Archive

Posts Tagged ‘Medicaid’
December 5th, 2013 at 3:29 pm
Delay in Obamacare’s ‘Seamless’ Online Medicaid Enrollment Could Morph into an Unfunded Mandate

Obamacare’s “original vision of seamless Medicaid enrollment for all consumers will remain elusive indefinitely because of varying levels of readiness among states and the continued inability of the feds to transfer accounts directly to individual Medicaid agencies,” reports Governing.

That’s more bad news for Healthcare.gov, the federal health insurance exchange serving 36 states.

The problem is simple but not easy to fix. Because there is such a wide disparity among states in their ability to connect their Medicaid databases to the federal server, many of those who qualify for Medicaid can’t sign up for the program online. To compensate, federal workers send digital copies of an applicant’s qualifying information to state counterparts who then must verify eligibility.

Bottom line: All this checking and rechecking loses the efficiency gains assumed by Obamacare’s drafters. Among others, these cost savings were counted toward the health law’s now dubious claim of deficit neutrality.

Now the bad news for states.

Since every state participates in Medicaid, problems with the program created by Obamacare will impact state budgets regardless of whether they run their own health insurance exchange or let the feds do it. That’s because the exchanges are designed to serve those who don’t qualify for Medicaid. If seamless Medicaid enrollment proves impossible, then the resulting expenditures to meet the uptick in demand will be yet another unfunded mandate passed on to state taxpayers.

December 5th, 2013 at 2:23 pm
From Romneycare to Single-Payer in Massachusetts?

The Obama administration’s former chief of Medicare and Medicaid is running for Governor of Massachusetts, and hints that his goal is to turn Romneycare into a single-payer system.

“It is time to seriously explore the possibility of a single payer system in Massachusetts,” declares Donald Berwick’s campaign website. (Emphasis in the original) “I will work with the Legislature [to] assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.”

Along with achieving this goal, Berwick makes a series of other promises that seem breathtaking when one considers the amount of information, oversight and control necessary to fulfill them. Again, all bolded words appear the same way on the site.

·    I will personally lead a statewide initiative to make Massachusetts the healthiest state in the nation, through smoking cessation, obesity prevention and reduction, and specific programs to curb domestic and physical violence.
·    We will stop the obesity epidemic in Massachusetts.
·    We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.
·    Massachusetts will be the national leader in patient safety.

I do not dispute that Americans in general – and apparently Massachusetts in particular – are suffering from very serious problems like obesity, substance abuse and suicide, along with all the ancillary problems that follow in their wake. But how is it sensible to assume, as Berwick’s manifesto does, that politicians can solve these deeply personal problems – abetted by a nihilistic culture – through bureaucratic fiat?

Moreover, who is going to pay for all this? Nowhere does Berwick mention the massive increases in state spending his plan implicitly calls for, since Massachusetts will now need an army of public employees to collect data, push ad campaigns and fine or penalize those who don’t change their behavior.

Joshua Archambault outlines other problems with Berwick’s platform, among them the myriad technical difficulties facing a state trying to operate a stand-alone single-payer system.

Berwick is no shoe-in to win the Democratic nomination for governor, but his ideas about single-payer are gaining ground in Massachusetts politics. As Archambault notes, 20% of the state’s heavily Democratic state senate are on record as supporting a single-payer system. That’s not surprising since the Bay State was the first to impose a health insurance mandate on individuals in 2006. As costs have grown, so have calls for more government control.

It bears remembering that President Barack Obama has said repeatedly that Romneycare was a model for Obamacare. If Berwick’s ideas manage to transform the former into a single-payer system, national health care policy may soon have a new maxim: As goes Massachusetts, so goes the nation.

November 29th, 2013 at 5:37 pm
Obamacare Swells New York’s Medicaid Rolls

“Since the Oct. 1 rollout of the Affordable Care Act in New York, nearly half of New Yorkers who signed up for insurance on the state-run exchange qualified for Medicaid,” reports the New York Post.

