Justifying Cuts: A Well-Used But Misleading Medicaid Statistic
“Cash-strapped states are also feeling the burden of the Medicaid
entitlement. The program consumes nearly 22 percent of states’ budgets today, and things are about to get a whole lot worse.”
— Sen. Orrin Hatch (R-Utah), June 23, 2011, at a hearing of the Senate Finance Committee
“Medicaid is the lion’s share of that spending burden as it now consumes about 22 percent of state budgets now and will consume $4.6 trillion of Washington’s budget over the next ten years.”
— Former Kentucky governor Ernest Lee Fletcher (R), June 23, 2011, at the same hearing
“Across the country, governors are concerned about the burgeoning cost of Medicaid, which in fiscal 2010 consumed nearly 22 percent of state budgets, according the National Association of State Budget Officers. That’s larger than what states spent on K-12 public schools.”
— Washington Post front page article, June 14, 2011
When a statistic is universally tossed around as a certified fact, it’s time to get suspicious.
Such is the case with this oft-cited statistic that 22 percent of state budgets is being gobbled up by Medicaid, the state-federal program that provides health coverage for the poor and the disabled. Medicaid supposedly is even dwarfing what is spent on educating children and teenagers.
But note the phrase “state-federal.” There’s billions of dollars in federal money involved, and the “22-percent” statistic obscures that fact. Let’s dig a little deeper into the numbers.
The Facts
Medicaid was a central part of President Lyndon Johnson’s “Great Society” initiative in the mid-1960s. Each state administers its own Medicaid program, but with federal oversight, federal requirements—and plenty of federal dollars. On average, the federal government provides 57 percent of Medicaid funds.
Initially, Medicaid was focused low-income Americans, but elderly nursing home care has also become a big part of it. The new health care law would also greatly expand eligibility to people up to 133 percent of the official poverty line.
There’s no question that the recession has put pressure on Medicaid spending, as more people lost jobs or income and so became eligible for coverage. The new requirements of the health care law also will boost Medicaid spending.
The assertion that Medicaid is 22 percent of state spending, and thus now exceeds education spending, comes from an annual survey of the National Association of State Budget Officers (NASBO). But if you dig into the report — if you just go to page
one — you will see that this number includes the federal contribution, in what
is known as “total funds.”
If you want to see what states themselves are spending on Medicaid —“general funds” — you have to use another set of statistics.
As NASBO says on page one, “For estimated fiscal 2010, components of general fund spending are elementary and secondary education, 35.7 percent; Medicaid, 15.4 percent; higher education, 12.1 percent; corrections, 7.2 percent; public assistance, 1.9 percent; transportation, 0.8 percent; and all other expenditures, 27.0 percent.”
In other words, without the federal dollars included, Medicaid falls to second place, far behind education. It turns out that on average, states spend 15.4 percent of their funds on Medicaid — not 22 percent.
Brian Sigritz, NASBO’s director of state fiscal studies, said, “You are correct that there are several different ways of looking at Medicaid spending that you can use. If you consider just general funds, K-12 easily remains the largest component of general fund spending, as it historically has been.”
Indeed, when you look at NASBO’s historical data (table three of this report), it becomes clear that Medicaid spending, as a proportion of general funds, has remained relatively consistent since 1995 — about 15 percent — in contrast to the popular image of being a drain on state budgets.
Sigritz said that the two figures provide a different picture of state spending. “General funds gives you a sense of spending deriving from state revenue, while total funds gives you a sense of total state expenditures,” he said. “Typically when you discuss overall state budgets you examine the various funding sources that go into them including general funds, other state funds, bonds, and federal funds.”
The Office of the Actuary for Medicare and Medicaid makes this distinction. The 2010 Actuarial Report for Medicaid notes the broad figure, but then takes pains to add: “This amount, however, includes all Federal contributions to State Medicaid spending, as well as spending from State general revenue funds and other State funds (which for Medicaid consists of provider taxes, fees, donations, assessments, and local funds).” The report concludes: “When only State general revenues are considered, however, Medicaid spending constitutes an estimated 16.2 percent of expenditures in 2009, placing it well behind education.”
Antonia Ferrier, a spokeswoman for Hatch, defended the 22-percent figure, noting its wide use. “It is part of their budgets, and there are many different streams of funding that fund those state budgets (including federal funding, taxes, etc.) that fund their many programs,” she said.
