Conservatives are in a box. Having run on demonizing Democrats for reallocating 500 billion out of Medicare Advantage, they can’t attack Medicare. They just spent two years and hundreds of millions of dollars promising to keep spending more and more and more on Medicare, forever. Too, seniors vote, in the crucial states of Ohio, Florida, Wisconsin and Pennsylvania. The VA is probably out, for obvious reasons. That leaves Medicaid.
Here’s a WSJ op-ed my sister sent me, ObamaCare and the Medicaid Mess, and it’s a good example of the tactics we can expect to see in the War On Medicaid.
First, to get a broad view of the fundamental error, here’s The Incidental Economist.
The reason that the PPACA puts 20 million more people in Medicaid is that it was cheaper than putting them in the exchanges to get private insurance. Let me say that again – it was cheaper.
Simple enough.
But let’s look at specifics. Here’s the claim:
Medicaid currently covers 53 million people at an overall cost of $373.9 billion (states are responsible for about half). But starting in 2014, ObamaCare rules will add about 20 million more, according to Richard Foster, the program’s chief actuary.
With “ states are responsible for about half ” Suderman omits the fact that the PPACA provides federal funding for Medicaid at a much higher rate than 50% through 2019. He just doesn’t mention that additional funding. It’s a huge omission.
Conservatives have wildly exaggerated the cost to states of of Medicaid expansion over and over, and the claims have been debunked over and over.
The federal government will bear virtually the entire cost of expanding Medicaid under the new health-care law, according to a comprehensive new study by the Kaiser Family Foundation that directly rebuts the loud protests of governors warning about its impact on their strapped state budgets. Governors of many of those states have predicted fiscal calamity for their budgets, and some have cited the Medicaid expansion in the suits they have filed against the new law, saying it violates their states’ rights. But the Kaiser study released Wednesday predicts that the increase in state spending will be relatively small when weighed against the broad expansion of health coverage for their residents and the huge influx of federal dollars to cover most of the cost. Even the small increase in Medicaid costs may be canceled out by the savings states will enjoy from no longer having to subsidize the uncompensated care of uninsured people who will be on Medicaid, study co-author John Holahan said.
And on to Healthy Indiana, and the obligatory plug for Mitch Daniels that is in every conservative editorial:
In 2007, for example, Gov. Mitch Daniels created the Healthy Indiana Plan, which funded 95% of the cost of consumer-directed health savings accounts for low-income residents. Healthy Indiana now covers about 43,000 low-income people not otherwise eligible for Medicaid under federal rules. The program is also popular among state employees. It’s funded by cigarette taxes and Medicaid dollars thanks to a federal waiver. Mr. Daniels has asked the Obama administration for permission to use Healthy Indiana as a way to expand the state’s Medicaid program.
Healthy Indiana is a flop. Here’s the part Suderman left out:
The state began enrolling adults in the plan in January 2008. As of June 2008, over 53,000 adults had applied.
It’s now February of 2011. How many are covered under Healthy Indiana? 43,000. 830,000 people in Indiana are uninsured. Healthy Indiana, more than three years after it was launched, covers 43,000 of that 830,000.
Let’s look at how it was funded and whether it saves money.
Here’s Suderman again:
It’s funded by cigarette taxes and Medicaid dollars thanks to a federal waiver.
Here’s what actually happened:
Following requests for federal assistance from states seeking to expand publicly-funded health coverage for the uninsured, the Bush Administration announced its “Affordable Choices” initiative in January 2007. Affordable Choices provides no new federal funds to states. It simply permits states to divert federal funds now being used to support hospitals that care for the uninsured and use those funds instead to help uninsured people purchase “basic private coverage” — that is, coverage provided through private health plans rather than Medicaid.
How much did Mitch Daniels divert out of the fund Indiana uses to reimburse hospitals for uncompensated care to Healthy Indiana?
And in order to pay for the 44,000 Indianans in the Healthy Indiana Plan, the state took $50 million from funds that it uses to help reimburse hospitals for uncompensated care. In other words, 40 percent of the state’s uncompensated care funds were spent on only 5 percent of Indiana’s uninsured population.
Does the private program save money over Medicaid? Nope.
First, many beneficiaries have to pay a lot more out of pocket than they would if they had traditional Medicaid coverage. Nonpayment has been the No. 1 reason for terminating beneficiaries from Healthy Indiana since the program began in 2008, with up to 35 percent of beneficiaries in certain income levels failing to make their first payment.
Second, providers serving Healthy Indiana beneficiaries have indeed been paid more than they would have if the beneficiaries had been covered under Medicaid. However, Healthy Indiana covers only about 44,000 Indiana residents, while more than 830,000 Indianans are uninsured.
