Medicaid Expansion Is Not Dead

While the Joint Revenue Committee continues to talk about how to increase the corporate tax burden here in Wyoming - see the agenda for their November 28-30 meeting here in Cheyenne - the debate over Medicaid expansion is picking up steam again. 

Sometimes, it seems as though the idea with government is the same as with just-in-time manufacturing: no input should remain in the factory more than 30 minutes before it goes out as part of a finished product. In government, a dump truck unloads tax revenue in one end of the legislature, and before the money has even fallen to the ground a big fan blows it into the spending pipelines in the other end. 

The trucks get bigger, and the fan blows harder.

Medicaid expansion, a great example of this spend-to-the-end attitude, is back again after a brief hiatus. From the Casper Star Tribune:
Three red, rural Western states passed Medicaid expansion ballot measures on Election Day. But Wyoming’s next governor, current state Treasurer Mark Gordon, remains uninterested in broadening the program here. “I just don’t think it’s necessarily the right solution for Wyoming at this time,” he said Wednesday on a conference call with reporters.
We will just have to wait and see what the incoming legislature, and our new governor, agree on. Anyone who opposes Medicaid expansion is right on the issue, but just opposing the expansion is not enough. The all-too-common mistake among fiscal conservatives in general is to just say no to more spending. That is good, but to win the debate we need to formulate and present alternative reforms that restore free-market health care and health insurance here in Wyoming. 

The last part takes some work, but it is absolutely necessary. We need to increase competition and free-market choice in Wyoming, both in terms of health care and in terms of health insurance. 

As things are now, we are in a slow but unrelenting process of socializing our state's entire health care system. That is not going to end well.

As yet another reminder of why we need free-market reform so badly, keep in mind that a bad end result is of no consequence to those who advocate health care socialization. On the contrary, their mode of thinking is entirely static. The Casper Star Tribune article offers a good example:
Voters in Nebraska, Utah and Idaho all passed ballot initiatives last week authorizing the expansion of Medicaid, joining other western states like Colorado, Nevada and Washington. The successful efforts will bring coverage to 363,000 low-income adults, adding to the 12 million who’ve already received coverage under expansion. 
This line of argument suggests that all these 12 million toiled in the shadowland of the uninsured before Medicaid expansion. The truth is that most of them belong to either of two categories. The first are those who were on private insurance before, but lost it thanks to all the destructive features of the "Affordable" Care Act. The second category are people who can work and can provide for themselves through private coverage, but thanks to Medicaid expansion don't have to. This point is explained well in an article at The MaineWire from last year
The truth is that Medicaid expansion will just give able-bodied adults free healthcare. Most of these adults do not have children, and they should be working. Then they can get insurance on the exchanges or contribute to the cost of their own health care through their employers. ... When Maine expanded Medicaid in 2002, it created a $750 million hospital debt, and it ruined the state’s budget. We cannot go down this road again. Another Medicaid expansion would cost $500 million over the next five years, and hard-working Mainers would have to pay the bill. 
Medicaid expansionists do not see this as a problem. Paying for the welfare state is an afterthought. There is always another taxpayer there to pickpocket, but to make expansion more tempting they try to give us the impression that the taxpayer to be picked clean today, is not you or me. It is the next guy, you know that guy over there, the one who pays federal income taxes... 

The Maine Wire again:
Social activists claim the federal government will pick up most of the tab. That’s simply not true. States that took the bait and expanded Medicaid under ObamaCare are now paying the price.
Before we continue, let us just note that over the next couple of years, the federal government is not going to be a reliable business partner for our state, or any other state. Its fiscal problems are rising to a point where we can no longer rule out a Greek-style budget meltdown, especially if the Democrats start demanding higher taxes. When that budget meltdown happens, we are going to see spending cuts like never before. Nothing will be sacrosanct, especially not Medicaid expansion.

Back to The Maine Wire: 
The cost of Medicaid expansion is soaring beyond their projections and creating massive budget shortfalls. A Senate Committee in Washington, D.C. is investigating why Medicaid costs are so out of control. In Ohio, new enrollees exceeded estimates by 60%, and the cost per enrollee jumped by 30%. In Michigan, costs skyrocketed by 72%, and the cost per enrollee surged by 86%. Next door in New Hampshire, Medicaid expenses increased a whopping 253% between 2014 and 2015. Other states facing financial disasters from Medicaid expansion include Illinois, California, West Virginia, New York and Hawaii. Add New Mexico and Kentucky to the list. They were among the very first to take a hard budget beating from Medicaid expansion. 
Speaking of taxes, let us go back to the please-grow-Medicaid-now story in the CasperStar Tribune. It reports that on election day, voters in Montana
shot down a tobacco tax that would have permanently funded [Medicaid] expansion. The debate there will now go to that state’s legislature. 
This is a classic strategy by people who want government to pay for all our health care: put the tax burden on those who use unhealthy products. The message, of course, is not that you should stop smoking, but that you should continue to do so. If you stop smoking, government can no longer afford people's health care. Yours included - you know, the health care you will need because you are smoking, so you can help pay for health care. For others. And yourself. Which you will need because you smoke so that...

Now we are just waiting for the Medicaid expansion advocates to start smoking two packs per day to help pay for that program. That goes for Montana - and according to the Casper Star Tribune we should copy their plan:
With last week’s addition of the three western states, there are just 14 states remaining that have not expanded, including just one of Wyoming’s mostly conservative-leaning neighbors, South Dakota. 
Those evil conservatives who cling to their flag, their Bible, their guns and their stupid idea that people should take care of themselves... Nobody should take care of themselves. Nobody should grow up to be an adult. Everybody should live off the taxes that someone else is paying. Right? 

But somewhere in the midst of this statist propagation for Medicaid expansion, the Tribune reports that Governor-elect Mark Gordon actually made a good point:
“The question is, to me, what happens if (expansion) starts to gobble up our budget as some states have seen, we have to go back on some of those programs and have built a more expensive cost structure?” Gordon said. On the conference call, Gordon floated the potential for the return of high-risk pools to Wyoming.
Now, listen to this. If you ever thought logic was an ingredient in the writing over at the Casper Star Tribune, this paragraph should set you free of that delusion: 
He said he wanted to work with the Legislature to find a “good, workable solution for Wyoming” that was more market friendly. High-risk pools, before the ACA’s passage, were used across the country for chronically ill Americans who could not obtain commercial insurance. The pools were typically more expensive, both for patients and states, and frequently lost money. 
So now all of a sudden the cost of a spending program is a problem. But if the exact same budget over-run goes toward Medicaid expansion, it is not a problem.

Hopefully, there will be enough common sense summoned in the legislature to stop Medicaid expansion from happening. Our health care system here in Wyoming is dependent enough on tax-paid health insurance as it is; any expansion would effectively socialize our health care system. 

This is an under-appreciated issue. More to come. Stay tuned - and if you are a Medicaid expansion fan, please start smoking now to show your commitment. 

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