Apparently, the media attention surrounding Obamacare enticed many lower-income Empire State residents to apply for insurance, only to find out they qualified for taxpayer subsidized Medicaid instead. If every New Yorker that qualifies for Obamacare’s expanded version of Medicaid actually signs up, the state’s total Medicaid population could hit 6 million in a few years. That would be nearly 1/3rd of the state’s population.

The implications for federal spending levels are ominous. Currently, Medicaid spending is split between states and the feds. But once 2014 arrives, “the feds will pick up 75 percent of the tab and eventually 90 percent for childless Medicaid adults, instead of the current 50 percent.”

As the Post’s article indicates, Obamacare’s failure to lure enough buyers onto its public-private insurance exchanges is only half the story. The real win for those who want to impose a government-run, single-payer system onto the American health care system may be in the massive expansion of Medicaid consumers paid for out of the federal treasury. Thus, even if the public-private part of Obamacare fails, the number of citizens depending on Washington for health care will increase dramatically. In the long run, that may be just what Obamacare’s staunchest supporters desire.

October 15th, 2013 at 12:20 pm
Was Obamacare Website a No-Bid Job?

If anyone is looking for another reason to criticize the Obamacare website rollout, here it is.

“Rather than open the contracting process to a competitive public solicitation with multiple bidders, officials in the Department of Health and Human Services’ Centers for Medicare and Medicaid accepted a sole bidder, CGI Federal, the U.S. subsidiary of a Canadian company with an uneven record of IT pricing and contract performance,” reports the Washington Examiner.

An open, competitive process would have revealed that CGI was fired in 2011 by the Ontario government for failing to deliver on time “a new online medical registry for diabetes patients and treatment providers.”

In other words, CGI – the firm responsible for creating a health insurance portal to service 36 American states – couldn’t deliver a much less complicated system for 1 Canadian province. The service was so bad that the Ontario government still refuses to pay any outstanding fees it owes to CGI.

Remember when liberals screamed bloody murder about the no-bid contracts awarded by the George W. Bush administration to defense contractors?

Well, it’s time to mount their high horses again and demand accountability.

I’m looking at you in particular, Jon Stewart.

September 30th, 2013 at 7:34 pm
Shaky Launch for ObamaCare Exchanges Looming

However tonight’s government shutdown/showdown plays out, tomorrow’s big news is likely to be how well the 51 ObamaCare insurance exchanges are performing.

Projections don’t look pretty, according to the New York Times.

A few of the low-lights include:

·    The District of Columbia will not be able to determine online whether people qualify for Medicaid or for a federal subsidy (the difference is crucial)

·    In Nevada, a Spanish-language version of the exchange’s website will not be ready until mid-November

·    In Maryland, small businesses will not be able to buy insurance for their employees until January

Rocky King, Oregon’s exchange director and winner of the Mr. Honesty award, tells the Times, “I have no idea what this thing’s going to look like on Oct. 1. We could crash and burn and have to close it down.”

We’ll know soon enough.

September 17th, 2013 at 5:47 pm
ObamaCare in Your Bedroom?

The New York Civil Liberties Union and the Goldwater Institute are both warning of dire threats to privacy if ObamaCare’s financial incentives and penalties on doctors aren’t changed soon.

The health law’s ‘reforms’ “aim to turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary, and to violate their Hippocratic Oath to keep patients’ records confidential,” writes Betsy McCaughey in the New York Post.

Topics include asking whether a patient is sexually active, and if so, with what number of partners. Whether a person has same-sex partners is also an area the feds want to know about.

And don’t forget to add in the required questions about a person’s drug history.

Combine this with all the routine yet highly sensitive health information people share with their doctor, and you’ve got the makings for a single-source document that could ruin someone’s life if made public.

To do this, ObamaCare uses financial pressure to compel doctors to participate. Answers go into federally mandated electronic health records. Highly portable, the records can be accessed and shared among regulators.

Resistance won’t be easy.

“Doctors and hospitals who don’t comply with the federal government’s electronic-health-records-requirements forgo incentive payments now; starting in 2015, they’ll face financial penalties from Medicare and Medicaid,” according to McCaughey. “The Department of Health and Human Services has already paid out over $12.7 billion for these incentives.”