Meanwhile, for those actually in the program, the state paid $75 more per month in 2009 for the healthiest group of Healthy Indiana enrollees than it did for comparable adult Medicaid beneficiaries, even though Healthy Indiana beneficiaries are ineligible for many expensive services, such as maternity care, that Medicaid beneficiaries receive.
Mitch Daniels is going in the wrong direction. He’s spending more to cover less. Why does he want to expand this program, again?
Because private is better than public, and state “innovations” are better than federal rules. They just are, so shut up. Mitch Daniels will happily pay more for less because….private is better than public, and anything is better than giving the Patient Protection and Affordable Care Act a chance to work, if you’re a partisan Republican.
Morbo
And with that, my head exploded; damn, I was still using it.
cleek
i’m shocked that Mr McArdle is a dishonest hack.
TooManyJens
Is gastritis contagious?
atlliberal
One thing people don’t mention with Medicaid is how much of that money is spent by old people in nursing homes. Republicans talk about it paying bills for the poor, but increasingly it is paying for grandma’s nursing home. Medicare doesn’t pay for home care to keep people in their homes. It also doesn’t pay for long term care of the patient can’t care for themselves. So more and more people are “spending down their assets” so that Medicaid will pay for nursing home care.
slag
Suderman…Suderman…where do I know that name from?
And this:
So true! I often feel like we’re still going pre-Enlightenment in this country. And the denigration of the word “public” is just another example of that shift.
Tom Levenson
This is the way it works: Spew enough bullsh*t from enough holes in the dyke and the good guys run out of fingers.
Stupid and dangerous arguments persist and the result is…
Profit!
(and dead folks who needn’t have shuffled off that coil so soon.)
slag
@atlliberal:
Exactly. So many people I talk to who are dealing with aging parents have been helping them do stuff like this. I wonder what the stats on this seeming trend are.
Kay
@atlliberal:
Because old people and disabled people can’t be effectively demonized. Plus, it’s easy to insure young and healthy people! So conservatives focus there, rather than where the money actually goes.
JCT
Of course it is much harder to demonize poor grandma as opposed to the browns, so there you have it. And don’t ever forget all that money we toss down the drain in futile end-of-life ICU hospital care [DEATH PANELS].
John– at the rate this day is going we’re going to need some serious Lily/Rosie and TUNCH pics (from the front, please) very soon.
It’s like a volcano of badness and hopeless stupidity has erupted.
JGabriel
Kay @ Top:
That’s because Mr. McArdle’s wife helped him with the math.
.
Zifnab
Gee, wonder if he got a lot of money from insurance companies to fund his election campaign?
Capri
Right now, Daniels is trying to force all the Indiana school corp.s to save money by making their employees join Healthy Indiana instead of having their own insurance.
Ugh
kay
@JGabriel:
I don’t read as widely as you-all do because I only began reading politics online in 2005.
I went to Daily Kos after the 2004 election because my friend Ann told me to, on election law.
My sister did note that he’s McArdle’s husband, however :)
atlliberal
So if they want to cut medicaid funding, do they want to kick grandma out of the nursing home?
Phlip
Lets not forget that a large chunk of the money goes to duel qualifiers, aka nursing home residents. Lets also not forget that before qualifiers can get that money they have to go through a “spend down”. Here is a simple explanation of that here.
You can have substantial resources saved up for the end of your life, but if you end up in a situation like, I don’t know, Terry Shiavo, you can blow though even those resources.
kay
@Capri:
“It’s popular with public employees!”
JPL
Bullshit in…Bullshit out. Murdoch must be so proud.
toledored
You’re my hero Kay.
Omnes Omnibus
@atlliberal: Why no. That would never happen. Deserving people would never be harmed. It is always “those” people, you know, the ones who don’t work hard, the ones who cheat the system.
/foolish, foolish person
Comrade Luke
Conservatives are in a box?
Seems like they’re winning, doesn’t it?
Citizen_X
If McArgleBargle and Suderman ever (shudder) breed, I call for an intervention. Those kids are never gonna learn basic arithmetic in that house.
Felanius Kootea (formerly Salt and freshly ground black people)
Thanks for consistently exposing these bullshit tactics Kay.
Bob
Can’t forget that Mitch Daniel’s is one of Sully’s favorites right now! Because he tells the TRUTH at CPAC.
/sarcasm
kay
@Comrade Luke:
I don’t know how they handle Medicare. They really, really did run (and win) on “Democrats cut Medicare!”
If they so much as approach Medicare, Democrats in Congress are going to pounce.
slag
@Tom Levenson: I think of it as playing Whack-a-Lie, a game so boring you quit before it’s even over and just leave the few tickets you’ve won from it in the machine for the next person foolish enough to put their 25 cents in.
