippi that will tax businesses and kill job creation at the very time it is needed most. The end result, despite what they say, will be an expansion of Medicaid, and the poor health outcomes that come with it.
According to the sponsors, the proposal is much like one proposed in Arkansas. The Natural State has proposed taking federal dollars for Medicaid expansion and instead using them to subsidize those potential beneficiaries into a state based insurance exchange. The Federal Department of Health and Human Services Director Kathleen Sebelius has given the Arkansas proposal her initial blessing, as the Obama Administration looks for any way to dangle an evermore irresistible carrot in front of states not anxious to jump into bed with a federal partner fully expected to renegotiate the contract through constant regulatory changes.
Hurry Up and Sign Here.
There are several things wrong with this latest Democrat proposal that all lead back to the same question for Mississippi: What the hell is the rush?
It feels a lot like a pressure sales pitch from a used car salesman trying to sell a lemon to a unprepared and uniformed customer. It doesn’t pass the smell test.
It’s Not Private Insurance
The proposal offers enticing and hypnotic terms conservatives like to hear like “private” and “market”. But, beware the poisoned apple. The Dems deal does have elements of private insurance. However, it is still Medicaid expansion money, and still legally part of the Medicaid program. That program as it currently stands is rife with fraud, abuse and government regulations that restrict choices and coverage to the needy, and result in most cases in health outcomes worse than those with no insurance at all.
References to “managed care” and “private insurance” in this new proposal are window dressing for a federal program that will come back to roost later with more regulations and restrictions, much as is the case with the current Medicaid program. Are we really going to trust the federal government enough to partner with them in building on such a cracked and shifting foundation?
The feds have already changed the original intent by writing tens of thousands of pages of new regulations not authorized in the law. There are several lawsuits in play that could affect whether much of the regulatory bait and switch is legally allowed.
We should be talking about reforming Medicaid first.
With all the “what ifs” floating around there is one thing and one thing only Mississippi legislators have full control over and can do right now. There are several options to reform Medicaid and see a significant cost savings AND better health outcomes for those on the program.
Florida has a pilot program in play in three of its most populous counties that has already saved the state $118 million, and led to better outcomes for those in that states program. When fully implemented it will save an estimated $1 billion dollars that Florida will reinvest into the program to continue reform.
Those same reforms in Mississippi would realize savings of around $250 million here.
Getting the Cart Before the Horse
If this new proposal isn’t Medicaid expansion, as Democrats say, then why aren’t we dealing with reauthorization of Medicaid first? Isn’t that the most pressing need? Is the drive to expand care to a couple hundred thousand people worth jeopardizing the needs of 700,000 needy that are already on Medicaid?
In case the Democrats forgot, July 1st is D-Day for the blind, disabled and elderly currently relying on the program for their care. The “D” stands for “Democrats Did Deny” those most in need a voice while they played politics for the Obama Administration. If they don’t change course, they will watch as their handiwork results in nursing homes across the state dealing with how to care for patients without funding.
Conservatives must hold the line and fight against the tax increase.
Behind the facade of Democratic rhetoric, this is nothing more than a political game. It’s not really about health coverage or health access. If it were, then Democrats would have already reauthorized the program and looked closer at reforms. This is about expansion of a government program that doesn’t work well for anyone except government lobbyists and those who can pay them the most. It certainly doesn’t help the beneficiaries or the doctors.
According to ObamaCare rules–again, rules the feds keep changing–exchanges are supposed to cover people between 100 percent and 400 percent of the federal poverty level. Medicaid expansion is to cover between 0 to 138 percent. There is an overlap of coverage for those who fall into the 100 percent to 138 percent range. If the state accepts the federal dollars for this proposal, we’ll be putting that overlap group into a state-exchange. Why not let them go into a federal exchange, and let the feds take the full responsibility? Why invest state money into a program the federal government will control anyway?
According to the ObamaCare law, and a source of another legal challenge, the IRS can ONLY tax small businesses the $2,000 per employee and force the individual mandate through a state based exchange. The reason for the lawsuit, filed in Oklahoma, is that the IRS has overstepped its authority by ruling on it’s own that it can tax businesses regardless of what the law says. But, that is not settled.
This Democrat proposal releases the state from that protection and opens the floodgates to taxing small businesses in Mississippi out of existence, and the jobs they provide right along with them.
The end result is that more people end up on Medicaid anyway as they lose their job and the coverage they currently have.
Pay no attention to the man behind the curtain.
The Congressional Budge Office estimates 100,000 Mississippians of the 300,000 the expansion would cover already have insurance through an employer, meaning we’ll be pulling people into a government system that don’t need it, and the numbers the pro-expansion forces are giving us are not what they seem. Either way, the projections for voluntary participation are so bad the federal government is now spending millions to advertise and entice people to join the program.
Without the participation of a skeptical public the whole house of cards comes tumbling down. The only way Democrats can make the program work is through a combination of enticement and force. It has become very obvious that anything state officials can do to keep Mississippi out of this debacle, then the better off we are on the other side of this nightmare.
Democrats are fond of saying this is the law of the land, and rejecting it is futile. Ever wonder why they have to keep repeating that?
Give the public the ability to purchase insurance across state lines, give them the incentive to start Health Savings Accounts, make Medicaid a truly block grant program to the states that offers innovation and, for godsakes, reform the program to do away with fraud and abuse and save the money that is already there to be saved. Those are ideas that put power in the hands of people.
Expanding government, taxes and control is proven time and again to be a drag on innovation and service. You need only look to the current Medicaid program as a perfect example.
About Keith: Keith Plunkett has worked on communications issues with a range of public officials from aldermen to Congressmen, and a variety of businesses, governmental agencies and non-profits. He serves or has served as a board member of several non-profit, civic and political organizations. Contact him by going to HorizonMediaMarketing.com or follow him on Twitter @Keithplunkett
- Democrats propose using “Arkansas model” to expand health insurance. (mississippipep.wordpress.com)