Medicaid expansion: The impact on the federal budget and deficit

From Kansas Policy Institute.

Medicaid Expansion: The Impact on the Federal Budget and Deficit

By Steve Anderson

The problem with the uninsured is not going to be solved by expanding Medicaid. Even amongst Medicaid’s staunchest proponents you’ll be hard pressed to find any who will claim it to be the equivalent of high quality private health insurance coverage. The number of federal senators and representatives that choose to exclude their staffers from Obamacare shows that many Washington politicians understand the quality of government insurance plans Medicaid and Obamacare represent. The simple fact is, that health insurance is not to be confused with health care.

Medicaid’s proponents can only claim anecdotal claims of improving health outcomes of recipients. Even in pre-ObamaCare Medicaid, beneficiaries largely do not access available preventable care services. In fact, a Harvard University study shows that emergency room visits actually increased by 40 percent for Medicaid recipients in Oregon after their expansion. Citizens would do well to remember, a “decrease in ER visits” was a key selling point of ObamaCare generally and Medicaid expansion specifically. ER visits are the most expensive form of care. When these increased visits are paid for by Medicaid, the taxpayers are picking up BOTH the state and federal portion of the high cost of emergency room visits. This flies in the face of the Obama Administration’s claim that Medicaid expansion would actually save money by limiting this sort of behavior.

It doesn’t stop there and this is the part that hardly anyone has mentioned, and what the Obama Administration would rather you not know — a staggering number of those enrolling in ObamaCare will actually be sent to Medicaid and not be in the private market. And by “private market” we mean one established and controlled by government.

The following charts are the pre-Medicaid expansion projection of revenues versus expenditures from the Congressional Budget Office. They were completed before the decision by 25 states and the District of Columbia to expand eligibility.ⁱ

The three lines with the steepest slopes and therefore the fastest growing expenditures are Medicaid, Unemployment payments (called Income Security) and Other Programs. The U.S. House of Representatives has addressed the unemployment expense growth by bringing the program back to its original intent – to provide a safety net between jobs. Other Programs will be largely controlled if current trends hold and extension of the various “stimulus” programs are curtailed. However, the one that is going to accelerate with expansion and is larger than the other two combined in total state and federal expenditures is Medicaid. At least 3.9 million of Obamacare participants are expected to be enrolled in Medicaid and 19 million nationwide overall will be added to Medicaid in the next year. A 35 percent increase in Medicaid participants.ⁱⁱ Picture these two charts with 35 percent greater additional costs for the Medicaid entitlement and you have an idea how problematic this is for the federal budget and deficit. Is it any wonder that President Obama has started to back track from the claim that the federal government—which let’s not forget, is funded by you the taxpayer — will pay all the costs for 3 years and 90 percent thereafter. Instead, his administration and he himself talk about blended rates that will transfer a sizeable portion of the cost to state budgets.ⁱⁱⁱ Despite his promises to the contrary.

The Impact on the Kansas State Budget

Even the leftist Center on Budget and Policy Priorities, which typically finds spending citizens’ tax dollars an event to celebrate, is cautioning that the “blended rate” shift by the President will “likely prompt states to cut payments to health care providers and to scale back the health services that Medicaid covers for low-income children, parents, people with disabilities, and/or senior citizens (including those in nursing homes). Reductions in provider payments would likely exacerbate the problem that Medicaid beneficiaries already face regarding access to physician care, particularly from specialists.”^iv This analysis actually left out the administrative cost of expansion that is largely being absorbed by the states. If anything, this suggests that reality will be more dire than CBPP’s predictions.

KPI’s own cost study of Medicaid expansion, conducted by a sitting member of the Social Security Advisory Board and former chief economist at the Federal Reserve in Cleveland, shows that Kansas taxpayers can expect to pick a $600 million tab if Medicaid is expanded. Hardly the “free money” that the Kansas Hospital Association has tried to foist on your family. They’ve even hired a former George W. Bush cabinet secretary to aggressively lobby for this “free money.” They’ve also yet to explain what services they recommend the state cut to fund the expansion and if their members are willing to pick up the additional costs when “blended rates” almost certainly take effect.

As a taxpayer you are going to pay for this on both the federal and state level and you deserve answers when any special interest groups come asking for more of your money.

ⁱ http://directorblue.blogspot.com/2011/01/liberals-democrat-party-will-split-if.html
ⁱⁱ http://www.bloomberg.com/news/2014-01-02/obamacare-s-medicaid-expansion-may-create-oregon-like-er-strain.htm
ⁱⁱⁱ http://www.cbpp.org/cms/index.cfm?fa=view&id=3521
^iv Ibid