Stefan
You know, I feel terrible for saying this, but I kind of miss the days when conservatives spent all their time and energy in destroying countries in the Middle East. At least it diverted them from destroying America…..
mai naem
I am shocked, just shocked that a Bush 11 Alum would try to privatize a government program with cronies getting to make a buck off it. I tell you I am shocked.
Villago Delenda Est
I’m sorry, but the problem here is that Republicans cannot add.
I blame the “new math”.
Brachiator
@Kay: Thanks very much for this. It puts the Medicaid and Indiana issue into clear perspective. I love how the conservative position is “I don’t care if our plans don’t actually work. Our core philosophy is correct.”
Librarian
Has anybody noticed that Sully has volumes to say about the middle east, but not one word about Wisconsin? It seems that he’s all for popular protest- as long as it’s in other countries. In this country, especially if it’s by those evil unions-not so much.
Villago Delenda Est
BTW, George Will, voted several times “Most in need of a tumbrel ride” by a large jury panel, is praising the idiot governor of Indiana as “showing the way” for the rest of the country.
jl
Thanks for an informative post.
My only disagreement is that I think no contradiction will box the GOP in. They are busy formulating a battery of bamboozlements, and will start sending up trial balloons soon. Watch Brooks and McArdle, they will one of the experimental platforms for the trials.
When a winning formula is found, the campaign will begin. All you have to do is disguise the cuts, or use a divide and conquer strategy to shift the burden of the cuts (for example, some scheme that involves a tax shifting dodge to attract healther higher income people to an expanded Consumer Choice Health Savings Account, otherwise known as a Chancy Chump-change Health Slushfund Account.
The GOP and fake deficit hawks have no compunction about lying, that should be clear by now. They are artists at the lie in all of its forms, and combine overt, covert, implicit and explicit lies in dizzying seemingly impossible and uncomputable combination.
Look at the deficit. Most of last year the the GOP was saying that the deficit and debt and government spending was impeding growth, and that the magical free market US job machine would kick in if only government would get out of the way. And of course, the mantra of any right thinking person should be ‘jobs, jobs, jobs!’
Then there was a decent interval of silence to befuddle the impaired and corrupt hacks on the corporate media. Now Boehner and his henchfolk say that it is a moral issue, some kind of immediate existential crisis (based on what exactly seems a non issue) , and if the spending cuts cost jobs, so be it.
Makes not one lick of sense, but it works in the dishonest rotten corrupt and degraded condition of public debate in the US.
Edit: thanks to commenter above who reminded me that Will’s column will be an experimental platform for the trial balloons on how to wreck Medicare, that is another place to watch for signs they are getting ready for another assault. And Robert (no relation to the late Paul) Samuelson.
Villago Delenda Est
@Capri:
But…but…
I thought “mandates” were unconstitutional!?
Judas Escargot
Has anybody noticed that Sully has volumes to say about the middle east, but not one word about Wisconsin? It seems that he’s all for popular protest- as long as it’s in other countries.
No, you’re not the only one who’s noticed this. In fact, something like three posts in a row about demonstrations in other countries. Not a single one for WI.
Like I said yesterday, Sullivan only seems to care about the working class when they are {{Non-White OR Muslim} AND foreign}.
Not that there’s anything wrong with rooting for foreign non-white/muslims when they organize for freedom… just that if you obsess about the one case, and ignore the other, doesn’t say much for your ethos.
AkaDad
Of course private is better than public, it just needs time to work. Give us 50 years, 100 tops.
kay
@jl:
Good comment. The one and only reason I think they’re screwed on Medicare is liberal Democrats in Congress. They were understandably mad as hell that they were portrayed in 2010 as cutting Medicare, a program they invented, when they actually cut the privatized program that conservatives invented, Medicare Advantage.
I think they get revenge on that.
lamh32
OT, but this has to be read.
Democratic Congresswoman Jackie Speier Talks About Her Abortion (VIDEO)
kay
@Villago Delenda Est:
There’s a lot of problems with the much-ballyhooed Mitch Daniels reforms. A person could fill 20 hours a week on debunking his claimed Big Successes, starting with how he cooks the books on job creation, because he got caught red-handed there.
Suffern ACE
@kay: Same could be said for Chris Christie. A lot of bluster to close a 10billion dollar deficit so that a year later he can have another 10 billion deficit. But the progress at closing the hole that just stays makes him a hero.
Joey Maloney
@Top:
Stop right there. What do you mean, they can’t attack Medicare? Sure they can. It doesn’t matter what they said yesterday. They can say the exact opposite today, secure in the knowledge that no major media outlet will challenge them. Well, maybe Jon Stewart. But aside from him and a bunch of shrill blog commenters, they’re safe.
Other than that, great post.
kay
@Brachiator:
They’re remarkably dishonest. This liar asserts:
“between 2008 and 2009 spending on Medicaid nearly doubled”
Jeez. That’s…incredible.
