Medicaid: A disconnect between debate and reality, Sutherland Soapbox, 2/3/15


Photo: Caremate

Photo: Caremate

This post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

I want to discuss a topic of significant political news reporting this week: how should Utah deal with Medicaid expansion, as allowed and encouraged by Obamacare.

The proposals for expanding Utah’s Medicaid program being considered by the Utah Legislature are varied, including a plan for full Medicaid expansion using the traditional Medicaid program; Governor Herbert’s alternative plan for full Medicaid expansion under Obamacare using private health insurance; and the Health Reform Task Force recommendation to avoid Obamacare altogether and opt for a targeted expansion to the “medically frail.”

The defining feature of the debate can be summed up in one word: “complexity.” Health care generally is an extremely complex policy issue – whether morally, fiscally, economically or politically. Add to that the fact that we’re talking about health care for low-income Utahns, and the fact that the debate stems from an unpopular law named after a liberal sitting president, and the complexity and difficulty increases exponentially.

It should come as no surprise then that finding the right way forward has been hard to come by. Simply put, there is no easy answer to the question of Medicaid expansion. For our part at Sutherland, we think the federal involvement and restrictions on Medicaid policy make this herculean task nearly impossible, because the feds shoot down the ideas that hold the most potential to generate support.

But an even bigger problem with Medicaid policy and debate is the misguided focus on all sides about what Medicaid is and should be. First and foremost, Medicaid is and should be a response to poverty in society – an anti-poverty program, not a health care program. Another way of putting it is that we created Medicaid in the first place because poverty made health care unaffordable for some, not as a response to issues of public health.

But Medicaid policy and debate ignores this fundamental issue. Instead of trying to address the poverty of the poor, the debate focuses on improving health care for the poor. As a result, Medicaid policy obsessively focuses on the symptoms of the problem, such as access to doctors, payment rates for providers and costs to taxpayers, rather than on the problem itself, which is that poverty makes needed health care inaccessible and unaffordable for low-income Utahns. This disconnect between political debate and human reality drives much of the complexity of Medicaid policy debates, as liberals intuitively understand and focus on the symptoms of poverty and conservatives intuitively understand and focus on the problems created by programs like Medicaid.

A big part of the solution is to recognize and accept that Medicaid should be an anti-poverty program, not a health care program. The latter approach means that Medicaid will be a failure as policy if all it does is provide health care coverage to low-income Utahns, while doing little or nothing to help them get out of poverty. What’s more important, this new approach is likely to be better for society and the common good on all levels.

It is better morally because Medicaid will actually improve the lives of poor Utahns, by helping them get the education, life skills and networks they need to rise out of poverty, rather than naively assuming we’ve solved their problems by cutting a check for their medical bills. It is better fiscally because it provides a financial commitment from taxpayers that lasts only until an individual or family rises out of poverty, rather than an unending entitlement that adds to federal deficits and eats up ever-larger portions of state budgets. It is better economically because it means helping low-income Utahns become more prosperous and economically productive, while limiting the economic resources required to get and keep them in that position. And it is better politically because both liberals and conservatives are voicing understanding of the need to address poverty.

So what does this approach mean for dealing with Medicaid expansion today? It means Utah should focus on a minimal expansion of the current flawed approach to Medicaid, such as the targeted proposal for the medically frail, and then get back to the drawing board to reform Medicaid into a program that uses health care to combat poverty. Only then will we get a Medicaid program that is actually solving real problems, rather than just chasing after the next symptom.

For Sutherland Institute, I’m Derek Monson. Thanks for listening.

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Vaccination: the debate that shouldn’t exist

measlesVaccines have fallen victim to their own success. They have worked so incredibly well that no one remembers the reality of the diseases that vaccines have kept at bay, and instead too many people, out of fear, focus on a very few bad outcomes.

The granddaddy of the anti-vaccine accusations, the infamous Wakefield study from 1998 – which claimed a link between the MMR (measles-mumps-rubella) vaccine and autism – was a fraud.

Unfortunately it gave rise to an anti-vaccine movement, sped on its way by well-meaning parents (and others) with the best of intentions. Alarmed by the rise in autism cases, they looked for ways to reduce the chances of their children being affected by this disorder – especially if they already had family members with autism.

As the mother of an autistic 13-year-old, I empathize utterly. I’ve read many books, considered different treatments, and agonized over what I might possibly have done during pregnancy and birth to trigger autism in my son.

