Dear
Steve,
Your
attack on Jim Denning may be justified relative to his position, but I think
you’ve missed the point about opposition to Medicaid expansion. Normally, your articles are strongly
educational, but this article appears to veer strongly to the other side, contributing
to massive mis-education of the public.
You
argue that “the bulk of expenses are paid for by the federal government”, the
typical misleading short-term-focus argument of those espousing Medicaid expansion. You then indicate repeatedly that opposition
to Medicaid expansion is petty politics.
Personally,
I am not inclined to expand Medicaid in this fashion, but I am not completely
opposed to it, as explained below.
However, we should have honest, balanced discussion.
Here’s
how I view the ACA Medicaid expansion.
Please advise if you think I am incorrect.
- The Federal
government is NOT paying for it. It
increases the Federal government debt which is already an incredible
burden on future generations. (We practice severe systemic taxation without
representation by foisting current costs on future generations and it is
beyond their carrying load.)
- All Federal money
comes from the citizens in one way or another.
- Approximately half
of the cost of Medicaid is traditionally charged to the Federal budget.
- The Democrats wanted
to extend Medicaid but knew the states could not afford their half. (Whether the Federal budget could afford
its half was irrelevant because it would just be added to the debt.)
- So the Democrats said
that 100% would be charged against the Federal budget for 2014-2016,
dropping to 95% in 2017, 94% in 2018, 93% in 2019, and supposedly levelling
off at 90% for 2020 and beyond.
- (The Democrats
also wanted to punish states that did not expand Medicaid by withdrawing
their traditional Medicaid funding.
However, the Supreme Court invalidated this, so it is no longer
relevant, other than perhaps in understanding the intent.)
- Correct me please
if this has changed. At one point,
the ACA said that once a state expands Medicaid, it has no right to reverse
thereafter. I don’t think the
Supreme Court decision over-turned this, but I don’t know if this is still
the case. Is such a restriction
appropriate? Why put such wording in
the law? I think the wording is
intended to allow the federal government to increase the unfunded mandate
it imposes on states, by reducing the percentage of Medicaid expansion
cost charged to the federal government in the future.
- Are you aware of
anything that would restrict the Federal government from increasing the
states’ shares in the future?
The
Medicaid expansion argument that “citizens in other states are paying for it,
so we should grab as much as we can” (or “we’re paying the money to Washington,
we should at least get our share back”) is related to the mentality that leads
to “roads to nowhere” and keeping unnecessary federal facilities open. To me, such a system and such a mindset are
dangerous examples of the “tragedy of the commons”.
A
more minor issue that you can perhaps help me with is the eligibility up to
138% of the Federal Poverty Level (FPL).
Is that because legislators feel that people above a proper poverty level
need help with insurance costs (I think so) or is it because they feel the FPL
is defined at too low an income level? If
the FPL is raised to an appropriate level (subjective of course), will thresholds
above FPL be appropriate?
I’m
concerned about people lacking access to health care and I understand that providing
health care creates jobs, improves recipients’ productivity, lowers other costs
and reduces net income disparity, all of which are positives. However, the debate should be based on those
issues and what decisions should be federal vs. state, recognizing the full
cost rather than promoting this “other states will pay” argument.
I
remain a big fan of yours despite disappointment with this particular article.
Claude
No comments:
Post a Comment