And it’s just going to get worse.

Best advice: Try to convince your doctor to keep two sets of books. One that’s real; the other for the Feds.

ObamaCare: Bringing people together in opposition to their government.

May 21st, 2013 at 6:54 pm
Another ObamaCare Gap in Coverage Exposes Tangled Safety Net

How big is a “gap” in coverage when it affects 840,000 people?

The Los Angeles Times says that California is racing to pass a “bridge” program into law that helps individuals and families likely to be caught between qualifying for Medi-Cal (the state’s version of Medicaid), and ObamaCare’s new state-based health insurance exchange.

In California, residents earning up to 138% of the federal poverty level, or about $15,000 a year, will be eligible for Medi-Cal next year. Individuals earning up to 400% of the federal poverty level, or about $46,000, will be eligible for subsidies through the exchange, known as Covered California.

The Covered California board approved a plan in March to help patients expected to jump between the two. The “bridge plan” would enable patients now on Medi-Cal managed care whose incomes rise to continue to stay with their health plan once they move to the exchange.

The program, which still needs federal approval and state legislation to take effect, could serve as many as 840,000 people next year. The plan should streamline the process, keep out-of-pocket premiums low and make it easier for people to keep their providers, said David Panush, external affairs director with Covered California. “It is better for their quality of care, it is better for continuity of care,” he said.

While it’s refreshing to see California taking steps to protect people from being penalized for working more, what the article doesn’t mention is how related government policies are putting the squeeze on the state’s working poor.

California’s anti-business climate – coupled with ObamaCare’s perverse incentive structure that makes it more affordable for businesses to cut hours rather than pay hefty premium increases for employee’s health insurance – are underreported tax increases on the working poor.

By diminishing the number and quality of jobs available to people at the bottom of the employment ladder, certain public policies make it exceedingly difficult for people to work their up into a better standard of living.

Because of this, one way to think of the constant tinkering and enlargement of public benefits is as a way to compensate the working poor for taking away their access to an abundance of jobs where they can get the experience and skills needed to move upward an onward.

Under the current regime, a “bridge” program between Medi-Cal and Covered California is the least state policymakers can do. Still, those entangled in the state’s safety net deserve better.

April 5th, 2013 at 3:52 pm
HHS Refuses State Requests for Medicaid Expansion Flexibility

States looking for flexibility under ObamaCare in how to structure and pay for expanding Medicaid can take a hike, according to an analysis by the Heritage Foundation.

States like Arkansas and Indiana have requested waivers from the health reform law’s expansion formula that creates millions of new enrollees at an eventual cost of billions of dollars to states.

The hope was to use existing state-based models like Indiana’s successful health savings account for low-income Hoosiers to increase Medicaid enrollment while retaining cost certainty for state budget writers.

But those hopes were dashed after the federal Department of Health and Human Services released a frequently asked questions (FAQ) sheet that flatly denied any request to deviate from ObamaCare’s one-size-fits-all, open-ended spending commitment for Medicaid.

With this announcement, the Obama administration has definitively articulated its idea of bipartisan reform.  Republican governors who capitulate and get in line are welcomed with open arms.  Those like Indiana’s Mike Pence can take their policy entrepreneurship somewhere else.

April 1st, 2013 at 2:49 pm
Indiana’s Pence Makes Progress with Innovative Medicaid Expansion

The Indianapolis Star reports that Indiana Republican Governor Mike Pence, a possible 2016 presidential candidate, cleared an important hurdle today when the state’s House Public Health Committee approved a bill to expand Medicaid eligibility without relying on ObamaCare’s open-ended spending incentives.

Pence’s plan would increase Indiana’s Medicaid enrollment by an estimated 400,000, but within the state’s Healthy Indiana initiative begun in 2007.  As a health savings account, Healthy Indiana allots a certain amount of money to qualifying Hoosiers who then shop for doctors and treatment options within their budget.  In effect, it transfers the decision making process for health care away from government bureaucrats to private citizens.  By capping the amount, Healthy Indiana also gives state budget writers more certainty about the cost of Medicaid expansion in future years.

