Sunday, September 29, 2013

Was Lewin Contracted By Alaska To Find Fault With Medicaid Expansion Under Affordable Care Act?

I posted the other day about Sen. Bill Wielechowski's unsuccessful attempts to get a copy of the Lewin Group's completed report on the impacts of Alaska expanding Medicaid under the  Affordable Care Act.  It was finished last April but, apparently in violation of the state's public access laws, the Parnell administration has not released copies of the report.

The original press release that alerted me to this, did, however, have a copy of the contract the state had with the Lewin Group.

As I read this contract, I only see them being asked to identify the potential problems, not the benefits of expanded Medicaid in Alaska.   Look for yourself:

[Sorry, the PDF was in a format that didn't allow copying text.  These are screen shots - rather than writing it all out.  You can see the original contract here.]

You can click on the images to enlarge them considerably
(A) through (I) ask for costs.  

(E) is particularly cynical.  It asks for the costs of people who will lower their income to become eligible.  I do know a few folks who are forced into keeping their income low to stay qualified.  One is a graduate student at UW who was paralyzed from the waist down in a motorcycle accident and has other accident related problems.  His parents are not alive.  He's pretty much on his own.  He had to turn down a job because it would put him at an income level that would make him ineligible for Medicaid and his medical expenses are huge.  The job didn't offer insurance, but would have made him ineligible.  

I also know an FAS kid who has some serious deficits  which make living a normal life difficult.  But he also has some great skills which means he can hold down a low level job, which he has done for a number of years now.  But he has to watch how much he makes or will lose his Medicaid eligibility which would end any health care.  

Maybe I'm wrong.  Maybe they're just trying to calculate the costs of this sort of person.  But I have a hunch they believe there are all these welfare cheats out there who love being poor so they can live on government handouts.  I know such people exist, but most people would love to have a good paying job that had health coverage.  

There's only one item in the list of deliverables - #8 - that looks for positives.  #8 is cost savings due to reduction or elimination of existing programs.

As I mentioned in the previous post on this, the Lewin Group's study on the same topic for New Hampshire lists the costs to the state of New Hampshire to be around $100 million.  BUT it then goes on to explain that New Hampshire will get about 20 times that much (about $2 billion) in Federal revenues to the state.   It also says that 22,000 fewer people in New Hampshire will UNinsured.

This Alaska contract doesn't seem to call for these positives.  It doesn't ask for how much federal money will come in or how many people will become eligible for Medicaid and sign up.  Well, that's not exactly true.  It does ask for different categories of folks who will likely sign up - but the focus of the contract is not on the benefits of more people being covered.  Rather it seems to be on the liabilities to the state of more people being covered by health care.  My sense is they see people who have Medicaid as deadbeats. 

I always try to acknowledge that I might be missing something.  I might, so if my thinking here is overlooking key points, I hope readers will point that out to me.  But from what I see of the contract, the Parnell administration was contracting for a report that would support their position against the state expanding Medicaid under the Affordable Care Act.  An honest study would look at the costs AND the benefits and then determine the right policy. 

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