State Senator Pete Kelly (R, Arrogance) or one of his staff wrote an opinion piece for the Fairbanks Daily News-Miner last week, claiming that Governor Walker should get Medicaid “fixed” before expanding it under the Affordable Care Act. He claims “total Medicaid sending” exceeded $1.6 billion in 2015. He claims it will grow to $2.8 billion by 2025. He launches into a half-baked economic analysis claiming increasing Medicaid services will increase demand. And he goes on like this for a couple hundred words.
So many lies, half-truths; so much ignorance and bigotry in a few hundred words. Let’s examine some of the real whoppers.
Governor Walker Must “Fix” Medicaid.
First, “fixing” Medicaid isn’t the Governor’s job. State Medicaid is legislation and, the last time WC checked, the Legislature, not the Governor, was in charge of legislation. So basically Senator Kelly, not Governor Walker, has failed to do his job. Governor Walker acted because the Legislature utterly failed to do so for four years. Second, there’s no evidence that Medicaid is “broken” and needs fixing. Health care services generally have been increasing in cost more rapidly than inflation, but the impact of inflation on Medicaid is actually lower than health care costs generally. Senator Kelly is spouting Teabagger nonsense as if it were facts.
Total Medicaid Spending
Alaska doesn’t pay $1.6 billion. Medicaid is a shared cost program. The amount paid by the Feds varies from state to state depending on a state’s average per capita income. For most Medicaid services, the Feds pay 65%. So Senator Kelly is only telling 35% of the truth with his claim of $1.6 billion. And in the case of Medicaid expansion, it’s 90%, so there Senator Kelly is only telling 10% of the truth. Which isn’t very much truth, you’ll have to agree.
Growth in Medicaid Expense
Senator Kelly claims “total Medicaid spending” will grow to $2.8 billion by 2025. Well, WC sure hopes so, because it means more folks will be getting medical coverage through the Affordable Care Act’s expansion of Medicaid. A good thing. And the State of Alaska only pays 10% of those new Medicaid participant’s cost.1 Most of the projected growth in cost will cost the State 10% of expenses, not 35% or even 50%.
Increased Demand Will Drive Up Costs
Senator Kelly thinks expansion of Medicaid will increase demand for medical services, and that increased demand will drive up costs. Perhaps Senator Kelly should stick to something he understands, like demagoguery, and not dabble in economics? All Alaskans, whether they get Medicaid or not, consume medical services. The question is whether or not they pay for it. WC isn’t aware of any studies showing that demand for medical services has increased among expanded Medicaid-eligible persons in states that adopted Medicaid expansion at the outset. If Senator Kelly thinks this is a risk, the federal enabling statutes allow implementation of a modest co-pay. But the bottom line is that there isn’t going to be an increased demand. In fact, if expanded Medicaid encourages earlier attention to potentially serious health conditions, demand could decrease. And without increased demand, Senator Kelly’s half-baked supply/demand argument falls apart.
The Feds Can’t Afford It
Senator Kelly argues that the federal government is broke and can’t afford Medicaid. By definition, the guys in charge of printing money can’t go broke. Senator Kelly and his intellectual peers have been claiming the federal government was going broke since WC was in high school. It was even the official debate topic one year. That was 48 years ago. This is just more Teabagger nonsense, and stale Teabagger nonsense, at that.
The Legislature is Already “Fixing” Medicaid
Senator Kelly argues that the Alaska Legislature is already on the job, “reforming” Medicaid. Of course, our friends in the Legislature can just barely pass a budget, and are distracted by important issues like taking recesses, so placing faith there might result in disappointment. And has. For four years now. But the purported legislative zeal to “fix” Medicaid doesn’t require still more delay in Medicaid expansion. Senator Kelly is welcome to “reform” Medicaid. WC won’t hold his breath while waiting for it to happen. But it doesn’t justify delaying expansion.
The Issue Deserves a Public Debate
There was a debate. Senator Kelly has apparently forgotten it. There was a gubernatorial contest. Once candidate had refused to expand Medicaid. The other candidate, pointing to polls showing two-thirds of Alaskans supported the idea, strongly supported Medicaid expansion. Parnell lost. Walker won.
The Bottom Line
Senator Kelly manages to cram a lot of kinds of lies in his little essay. Let’s review:
Half truths? Check
Blame the other guy? Check
Old, stale lies? Check
Misleading arguments? Check
False premises? Check
The only variety Senator Kelly overlooks is the hardest kind of lie: to tell the truth but it do so unconvincingly your listener thinks you are lying. But that kind of subtlety is far beyond Senator Kelly’s skill set. Like telling the truth: that Medicaid expansion is a win-win solution for all Alaskans.2
- The first few years would have been zero percent if Senator Kelly and his buddy, Captain Zero, hadn’t refused to expand Medicaid. So after Senator Kelly has jacked the average amount of State obligation up, WC isn’t inclined to listen to Senator Kelly’s claims it “costs too much.” ↩
- One of the late Ambrose Bierce’s little parables: “A Member of the Kansas Legislature meeting a Cake of Soap was passing it by without recognition, but the Cake of Soap insisted on stopping and shaking hands. Thinking it might possibly be in the enjoyment of the elective franchise, he gave it a cordial and earnest grasp. On letting it go he observed that a portion of it adhered to his fingers, and running to a brook in great alarm he proceeded to wash it off. In doing so he necessarily got some on the other hand, and when he had finished washing, both were so white that he went to bed and sent for a physician.” Substitute Alaska for Kansas and the truth for Bierce’s bar of soap and you have exactly WC’s opinion of Senator Kelly. ↩