Contrast this with the unlimited spending commitment envisioned by the Medicaid expansion system under ObamaCare, and conservatives will see why Pence’s proposal should be watched closely.  Under ObamaCare, states would pay no cost for expanding their eligibility pool up to 138 percent of the federal poverty line.  But starting in 2017, those that expanded enrollment would pay for 10 percent of the increase.  Though seemingly a small percentage, the costs will run into the billions, with even more likely if the federal government decides to reduce its 90 percent subsidy, as President Barack Obama has already hinted at doing.

The future of health insurance reform looks like it will include some mix of government-regulated exchanges, subsidies, and cost controls.  The question dividing conservatives like Mike Pence and Paul Ryan on one hand from liberals like Obama on the other, is who gets to make the lion’s share of the decisions on how health insurance dollars are spent.  Conservatives value individual choice, while liberals favor centrally planned mandates.

Ironically, if the President wants ObamaCare to be fiscally sustainable, he’ll have to accept that the only way to do it is allowing conservatives like Pence and Ryan to inject into it as much personal freedom as possible.

March 16th, 2013 at 3:22 pm
WSJ: GOP Medicaid Flippers’ Wishful Thinking

An editorial in the Wall Street Journal nails a specious legal argument by at least two GOP governors trying to convince their Republican legislatures to approve the ObamaCare Medicaid expansion now, with the intention of opting out when the state’s bill comes due in three years.

The argument, a product of a private law firm in Ohio, makes some nice lawyer’s points, but ultimately fails to take into account how government programs – and the politics that drive them – actually work:

But there’s no evidence in the original law or the Supreme Court opinion that states can join or leave at their own whim. The logic of Justice Roberts’s opinion  [upholding ObamaCare] suggests that once states adopt new Medicaid, the program immediately becomes the old program for the purposes of the law and then states can’t leave.

The Becker memo also cites “guidance” from the federal Health and Human Services Department that states “may decide later to drop the coverage.” But these informal documents on the HHS website lack the force of law or even of regulation; they aren’t part of the Federal Register. In any case, HHS doesn’t have such authority. Congress didn’t grant the Administration any more statutory leeway than it did the states.

We wouldn’t be surprised if HHS is promising flexibility now only to revoke it later as a deliberate bait and switch. That wouldn’t be any more deceptive than Mr. Kasich’s legal claims. Republicans tempted to sign up for ObamaCare’s Medicaid expansion had better think twice because once they do, the likelihood is they’re ceding control forever.

The decision facing Republican legislatures is straightforward: Either continue with Medicaid as it is and have (some) discretion over your state budget, or accept ObamaCare’s expansion and get ready to lose control.

It’s time for the GOP flip-floppers to be honest about the implications of this decision and debate the choice, and the consequences, on the merits.

March 12th, 2013 at 3:06 pm
Florida’s ObamaCare Medicaid Expansion on Hold

Republicans in the Florida house and senate have rejected Governor Rick Scott’s plan to expand the state’s Medicaid population.  Under ObamaCare, states are promised three years worth of federal funding to cover the cost increases.  Last week, Scott reversed his earlier opposition and accepted those terms.

The move by Florida’s Republican legislators is a welcome corrective to the knee-buckling capitulation of Scott and other GOP governors.  Borrowing a play out of Rep. Paul Ryan’s budget proposals, State Senator Joe Negron is using his no vote to pivot in a new direction.

“This will be the beginning of a transformation of the entire Medicaid system,” committee Chairman Sen. Joe Negron said. “My goal is that we will get out of the federal Medicaid system as we know it. Now, we can’t do that all at once, but we have an opportunity to begin that process.”

Negron wants the state to create a basic health insurance plan for the expanded Medicaid population and require recipients to pay a sliding scale premium based on their income. He suggested using Florida Healthy Kids, a managed care program that provides health insurance to low-income children, as the vehicle for delivering the new system.

Negron and his colleagues are showing real policy leadership.  Now that Scott’s dash for cash is on hold, it’s time for the former health care executive to rediscover his private sector creativity and help Negron put Florida on a path toward sustainable social safety net spending.

