Gail Kerr, a columnist for The Tennessean, wrote an article in the December 22nd edition of the paper expressing support for the state expanding Medicaid (or as it's called in Tennessee, TennCare).
No facts, logic or reason is used in her support for such an expansion. She uses emotional arguments and arguments tinged with the "Republicans don't care about poor people" line that has become so prevalent in the discourse of the intellectually dishonest Left.
Kerr mainly directs her attacks at Governor Bill Haslam who is up for re-election in 2014. She correctly points out that, "He has no known opponent to stop him from easily being re-elected. The possible negatives he may face during a campaign are long shots. He’s Teflon right now." However, I see this issue being used more against Republicans running for the Tennessee General Assembly than against Governor Haslam. That is why I decided to address this issue one claim at a time in an attempt to head this off at the pass.
Claim: He [Gov. Haslam] has not been swayed by arguments that other states will get our federal tax dollars.
What she is saying here, is that if Tennessee does not expand Medicaid, then the money that Tennessee would have gotten if the program would have been expanded would go to other states instead of Tennessee. This is false. Nina Owcharenko explains: "The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states."
I also find it puzzling that in her previous paragraph, Kerr says that "Instead, the governor is trying to persuade the federal government to allow Tennessee to use federal dollars to pay private insurers to take on those people." Wouldn't this qualify as Tennessee getting "our" federal tax dollars?
Claim: He has not been convinced that Tennessee would get this money with no strings attached.
Really? No strings attached? How many federal dollars come into states with absolutely no strings attached? (Also notice that no source was given to substantiate this claim by Kerr.)
How's this for a string: "Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death." Or how about the fact that the states will eventually have to pay 10% of the total cost of expansion? (Medicaid is one of the biggest expenses state governments face. It makes no difference the percentage that the federal government pays if states can't pay their piece.)
The biggest "string" attached to the Medicaid expansion is that Medicaid is not really that effective of a program if you consider that:
Claim: In three years, the state would be required to pick up part of the tab, but the state can withdraw from the program at any time.
Can you imagine the disaster this would be? What exactly would happen if a state was to withdraw? Would that mean that the state would then be responsible for all the added costs of Medicaid expansion? What would be more likely to happen would be all the new enrollees would be kicked off Medicaid. This is too much of a risk to make this an argument for expanding Medicaid.
Claim: He’s not convinced, even though 26 other states have opted into this program with great success
Again, no source was given to show the "success" of other states. We can look to two states who have expanded Medicaid, Arizona and Maine, and see what experiences they have had. They don't look like successes to me:
Claim: Logic has not convinced the governor that it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits. With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care. That expensive price tag is passed to paying patients.
Here's the biggie. This is the most common argument used to support expanding Medicaid. It might seem logical on the surface, but if you dig a little deeper it becomes obvious it is not. Kerr makes a lot of assumptions here that are flawed. Let's dive in.
First, Kerr claims that "it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits."
This is a silly claim to make. Why? Because when Kerr says it makes more sense to "insure" people she means to insure them with Medicaid. Well, who pays for Medicaid? You and me! The same people are paying for it. They are just doing it through a different financial apparatus. The "insuring" of the uninsured through Medicaid doesn't magically absolve taxpayers from paying for it. We are still going to pay for it.
This statement also makes one big assumption: that the amount paid for uncompensated care for the uninsured will be reduced if more people are insured with Medicaid. This is not true. Let's look at Maine and Massachusetts for an example.
Maine expanded their Medicaid program in 2002. This state's Department of Health and Human Services Commissioner said in 2013 that uncompensated care more than doubled to $194 million from $94 million dollars and also that this expansion has been a "calamitous failure". So, Maine's uncompensated care went up even after Medicaid was expanded. Why? Because the number of uninsured people was not significantly reduced.
Massachusetts's program was expanded in 2006. Their share of uncompensated care didn't decrease either. Hospitals have still successfully lobbied for continued funding of over $200 million a year to cover uncompensated care.
The second claim made by Kerr is this: "With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care."
To make this argument another way, you could say because people are uninsured, they use the ER more. If they were insured they would use the ER less because they wouldn't go for "nonemergencies". This is the implication given with Kerr's statement. However, the evidence shows that the opposite is true.