But Colleen Chapman, a spokeswoman for the Georgetown University Center for
Children and Families, a policy and research center, said, “In the current budget debate, the data are being misused to argue that the Medicaid program in states is out of control and needs to be cut dramatically, when in fact, Medicaid is still much less of state spending than education and has not grown, as a portion of state budgets, in any way close to the mammoth way that others argue it has.”
The Pinocchio Test
We will label this with one of our rarely used categories: TRUE BUT FALSE.
(We still need to get an appropriate icon for this one — suggestions are welcome.)
Yes, the 22-percent figure is a valid number. But it is being used in an inappropriate way, and therefore is misleading. Hatch and Fletcher are only the latest in a long line of public figures — and news outlets — who have seized onto this number without apparently realizing that it is the wrong statistic to use. If people want to understand the impact the Medicaid is having on state budgets, politicians should begin to use the 15-percent figure — or at the least offer a caveat to the 22-percent number. Otherwise, there might be some Pinocchios in their future.
By: Glenn Kessler, The Fact Checker, The Washington Post, July 5, 2011
The Minnesota Shutdown – A Glimpse Into The Nation’s Future And The GOP’s True Intentions
A telephone help line service for the elderly will not be ringing today in Minnesota.
Blind residents reliant on state funding for reading services will remain in the dark for as long as the government’s lights are turned off. Poor families who receive subsidies for childcare are on their own. The St. Louis Park Emergency Program’s food shelf will have bare pickings for those who depend on the program for sustenance. The Community
Action Center of Northfield will likely be forced to close down its homeless shelter without the state funding upon which it relies to house the homeless.
And yes, 23,000 state workers will be trying to figure out how to care for their families without a paycheck for the duration along with an estimated 5,000 to 10,000 construction workers who will be laid off as the state shuts down dozens of road and highway projects.
These are but a few of the consequences of the shutdown of Minnesota’s government.
At issue is how to close a $5 billion deficit in the state left by the previous Minnesota governor, Tim Pawlenty.
Minnesota Governor Mark Dayton, a Democrat, had tried to bargain his way toward an agreement by offering up massive cuts in state services. In return, he asked the Republicans to agree to a tax increase for the wealthier citizens of the state to make up the remainder of the funding required to close most of the gap in the budget.
But the Republicans held firm on taxes – even when Dayton made his final offer that would have placed an additional 3% tax on only those Minnesotans earning over $1 million a year, a burden that would have been placed on just .03% of all Minnesotans.
It’s not so much that the state’s GOP leaders had a violent, allergic reaction to those earning seven figures a year having to pay a few percentage points more in taxes. What appears to have ended negotiations were the
Republican demands that Governor Dayton agree to their social agenda issues, including Voter ID legislation and abortion restrictions, as the price for the Republicans allowing the very wealthy to pay a little more.
When the Governor refused to swallow the notion that the conservative social agenda should be used as a tool to resolve budgetary issues, the talks broke down and the lights at the statehouse were turned off.
So, you might wonder, how did the Minnesota GOP suggest that the gap in the finances be met even as they seemed to realize that there was little left for the Governor to offer on the cutting side of the ledger?
You won’t believe it.
The Republicans actually proposed creating more debt to close the gap.
The GOP proposed delaying another $700 million in payments owed to schools, which would add to the more than $1 billion the state already owes K-12 schools.
Republicans also offered to issue “tobacco bonds” of an unspecified amount to cover any remaining budget gap. Sources said Dayton considered the offer, but he criticized it as unwise borrowing late Thursday. Via The Star Tribune
I guess a Republican has to do what a Republican has to do when it comes to protecting the wealthiest in the state from paying a higher tax rate- even if it means creating more debt despite a GOP platform that, allegedly, abhors debt.
If you find the lessons of Minnesota disturbing, get used to it.
What you are seeing is simply the national debate playing out on a smaller stage. I suppose this is what Republicans mean when they suggest using the states as laboratories for what will and won’t work on the national level.
You can bet that every political player on the national stage will be watching to see how the Minnesota public reacts to their situation along with which party gets the lion’s share of the blame for bringing this blight upon their land.
If Governor Dayton caves and simply accepts the GOP budget, we can expect that our Congressional Republicans would take great heart in such an occurrence and be emboldened to stick with the plan.
