On the Arkansas Times, Part III: Are Private-Option Advocates Really That Much Smarter Than We Are?

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Speaker of the House Davy Carter

Upon rereading David Ramsey’s piece on the genesis of the “private option,” it’s hard not to notice the flood of admiring compliments he bestows on the intellect of its creators. They are “clever,” “smart,” “open-minded,” and “pragmatic.” As they work in tandem with Governor Mike Beebe, they are “thoughtful and nuanced.” In particular, Senator Jonathan Dismang’s “comfort with getting into the weeds on policy details” makes him “open to pragmatic problem-solving.” Representative John Burris is a “wunderkind.” The support staff who had to sweat the details? They are “tireless and creative”; Andy Allison, in particular, is “whip-smart.”

For some reason, Ramsey’s not quite as impressed with those who resisted Obamacare implementation. Take, for example, Majority Leader Bruce Westerman. Rep. Westerman was an early advocate of the “private option.” In fact, Westerman was originally a cosponsor of the bill. But when he realized the plan was unworkable and unaffordable — and HHS dropped the hammer in the form of the now infamous “Good Friday memo” — he then backed away from the plan. This, in my judgment, is an act that required significant personal integrity and strength (some might even say that Westerman’s intellect was demonstrated when he was willing, unlike some, to alter his strategy in the face of reality) — but Ramsey is apparently unconvinced. Ramsey even argued that Westerman knew “the numbers well enough to know that the choice to expand has no meaningful impact on the national debt” — a judgment that the evidence cannot support. In fact, Ramsey speculates that Westerman dropped his support for the plan because of a “political calculation,” spurred by the actions of shadowy right-wing interest groups and “the Tea Party faithful.” (It is unclear whether Ramsey actually interviewed Westerman before writing this story, which goes into such detail about his his motivations.) Similarly, Ramsey describes House Republican opposition to the private option as being “out of spite” at Speaker Carter — because, of course, this kind of legislative opposition could have nothing to do with long-running GOP commitment to oppose Medicaid expansion and Obamacare implementation in Arkansas. Nope. It was spite. Just ask David Ramsey!

Again, David Ramsey’s writing is often intriguing and sometimes insightful. But I have to wonder if his breathless descriptions of the intellect of the private-option designers are really all that even-handed — or, alternately, if these judgments are based on the essentially irrelevant fact that, on this question, these legislators agree so very much with David Ramsey.

Comments

  1. Eric Swanson says:

    AMAC.us had a great article…
    10 Myths About the Obamacare Medicaid Expansion

    Posted 05/13/2013 | In The News, Obamacare Watchdog

    Alyene Senger – The Foundry –

    As Obamacare’s Medicaid expansion is being debated in the states, many myths are being perpetuated by its advocates. Here, Heritage provides the research to debunk such myths:

    1. Myth: Expanding Medicaid is “free money” for the states.

    Reality: The expansion adds an estimated $638 billion in new government spending from 2013–2023. New spending at the federal or state level is reckless in light of the country’s trillion dollar budget deficits and over $16 trillion in national debt. As Governor Rick Perry (R–TX)stated, “[T]here is no such thing as ‘free’ money. We know there’s only money that’s collected from taxpayers, and money borrowed from other countries like China against the good credit of our children and grandchildren.”

    2. Myth: Expanding Medicaid will entail little to no costs to the states.

    Reality: Within three years, costs would exceed any projected savings. Heritage research shows 40 of 50 states would see increases in costs due the Medicaid expansion. If all states expand, state spending on Medicaid would increase by an estimated $41 billion by 2022.

    3. Myth: Medicaid expansion can bring savings to the states.

    Reality: Analysis by Heritage shows that by 2022 any projected state savings are dwarfed by costs. Moreover, these projected savings assume states will further reduce payments to hospitals and clinics for uncompensated care. But, as Heritage’s Ed Haislmaier points out, it is more likely that hospitals will lobby state legislatures for more money rather than less.

    4. Myth: States can opt out of the Medicaid expansion if they change their mind later.

    Reality: Some proponents of the expansion claim that states could drop out of the expansion if the federal government reneges on its commitments. But as legal experts Robert Alt and Dan Greenberg state, “[I]n fact, there is substantial reason to believe that when a state chooses Medicaid expansion, it is something like a decision to go down a one-way street” and that “legislators are mistaken to ignore the possibility that expansion cannot be abandoned as easily as it was entered.”

    5. Myth: States can circumvent Medicaid requirements for the expansion population.

    Reality: In its recent Frequently Asked Questions, the Centers for Medicare and Medicaid Services (CMS) clearly states that beneficiaries under any premium support arrangement would still be Medicaid beneficiaries, “entitled to all benefits and cost-sharing protections,” and that states must provide “wrap around” to fill in any gaps. As Ed Haislmaier has pointed out, “[A]ny state that agrees to the Medicaid expansion will get exactly what the term expansion implies: simply a bigger version of the same expensive and dysfunctional program.”

    6. Myth: States must act quickly before Obamacare cuts hospital payments.

    Reality: Hospitals are pushing states to expand Medicaid coverage because Obamacare is going to reduce their payments for uncompensated care by $56 billion over 10 years. However, the President’s latest budget proposes delaying the Medicaid disproportionate share hospital (DSH) payment reductions until 2015, which raises questions over the future of the cuts. But regardless, as Heritage’s Nina Owcharenko points out, “[m]aybe it is time for the states to tell the hospitals to shift their attention to the real problem: Obamacare.”

    7. Myth: Hospitals will go out of business if states do not expand Medicaid coverage.

    Reality: Hospitals have been lobbying hard on the idea that without expansion, the Obamacare uncompensated care payment cuts will be unsustainable for their business. But according to Ohio Media Trackers, about 80 percent of Ohio hospitals would still net millions in profits if their charity care was cut.

    8. Myth: States can trust the federal government to keep its funding promises.

    Reality: “Although Obamacare stipulates the federal government will pay at least 90 percent of the benefit costs of the Medicaid expansion,” Heritage explains, “state lawmakers have no guarantee future Congresses will keep that promise.” In fact, the Obama Administration has already proposed changing the deal in its fiscal year 2013 budget proposal.

    9. Myth: Medicaid expansion will help low-income workers out of poverty.

    Reality: Medicaid expansion actually locks low-income workers in poverty because of its backward incentives that discourage work. As Dan Greenberg explains for Advance Arkansas, “[E]mployees who earn too much money—or who work too many hours—face a set of unpleasant choices. They can quit. They can work fewer hours. They can decline raises. Realistically, a large number of employees who face such choices will opt to preserve Medicaid coverage by reducing the hours they legally work.”

    10. Myth: Medicaid is quality health coverage.

    Reality: Research has consistently shown that Medicaid produces worse access and health outcomes than private insurance. As Heritage’s Kevin Dayaratna writes, “By further expanding this broken program, Obamacare only exacerbates the situation by adding millions of low-income Americans to a failing program.”

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