The Journal of the American Medical Association conducted a study centered around Emergency Department visits from 1997 to 2007. They found that, "Adults with Medicaid accounted for most of the increase in ED visits....These findings indicate that ED visit rates have increased from 1997 to 2007 and that EDs are increasingly serving as the safety net for medically underserved patients, particularly adults with Medicaid."
If giving people Medicaid would prevent Emergency Room visits then why did ERs see the biggest increase of visits by Medicaid recipients? If Kerr was correct, the biggest increase would be among the uninsured, but it wasn't.
The New York Times reports that people on Medicaid use Emergency Rooms more than uninsured people, "Among the uninsured, 7.4 percent made two or more visits to an E.R., but so did 5.1 percent of people with private insurance. Medicaid recipients were the heaviest users of E.R.’s, with 15.3 percent of them making two or more visits during the year." So, if we want to reduce the amount of ER visits, expanding Medicaid is not the answer.
Another study, The Oregon study mentioned above that looked at Oregon's Medicaid expansion, found "we did not find significant changes in visits to the emergency department or hospital admissions."
The Boston Globe reported that, "The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use."
All of this is all well and good, but this has been the experience of other states. What about in Tennessee?
The University of Memphis Methodist LeBonheur Center for Healthcare Economics released a study showing similar results. Here is the main highlight:
"TennCare patients made up 35.0% of all ED visits, and 59.3% of these were non-urgent. Uninsured patients, in contrast, made up 17.5% of all ED visits, and 52.0% of these were non-urgent"
This study strikes a death blow to Kerr's claims that expanding Medicaid will reduce ER visits and would reduce the ER being used for "nonemergencies." As we can see, visits to Emergency Rooms by TennCare enrollees were double that of the uninsured. Not only that, but TennCare enrollees use ERs for non-urgent visits more so than uninsured patients.
Emotional rhetoric never stands up to facts.
No facts, logic or reason is used in her support for such an expansion. She uses emotional arguments and arguments tinged with the "Republicans don't care about poor people" line that has become so prevalent in the discourse of the intellectually dishonest Left.
Kerr mainly directs her attacks at Governor Bill Haslam who is up for re-election in 2014. She correctly points out that, "He has no known opponent to stop him from easily being re-elected. The possible negatives he may face during a campaign are long shots. He’s Teflon right now." However, I see this issue being used more against Republicans running for the Tennessee General Assembly than against Governor Haslam. That is why I decided to address this issue one claim at a time in an attempt to head this off at the pass.
Claim: He [Gov. Haslam] has not been swayed by arguments that other states will get our federal tax dollars.
What she is saying here, is that if Tennessee does not expand Medicaid, then the money that Tennessee would have gotten if the program would have been expanded would go to other states instead of Tennessee. This is false. Nina Owcharenko explains: "The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states."
I also find it puzzling that in her previous paragraph, Kerr says that "Instead, the governor is trying to persuade the federal government to allow Tennessee to use federal dollars to pay private insurers to take on those people." Wouldn't this qualify as Tennessee getting "our" federal tax dollars?
Claim: He has not been convinced that Tennessee would get this money with no strings attached.
Really? No strings attached? How many federal dollars come into states with absolutely no strings attached? (Also notice that no source was given to substantiate this claim by Kerr.)
How's this for a string: "Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death." Or how about the fact that the states will eventually have to pay 10% of the total cost of expansion? (Medicaid is one of the biggest expenses state governments face. It makes no difference the percentage that the federal government pays if states can't pay their piece.)
The biggest "string" attached to the Medicaid expansion is that Medicaid is not really that effective of a program if you consider that:
- One third of physicians will not accept new Medicaid patients (what good is putting more people on Medicaid if they can't see a doctor?)
- Patients with Medicaid (and uninsured patients) are both 50% more likely to die from head and neck cancer
- Patients with Medicaid are 13 % more likely to die from surgery than people without insurance
- Lung transplant recipients on Medicaid are 8.1% less likely to survive after 10 years than uninsured and privately insured recipients
- An Oregon study found Medicaid had no significant effect on health outcomes vs being uninsured
Claim: In three years, the state would be required to pick up part of the tab, but the state can withdraw from the program at any time.