If the GOP legislators begin to fear that their jobs may be in jeopardy as punishment for shutting down the state in order to protect a little more than 7,000 Minnesotans earning at least a million bucks a year, that too will be noticed.
Watch the polls in Minnesota over the next week or two. They may tell you everything you need to know about what is likely to happen as we move towards resolving the debt ceiling debate.
By: Rick Ungar, The Policy Page, Forbes, Junly 1, 2011
Maine GOP Chair: We Must Make It Harder To Vote Because ‘Democrats Intentionally Steal Elections’
For nearly four decades, Maine has been one of eight states which provides same-day voter registration to voters at the polls. This policy of enfranchising the greatest number of Maine voters is likely to end, however, now that the GOP-controlled state legislature has passed a bill ending same-day registration and Tea Party Gov. Paul LePage is expected to sign it. Worse, state GOP Chairman Charlie Webster explained it was necessary to disenfranchise the thousands of Maine voters who take advantage of same-day registration every election year in order to save Maine from one of his paranoid fantasies:
“If you want to get really honest, this is about how the Democrats have managed to steal elections from Maine people,” Webster told a columnist for the Portland Press Herald in a piece published Friday. “Many of us believe that the Democrats intentionally steal elections.”
Sadly, Maine’s voter disenfranchisement bill is only the latest example of the Republican war on voting that began almost immediately after the GOP took over several statehouses this year. Numerous GOP state legislatures have rammed through “voter ID” laws which disenfranchise thousands of elderly, disabled, and low-income voters. Republicans typically justify these voter disenfranchisement laws by claiming that they are necessary to combat voter fraud at the polls, but in-person voter fraud is only slightly more common than unicorns. A recent Supreme Court decision upholding a voter ID law was only able to cite one example of in-person voter fraud in the last 143 years.
Nor are voter ID laws the only front in the GOP’s war on voting. As Jonathan Chait explains, their efforts also include measures “restricting early voting, shortening poll hours, [and] clamping down on students voting at their campus.” And in Wisconsin, Gov. Scott Walker (R) even plans to gut his state’s public financing program — a program designed to make candidates less dependent on wealth donors — in order to pay for a voter disenfranchisement law.
Yet, while the Maine GOP may have won a skirmish in the war on voting with their repeal of same day registration, it is anything but certain that they will win this war. The state’s Democrats hope to invoke Maine’s “people’s veto” process, which allows the voters to repeal a newly enacted state law by referendum. To invoke this procedure, they must collect just over 57,000 signatures before a 90-day window closes.
By: Ian Millhiser, Think Progress, June 13, 2011
Gov. Rick Scott May Personally Benefit From New Law That Hands Medicaid Program Over To Private Companies
Florida Gov. Rick Scott (R) signed “a landmark Medicaid overhaul” yesterday that will put “hundreds of thousands of low-income and elderly Floridians into managed-care plans.” The proposal “gives managed care companies more control over the program that’s paid for with federal and state money,” a shift the state GOP claims will “hold down spiraling costs in the $20 billion program.” However, as TP Health editor Igor Volsky pointed out, a five-county pilot program in Florida already revealed that such a plan produces “widespread complaints and little evidence of savings.” Under managed care, states “have to ensure that private payers aren’t looking out for short term profits by denying treatments or reducing reimbursement rates” and — given what occurred during the pilot program — the results “are already less than promising.”
But Scott may have another reason to push a dubious bill into law. As Mother Jones reported, one of the private managed-care companies that stand to gain from the new law is Solantic, “a chain of urgent-care clinics aimed at providing emergency services to walk-in customers. Solantic was founded in 2001 — by none other than Rick Scott:
The Florida governor founded Solantic in 2001, only a few years after he resigned as the CEO of hospital giant Columbia/HCA amid a massive Medicare fraud scandal. In January, according to the Palm Beach Post, he transferred his $62 million stake in Solantic to his wife, Ann Scott, a homemaker involved in various charitable organizations.[…]
“This is a conflict of interest that raises a serious ethical issue,” says Marc Rodwin, a medical ethics professor at Suffolk University Law School in Boston. “The public should be thinking and worrying about this.”
Scott’s office dismissed the conflict of interest concern as “incorrect and baseless.” However, Scott’s history of fraud with entitlement programs (in that case Medicare) should certainly raise a red flag here. And it is not as if Scott is completely clean when it comes to the mix between professional office and personal interest.