H/T: Tampa Bay Online

March 5th, 2013 at 1:18 pm
Pennsylvania Next Medicaid Expansion Domino to Fall?

Pennsylvania Republican Governor Tom Corbett may be wavering on his refusal to expand Medicaid under ObamaCare’s bait-and-switch funding scheme.

I don’t envy him.  He’s surrounded by states like Ohio and New Jersey, whose GOP governors opted to indulge the fantasy that they can accept the federal government’s promise of full funding at face value.

To his credit, Corbett isn’t allowing himself to act like there are no costs associated with agreeing to so-called “free” Medicaid expansion for the next three years.

Here’s some refreshing honesty from Corbett’s spokeswoman Christine Cronkright:

The Corbett administration has estimated that participating in the Medicaid expansion that would add 800,000 people to medical assistance would cost Pennsylvania $1 billion through 2014-15 and a total of $4.1 billion. Advocates maintain that the Medicaid expansion would pay the way for $43 billion in federal contributions, beginning with three years in which the federal government would pay 100 percent of the expansion.

“Regardless of the federal government’s claims, the presumption that they will cover 100 percent of the costs of full expansion is simply not true. Regardless of any other costs under the (Affordable Care Act) that we’d have to bear, there are still IT and staffing costs, costs for additional clients coming into the system that may have been eligible before, and costs for those we believe will drop employer-based coverage,” Cronkright said.

So it turns out “free” really means $1-4 billion.

The simple truth about ObamaCare’s Medicaid expansion is that it establishes a one-way street toward greater federal intervention in every individual’s health care decisions. Democrats know this, and are using the “free” money trope to lure weak-willed Republicans into a federally-dominated system from which a state will not be able to extract itself.

GOP governors who agree to expansion and believe that they will have the political support to simply cut off access to Medicaid when the feds pull back funding are deluding themselves. Besides, what kind of leadership is it to support welfare expansion on the condition that someone else pays for it with their debt-laden credit card?

So far, Governor Corbett is standing firm in the face of tremendous opposition to fiscal sanity.  Let’s hope he continues.

February 27th, 2013 at 2:55 pm
Chris Christie to Expand Medicaid

The key passage from Governor Chris Christie’s budget speech yesterday speaks volumes about where the New Jersey Republican stands on principle:

Let me be clear, I am no fan of the Affordable Care Act. I think it is wrong for New Jersey and for America. I fought against it and believe, in the long run, it will not achieve what it promises. However, it is now the law of the land. I will make all my judgments as governor based on what is best for New Jerseyans. That is why I twice vetoed saddling our taxpayers with the untold burden of establishing health exchanges.

But in this instance, expanding Medicaid by 104,000 citizens in a program that already serves 1.4 million, is the smart thing to do for our fiscal and public health. If that ever changes because of adverse actions by the Obama Administration, I will end it as quickly as it started.

Almost all of the same criticisms I leveled at Florida Governor Rick Scott this weekend apply to Christie and his reasoning.

The Governor’s characteristic bluntness, though, merits one further point.

By claiming that the Affordable Care Act (aka ObamaCare) “is wrong for New Jersey and for America,” and that “in the long run, it will not achieve what it promises,” Christie is admitting that he has decided to entangle New Jersey in a fundamentally flawed program that will fail to achieve its goals.  But don’t worry.  In the meantime, New Jerseyans can breathe easy because Christie, like Scott and the other Republican capitulators, will make sure to gobble up as much “free” federal taxpayer money as possible until he decides to pull the plug rather than help cover the costs.

One of the first rules of persuasion is to be coherent.  Christie’s tortured, self-serving logic doesn’t come close.

February 23rd, 2013 at 7:02 pm
Florida Joins Dark Side on Medicaid Expansion

With all due respect to Newsmax CEO Christopher Ruddy, and as a fan of his website I mean that sincerely, I couldn’t disagree more with his defense of Florida Governor Rick Scott’s decision to accept ObamaCare’s Medicaid expansion.

