McAuliffe Muffs Medicaid Expansion Questioning (Round 4 – Childless, Able-Bodied Adults)

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Photo courtesy of Watchdog.

Photo courtesy of Watchdog.

See Part 1 | Part 2 |  and Part 3

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

Once again, no response from the Governor.

As VMRT wrote his office:

Medicaid expansion favors childless, able-bodied adults over the aged, poor, and disabled.  Further, states that have expanded Medicaid have experienced access problems in their Medicaid programs.

Below please find a number of questions addressing these issues.  It is incumbent on the Governor, who has proposed Medicaid expansion for the third time, to answer these questions before his proposal is taken seriously.

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.

The results of our previous inquiries are published here –
http://www.liberato.us/confrontations.html

The story has been picked up by three other media outlets, so far.

Set #4 – Childless, Able-Bodied Adults

 

  1. Isn’t it true that Medicaid expansion is for childless, able-bodied adults who are above the federal poverty line?
  2. Aren’t John Kasich and others who claim that Medicaid expansion is for the ‘most vulnerable among us’ either mistaken or lying?
  3. How do you respond to the study (documentation below) showing that Medicaid expansion to able-bodied adults cuts the likelihood of their working by up to 10 percentage points and can reduce earnings by up to $1,200 a year?  Why should we expand Medicaid when it disincentivizes work for childless, able-bodied adults, including millennials?
  4. The federal match rate for the Medicaid expansion population is currently 100 percent but far less (50 percent in Virginia) for indigents originally on the program. What sense does that make?
  5. What sense does it make to chop $716 billion out of Medicare to pay for expanding Medicaid primarily to childless, able-bodied, working-age adults?
  6. Isn’t it true that about a third of primary care physicians don’t take new Medicaid patients and, further, that Virginia is in line with this national average?
  7. Isn’t it true that Medicaid expansion has caused access problems in California, New Jersey, and Colorado?  Haven’t these access problems included long wait times, more ER visits, and enrollees scrambling for alternatives?  This is Medicaid expansion in the real world, not just some idle theorizing.  How do you know for sure the same thing won’t happen in Virginia?
  8. Isn’t it true that, in Ohio, Medicaid expansion has hurt access for the truly needy, the developmentally disabled, pediatric hospitals, and cancer services?  Why should they suffer for the sake of giving childless, able-bodied adults a new middle-class entitlement?
  9. How do you propose to deal with the fact that Medicaid expansion makes it more difficult for recipients to get access to cardiologists, orthopedists, and other specialists?  Also, Isn’t it true that there is no federal match for specialists, leaving Virginia taxpayers entirely on the hook for specialized care if Medicaid is expanded?
  10. Isn’t it true that Medicaid expansion in Kentucky has caused access problems because doctors drop Medicaid patients after getting stiffed by managed care companies?  Virginia uses a managed care approach.  How do you know the same thing won’t happen here?  Don’t these companies have every incentive to cut corners to boost their bottom lines?

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*  *  MEDIA EVENTS  *  *

VMRT’s ‘Hard Questions’ campaign has been featured here:  

  • Virginia Free Citizen – Round 2
  • Fairfax Free CitizenRound  1  2  3
  • (reader comment: “Our governor had better come clean with some answers.”)
  • Rob Schillling Show (WINA News Radio – Charlottesville at 20:00 to 30:00)

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DOCUMENTATION

Childless, Able-Bodied Adults

Medicaid expansion match rate is 100% for able-bodied adults but only half for indigents – what sense does that make?
http://trib.com/opinion/columns/medicaid-expansion-is-the-opposite-of-fiscal-prudence/article_25764da3-aa71-5876-86f0-e7e954c8171d.html

Medicaid expansion financed by $716B chop to Medicare. Why take from grandma to give to 28yo living in her basement?
http://trib.com/opinion/columns/medicaid-expansion-is-the-opposite-of-fiscal-prudence/article_25764da3-aa71-5876-86f0-e7e954c8171d.html

Urban Inst: 82.4% of Medicaid expansion beneficiaries are able-bodied, childless adults; majority are millennials.
http://www.nhbr.com/February-20-2015/NH-Medicaid-expansion-hurts-the-disabled-poor/

