It seemed like a breakthrough moment. In late February, Florida Gov. Rick Scott (R), who had made hating “Obamacare” his raison d’etre, announced his support for the Medicaid expansion policy in the Affordable Care Act. The Republican governor said at the time, “I cannot, in good conscience, deny the uninsured access to care.”
It was an open question whether Scott’s principal concerns were with the uninsured or the state hospitals he’s been friendly with in the past, it was nevertheless welcome news for health care advocates. Florida’s governor, an unlikely ally, had cleared the way for bringing health care access to 1.3 million Americans, expanding the reach of Obamacare to new heights.
At least, we thought so at the time. What was unexpected was Rick Scott’s own legislative allies ignoring the governor’s wishes and punishing Florida on purpose.
Scott wouldn’t be the one to “deny Floridians” a part of the health care law — but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year — which some Democrats are calling for — Florida will not expand Medicaid in 2014.
In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the Medicaid expansion. About a quarter of those people — Floridians earning between 100 and 133 percent of the Federal Poverty Line — would still be eligible for tax subsidies on the health insurance exchange.
As we talked about in March, Scott isn’t the only Republican governor in this boat. In Ohio and Arizona, GOP state lawmakers remain reluctant to accept Medicaid expansion, regardless of its benefits, and regardless of the wishes of their Republican partner in the governor’s office.
But the move in Florida is especially jarring given the circumstances — the state has an enormous Medicaid-eligible population, and was poised to receive $66 billion in federal funds over the next decade. What’s more, Florida already has struggling public hospitals, which will now be in even worse shape.
A Democratic state senator called the Medicaid decision “unconscionable,” which is true, but apparently irrelevant to state GOP lawmakers.
By: Steve Benen, The Maddow Blog, May 6, 2013
There’s a growing number of Republican-run states accepting Medicaid expansion under the Affordable Care Act, at least at the gubernatorial level, but South Carolina isn’t one of them. Gov. Nikki Haley (R) ruled out the possibility months ago, despite the pleas of South Carolina hospital administrators and public-health officials.
In fact, physicians in South Carolina are still hoping to change the state’s policy against Medicaid expansion, lobbying legislators this week on a White Coat Day organized by the South Carolina Hospital Association. Will it succeed? Consider the take of one insider.
Rep. Kris Crawford, a Republican from Florence and also an emergency room doctor, supports the expansion but expects the Republican caucus to vote as a block against the Medicaid expansion.
“The politics are going to overwhelm the policy. It is good politics to oppose the black guy in the White House right now, especially for the Republican Party,” Crawford said.
As it turns out, “the politics” were so successful in “overwhelming the policy” that Crawford himself voted against the policy he said he supports.
Kris Crawford, a Florence emergency room doctor, says he thinks South Carolina should accept billions of federal dollars to help pay the health care costs for poor people — also known as Obamacare.
There are only two problems: Crawford is a Republican, and he is a member of the state House of Representatives. So on Tuesday, when it was time to vote on whether to accept the money, Crawford voted not to accept it.
For what it’s worth, Crawford still supports Medicaid expansion as part of “Obamacare,” and regrets the way his party is concerned more about the “political argument” than the “policy discussion.”
So why did he vote with his party? Crawford cited procedural concerns, and wants the issue to be considered outside the state budget process. He intends to propose separate legislation later this year.
By: Steve Benen, The Maddow Blog, March 14, 2013
Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible. And no doubt there are individual conservatives who really have such idealistic motives.
When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — namely, that it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid.
Some background: Medicaid, which provides health insurance to lower-income Americans, is a highly successful program that’s about to get bigger, because an expansion of Medicaid is one key piece of the Affordable Care Act, a k a Obamacare.
There is, however, a catch. Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured.
Now, in the end most states will probably go along with the expansion because of the huge financial incentives: the federal government will pay the full cost of the expansion for the first three years, and the additional spending will benefit hospitals and doctors as well as patients. Still, some of the states grudgingly allowing the federal government to help their neediest citizens are placing a condition on this aid, insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want.
Consider the case of Florida, whose governor, Rick Scott, made his personal fortune in the health industry. At one point, by the way, the company he built pleaded guilty to criminal charges, and paid $1.7 billion in fines related to Medicare fraud. Anyway, Mr. Scott got elected as a fierce opponent of Obamacare, and Florida participated in the suit asking the Supreme Court to declare the whole plan unconstitutional. Nonetheless, Mr. Scott recently shocked Tea Party activists by announcing his support for the Medicaid expansion.
But his support came with a condition: he was willing to cover more of the uninsured only after receiving a waiver that would let him run Medicaid through private insurance companies. Now, why would he want to do that?
Don’t tell me about free markets. This is all about spending taxpayer money, and the question is whether that money should be spent directly to help people or run through a set of private middlemen.
And despite some feeble claims to the contrary, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. Partly this reflects lower administrative costs, because Medicaid neither advertises nor spends money trying to avoid covering people. But a lot of it reflects the government’s bargaining power, its ability to prevent price gouging by hospitals, drug companies and other parts of the medical-industrial complex.
For there is a lot of price-gouging in health care — a fact long known to health care economists but documented especially graphically in a recent article in Time magazine. As Steven Brill, the article’s author, points out, individuals seeking health care can face incredible costs, and even large private insurance companies have limited ability to control profiteering by providers. Medicare does much better, and although Mr. Brill doesn’t point this out, Medicaid — which has greater ability to say no — seems to do better still.
You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying.
But why would you insist on privatizing a health program that is already public, and that does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits.
So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 3, 2013
Via Think Progress, another item from the ever-increasing database of “facts” Republicans use to buttress ideologically dictated positions comes from everybody’s favorite health care expert, Florida Gov. Rick Scott.