Like other Republican governors who’ve flipped on the issue, Scott announced last week that even though he remains philosophically opposed to ObamaCare, he would accept at least the law’s Medicaid expansion for the next three years because federal taxpayers – not the state – would pick up the entire price tag.  Like many of the other capitulators, Scott claims that because the Supreme Court ruled ObamaCare constitutional, it doesn’t make financial sense for Florida residents to pay for ObamaCare through fees and penalties while other Medicaid-expanding states reap a windfall.

Ruddy defends Scott’s about-face with two arguments I don’t find compelling.

The first:

Scott has also made it clear that he has not agreed to continue the Medicaid expansion beyond three years, when federal funding will drop to 90 percent, and Florida could opt out at that point.

Let’s get real.  Once a state accepts more federal dollars and grows a politically sensitive program like Medicaid, the trend is to grow, not cut back.

Moreover, Scott’s calculation betrays a canny reading of the political calendar.  He’s up for reelection in November 2014, but will get credit for expanding Medicaid at no cost to state taxpayers in January of that year.  If successful in his bid, Scott can continue to enjoy favorable press until January 2017 when the federal largesse starts receding and Floridians start feeling the cost of all that “free” healthcare.  But by the time that happens Scott will be wrapping up his second term, and handing off that political football to a predecessor.

Which brings us to Ruddy’s other unpersuasive argument:

So governors like Scott and [Arizona’s Jan] Brewer have to put aside their personal views and accept the reality of the situation.

Since when do conviction conservatives want one of their own – as the Tea Party-backed Rick Scott claimed to be in 2010 – to “put aside their personal views” in favor of growing government?

The “reality of the situation” with ObamaCare’s Medicaid expansion is that it’s completely voluntary.  Any governor that accepts its terms is intentionally saddling his or her state’s future taxpayers with a costly new entitlement that will be impossible to scale back through the political process.

After all, if politicians like Scott can’t weather the storm of saying no to entitlement increases when they don’t even exist, how does it pass the laugh test to think he’ll have the political courage to scale back when the feds re-impose reality?

To be fair, Ruddy isn’t alone trying to defend the indefensible.  Charles Krauthammer is singing a similar tune.  But again, with all due respect, it’s just not true that you can claim to be a fiscal conservative and then capitulate on something as basic as a budget-busting expansion of Medicaid.

February 8th, 2013 at 8:15 pm
Indiana’s Pence Wants Sensible Reform to Medicaid Expansion

Like Ohio’s John Kasich and four other Republican governors, Indiana’s Mike Pence seriously considered expanding Medicaid eligibility under ObamaCare.  But unlike Kasich & Company, Pence ultimately decided against it when HHS refused to grant him one sensible reform.

Established under Mitch Daniels, Pence’s predecessor, the Healthy Indiana program allows uninsured adults aged 19-64 to use a state-based health savings account to pay for medical expenses, such as doctor’s visits, hospital services, diagnostic tests, and prescription drugs.  Incentives apply to reward cost-effective spending, but it’s critical to point out that the spending decisions within the account are determined by the policyholder, not the state.

In order to go along with expansion under ObamaCare that increases the eligibility pool for Medicaid, Pence asked permission to use Healthy Indiana accounts to help keep costs down.  The request is imminently reasonable.  If the purpose of Medicaid expansion is to cover uninsured people, why not let Indiana migrate a state-based program with a 94% satisfaction rating?

Predictably, Kathleen Sebelius’ Department of Health and Human Services said no, preferring to retain federal control over coverage and spending.  Without a program like Healthy Indiana in place, costs are likely to spiral upward since Medicaid beneficiaries are not tethered to the consequences of their spending decisions.

So, Pence said no to the Medicaid expansion.  But I think it’s crucial to understand that his response was not a kneejerk reaction against helping the uninsured get normal access to healthcare.  Instead, he proposed a sensible reform that would have accomplished the same goal as Medicaid expansion, but with more cost certainty for the state budget, and thus less tax receipts from taxpayers.

I’ve speculated before that Pence might be the GOP’s best bet in the 2016 presidential race.  A moment like this, even when it doesn’t result in a “win” politically speaking, helps confirm that suspicion because it’s based on sound principles.

