Tag Archives: health care

Medicaid Transfers

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It’s well understood that Medicaid badly wants reform.  My own view is to give it back to the States by reducing Federal fund transfers to them until the transfers are zero, which also would eliminate Federal strings jerking the States to do everything the same way, the Federal way.

There are lots of paths to that end, and there are a number of other reforms that would help the situation at least a little.  The House plan for repeal and replace of Obamacare, the first step of which was the American Health Care Act, has one such step, the repeal of Obamacare’s Medicaid expansion.

Expanding State participation in Federally provided—with those strings attached—funds—expanding Medicaid—as a number State governors have done, is not one of those reforms.  Not even for Republican governors.

Sixteen GOP governors represent states that expanded Medicaid under the Affordable Care Act, and they are generally loath to see the program cut back.

Nobody forced these persons to mainline the Federal funds drug. They stuck that needle in their veins and addicted themselves, with no outside pressure at all.

These guys are badly mistaken, and they’ve only made things worse for the constituents for whom they claim to work.

Michigan Governor Rick Snyder, one of those 16, thinks the expansion is just peachy keen; he’s still riding the high from his needle.  He says that “600,000 Michiganders have gained coverage and the state’s hospitals have saved about $300 million.”

What he’s carefully ignoring, though, is how much money Michiganders and those hospitals sent to the Federal government in various taxes and fees to contribute to 49 other States’ Medicaid program participation.  How many of those Michiganders could have been helped and how much money could Michigan’s hospitals have saved had the State kept those monies, instead?  How much would those Michigan citizens and those Michigan hospitals have benefited, had they been able to keep their money—their money, not the State or Federal government’s money—instead of paying all those taxes and fees to the Federal government?

Medicaid Cuts?

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Some conservative Republican Senators are looking to cut Federal transfers to the States earmarked for those States’ Medicaid programs.  Others are concerned.

[T]he [conservative Senate Republicans’] Medicaid plan could affect many more people and shift significant costs onto hospitals and states.

One State’s Medicaid program, though, should be paid for exclusively by that State and not subsidized by the other 49 through those Federal transfers. Medicaid is, after all, a state program by design, and Medicaid eligibility is determined by each State.  The Federal transfer subsidies are made the more egregious by the fact that each State determines its own citizens’ eligibility for Medicaid, and that eligibility is income-based—with the maximum income for eligibility in most States being a multiple of the Federal Poverty Guidelines.  This means that in those States, a citizen can be eligible for Medicaid funds even though, by definition, that citizen isn’t in poverty.  Other States ought not be required to subsidize, through Federal Medicaid transfers, such eligibilities.  Not only are the States are defining “low income” much too loosely, other States have to pay into those definitions.

If each of those other 49 were able to keep the monies collected by the Feds for transfer, they’d also have more money—of their own—with which to fund their own Medicaid programs, and each of the States, absent attendant Federal strings, would be freer to structure their individual Medicaid programs according to their own citizens’ needs and demands.  As it is, States wanting to structure their programs must waste time and resources pleading to the Feds “Mother, may I?” and then argue the matter.

Such State-initiated restructuring—subject to central government approval—already is beginning to include things like work requirements, drug testing and time limits on coverage, all of which would free up State resources for the State’s truly poor.  Federal cuts to transfers to State Medicaid need not interfere with this; on the contrary, such cuts would encourage needed restructuring, while moving to insulate each State from other States’ decisions.

Of course, such Federal transfer cut would have complex implications and require serious Federal tax code restructure and reform—the taxes the Feds transfer for Medicaid come from a variety of sources: individual and business income taxes, dividend and cap gains taxes, and on and on.

That just puts a premium on getting started.

Going Soft

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Senate pseudo-Republicans are balking at one good item that was contained the House-passed American Health Care Act: repeal of Obamacare’s trillion dollars’ worth of taxes.  These guys actually don’t see the value of that repeal.  Senator Susan Collins (R, ME) is typical:

I don’t see how you can repeal all of the pay-fors…and still meet the goal of providing health-insurance coverage for people who truly need assistance[.]