Scott has been bruiting it about that his refusal to implement the Medicaid expansion provided for in the Affordable Care Act, which would have supplied health insurance to a cool million residents of that steamy state, was based on its vast cost: $26 billion over ten years in new state costs!
Them’s a lot of dollars, to be sure. But turns out Scott just kinda made the number up, or more accurately, didn’t bother to share the preposterous assumptions needed to generate it. Health News Florida explains:
The state’s chief economist has warned the staff of Gov. Rick Scott that his Medicaid cost estimates are wrong, but Scott keeps using them anyway, according to a series of e-mails obtained by Health News Florida.
Scott says he opposes expanding Florida Medicaid because it would cost too much: $63 billion over 10 years, he says, with the state paying $26 billion of that.
But those numbers are based on a flawed report, according to a legislative budget analyst and State Economist Amy Baker. A series of e-mails obtained by Health News Florida shows the analysts warned Scott’s office the numbers were wrong weeks ago, but he is still using them. He cited them in a Tampa Bay Times op-ed on Sunday and at at a Washington press conference on Monday.
The trumped-up number, it seems, comes from assuming the federal super-match for the expanded Medicaid coverage provided for in the ACA will never actually materialize. Why? Here’s the response from Scott’s “health policy coordinator,” Michael Anway:
Anway said he doesn’t believe the federal funds will come through. “The federal government has a $16 trillion national debt, must borrow 46 cents of every dollar it spends, and in 2011 had its credit rating downgraded for the first time in history,” he wrote in explanation.
So Scott is assuming the feds will renege on their statutory obligation to provide the Medicaid match. That’s a new one, and is particularly ironic since the only threat to the federal government defaulting on its spending obligations comes from Scott’s conservative buddies in Congress.
Truth is, the most authoritative estimate of state costs associated with the Medicaid expansion, from the Kaiser Family Foundation, put Florida’s costs at $1 billion over ten years, and that doesn’t even include potential savings from costs currently incurred by the state in uncompensated care for the uninsured.
So Scott’s costs estimates are off a mere 96%, at least. But what are facts when it comes to the ontological necessity of thwarting Obamacare and saving a million Floridians from the slavery of dependence on government?
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, January 8, 2013
“I’m concerned about the poor in this country,” Mitt Romney said the other day. “We have to make sure the safety net is strong and able to help those who can’t help themselves.”
I perked up at those words, because they were something of a departure from his usual stump speech and because they happened to come on a day when I had written about the dire implications of Romney’s proposals for the social safety net.
I don’t question his sincerity. The problem: This fine sentiment doesn’t square with his actual policies.
Consider Romney’s support for the budget plan crafted by Wisconsin Rep. Paul Ryan and passed by the Republican House. It would cut Medicaid spending by $700 billion over 10 years, reduce food stamps by $127 billion and cut in half the funding of Pell Grants for low-income college students.
As Fox News’s Chris Wallace usefully pointed out in an interview with Romney last month, “You would cut all of these programs, Governor, that people depend on, and a lot more than that.”
Romney, in response, focused on his proposal for Medicaid. He would turn the program over to the states and allow funding to grow at inflation plus 1 percentage point — significantly less than the historical growth of health-care costs.
“By doing that, you save an enormous amount of money,” Romney said. “I happen to believe that states can do a better job caring for their own poor, rooting out the fraud and waste and abuse that exists within those programs.”
Wallace: “But you don’t think, if you cut $700 billion in aid to the states, that some people are going to get hurt?”
Romney: “By cutting welfare spending dramatically, I don’t think we hurt the poor. In the same way, I think cutting Medicaid spending by having it go to the states, run more efficiently with less fraud, I don’t think will hurt the people that depend on that program for their health care.”
Really? Reforming welfare to encourage work was a good idea, but for those who need temporary help, benefits are increasingly inadequate. Adjusting for inflation, benefits are now below the 1996 level in all but two states. And turning the program into a block grant has meant that states, reeling from the impact of the recession, have been unable to respond adequately to increased needs.
That history is hardly reassuring about Romney’s plan to cut hundreds of billions from Medicaid. But the welfare analogy isn’t the only cause for concern. The Congressional Budget Office (CBO), analyzing the Ryan cuts, found that states “would face significant challenges in achieving sufficient cost savings through efficiencies to mitigate the loss of federal funding.”
So much for Romney’s mythical world in which huge cuts can be accomplished with zero harm to the poor and disabled.
Instead, according to the CBO, states would face a menu of unappetizing choices. If they did not want to raise taxes or reduce other spending, they would have to choose among cutting already low provider payments; reducing the benefits that the program covers; or throwing people now eligible for help off the program.
The impact of Romney’s approach on the safety net would go far beyond Medicaid. The brutal arithmetic of his stated plan to cap spending at 20 percent of gross domestic product — while, unlike Ryan, increasing defense funding — is that safety-net programs would have to be chopped significantly beyond where even Ryan would take them.
Romney’s tax plan would exacerbate the unfairness. He would continue the Bush tax cuts for the wealthiest Americans and provide extra breaks that would primarily help the rich. According to a new analysis by the nonpartisan Tax Policy Center, taxpayers with incomes of $1 million or more would see an average tax cut of $287,000 compared to letting the Bush tax cuts for the wealthy expire.
At the same time, Romney would do away with recent increases in the child tax credit and the earned-income tax credit — provisions that help low-income families. As a consequence, between 16 and 20 percent of those with incomes of $50,000 or less would actually see their taxes rise under a President Romney.
In other words, Romney would spend hundreds of billions for a tax cut whose benefits flow overwhelmingly to the wealthiest Americans, even as he would cut even more from programs that help the most vulnerable.
Those skewed priorities are hard to square with Romney’s stated concern, however heartfelt, for the poor. The man from Bain Capital needs to take another look at his figures.