October 25th, 2012 at 6:32 pm
Income Inequality: It’s Easy to be Poor When We Don’t Count the Safety Net
Posted by Print

The American Enterprise Institute’s Kevin Hassett and Aparna Mathur have an important (and devastating) piece in today’s Wall Street Journal breaking down the misleading facets of the left’s argument that the U.S. is currently suffering through a crisis of economic inequality. Here’s a particularly eye-opening excerpt:

In the first place, studies that measure income inequality largely focus on pretax incomes while ignoring the transfer payments and spending from unemployment insurance, food stamps, Medicaid and other safety-net programs. Politicians who rest their demands for more redistribution on studies of income inequality but leave out the existing safety net are putting their thumb on the scale.

Second and more important, it is well known that people’s earnings in general rise over their working lifetime. And so, for example, a person who decides to invest more in education may experience a lengthy period of low income while studying, followed by significantly higher income later on. Snapshot measures of income inequality can be misleading.

Thomas Sowell frequently makes a point complimentary to Hassett and Mathur’s second observation above: that measuring income inequality over time tends to be deeply misleading because membership in any given income bracket is highly fluid, with people’s income often shifting dramatically over time. Thus, someone who’s in the bottom quintile of income in today’s measurements may be in the second quintile from the top in 15 years’ time. But we tend to analyze these groups as if their composition is static.

Hassett and Mathur’s first point, however, is the one that always bowls me over. If the point of a safety net is to remove people from the perils of indigence, yet the government refuses to factor those provisions into measurements of income, we end up with a perpetually imperiled underclass that only exists on paper. As Mark Twain said (supposedly quoting Disraeli), there are three kinds of lies: “Lies, damned lies, and statistics.”

October 16th, 2012 at 6:01 pm
5 Points Romney Should Make in Tonight’s Debate

The Heritage Foundation tees up five issues that so far haven’t been mentioned in the Romney-Obama or Ryan-Biden matchups:

1)      Welfare Reform

2)      Trade

3)      Medicaid

4)      Federal Spending and Debt

5)      American-Produced Energy

Each of these is not only critical to American prosperity, but also conveniently is attached to a disastrous policy decision by the Obama Administration.

This summer Obama’s HHS gutted the work requirement for receiving welfare checks that was the hallmark of the mid-1990’s reform.

The President and his fellow liberals in Congress held hostage free trade agreements negotiated by the Bush Administration as a favor to labor unions, and in the process damaged our international standing.

Obamacare is scheduled to hit Medicaid doctors with a 19 percent pay cut starting in 2014.

This is the fourth consecutive year of $1 trillion budget deficits presided over by President Obama, and there is no indication the incumbent will do anything differently if reelected.

As for domestic energy production, Obama’s rejection of the Keystone XL pipeline angered not only consumers paying high gasoline prices, but also the unionized labor that stood to benefit from short- and long-term job creation.

Mitt Romney should look for ways to insert these failures of leadership into his answers during tonight’s townhall debate with Barack Obama.  People need to be reminded that the President’s kneejerk liberalism is bankrupting the country.

August 23rd, 2012 at 5:59 pm
Romney-Ryan & a Realist Approach to Entitlement Reform

Over at National Review, John O’Sullivan argues that the Romney-Ryan ticket should take a realist tone when it sells its vision of entitlement reform, referencing a familiar example:

Despite all the guff written about him, Reagan was not an optimist. He was a realist who believed in the virtue of hope (which is quite another thing — see below). Realism is a combination of prudence and hope. Realists believe that they can solve problems and win battles, but only by evaluating the dangers accurately and proposing adequate responses to them. Reagan expressed great faith in the future of the American people, but he also warned that their grandchildren might lose that future if the present generation did not defend the U.S. Constitution and traditional liberties. He warned eloquently against the Soviet threat, but instead of looking on the bright side and leaving matters to chance, he drove through — against strong political and media opposition — tough policies on foreign policy and defense.