But fraudulent and misguided “science” has resulted in real harm. Resources that had to be spent in debunking this study and its fallout are resources that could not be used to direct scientific research into far more promising avenues. Who knows how much this unnecessary disaster has delayed real answers? How much time, money, effort and emotion have been wasted on this rabbit trail … and how much harm has it caused by casting aspersions on vaccines?

I fear that if parents choose not to vaccinate their children, the choice will ultimately be taken away from everyone. Don’t give the government a reason to mandate vaccinations. Be smart enough to do it of your own volition – and out of compassion for not-yet-vaccinated infants and the very few who really are medically unable to get vaccines.

Medicaid expansion: The moral question — Sutherland Soapbox, 1/6/15

Photo: Caremate

Photo: Caremate

This post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

As things stand today, the 2015 Legislative Session is just three weeks away. And while many important issues will be addressed, one that is likely to have more significance and long-term impact than most is the issue of Medicaid expansion.

The question of if, when, and how to expand Utah’s Medicaid program is important on multiple levels. But today I want to focus on the moral level.

The question of Medicaid expansion is important on a moral level because we are talking about the moral imperative we have as human beings to help our neighbors in need gain access to basic health care services. Simply stated, our moral impulses and reasoning will not allow us to sit by and let people suffer needlessly, and history has shown that if civil society and the marketplace are unwilling or unable to step up to provide basic health care for everyone who needs it, the government will. Hence we have one of Utah’s more conservative governors in recent memory proposing to expand Utah’s Medicaid program to the fullest extent under the rules of Obamacare, in the form of the Healthy Utah plan.

In fairness, some supporters of Healthy Utah object to its being called a “full Medicaid expansion” under Obamacare. But when you propose to cover the full Medicaid expansion population with coverage that is comparable in scope to traditional Medicaid, and a main purpose of doing so is to qualify for more generous federal funding offered for full Medicaid expansion, then the simple fact is that you have proposed a full Medicaid expansion plan.

In any case, the supporters of Healthy Utah regularly invoke a moral argument in favor of Medicaid expansion: namely, that we cannot sit by and do nothing to help the 60,000-plus uninsured Utahns that Obamacare has let fall through the cracks. Now that is an important moral consideration, but an incomplete one.  Read more

Health care and a history of misleading the public

President Lyndon B. Johnson

President Lyndon B. Johnson

The government has a long history of misleading the public in order to pass legislation it wants.

For instance, in the 1960s President Lyndon Johnson pressed his allies in Congress to suppress the true cost of his big health care legislation, Medicare and Medicaid, in order to garner enough support to get it passed.

According to taped conversations, President Johnson, speaking with Senator Ted Kennedy in 1962, describes how suppressing costs was vital to passing his bill, because if voters and their representatives in Congress knew how much the bill would actually cost over the long term they would be outraged,

A health program yesterday runs 300 million, but the fools had to go to projecting it down the road five or six years. And when you project the first year, it runs 900 million. Now I don’t know whether I would approve 900 million the second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in, saying my God, you’ve got a billion dollar program for next year on health, therefore I’m against any of it now. Do you follow me?

Not surprisingly, the projections the government made were wildly off. In 1967 the House Ways and Means Committee predicted Medicare would cost $12 billion in 1990. The actual cost was $98 billion.

Today, we find that something similar to LBJ’s dishonesty has happened with President Obama’s Affordable Care Act. For years the president repeated the refrain, “If you like your plan, you can keep your plan.” Once it became clear that wasn’t true, the president apologized to the millions of Americans who lost their insurance plans because of Obamacare.

Click here to read the rest of this post at Utah Citizen Network.

Sutherland Institute supports Health Reform Task Force recommendations

Sutherland Institute today released the following statement regarding the legislative Health Reform Task Force’s actions regarding Medicaid expansion:

Sutherland Institute supports the decision of the Health Reform Task Force to recommend an approach to Medicaid expansion that focuses on the needs of the medically frail in Utah. Most importantly, the Task Force’s recommended approach addresses the human question by striking a prudent balance of meeting the most pressing health care needs of uninsured Utahns and protecting health care access for the disabled individuals, low-income single parents and children for whom Medicaid was designed.

