Testimony: Medicaid Expansion Under Obamacare Is Wrong For Missouri

7/27/2019 Testimony: Medicaid Expansion Under Obamacare Is Wrong For Missouri

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TESTIMONY

ADVANCING LIBERTY WITH RESPONSIBILITY

BY PROMOTING MARKET SOLUTIONS

FOR MISSOURI PUBLIC POLICY

MEDICAID EXPANSION

UNDER OBAMACARE IS

WRONG FOR MISSOURI

By Patrick Ishmael

Testimony Before The Interim Committee on Citizens andLegislators Working Group on Medicaid Eligibility and Reform

August 14, 2013

[T]he Medicaid

expansion being

advanced in the

hearings before you is

Obamacare.

To the Honorable Members

of This Committee:

My name is Patrick Ishmael and Iam a policy analyst or the Show-MeInstitute, a nonprot, nonpartisanMissouri-based think tank thatsupports ree-market solutions or

state and local policy. Te ideaspresented here are my own.

In the coming years, Missourislegislature aces a clear question:Should Missouri expand Medicaidunder Obamacare? News reportsrom several citizens commissionhearings suggest the Yes crowd hascome out in orce to your meetings,but as the honorable members o

the committee certainly recognize,support or a project at a meetingdoes not always translate intogeneral support or the project.Indeed, Missourians soundlyrejected Obamacare in 2010 throughProposition C, with 71 percent

o the vote.1 Missourians rejectedit again last year, resoundinglypassing Proposition E legislationthat ensures the governor cannotunilaterally impose a state-basedObamacare insurance exchange onMissourians.2 In act, PropositionE received more votes than thegovernor received.

Missourians do not want Obamacarealso known as the Aordable CareAct (ACA), and in case there isany conusion about the matter,the Medicaid expansion beingadvanced in the hearings beoreyou isObamacare. Tat actis sometimes cloaked by moreambiguous portrayals because thepresidents signature legislation is sounpopular and public skepticism especially in Missouri is so high.Indeed, there is ample reason to beskeptical o an Obamacare-basedMedicaid expansion.

Patrick Ishmael is a

policy analyst at the

Show-Me Institute,

which promotes

market solutions for

Missouri public policy.


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SHOW-ME INSTITUTE I TESTIMONY

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First, the current Medicaid program doesnot work. More to the point, Medicaidmay be papering over serious accessand quality concerns that expansionproponents have consistently ailed toconront. A study that University o

Virginia doctors conducted examinedsurgical outcomes nationally between2003 and 2007, controlling or healthand demographic actors, and ound that(emphasis mine):

[t]he in-hospital death rate or surgicalpatients with private insurance was1.3 percent. Medicare, uninsured,and Medicaid patients were 54percent, 74 percent, and 97 percent,

respectively, more likely to diethan those with private insurance.Te average length o stay in thehospital was 7.38 days or those withprivate insurance; on an adjustedbasis, those with Medicare stayed 19percent longer; the uninsured stayed5 percent shorter; and those withMedicaid stayed 42 percent longer.3

Other studies that have drilled down

into the health outcomes o patientsundertaking specic medical procedureshave ound similar health outcomeproblems or Medicaid patients,including cancer treatment and thediagnosis o serious illnesses.4 Moreover,a recent study published in the NewEngland Journal o Medicine earlier thisyear, titled Te Oregon Experiment Eects o Medicaid on Clinical

Outcomes, supports this long line oearlier ndings. Te study showed that(emphasis mine) Medicaid coveragegenerated no signifcant improvementsin measured physical health outcomesin the frst 2 years although it didincrease use o health care services,raise rates o diabetes detection andmanagement, lower rates o depression,

and reduce nancial strain. Withdiabetes management, the authorsobserved no signicant eect [romMedicaid coverage] on average glycatedhemoglobin levels or on the percentageo participants with levels o 6.5% or

higher.5 And even assuming the patientdepression decline was not related topublic dollars owing to people generallyin high-risk nancial situations assuaging patient concerns about theirnancial well-being rather than actuallyameliorating health issues arentthere more efcient ways o decreasingdepression and protecting the pooragainst catastrophic medical bills that do

not include orcing them into a brokengovernment program?