Medicaid expansion could lead 2.6 million able-bodied adults to take up the violin
http://www.forbes.com/sites/theapothecary/2015/02/24/obamacares-medicaid-expansion-could-cause-2-6-million-able-bodied-adults-to-drop-out-of-labor-force/

15,000 Idaho residents could leave the workforce under Medicaid expansion (FGA study)
http://watchdog.org/236402/medicaid-expansion-idaho-2/

Medicaid expansion population – childless 19-34yo – needs jobs, not welfare that incentivizes them to work less.
http://www.kansas.com/opinion/opn-columns-blogs/article42349899.html

‘Medicaid and CHIP cover nearly 70M, or 1 in 5 people in the country.’ (yes, that’s the plan, but it’s unsustainable)
http://www.usnews.com/news/articles/2015/02/24/medicaid-enrollment-surges-across-the-us

Study: previous Medicaid expansions to able-bodied cuts working up to 10 percentage points, earnings up to $12K/yr
http://www.forbes.com/sites/theapothecary/2015/01/27/gov-pences-new-deal-same-old-obamacare-medicaid-expansion/

Indiana Medicaid expansion is new entitlement for able-bodied middle-class adults that discourages work, independence
http://www.forbes.com/sites/theapothecary/2015/01/27/gov-pences-new-deal-same-old-obamacare-medicaid-expansion/

Indiana Medicaid expansion plan, no matter how you slice it, creates more dependency and runs up the debt
http://dailysignal.com/2015/01/28/3-problems-indianas-medicaid-expansion/?utm_source=heritagefoundation&utm_medium=email&utm_campaign=morningbell&mkt_tok=3RkMMJWWfF9wsRolvKjBZKXonjHpfsX54u4oWKawlMI%2F0ER3fOvrPUfGjI4ET8NgI%2BSLDwEYGJlv6SgFQrLBMa1ozrgOWxU%3D

Medicaid expansion discourages work, hurts most vulnerable, balloons state budgets, ties states’ hands.
http://yellowhammernews.com/politics-2/alabama-should-reject-expanding-government-healthcare-through-medicaid-opinion/

Medicaid expansion for childless working-age adults at odds w/’most vulnerable’  #MakeProgress
http://townhall.com/tipsheet/mattvespa/2015/07/14/draft-n2024940

Medicaid expansion not about ‘the most vulnerable’ – ‘expansion population mainly able-bodied, childless adults’
http://juneauempire.com/opinion/2015-07-26/my-turn-alaska-cant-afford-medicaid-expansion-reform

“Government welfare programs can disincentivize Americans from lifting themselves out of poverty”
http://watchdog.org/236402/medicaid-expansion-idaho-2/

Hurts the Poor

Ohio Medicaid expansion hurts truly needy, developmentally disabled, pediatric hospitals, cancer services, access
http://watchdog.org/197221/ohio-budget-obamacare/

“Obamacare is robbing resources from the developmentally disabled” http://hotair.com/archives/2015/12/09/obamacare-is-robbing-resources-from-the-developmentally-disabled/

Medicaid expansion is NOT compassionate; program fails earlier recipients, crimps other state programs, cuts access
http://townhall.com/tipsheet/guybenson/2015/02/10/not-compassionate-obamacares-medicaid-expansion-failing-patients-in-california-n1955097

Medicaid expansion harms the most vulnerable, other state programs http://cjonline.com/news/2015-03-19/opponents-medicaid-expansion-get-their-day-have-their-say

Bigger fed share for able-bodied in Medicaid expansion is perverse incentive to siphon resources from truly needy
http://watchdog.org/231130/obamacare-expansion-state-budgets/

Medicaid expansion hurts the needy, relies on force, cost is unsustainable
http://www.forbes.com/sites/theapothecary/2015/10/07/three-major-problems-left-by-sec-sebelius-legacy-obamacares-medicaid-expansion/

Access Problems

“A July 9 analysis by medical journal Health Affairs estimated that, nationwide, more than 33 percent of primary care physicians, or PCPs, weren’t accepting new Medicaid patients.  …A CDC analysis … found Virginia in-line with the national average.