Additionally, the Task Force’s recommended approach answers the human question in a fiscally reasonable and conservative way: making a significant investment of taxpayer dollars without relying on “promises” of federal funding that are mathematically unrealistic due to the federal debt situation. Given that other states which have adopted a full Medicaid expansion plan have faced unexpectedly high costs – requiring states to reallocate funds that would otherwise go to public schools, road and highways or criminal justice – taking a more cautious approach to Medicaid expansion is a reflection of wise fiscal stewardship.

Sutherland encourages policymakers to continue along the path the Task Force has recommended. We look forward to continuing to engage this decision-making process as it moves forward.

Sutherland commends Gov. Herbert for not calling Medicaid special session

Sutherland Institute commends Governor Herbert for his wise and prudent decision not to call a special session to consider his proposed Healthy Utah Medicaid expansion plan. The question of whether Utah should add a second, private-insurance tier to its Medicaid program for the sake of federal funding is a momentous one. This decision has significant implications and consequences for the most vulnerable Utahns – the single parents, disabled individuals, and children who would be left behind in the lower tier of traditional Medicaid coverage. Additionally, given the long-term fiscal implications of creating a new entitlement program such as Healthy Utah, this decision ought to be considered within a budget process that sheds light on whether future state funding for Healthy Utah could be better utilized if instead spent on essential roles of government such as higher education, transportation, and corrections.

Despite calls from some to short-circuit thoughtful consideration of the details and impacts of Healthy Utah because they believe the decision merits no further evaluation, Governor Herbert made the correct decision and should be commended for recognizing the importance of a thoughtful process for making sound public policy. Sutherland looks forward to continuing this important policy dialogue where it ought to be engaged: in a general session of the Utah Legislature.

How states that take the federal bait end up on the hook – Sutherland Soapbox, 10/14/14

Fisherman_and_his_catch_SeychellesThis post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations.

Last week, Sutherland Institute had the opportunity to meet with Tarren Bragdon while he was in Utah’s capital. Tarren is CEO of the Foundation for Government Accountability – also known as the FGA – an independent, nonprofit policy organization based in Naples, Florida. With a focus on healthcare and welfare issues, the FGA works with policy makers in about 20 states helping them fix big-government and broken healthcare and welfare programs. Among their priorities is freeing people from dependence on government and helping them move on to a better life.

Medicaid expansion is a significant topic across the nation. A number of states have decided to expand while others have not. As Utah is in the process of working toward making that decision, Bragdon discussed with Sutherland key elements of this important issue that he and his colleagues are addressing as they meet with legislators and decision-makers across the nation. In the videotaped interview, Tarren talked about Medicaid expansion in general and briefly about the Healthy Utah Plan proposed by Governor Herbert.

In the brief, 14-minute interview, he describes the informative experience of states that have made the decision to expand Medicaid and, with the body of information now emerging, he highlights points of particular relevance he believes Utah policy-makers should keep in mind as they work through the decision process:

Essentially, what you have right now is the federal government dangling this promise of federal money in front of the states, hoping the states will embrace this Medicaid expansion voluntarily because they want this federal money to flow into their states. But what we’re seeing is that just like with almost every welfare expansion, that the prediction of how much it would cost is very different than the reality. And so we’re seeing states already having dramatically higher enrollment in Medicaid expansion than what they projected and dramatically higher costs. It turns out these individuals are much more expensive to cover than single moms. And so states are already seeing this as a budget buster. In states like Arkansas, the state taxpayers are on the hook for tens of millions of dollars just in the first year.

He then explains what this means for the most vulnerable populations – for whom Medicaid was implemented in the first place:

What that has meant in the states, and we’ve already seen this happen, is they will cut back Medicaid programs when times are tough for those most vulnerable populations because those are the populations who they have the lower match for. … Typically, lawmakers focus on making those cuts to the most vulnerable. We saw this in Arizona where, when the Medicaid expansion for childless adults got out of control, the Legislature voted to cut heart and lung transplants.

Read more

Video: The risks of Medicaid expansion and Healthy Utah

What is the significance of the numbers 1, 3 and 10 when it comes to Medicaid expansion? Watch this video to find out:

In this interview, Tarren Bragdon, CEO of the Foundation for Government Accountability (FGA), and Stan Rasmussen, director of public affairs for Sutherland Institute, discuss Medicaid expansion in general and the Healthy Utah Plan proposed by Governor Gary Herbert.

