Earnest: Rejecting Medicaid expansion is basically condemning Americans to death

The Party of Science has struck again. Conservatives who are either programmatically or philosophically allergic to the notion that expanding access to Medicaid is tantamount to providing the poor access to health care will be surprised to learn that they are heartless ghouls who may also be complicit in an untold number of negligent homicides.

During Monday’s White House press briefing, Press Sec. Josh Earnest reportedly equated the decision made by some governors to decline to expand access to Medicaid in their state under the Affordable Care Act with a lack of concern for the health of their constituents:

This is not an unfamiliar line of attack from the most aggressive elements of the liberal coalition. Even the president has echoed this theme, though he uses softer language when accusing Republicans of consigning their constituents to a prolonged and agonizing demise in service to their parochial political concerns. “I think there’s a recognition that it makes sense,” Obama said of Medicaid expansion during a winter meeting with the nation’s governors in February, “and it’s bigger than politics.”

For a segment of the American polity that projects so wildly that they routinely accuse their political opponents of treason and murder over slights to their fragile sensibilities, but howls over the perceived offense of having the president’s patriotism questioned, this behavior is at least consistent. This kind of paranoid is not, however, rooted in anything other than emotion and anxiety. For those with an interest in expanding access to healthcare, increasing the burden on state-level Medicaid programs is the wrong way to go about addressing that issue.

Among the benefits associated with Obamacare, its advocates once claimed, was the anticipated reduced burden on emergency rooms as newly insured low-income Americans finally began to seek primary care from other sources. That was just one of many purportedly positive aspects of the ACA that never came to be.

“When you give people Medicaid, it seems they use both more primary care and more emergency room services,” NPR reported last June. “In other words, people are going to the emergency department for things that aren’t emergencies. This is exactly what policymakers hoped to avoid by giving people health insurance – including the huge increase in Medicaid coverage coming as part of the Affordable Care Act.”

But at least those poor souls thrown into the Medicaid pool now have better health outcomes where they once did not, right? Wrong, according to Oregon Health Insurance Experiment researchers. “Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees,” CATO’s Michael F. Cannon summarized. “There were some modest improvements in depression and financial strain–but it is likely those gains could be achieved at a much lower cost than through an extremely expensive program like Medicaid.”

This exposes the third and perhaps most galling distortion from Obamacare backers. The Oregon study also found “Medicaid increases annual spending in the emergency department by about $120 per covered individual.” That’s right: There are no cost reductions associated with expanded Medicaid access. “If all 50 states had implemented the law’s Medicaid expansion, the additional ER spending might have hit $1 billion per year,” Cannon wrote in a subsequent piece for Forbes.

For those state governments that do opt to expand access to Medicaid, they will soon be responsible for the full costs associated with that expansion when the federal funding runs dry. Those states are in for a political crisis, as foreshadowed by Florida Gov. Rick Scott.

“We saw that firsthand with education,” he wrote in 2012. “When Washington cut off the roughly $1 billion in stimulus money to our education budget, our people demanded that our state legislature and I replace it. It wasn’t easy, but we did it. We don’t want to be forced into a position where we have to choose between Medicaid and education or other important parts of our state budget.”

Agree or disagree with the arguments above, at least they are based in reason. Implying your political opponents are motivated by wholly base motives is a compelling argument only for those already predisposed to agree with the premise. But so much of the rhetoric out of the Obama administration today is focused on shoring up the increasingly fractious liberal Democratic coalition and not expanding the tent by appealing to skeptics’ common sense.

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Jazz Shaw 3:01 PM on January 26, 2023