Sunday, June 14, 2015

When Is A Bear Not A Bear? Face Saving Medicaid Review?

From yesterday's Alaska Dispatch:

The Alaska Legislature plans to hire a consultant to help lawmakers separate “fact from fiction” in the debate over expansion and reform of the public Medicaid health care program.
The Legislative Budget and Audit Committee, chaired by Rep. Mike Hawker, R-Anchorage, on Friday issued a request for proposals for what it called an “independent professional policy resource.”

While I try to step back here and look at things from all sides and present the facts.  But sometimes doing that seems disingenuous.   It's like saying, "There's a large four legged furry animal, bigger than most dogs with sharp teeth that stood up on its hind legs and sniffed the air.  Some say it is a bear and some said they couldn't see it well enough to tell."  The people who can't be sure are generally those who have a vested interest in their not being a bear.  Maybe it's because
  • they've always believed there are no bears in the area, so it must really be a big dog.   Or  
  • they told you flat out that there are no bears around, and it's hard to admit being wrong.  Or
  • they have a vested interest in their being no bears - like they're being paid to keep bears away.

Medicaid expansion is the bear wandering around Alaska.  Republicans have believed it's bad since they first started calling it Obamacare.
  • Some believed this through genuine belief that the market is the best way to do everything, despite the fact that the market was leaving millions of Americans uncovered, particularly people who really needed coverage. 
  • Some were with Sen. McConnell who declared "The single most important thing we want to achieve is for President Obama to be a one-term president."  Anything the president wants, they oppose it and Obamacare, along with Medicaid expansion, has always been a key target.
  • Some, with an eye toward national conservative PAC's that promise money for candidates who vote against Medicaid expansion and to defeat those who vote for it, Republicans (and Democrats) have a vested interest in preventing Medicaid expansion.
The irony is that states who refused to set up their own insurance exchanges are now facing the possibility of losing all federal Medicaid funding.  And they brought it own themselves.  They sued the federal government on a technicality.  The bill says there can be subsidies for people in states with a state exchange and they've argued those without a state exchange, using the federal exchange instead.  Their intent was to end the subsidies and thus kill Obamacare.  But now it's turning out that those states will be cutting off millions of citizens from affordable health care and huge costs will be shifted to those states.

They're charging Obama with not preparing for the possibility that the Supreme Court rules in their favor, which now they see as a catastrophe.  Obama, a constitutional lawyer, is just saying that he can't imagine the court ruling against Obamacare.   I'm sure behind that objective mask, he's got a big smirk as he thinks, "These guys brought this on themselves, let them squirm."

That's all some of the background behind yesterday's headline about the Alaska majority caucuses spending more money that they have repeatedly said we don't have, for a "report."

I'd just remind them that former Republican governor Parnell commissioned a study on Medicaid expansion from a conservative think tank.  He kept that study secret - even though it was paid for with public money - until the very last minute.

He kept is secret with good reason:  The facts contradicted his anti-expansion decision.
"Under our baseline participation assumptions, expanding Medicaid would cost the state $200.6 million more over the 2014 to 2020 period, compared to not expanding Medicaid, for a total increased cost of $240.5 million.  However, the state would receive $2.9 billion in additional federal funds and fewer individuals would remain uninsured.  Additionally, this new cost would comprise only 1.4 percent of total Medicaid costs from 2014 to 2020 (Figure E-4).
 To minimize state costs under expansion, the state could also elect to implement expansion under a number of alternative design scenarios."
 I posted about this study and Parnell's decision on it in detail here.

The legislature doesn't need to spend more time on yet another study.  All they have to do is do their jobs.  Sit down and read the original study.  There are a number of legislators who, I'm sure, would have trouble understanding the study.  But Hawker, who's cited in the article, is a retired CPA.  He should be able to understand that study and know we don't need yet another study.  But he's also the legislator most responsible for the opulent redo of the Anchorage Legislative Information Office that everyone agrees is way above market value. 

The conclusion that makes the most sense to me (which doesn't mean its the right conclusion) is that another study could cite new evidence that would allow the Republicans to let the governor, on his own, expand Medicaid without any serious opposition from the legislators.   And if that is the case, then the already stressed Alaska budget will take another hit so the Republican majority's ego can be massaged.

This is really a bear.  But if that's what it takes to get Medicaid expanded in Alaska and adding health care coverage, many say, to 40,000 people, so be it.  But I hope the people of Alaska - particularly those who have given up on the process and stopped voting - realize how the Republican majority's talk of fiscal carefulness is belied by most of what they do.  The list of the legislators - particularly those from Anchorage and Mat-Su - who took excessive per diem during the special session is just yet one more piece of evidence of their lack of concern for the people of Alaska.

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