Bragdon, whose nonprofit is based in Naples, Fla., talks about the experiences of states that have made the decision to expand Medicaid – and why Utah should be wary of the “free” federal money offered for expanding Medicaid.

Is Healthy Utah a good idea? More information changes people’s minds – Sutherland Soapbox, 9/16/14

Man-inside-note-headThis post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations.

Sutherland Institute commissioned a poll by Magellan Strategies that was released yesterday about Utah voters’ support for Medicaid expansion in its various forms, including Governor Gary Herbert’s preferred “Healthy Utah” form of expansion. The question we aimed to address was this: “What do Utah voters think about Medicaid expansion when they are informed about the issue in a way that is comparable to Utah legislators?”

Utah voters’ answer was to reluctantly say “Utah should probably do nothing on expansion for now, and should instead start looking for better ideas.” But before I dig into that, I think it’s important to understand why we thought to commission a poll at all.

Multiple polls on Medicaid expansion in Utah have been published and reported on in the press. These polls reported that somewhere between 70 and 88 percent of Utah voters support either traditional Medicaid expansion, or the Healthy Utah version – overwhelming support by any reasonable standard.

But think for a minute about whether those numbers make any sense. If these numbers are accurate, it means that a higher portion of Utah voters support expanding Medicaid than supported Utah’s marriage amendment in 2004. Now, does anyone really believe that’s true? Yeah, neither did we.

Rather than accepting hard-to-believe polling results at face value, we thought it better to commission a poll that gave more complete information and context to Utah voters about the costs, enrollment, and uncertainties of Medicaid expansion in Utah.

What happened is that voters said that none of the Medicaid expansion options merit majority support. In fact, the only one that received positive net support was the “do not expand Medicaid right now” proposal, with 45 percent in favor and 26 percent opposed. For comparison, Healthy Utah got 32 percent in favor and 40 percent opposed, traditional Medicaid expansion got 21 percent in favor and 49 percent opposed, and partial Medicaid expansion got 19 percent in favor and 48 percent opposed. Thirty percent of Utah voters on average said they were unsure or didn’t know whether they supported or opposed each proposal. Read more

New poll shows Utahns reluctant about Medicaid expansion proposals

Study tableThe results of a new survey conducted by Magellan Strategies seem to contradict other recent polls on the topic of Medicaid expansion in Utah.

In the Magellan poll, conducted last week, no more than 45 percent of poll respondents favored any of four proposals once those proposals had been explained in detail.

Sutherland commissioned the poll because we wanted to see what Utah voters thought about Medicaid expansion when they were given more complete information about the costs, enrollment, and uncertainties of Medicaid expansion than provided in the previous polls.

In essence, the poll tackled the question: “When voters are informed about the options for Medicaid expansion on a level comparable to Utah legislators, what do they think the state should do?”

The voters’ reluctant answer was this: “They should probably do nothing for now and look for something better than the currently available options.”

In fact, the only proposal that had positive support was the “do not expand Medicaid right now” proposal, which was favored by 45 percent of poll respondents, compared with 26 percent opposed.

The other three proposals in the poll had more opposition than support: Traditional Medicaid expansion had 21 percent in favor, 49 percent opposed; partial Medicaid expansion had 19 percent in favor, 48 percent opposed; and the Healthy Utah plan had 32 percent in favor, 40 percent opposed.

The survey found that a sizable percentage of Utah voters are uncertain about what Utah policymakers should do, when they are given all of the information. On average, 30 percent of respondents were unsure if they favored or opposed the proposals when they were informed and asked about them in a stand-alone format.

After hearing all of the proposals described in detail, respondents were then asked to choose which plan they thought was best. The “do not expand Medicaid right now” proposal won a plurality of support with 31 percent, followed by “unsure or don’t know” at 20 percent, Healthy Utah at 17 percent, traditional Medicaid expansion at 15 percent, partial Medicaid expansion at 10 percent, and “don’t like any of the proposals” at 7 percent.

Put together, this means that only 42 percent of those polled said that some form of Medicaid expansion was the best option, compared with 58 percent who were either unsure or preferred something other than the proposals that would immediately expand Medicaid.

The poll was a landline and cell phone survey of 500 registered voters in Utah on Sept. 8 and 9. It has a margin of error of +/- 4.38 percent at a confidence level of 95 percent.

Click here to read the survey done by Magellan and see details about the questions and methodology used.

For crosstabs detailing information about subgroups within the survey population, click here.