Incidentally, Scott also just signed a bill that will require anyone applying for welfare benefits to pay for a drug test to qualify for benefits. They will only recoup that fee if they pass. One company that provides such drug tests? Solantic.
By: Tanya Somander, Think Progress, June 3, 2011
A “No New Taxes” Pledge Is A Death Trap For Seniors
This has to be one of the funniest political stories of recent weeks: On Tuesday, 42 freshmen Republican members of Congress sent a letter urging President Obama to stop Democrats from engaging in “Mediscare” tactics — that is, to stop saying that the Republican budget plan released early last month, which would end Medicare as we know it, is a plan to end Medicare as we know it.
Now, you may recall that the people who signed that letter got their current jobs largely by engaging in “Mediscare” tactics of their own. And bear in mind that what Democrats are saying now is entirely true, while what Republicans were saying last year was completely false. Death panels!
Well, it’s time, said the signatories, to “wipe the slate clean.” How very convenient — and how very pathetic.
Anyway, the truth is that older Americans really should fear Republican budget ideas — and not just because of that plan to dismantle Medicare. Given the realities of the federal budget, a party insisting that tax increases of any kind are off the table — as John Boehner, the speaker of the House, says they are — is, necessarily, a party demanding savage cuts in programs that serve older Americans.
To explain why, let me answer a rhetorical question posed by Professor John Taylor of Stanford University in a recent op-ed article in The Wall Street Journal. He asked, “If government agencies and programs functioned with 19% to 20% of G.D.P. in 2007” — that is, just before the Great Recession — “why is it so hard for them to function with that percentage in 2021?”
Mr. Taylor thought he was making the case for not increasing spending. But if you know anything about the federal budget, you know that there’s a very good answer to his question — an answer that clearly demonstrates just how extremist that no-tax-increase pledge really is. For here’s the quick-and-dirty summary of what the federal government does: It’s a giant insurance company, mainly serving older people, that also has an army.
The great bulk of federal spending that isn’t either defense-related or interest on the debt goes to Social Security, Medicare and Medicaid. The first two programs specifically serve seniors. And while Medicaid is often thought of as a poverty program, these days it’s largely about providing nursing care, with about two-thirds of its spending now going to the elderly and/or disabled. By my rough count, in 2007, seniors accounted, one way or another, for about half of federal spending.
And in case you hadn’t noticed, there will soon be a lot more seniors around because the baby boomers have started reaching retirement age.
Here are the numbers: In 2007, there were 20.9 Americans 65 and older for every 100 Americans between the ages of 20 and 64 — that is, the people of normal working age who essentially provide the tax base that supports federal spending. The Social Security Administration expects that number to rise to 27.5 by 2020, and 31.7 by 2025. That’s a lot more people relying on federal social insurance programs.
Nor is demography the whole story. Over the long term, health care spending has consistently grown faster than the economy, raising the costs of Medicare and Medicaid as a share of G.D.P. Cost-control measures — the very kind of measures Republicans demonized last year, with their cries of death panels — can help slow the rise, but few experts believe that we can avoid some “excess cost growth” over the next decade.
Between an aging population and rising health costs, then, preserving anything like the programs for seniors we now have will require a significant increase in spending on these programs as a percentage of G.D.P. And unless we offset that rise with drastic cuts in defense spending — which Republicans, needless to say, oppose — this means a substantial rise in overall spending, which we can afford only if taxes rise.
So when people like Mr. Boehner reject out of hand any increase in taxes, they are, in effect, declaring that they won’t preserve programs benefiting older Americans in anything like their current form. It’s just a matter of arithmetic.
Which brings me back to those Republican freshmen. Last year, older voters, who split their vote almost evenly between the parties in 2008, swung overwhelmingly to the G.O.P., as Republicans posed successfully as defenders of Medicare. Now Democrats are pointing out that the G.O.P., far from defending Medicare, is actually trying to dismantle the program. So you can see why those Republican freshmen are nervous.
But the Democrats aren’t engaging in scare tactics, they’re simply telling the truth. Policy details aside, the G.O.P.’s rigid anti-tax position also makes it, necessarily, the enemy of the senior-oriented programs that account for much of federal spending. And that’s something voters ought to know.
By: Paul Krugman, Op-Ed Columnist, The New York Times, May 12, 2011
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