Aside from the false premise of needing Federal government “pay-fors” as a default position, rather than a last result, the Lady from Maine and her fellows plainly either don’t understand free market principles, or they have no confidence in free markets.

One path for the Senate could be a repeal of the taxes but a delay in the effective dates.

This is the only legitimate point of discussion on the repeal of these taxes.  The AHCA makes the repeal retroactive to 1 Jan 2017.  It’s the repeal that’s important, not its date of effectivity.  Effective 1 Jan 2018 is fine, so is a date (certain) in 2019, to the extent health coverage providers, businesses, and individual citizens need time to plan and prepare.  The repeal itself, however, must be inarguable.

I’ve decried the House’s Freedom Caucus of No, but the Caucus of Squish in the Senate is going too far in the other direction.  These folks need to do the job they were sent to the Senate to do vis-à-vis Obamacare and our nation’s health provision and health coverage industries.  Failing to repeal the Obamacare taxes in addition to the reductions in other business and personal taxes that have been proposed is unacceptable.  If the Caucus of Squish fails to do this, its members need to be replaced at the next available elections for each of them.

If that costs the Republican Party control of the Senate, well—how will we tell the difference?  The Caucus of Squish is, with its timidity, worse even than the Progressive-Democratic Party.

Foolishness

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James Capretta and Lanhee Chen of American Enterprise Institute and the Hoover Institution, respectively, have a piece in a recent Wall Street Journal edition that talks about how to “nudge” uninsured Americans into getting health coverage plans.  It’s impressive in its…foolishness…(I’m being polite).

Congress can help these Americans and many others get insurance by enrolling them in no-premium, no-obligation plans from which they could withdraw if they wanted to.

No. Not only no, Hell no. No squared. We’ve enough Big Government intruding into our private lives, arrogantly presuming to make our private decisions for us, without adding this to the steaming pile.

But how to make sure people stay covered?

None of your business, and none of Big Government’s. This is an individual’s choice whether to stay.  Or even to get a plan in the first place.  Full stop.

But their [Republicans’] plan also must make sure most Americans have health insurance.

No it mustn’t. It need only ensure Americans (all, not just your “most”) have access to insurance. That access will come most broadly from a free market in which actual insurance policies are sold (not the currently available welfare coverage plans that Big Government is trying to force on us in ever diminishing variety and ever increasing cost). The decision to buy—the decision to participate at all—can only be the individual’s in a free nation.

And: keep your hands out of my pockets looking for money with which to pay for your “no-premium, no-obligation” schemes.  Of course you—and every American with two neurons to bump against each other to form a ganglion—know that your schemes won’t be free or without obligation: someone is going to pay for that stuff.

Talk about false premises.  Jeez.

Finally: when did these two AEI and Hoover Institution denizens join the Progressive-Democratic Party?

Obamacare

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As The Wall Street Journal rightly pointed out, regarding the failed Obamacare repeal and replacement effort and the failing renewed discussions between the House Republican Conference and the Freedom Caucus of No,

The fury…suggests that some Freedom Caucus opposition is more cynical than sincere. Do its members want to appear to negotiate in good faith but insist on changes that centrists can’t accept, so they can then accuse centrists of killing the reform revival?

And

…perhaps there’s still hope for health-care reform. But first Republicans have to decide if they can accept progress that is short of perfection. If they can’t, then they’ll blow their best, and maybe only, shot at repealing and replacing a failing entitlement.

Here’s the problem, though: the Freedom Caucus of No already has betrayed their constituents once through that first failure by inflicting on them continued Obamacare instead of an improved system because the improvements weren’t perfection.

For how long will the No-ers continue to betray their employers? The No-ers are carefully eliding the back half of Reagan’s remark about half a loaf: come back tomorrow for the rest. Of course, that requires accepting the first half first….