Can you imagine the disaster this would be? What exactly would happen if a state was to withdraw? Would that mean that the state would then be responsible for all the added costs of Medicaid expansion? What would be more likely to happen would be all the new enrollees would be kicked off Medicaid. This is too much of a risk to make this an argument for expanding Medicaid.
Claim: He’s not convinced, even though 26 other states have opted into this program with great success
Again, no source was given to show the "success" of other states. We can look to two states who have expanded Medicaid, Arizona and Maine, and see what experiences they have had. They don't look like successes to me:
- Medicaid expansion had little impact on the rate of uninsured. Arizona’s uninsured rate actually increased in the five years after expansion, while Maine’s
did not change - Enrollment among the expansion populations was much higher and faster than the slow and gradual enrollment that was projected
- Per-person costs for the new expansion populations were much higher than projected—particularly for the childless adult populations
Claim: Logic has not convinced the governor that it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits. With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care. That expensive price tag is passed to paying patients.
Here's the biggie. This is the most common argument used to support expanding Medicaid. It might seem logical on the surface, but if you dig a little deeper it becomes obvious it is not. Kerr makes a lot of assumptions here that are flawed. Let's dive in.
First, Kerr claims that "it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits."
This is a silly claim to make. Why? Because when Kerr says it makes more sense to "insure" people she means to insure them with Medicaid. Well, who pays for Medicaid? You and me! The same people are paying for it. They are just doing it through a different financial apparatus. The "insuring" of the uninsured through Medicaid doesn't magically absolve taxpayers from paying for it. We are still going to pay for it.
This statement also makes one big assumption: that the amount paid for uncompensated care for the uninsured will be reduced if more people are insured with Medicaid. This is not true. Let's look at Maine and Massachusetts for an example.
Maine expanded their Medicaid program in 2002. This state's Department of Health and Human Services Commissioner said in 2013 that uncompensated care more than doubled to $194 million from $94 million dollars and also that this expansion has been a "calamitous failure". So, Maine's uncompensated care went up even after Medicaid was expanded. Why? Because the number of uninsured people was not significantly reduced.
Massachusetts's program was expanded in 2006. Their share of uncompensated care didn't decrease either. Hospitals have still successfully lobbied for continued funding of over $200 million a year to cover uncompensated care.
The second claim made by Kerr is this: "With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care."
To make this argument another way, you could say because people are uninsured, they use the ER more. If they were insured they would use the ER less because they wouldn't go for "nonemergencies". This is the implication given with Kerr's statement. However, the evidence shows that the opposite is true.
The Journal of the American Medical Association conducted a study centered around Emergency Department visits from 1997 to 2007. They found that, "Adults with Medicaid accounted for most of the increase in ED visits....These findings indicate that ED visit rates have increased from 1997 to 2007 and that EDs are increasingly serving as the safety net for medically underserved patients, particularly adults with Medicaid."
If giving people Medicaid would prevent Emergency Room visits then why did ERs see the biggest increase of visits by Medicaid recipients? If Kerr was correct, the biggest increase would be among the uninsured, but it wasn't.
The New York Times reports that people on Medicaid use Emergency Rooms more than uninsured people, "Among the uninsured, 7.4 percent made two or more visits to an E.R., but so did 5.1 percent of people with private insurance. Medicaid recipients were the heaviest users of E.R.’s, with 15.3 percent of them making two or more visits during the year." So, if we want to reduce the amount of ER visits, expanding Medicaid is not the answer.
Another study, The Oregon study mentioned above that looked at Oregon's Medicaid expansion, found "we did not find significant changes in visits to the emergency department or hospital admissions."
The Boston Globe reported that, "The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use."
All of this is all well and good, but this has been the experience of other states. What about in Tennessee?
The University of Memphis Methodist LeBonheur Center for Healthcare Economics released a study showing similar results. Here is the main highlight:
"TennCare patients made up 35.0% of all ED visits, and 59.3% of these were non-urgent. Uninsured patients, in contrast, made up 17.5% of all ED visits, and 52.0% of these were non-urgent"
This study strikes a death blow to Kerr's claims that expanding Medicaid will reduce ER visits and would reduce the ER being used for "nonemergencies." As we can see, visits to Emergency Rooms by TennCare enrollees were double that of the uninsured. Not only that, but TennCare enrollees use ERs for non-urgent visits more so than uninsured patients.
Emotional rhetoric never stands up to facts.
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