McAuliffe Muffs Medicaid Expansion Questioning (Round 3 – Exploding Enrollment and Costs)

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The Virginia Medicaid Reform Team (VMRT – a group of grassroots activists) recently sent Virginia Governor Terry McAuliffe the third of several sets of hard questions about Medicaid expansion.

Once again, the Governor ducked the hard questions.

As VMRT wrote his office:

Medicaid enrollment and costs are exploding in at least 15 expansion states. Below please find a number of questions derived from that fact, followed by copious documentation that enrollment and costs are running way past projections just about anywhere you look.

It is incumbent on the Governor, who has proposed Medicaid expansion now for the third time, to speak to expansion’s track record in other states as well as to the predictions that have gone awry.

Any serious discussion of the Medicaid expansion issue would include the downsides, not just pump the glorious benefits of spending ‘free’ money like there was no tomorrow.

The Governor is on notice that the Virginia Medicaid Reform Team expects answers. In a week, we will publish the results of this inquiry so that all Virginia residents can weigh for themselves the sufficiency of the Governor’s answers or, if he chooses not to answer, his nonresponse.

Again, we look forward to the Governor’s expeditious replies.

Set #3 – Exploding Enrollment and Costs

Enrollment under Medicaid expansion is double what was expected in Washington, Kentucky, Illinois and Colorado. Enrollment and costs are much higher than expected in California, Iowa, Massachusetts, Michigan, Nevada, New Mexico, North Dakota, Ohio, Oregon, Vermont, and West Virginia.

1. What is driving enrollment so far past expectations in these other states? Why are so many people signing up?

2. How could all these other states get it so wrong?

3. How do you know the same thing won’t happen in Virginia? What do you know that these 15 other states don’t?

4. Where are the stress tests, i.e., the studies that show what happens to state expenditures in Virginia if enrollment doubles past expectations here? If no such studies exist, how can you in good conscience recommend expansion without knowing what will happen to the state budget if your numbers are way off?

5. In Vermont after expansion, the average federal match rate unexpectedly went DOWN, not up. Where are the stress tests that show what happens to Virginia’s state budget if the same thing happens here?

6. State agencies claim Medicaid expansion will save Virginia money. However, such savings never materialized in Maine under a previous expansion. What is your backup plan if the claimed ‘savings’ don’t materialize here?

7. A previous proposal in Virginia would have set up a ‘rainy day fund’ or ‘lockbox’ to capture all the supposed savings from Medicaid expansion to pay program costs after the federal match declines from 100 percent. But there is no scenario where that fund doesn’t eventually run out, even if enrollment stays what was expected. How do you propose to pay for Medicaid expansion after the fund runs dry?

8. Medicaid expansion is on track to cost Ohio an extra $30 million a month by 2020. Where will Virginia find that kind of money if we have the same enrollment and cost experience as Ohio? What taxes will you raise? What programs will you cut – education, transportation, public safety, or state pensions?

9. Medicaid is not being paid for. Everybody knows that. The federal government borrows 40 cents of every dollar it spends. Why does it make sense to put Virginia residents who are federal taxpayers on the hook for increased federal deficit and debt arising from Medicaid expansion?

10. How is any of this sustainable in the long run? How is what you propose at all compassionate in the long run if it is not sustainable in the long run?