He doesn’t tell you how many people were added between 2008 and 2009, which is, of course, when the economy imploded.
kay
@Suffern ACE:
I feel like he’s going to crash and burn. Any former US attorney who pulled all that traffic-related bullshit with police that came out in the campaign is a loose cannon. Who lies about a fender bender? He does.
A traffic incident is just not a good enough reason to screw with police when you’re a US attorney. Hubris! And a huge ego.
PurpleGirl
OT (and reposting something I posted in thread below)
http://www.channel3000.com/news/26908918/detail.html
If the Wisconsin denial of union rights succeeds, it will also affect bus service in Madison. It seems that $45 million in federal aid depends on collective bargaining rights and agreements. No union rights, no federal money.
El Cid
From 1934, as unemployment insurance and social security are beginning to be studied and a proposal put forth. Roosevelt nominated a Committee for Economic Security (i.e., totalitarian communism in the view of the right).
Before that CES began, there was a conference in the White House between various politicians, business leaders, and academic and other experts.
One of them put discussion of unemployment insurance in some perspective.
Later, this. Note the top question.
What an uncivil President.
Brachiator
@kay:
Equally dumbass is this Michelle Bachmann Nonsense Overdrive over the recent IRS rule to make breast pumps eligible for tax breaks.
The GOP has made a conscious decision either to lie about any health care proposal coming from or related to any Obama Administration plan, or to simply oppose it, no matter how reasonable, and to accuse the Democrats of imposing sharia sozul ism on Real Americans(tm).
The sad thing is that they have convinced millions of Americans to hurt themselves rather than to accept proposals that are often either common sense or previously offered by Republicans.
R. Porrofatto
Wow. I read that op-ed and started to read the comments but had to stop at the first one that showed up — written allegedly by a “doctor” — complete with your standard right-wing vileness:
I see a lot of obese lazy people who smoke and drink and live on food stamps in subsidized housing with every member of the family having a different last name due to a lack of family morals.
Discussion is not possible with people for whom bigotry is a starting premise.
jacy
BTW, the House has just voted to strip funding from Planned Parenthood.
jacy
@R. Porrofatto:
I am proud to say that between my husband, me, and our five kids, we have 4 different last names in our household! Woot, I’m immoral!
ETA: of course we are very pale folk, so maybe that doesn’t count…
Redshift
Note the obligatory skirmish in the Republican war on women, as well:
Yeah, forcing everyone into a health insurance program with no maternity care is workable, for sure. “Think of the children,” like every other conservative tactic, is something Republicans only care about when they can use it as a club to beat Democrats.
But remember, they’re “pro-life”!
Mnemosyne
@Redshift:
Especially once you cut the funding for Planned Parenthood, which would be the other affordable place women could go for pre-natal care.
Republicans love zygotes, but they hate actual babies.
Redshift
@Mnemosyne: I guess this one pretty well proves they’re sincere when they say they consider zygotes full human beings — they want them to suffer without proper health care and nutrition unless they can pay for it, just like everyone else!
JCT
@Redshift: No, that would actually be “consistent” and we know the Republicans don’t “do that”.
PurpleGirl
@efgoldman: Yup, you’re right. The rethugs really do hate anyone who isn’t rich and don’t want any of us to have even moderately more comfortable lives.
rikryah
I say we need to stop Medicaid from paying for nursing homes. Let all those middle-class (mostly WHITE) folks who have hidden Mommy and Daddy’s assets to get their nursing home bills paid….PAY FOR IT.
nestor
Just don’t look in the box. Problem solved.
Dennis SGMM
@JCT:
I don’t think that’s it. Their masters have this insatiable need to be above the rest of us and so the Republicans obliged them. Like any group of addicts, they needed more and so the R’s chopped us off at the ankles, then at the knees. Now they’re coming for our necks.
PurpleGirl
@rikryah: Ah, we did make it illegal more than 20-odd years ago. But there is a very large business in estate planning to work on the parental estates to circumvent the laws. As it stands now, they (state agencies) look at the estate actions in the previous 3 years (IIRC) before the medicaid application for nursing home benefits is processed. We may have to move that time boundary back even further, to maybe 10 years.
Also there are legitimate claims for benefits by poor people/people who didn’t have children, etc. who would be punished and who do need the care.
Brachiator
@jacy:
This cannot be allowed to stand. Obama has got to do some executive order mojo to keep funding going.
shortstop
Nice work, kay.
Chris
SATSQ: It is a giant fucking scam. Private entities can kick money back to Daniels’ campaign(s) (reelection/president) in a way that public entities can’t.
And, it lets other corporate interests know Daniels is on their side.
(by this logic, we will see a Walker-for-Prez! boomlet in 3, 2, 1…)