Hope and prudence are what Ryan has shown with his persistence in speaking the fiscal truth to seniors in his Wisconsin congressional district.  It was hope in the power of fact-based arguments that compelled him to spend hours in town hall meetings detailing the chronic deficits afflicting Medicare and Medicaid.  And it was from a deep well of prudence that he sought to explain how the continued failure to reform their structure will result in either taxes we can’t afford or cuts in coverage some people can’t endure.

This election will likely turn on whether Ryan’s realistic appraisal of entitlement reform will be interpreted by the public as a blend of hope and prudence or instead an accountant’s excuse to throw granny off a cliff.

August 8th, 2012 at 7:32 pm
President’s ObamaCare Deception

Politico reports that in a campaign speech in Colorado today President Barack Obama framed his Patient Protection and Affordable Care Act (aka ObamaCare) this way:

“Let me tell you something, Denver, I don’t think your boss should get to control the health care that you get,” Obama told the crowd at a campaign stop in Colorado. “I don’t think insurance companies should control the care that you get. I don’t think politicians should control the care that you get. I think there’s one person to make these decisions on health care and that is you.”

What the President neglected to mention is that instead of employers, insurance companies, and politicians – and despite his comments about individuals – the constituency he really favors making health care decisions is the federal bureaucracy.

ObamaCare’s Medicaid expansion is intended to capture millions of Americans newly eligible for government coverage that will be – at least initially – cheaper than their current private provider.  The state-based, but federally-directed, health care exchanges are really just Trojan horse structures allowing HHS to seize control of the states’ traditional role in regulating health insurance whenever a state defies a federal prerogative.

And let’s not forget that the Independent Payment Advisory Board is empowered to act as a backdoor ration board, setting price caps on medical reimbursements that will distort the market and cause shortages.  In socialized systems like Britain and Canada long waiting times are the norm, as are denials of procedures in favor of pain management.

All of these elements – Medicaid expansion, federally managed health exchanges, and IPAB – empower one group: unelected, unaccountable bureaucrats.  To claim as the President does that private individuals will be the ones calling the shots on health care decisions is either foolish or deceptive, and I don’t think the man is lacking in smarts.

August 7th, 2012 at 1:54 pm
Feds’ Reliance on Medicaid to Cover More Americans Blowing Up on the Launchpad
Posted by Print

Last week, I posted here about the fact that the growing crisis in the supply of American doctors is driven partially by structural deficiencies in Medicare. A new piece out today in the Wall Street Journal (subscription required) illuminates another key part of the puzzle: the growing tendency of doctors to refuse new patients under Medicaid — the vehicle that the Obama Administration intends to use to insure millions more Americans under Obamacare:

Some 31% of physicians in a sample of 4,326 said they wouldn’t accept Medicaid beneficiaries, economist Sandra Decker of the National Center for Health Statistics reported in an article in the journal Health Affairs published Monday. Most of the doctors cited the low reimbursement from Medicaid.

The health law passed by Democrats in March 2010 was supposed to expand coverage to around 16 million low-income people by signing them up for Medicaid. The Supreme Court decision in June effectively gave states the chance to opt out of the expansion. It isn’t yet clear how many will do so, although it’s likely to be a hot political issue. Either way, the coverage gained by low-income Americans could be less useful if they are unable to find a doctor to see them.

There are problems at the macro level too. Consider what Democratic(!) governors have been saying about the Medicaid expansion. Kentucky’s Steve Beshear has said “I have no idea how we’re going to pay for it.” California’s Jerry Brown has called it “devastating.” And Montana’s Brian Schweitzer — a man often touted by Democrats as a potential presidential candidate — has warned, ” I’m going to have to double my patient load and run the risk of bankrupting Montana.”

As Thomas Sowell is fond of saying, one of the hallmarks of liberalism is judging intent rather than outcomes when it comes to public policy. Thus do we get decades-long wars on poverty that do next to nothing for the impoverished, and stimulus programs of which it is always claimed that they would have worked if they only been a little bit bigger.

I’m not sure the abject failures of Obamacare will get a free pass based on good intent though. Theses sorts of consequences — patients unable to find doctors, states teetering on the verge of bankruptcy — are nearly impossible to ignore … no matter how desperately the White House will try.