New Report Details Arguments Against Medicaid Expansion

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A Foundation for Government Accountability (FGA) white paper published jointly with Opportunity Ohio on June 12 detailed eight reasons Ohio should not expand Medicaid, as well as eight Medicaid reforms legislators should pursue instead. The paper was written by Jonathan Ingram, the research director for Florida-based FGA.

“The wisest course for Ohio policymakers is to reject Medicaid expansion, or, at the very least, delay any decision until there is a clear understanding of how it will impact patients and taxpayers,” Ingram wrote before explaining a lengthy list of arguments against the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion.

The white paper listed the following reasons Ohio should not expand Medicaid.

  1. Able-bodied childless adults have never been — and were never intended to be — eligible for taxpayer-funded Medicaid.
  2. Medicaid costs are growing and jeopardizing all other state priorities.
  3. Ohio policymakers have no reliable cost estimates on which to base their decision.
  4. Expanding Medicaid is unlikely to decrease hospitals’ uncompensated charity care.
  5. Medicaid is failing to meet its mission of protecting Ohio’s most vulnerable patients.
  6. Medicaid expansion crowds out private health coverage.
  7. The federal government is unlikely to keep its funding promises to Ohio.
  8. It is unlikely Ohio will ever be able to scale back the size of Medicaid once it expands.

Details Ingram provided regarding the fourth point, in particular, should serve as a reminder of what a miserable job Ohio’s legacy press has done informing Ohioans about Medicaid expansion.

“Proponents of the ACA’s Medicaid expansion argue that expanding Medicaid will reduce uncompensated charity care and cost-shifts to private insurance,” Ingram wrote. “But the experiences of states that have already expanded Medicaid tell a much different story, and are instructive for Ohio lawmakers. In those states, these same promises of reduced uncompensated charity care and cost-shifting were made by expansion supporters.”

“Those expansion supporters were unable to keep their promises in those states and will likely fail to keep them in Ohio if lawmakers decide to expand,” Ingram added.

These assertions, which Ingram backed up with data from Maine, Arizona, Massachusetts, and the National Center for Health Statistics, refute talking points from Governor John Kasich and the Ohio Hospital Association (OHA).

Much of the information Ingram cited was shared by FGA’s Tarren Bragdon during a March 13 House panel, but Bragdon’s testimony was utterly ignored by Ohio reporters.

Several of the other arguments Ingram explained debunk pro-expansion rhetoric that newspapers have repeated without skepticism.

Ingram continued with the eight following Medicaid reform recommendations:

  1. Launch program integrity initiatives to root out fraud, waste and abuse in Medicaid.
  2. Include all services, benefits and populations in the reformed managed care program.
  3. Permit provider-led plans — physician practices, hospitals, federally qualified health

    centers, patient-centered medical homes, etc. — to compete for patients alongside

    traditional managed care organizations.

  4. Allow specialty plans to be offered alongside other health plans.
  5. Enable health plans to offer more customized and extra benefit packages.
  6. Build enhanced benefits rewards into capitated rates that help patients take more

    control of their health.

  7. Transform Medicaid into a personalized, patient-centered program.
  8. Institute reasonable work requirements for government assistance.

As with the reasons Ingram listed for opposing the PPACA Medicaid expansion, he provided explanation and research to support each of these suggestions in the 30-page white paper.

Variations on several of the reforms recommended by FGA and Opportunity Ohio are included in the Medicaid reform bill proposed by Rep. Barbara Sears (R-Monclova Twp.), but Sears seems intent on using reform as window dressing for Medicaid expansion.

None of the reforms proposed by Rep. Sears, Gov. Kasich, or other leaders of either party would come close to saving enough taxpayer money to pay the billions per year the PPACA Medicaid expansion would cost if adopted in Ohio.

“As Matt Salo, Executive Director of the National Association of Medicaid Directors, said about the two things America knows about Medicaid expansion: ‘More people show up than you think will show up, and the people that show up are sicker than you expected,'” Opportunity Ohio President Matt Mayer wrote in a June 10 release.

“The bottom line is that our elected officials should stand for real reform, not expanding a costly and broken program,” Mayer concluded.