Wednesday, February 13, 2013

WisGOP lies, chooses wrong on Medicaid and Obamacare

   I can't put it any simpler than that. I recognize that Governor Walker picks ideology and poses over anything that would work for Wisconsinites, so his decision to turn down the federal Medicaid expansion that's part of the Affordable Care Act didn't shock me. But the lies his associates are telling to try to justify this stupid move, as well as the costly, set-up-to-fail solution that Gov. Dropout is proposing in its place are the things that have reached a new level of disgusting insanity.

   It's not a coincidence that the day before Walker made his announcement (at an event funded by the greedhead oligarchs at Wisconsin Manufacturers and Commerce, naturally), the lying propagandists at Bradley Foundation front group Media TraKKKers shot out a release that got my bullshit detectors ringing loud and clear.
Supporters of expanding Medicaid have argued that by taking advantage of federal money appropriated through ObamaCare, the state can save up to $95 million. But that statistic, taken from a Legislative Fiscal Bureau report, isn’t completely accurate. The Kaiser Foundation study found that just the first 9 years a Medicaid expansion would cost the state of Wisconsin $725 million.

One of the reasons the LFB report reached a savings was because it only looked at the first 3 years of an expansion. The vast majority of the rising costs that state will bear because of the expansion come over time, well after the first three-year period is up.
So I went to the source to figure out where  smarmy d-bag Brian Sikma came up with the $725 million figure, and you also can go to the source by clicking right here.

   If you do, you'll see that Media Trakkkers is using a ridiculous apples-to-oranges comparison to come up with that claim. The reference is on page 42, but it doesn't deal with the question of "What will happen if Gov. Walker takes the Medicaid expansion in Obamacare?" Instead it compares what would happen IF THERE WAS NO OBAMACARE AT ALL. This is a non-issue when it comes to Walker's decision to take the Obamacare Medicaid money, because Obamacare is the law of the land and will not go away anytime soon (and probably not ever). Amazingly, the Journal-Sentinel's Jason Stein fell for Media Trakkkers line in his recap of Walker's absurd plan. (Update: Stein has taken down the "$725 million more expensive" reference from the story after being alerted to the faulty comparison. Golf clap.)  

   And what Media Trakkkers leaves out of that faulty comparison is the number of uninsured in Wisconsin is more than CUT IN HALF with Obamacare in place and with Wisconsin taking the Medicaid expansion- 300,000 people getting insurance (see page 51), and the improved economy and stability that comes from having more people insured pays back that projected $72.5 million a year extra many times over.

Now that the false Trakkkers claim has been put to bed, let's do the apples-to-apples comparison. First, how could states save money by choosing to expand a service? It seems counterfactual, but the Kaiser Foundation explains
The ACA Medicaid expansion aims to extend Medicaid coverage to most low-income people. Specifically, beginning in 2014, the ACA expands Medicaid eligibility to 138% of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012) for citizens and qualified immigrants. The Medicaid expansion is 100% federally funded for the first three years (2014-2016) and at least 90% federally funded thereafter.

If all states undertake the ACA Medicaid expansion, they can extend coverage to their residents with minimal or no increase in state spending due to new federal Medicaid funds. If all states expand Medicaid under the ACA, total national Medicaid spending would increase by about $1.0 trillion over the 2013-2022 decade, with the federal government paying 93% of these costs. Most additional spending would be for the newly eligible. Of the total increased costs if all states implement the expansion, the federal government would pay $952 billion over 2013-2022, and the state share would be $76 billion (Figure ES-1). Under the ACA, the federal government will pay between 90% and 100% of the costs for those made newly eligible for Medicaid. While total Medicaid spending would increase by 16%, federal spending is expected to increase by 26% and state spending would increase by 3%, though resuls vary among states.  
And if you go further into the Kaiser Family Foundation Study, you'll see that Wisconsin varies to the good side, and that choosing to take the Medicaid money and covering more people would have been set up to be a huge money-saver for the state, had Walker decided to do so.

    Wisconsin change in Medicaid costs, Medicaid expansion vs. no expansion
   In 2016- Taking Medicaid expansion saves $116 million
   2013-2022- Taking Medicaid expansion saves a total of $248 million

   Wisconsin reduction in uninsured
    By 2022- Taking Medicaid expansion reduces uninsured by 123,000.

 The Kaiser Foundation adds another factor that doesn't show up much in the balance sheets of government, but sure has real economic effects. The Kaiser Foundation mentions that expanding Medicaid would allow for a major decrease in uncompensated care costs, which it defines as
spending on behalf of the uninsured that they did not pay themselves. Earlier research found that states and localities finance 30 percent of the uncompensated care.

Spending by states and localities on uncompensated care comes from grants to hospitals and clinics, the state share of Medicaid DSH payments, state and local support for graduate medical education, public hospitals, and indigent care programs.
In other words, it tries to reflect the cost and extra needs that result from treating the uninsured at hospitals, because by law they have to be treated. In Wisconsin's case, the Kaiser Foundation estimates that expanding Medicaid would cut these uncompensated costs by $248 million over the next 10 years, in addition to having more room freed up in emergency rooms to treat people that are truly in dire need. Seems like a no-brainer from any honest assessment. But when you have a no-brainer governor that's more concerned with making symbolic poses in order to raise campaign money from oligarchs who can't wait to take advantage of those in need, often the smart thing is not the thing that is done.
I'll go into just how loaded with fail Walker's substitute plan is at a later point (and no Journal-Sentinel, it is not a "middle ground," Walker's planting his flag high above the top of Bullshit Mountain), but we saw another example of Walker's "death to medical care by a thousand cuts" method this week. Lutheran Social Services announced it could not continue to provide services in the Eau Claire area due to low reimbursement  costs, and is closing 4 facilities and laying off 44 employees. This goes along with last month's closing of Eau Claire home health care provider Lifenet,  and the loss of 360 jobs announced this Fall by Community Health Partners, due to CHP not being able to make ends meet on the state's low-payment contracts.    
 And oh yeah, the bid to replace Logisticare (with Logisticare at a higher expense?) closes next week, with plenty of questions about the fairness and scope of services laid out in the bid, and a lack of flexibility on the Walker boys' desire for a "one-broker-for-the-entire-state" approach.  So do you trust this administration to perform policy that helps people's health outcomes and is cost-efficient? I sure don't, and I bet we end up with the worst of all worlds for the next 2 year in Wisconsin- fewer people covered with higher taxpayer costs, and our economy slowed due to higher health insurance premiums and related uncertainties taking up too much of the pie.  

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