CA – Medi-Cal managed care approach failing to provide access to patients (#ACA promised access, right?)
http://www.npr.org/sections/health-shots/2015/06/22/416467076/californias-medicaid-program-fails-to-ensure-access-to-doctors

CA – Long waits and access problems have Medi-Cal patients (i.e., 1/3 of the state) scrambling for alternatives
http://blogs.kqed.org/stateofhealth/2015/02/19/more-pressure-on-providers-in-face-of-medi-cal-expansion/

CA – Medi-Cal: We give you access to autism care but yes we have no providers today (unicorns & rainbows)
http://ww2.kqed.org/stateofhealth/2015/06/22/medi-cals-autism-therapy-benefit-doesnt-mean-access-to-care/

CA – Access problems mount in Medi-Cal; not enough docs accept patients, ER visits increasing
http://calwatchdog.com/2015/02/20/medi-cal-woes-leave-ca-hurting/

CO – Poor Aspen residents find having Medicaid doesn’t get them in to see a doctor
http://www.aspendailynews.com/section/home/166791

NJ – Medicaid access problems multiply in New Jersey; rolls swell 30% after #Obamacare
http://www.nj.com/healthfit/index.ssf/2015/02/where_will_400k_new_nj_medicaid_patients_get_care.html

NJ – Christie budget seeks to divert millions to boost Medicaid reimbursements (the access problems cannot be denied)
http://www.nj.com/healthfit/index.ssf/2015/02/christie_budget_aims_to_ease_medicaid_doctor_short.html

OH Medicaiders can’t find dentists, problem to get worse (but they’re ‘covered’ and that’s all that matters, right?) http://www.10tv.com/content/stories/2015/03/05/columbus-ohio-ohio-medicaid-patients-struggle-to-find-dentists.html

TX – Cover this! “Only 34% of Texas physicians accept new Medicaid patients today, down from 67% in 2000.” (Force’em!)
http://www.woai.com/articles/woai-local-news-sponsored-by-five-119078/texas-doctors-describe-frustrations-of-dealing-13219133/

WI – Few dentists accept Medicaid in Wisconsin (but it works great on paper)
http://www.superiortelegram.com/news/wisconsin/3708681-lack-education-few-dentists-accepting-medicaid-are-barriers-dental-care

5 states add Medicaid dental coverage but have trouble finding enough dentists (promise me the moon…)
http://kaiserhealthnews.org/news/states-add-dental-coverage-for-adults-on-medicaid-but-struggle-to-meet-demand/

Medicaid expansion won’t magically create more doctors, but will increase dependency & lead to worse health outcomes
http://idahoreporter.com/38201/opinion-medicaid-expansion-will-not-save-lives/

LTE: media asleep at the switch about Medicaid access problems
http://www.app.com/story/opinion/readers/2015/03/08/letter-media-ignoring-medicaids-phantom-network-doctors/24529183/

ICYMI: “In Medicaid, Access to Coverage Does not Equal Access to Care”
http://morningconsult.com/opinions/in-medicaid-access-to-coverage-does-not-equal-access-to-care/

Utah Medicaid expansion would exacerbate state’s doctor shortage, shafting children and disabled
http://www.deseretnews.com/article/865636203/My-view-New-Medicaid-expansion-framework-still-fiscally-irresponsible-harms-Utah7s-poorest.html?pg=all

Medicaid expansion causing access problems to specialists; difficult to find cardiologists, orthopedists, etc.
http://www.pbs.org/newshour/bb/giving-millions-access-care-medicaid-expansion-strains-californias-health-system/#

Ky doc warns Va against Medicaid expansion: docs dropping Medicaid patients, getting stiffed by managed care co.s
http://www.roanoke.com/opinion/letters/rutherford-ky-s-medicaid-expansion-has-some-negative-side-effects/article_09410307-c136-5539-8c3e-c666d6bbfcef.html

#AccessShmaccess. JAMA study: “just half of all doctors will schedule appointments with new Medicaid patients.”
http://www.forbes.com/sites/sallypipes/2015/12/14/obamacare-bloats-u-s-healthcare-system/

Told you so: “Getting a Medicaid card doesn’t always guarantee healthcare”
http://www.healthcarefinancenews.com/news/getting-medicaid-card-doesn%E2%80%99t-always-guarantee-healthcare

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