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.

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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.

Charity care is crucial to Utah’s health – Sutherland Soapbox, 9/9/14

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

Health care and health care policy have become daily news topics. You may have noticed Governor Gary Herbert promoting his Healthy Utah plan. Although this proposal is touted as an alternative to Medicaid expansion, it would require the approval of the president’s Secretary of Health and Human Services. So in other words, a state government initiative, funded by the federal government – as long as the money is there – will be run, and effectively guaranteed, by state government. Considering the federal government is already in debt up to its neck, we think this sounds like a really bad bet.

As a conservative organization, Sutherland Institute does not believe in government-driven health care. We do not believe health care is a right, but rather a personal responsibility, and yet we believe all people have a moral obligation to care for each other. It’s manifestly human – a moral good – to care for our neighbors.

For the past 12 years, Sutherland has argued that authentic charity care creates the right kinds of socioeconomic incentives to build community, heal class divisions, control health care costs and set an example for the rest of the nation. We also assert that the increase in Medicaid can be mitigated through the expansion and improvement of something that already exists: the impressive care currently being provided across our state by charity-care clinics, private-practice physicians and institutions serving the “working poor,” indigent and needy uninsured. Read more

Deseret News op-ed: Healthy Utah plan would hurt the most vulnerable Utahns

Waiting Room, by Vincent van Gogh

Waiting Room, by Vincent van Gogh

Good public policy requires three elements: doing the right things for the right reasons in the right ways. These elements are the difference between good policy and bad.

The proposed Healthy Utah Plan does some of the right things and for the right reasons. It seeks to help uninsured individuals acquire private health insurance (the right thing) for the sake of their own health as well as that of Utah’s economy (the right reasons). However, Healthy Utah would do this by pushing the most vulnerable Utahns further back in the health care access line.

It also relies on federal funding that cannot be sustained — jeopardizing funding for government services like education and transportation. You simply cannot do the right thing in the wrong ways and make good public policy.

Healthy Utah proposes to subsidize private health insurance for some 55,000 uninsured Utahns in the Obamacare “coverage gap.” In short, it takes them from the back of the line for access to health care and puts them at the front.

But what does that mean for the more than 300,000 low-income children, single parents and disabled Utahns — the most vulnerable of Utahns — who are on Medicaid now?

Click here to read the rest of this op-ed by Sutherland’s Derek Monson on the Deseret News website.

The next broken Obamacare promise

President Barack Obama, Vice President Joe Biden, and senior staff react at the White House as the House passes the health care reform bill.

President Obama, Vice President Biden and staff celebrate as the House passes the health reform bill.

Remember the lie of “if you like your health care plan, you can keep your health care plan”? Now, it seems, Obamacare’s “promise” of free preventive health care, such as checkups, screenings and immunizations, is also turning out to be something less than accurate.

As summarized in an informative Politico story on the issue, “as millions of newly covered people begin to seek that benefit [of free preventive health care], some are still getting stuck with bills.” This is because many people getting free preventive health screenings and tests (e.g., a colonoscopy) are still being charged for any preventive health care that comes along with it (e.g., immediate removal of not-yet-cancerous polyps found during the colonoscopy).

Just add it to the growing heap of Obamacare falsehoods, misstatements, and factual inaccuracies.

As someone who admires Ronald Reagan, I believe in the political principle of “trust, but verify.” But how do you apply that with an administration that has proven through both incompetence and misleading statements to be untrustworthy when it comes to its signature health care program?

Unnecessary licensing restrictions raise cost of health care

Medical toolsWhy do we have licensing laws that restrict who can treat patients as a doctor and perform medical procedures?

Ostensibly, it is for the health and safety of people who need to visit the doctor (i.e. everyone). We don’t want John Doe off the street opening up a medical clinic, calling himself a doctor, and handing out drugs or performing surgery.

So what does it mean when we find out that some licensing rules meant to protect our health have no connection with health outcomes, and in fact harm us by making medical services more expensive?

A recent study published by the National Bureau of Economic Research reported that medical licensing rules that allow only physicians – not nurse practitioners – to prescribe drugs to patients “do not seem to influence health care quality.” Changing these licensing regulations does not seem to impact health outcomes such as infant mortality rates.

However, these licensing restrictions are connected with higher health care costs. For instance, the study “shows that more rigid regulations increase the price of a well-child medical exam by 3 to 16%.” This happens through various mechanisms, such as requiring a parent (or the parent’s insurance company, which charges premiums to cover those costs) to pay the more expensive rate charged by a physician for their child’s checkups, in order to access that physician’s ability to prescribe any drugs needed.

When nurse practitioners are allowed to prescribe drugs, the cost of a well-child exam goes down because the time of the nurse practitioner is less expensive than that of a physician. And as the study suggests, this less expensive medical option is likely to come without significant negative effects on health outcomes.

Why does this matter to Utah and Utah families? In every legislative session, without fail, there is a raft of new proposals to heighten licensing restrictions to prevent people from providing various services.

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Sutherland’s position statement on Medicaid expansion

hiddenmoneySutherland Institute understands the perspective of those calling for Utah to follow Obamacare’s vision of Medicaid expansion. The argument sounds reasonable: Since Utahns are paying tax dollars to Washington, D.C., under Obamacare, then why shouldn’t Utah take every Medicaid expansion dollar it can get?

Sutherland also recognizes this as a moment for political courage and leadership. The decision regarding Medicaid expansion is an opportunity for Utah politicians to become statesmen and stateswomen: to rise above short-sighted concerns of moneyed special interests and well-intentioned advocates and, instead, take the long view recognizing the real risks that Obamacare’s Medicaid expansion creates for taxpayers and the neediest Utahns. This is a moment for Utah’s leaders to show why it is and will remain one of the best-managed states in the nation.

Medicaid expansion is an idea that sounds reasonable in the short term, but it’s not. Thoughtful consideration of the issue from a broader, long-term perspective leads to the undeniably logical conclusion that Medicaid expansion is imprudent, irresponsible policy for taxpayers and dishonest, harmful policy for Utahns in need.

Click here to read the rest of this position statement.