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Most of the criticisms of the House and Senate health insurance reform bills have centered around the proposed repeal of Medicaid expansion. The House version of H.R. 1628 proposed repeal on January 1, 2020. To placate moderates, the Senate version would delay repeal Medicaid expansion on January 1, 2024.
Medicaid is a government program that provides health coverage for low-income Americans. ObamaCare expanded the program to cover those under 138 percent of the federal poverty line (FPL), or $33,600 for a family of four in the contiguous 48 states and the District of Columbia.
The only moderate member to come out against the Senate version of the bill is Sen. Dean Heller (R-Nevada), who is up for reelection in 2018. "You have to protect Medicaid expansion states," Sen. Heller said on Friday. "That’s what I want." Prior to coming out against the Senate version of H.R. 1628, the Better Care Reconciliation Act, Heller said, "I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.
Sen. Heller's concerns are similar to those of Sens. Shelley Moore Capito (R-W.Va.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Rob Portman (R-Ohio).
In June 2009, then-President Barack Obama acknowledged that Medicaid was a broken program. "“[W]e can’t simply put more people into a broken system that doesn’t work," he said during a speech. But that's exactly what ObamaCare did by expanding the program. A November 2016 analysis by the Foundation for Government Accountability found that "at least 11.5 million able-bodied adults have now enrolled in ObamaCare expansion – an overrun of 110 percent or more than double projections." As Brian Blase has noted, "CBO projected that the Medicaid expansion would cost $42 billion in 2015. The actual cost was $68 billion, about 62 percent higher."
"Using CBO’s current projections of state adoption of the expansion for its previous estimates shows that federal Medicaid spending between 2016 and 2024 is $232 billion in excess of its April 2014 estimates," he added.
ObamaCare did little to nothing to actually reform Medicaid. The program remained an open-ended entitlement and costs still weren't controlled. The program still faces a doctor shortage because of low reimbursement rates and red tape. ObamaCare also had the effect of moving individuals who previously had private health insurance coverage to Medicaid.
Another issue with Medicaid is that it doesn't provide better health outcomes. Yes, those on the program have coverage, but do they have better access to health care? Are they better off than those who are uninsured? The answer may surprise you.
"Several reputable studies have found that Medicaid patients experience no better health outcomes than uninsured people, and arguably even slightly worse outcomes," Shikha Dalmia explained in February. "But the most stunning of all was a 2013 study on Oregon's Medicaid program co-authored by ObamaCare architect Jonathan Gruber of MIT. By luck, it was the closest thing in real life to a controlled experiment."
"Here's what happened: Thanks to a budget crunch, Oregon was forced to rely on a lottery to distribute Medicaid coverage to 30,000 out of 90,000 applicants. These people were similar in every essential respect except that some got Medicaid and others didn't. Gruber compared the health outcomes of both groups and concluded that Medicaid 'generated no significant improvement in measured physical outcomes' for diabetes, high cholesterol, high blood pressure, and even mortality rates," she noted.
It has been suggested that there's a higher mortality rate for Medicaid patients treated for cancer than those who are private insurance. Medicaid patients are also more likely to die after a major surgical procedure, including heart procedures and lung transplants, than those with private coverage or no health insurance at all.
There are also questions about access to health care under Medicaid. In November, the Illinois Policy Institute noted that "752 Illinoisans on the state’s Medicaid waiting list have died awaiting needed care since the General Assembly voted to accept the Obamacare expansion for able-bodied adults. That’s 18 deaths each month, on average, since the expansion was authorized."
While there are concerns about whether Medicaid expansion will truly be repeal under the Senate version of H.R. 1628, the modernization of Medicaid, scrapping the open-ended entitlement model to giving states the option of block grant or per-capita grant as well as other long overdue, is one of the few bright spots of the bill.