Shouldnt Missouri pursue a reormthat protects the poor rom catastrophicmedical bills without doubling downon a broken Medicaid status quo, asObamacare does? Growing the programnow and in this way will serve to sustaina program that should, instead, besignicantly reormed rst.

As a state, we are ortunate to have hadthe opportunity to begin the discussionabout Medicaid reorm seriously andmethodically. Keep in mind, Obamacareas drated, would have required Missourito expand Medicaid or else lose allothe states existing Medicaid unding a gun to the head that the SupremeCourt removed by making ObamacareMedicaid expansions optional. Had

the Court ruled dierently, a meetinglike this one, substantively discussingthe pros and cons o committingbillions o dollars o state money to aMedicaid expansion, would never haveoccurred. It is a point worth reiteratingwhen policymakers are told that theexpansion is a good deal: that the lawas written and promoted by supporters

Medicaid may

be papering over

serious access and

quality concerns that

expansion proponents

have consistently

failed to confront.


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August 2013

would have given you no choice but toexpand Medicaid. Put another way: Is itreasonable to believe that a good dealwould have to be orced on a state?

Along with the billions the state would

spend on health services o dubiousvalue instead o other parts o thebudget education and roads included billions more would come romthe ederal government, paid or outo debt. In other words, that is moneyyour children and grandchildren wouldhave to pay o in uture years throughhigher taxes, reduced services, or both.From the policy perspective and myown moral perspective, it is enormously

problematic to create an entitlementdelivered today that is paid or withthe earnings o uture taxpayers,born and unborn, and that is to saynothing o the disputed eectiveness othe program in question. ObamacareMedicaid dollars are not ree money.

Tey are a mortgage taken out againstthe uture, a hamburger today billed toyour kids tomorrow. Does that soundlike a deal we should take?

All o us must engage the ailings

o the current Medicaid system andunderstand that expanding this systemunder Obamacare is not the solution. AMedicaid expansion beore its reorm isundertaken is not a good deal, especiallyor uture Americans and Missourians.

Is it reasonable to

believe that a good

deal would have to

be forced on a state?

Join the fght or liberty in our state.Become a Show-Me Institute supporter:

www.showmeinstitute.org/donate

NOTES1 Prop C passage sends political mes-

sage, supporters say, St. Louis Business

Journal. Business News - The BusinessJournals. N.p. Aug. 4, 2010. Web. Aug. 12,

2013. View online here: http://www.bizjour-nals.com/stlouis/stories/2010/08/02/daily35.

html?page=all.

2 Missouri Health Care Exchange Question,

Proposition E (2012). Ballotpedia. N.p., n.d.Web. Aug. 12, 2013. View online here: bal-

lotpedia.org/wiki/index.php/Missouri_Health_

Care_Exchange_Question,_Proposition_E_(2012).

3 The Medicaid Mess: How Obamacare

Makes It Worse. Manhattan Institute for Pol-

icy Research. N.p., n.d. Web. Aug. 12, 2013.View online here: http://www.manhattan-

institute.org/html/ir_8.htm; Primary Payer

Status Affects Mortality for Major SurgicalOperations. Annals of surgery. N.p., n.d.

Web. Aug. 12, 2013. View online here: www.ncbi.nlm.nih.gov/pmc/articles/PMC3071622/.

4 The Medicaid Mess: How Obamacare

Makes It Worse. Manhattan Institute forPolicy Research. N.p., n.d. Web. Aug. 12,2013. View online here: http://www.manhat-

tan-institute.org/html/ir_8.htm.

5 The Oregon Experiment Effects of

Medicaid on Clinical Outcomes. The New

England Journal of Medicine. N.p., May 2,2013. Web. Aug. 12 2013. Vie online here:

http://www.nejm.org/doi/full/10.1056/NEJM-sa1212321.


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SHOW-ME INSTITUTE I TESTIMONY

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Testimony: Medicaid Expansion Under Obamacare Is Wrong For Missouri

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