Health care reform has been thrust back into the public spotlight in the run up to the election in November. During the October 4 vice presidential debate between Democratic Party candidate Sen. Tim Kaine (VA) and Republican Gov. Mike Pence, the two candidates discussed at length the need for reform of the Affordable Care Act (ACA) and other health care issues.
The two candidates offered very different visions for the future of health care in America. Pence called for more free-market reforms and for Obamacare to be repealed and replaced, while Clinton called for expanding Obamacare and adding a “public option.”
In a recent National Review article, writer Chris Jacobs described the importance of health care in the election, asserting if Hillary Clinton captures the White House, “Obamacare is here to stay, and [Clinton] will likely push to expand Medicaid in the states that have rejected the program’s massive expansion under Obamacare.”
State legislators in many states across the nation will address issues related to Medicaid expansion prior to and following the election. The 19 states that have not expanded Medicaid will likely face pressure from Democrats to fall in line with the 31 states that have. But many lawmakers are rightfully skeptical about expanding Medicaid and anxious about expansion costs, which are rising faster than expected in states that have expanded the program.
The Affordable Care Act was originally projected to substantially increase the number of people who have health insurance – in large part by expanding Medicaid – which was intended to improve hospitals’ financial health by reducing the amount of care they provide to uninsured patients, many of whom pay little or nothing for their care. However, a recent report released by the Congressional Budget Office analyzing projected profit margins over the coming decade concluded, “Medicaid expansion will not make a material difference in hospitals’ overall viability.”
In a recent Forbes article, Brian Blase, a senior research fellow with the Spending and Budget Initiative at the Mercatus Center at George Mason University, argues Medicaid expansion under ACA has been and will continue to be a poor use of taxpayers’ money, arguing, “Government spending on Medicaid expansion enrollees is nearly 50% higher than the government projected … [and] Medicaid enrollees obtain only 20 to 40 cents of value for each dollar the government spends on their behalf.”
Blase also argues Medicaid affects health care utilization and health outcomes for people other than the targeted enrollees. “Expanding Medicaid increases demand for health care services, and therefore affects the allocation of those services,” Blase wrote.
Dr. Hal Scherz, the founder of Docs4PatientCare, told Health Care News in September states should avoid any expansion of Medicaid unless there is a major shakeup. “Expanding Medicaid only makes sense if things are different,” said Scherz.
One option proposed by Scherz is to provide each Medicaid recipient with a direct primary care doctor alongside existing Medicaid coverage. Together, this would act as a high-deductible wraparound and pharmacy program. Scherz told Health Care News this model could lead to substantial savings: Four-fifths of health care costs could be locked up for under $1,200 per year.
In a recent Heartland Research & Commentary, Senior Policy Analyst Matthew Glans also argued against Medicaid expansion. “Instead of expanding a flawed Medicaid model that is too costly, delivers subpar health care, and shifts more power to the national government, state lawmakers should focus on reforming the current system before choosing to expand it,” wrote Glans.
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Budget & Tax
Research & Commentary: Iowa Needs Civil Asset Forfeiture Reform
Civil asset forfeiture, also known as civil judicial forfeiture, is a controversial legal process through which law enforcement agencies take personal assets from individuals or groups merely suspected of a crime or illegal activity. In this Research & Commentary, Senior Policy Analyst Matthew Glans examines civil asset forfeiture laws in Iowa and argues assets should be seized only for criminal reasons. “Assets should be seized only when crimes have been committed and convictions have been made, and law enforcement officials should not be incentivized to seize any more property than is necessary and justified,” wrote Glans. Read more
Research & Commentary: Education Choice is a Popular Policy in Michigan
In this Research & Commentary, Policy Analyst Tim Benson reviews a new Mackinac Center for Public Policy survey of likely voters in Michigan that found 57 percent of respondents are in favor of creating a tax credit scholarship program and 55 percent supporting education savings accounts (ESAs). Republicans and African-Americans were the two demographics most likely to support the two programs. Benson argues while the passage of tax credit scholarships would be a good start for Michigan, the passage of a universal ESA bill would be a much better strategy for remedying Michigan’s dismal record of failing to educate its children. The goal, he says, should be “to allow every parent to choose, require every school to compete, and give every child an opportunity to attend a quality school.” Read more
Energy & Environment
Research & Commentary: New York’s Proposed E15 Rule is a Bad Deal for Consumers
In this Research & Commentary, Policy Analyst Tim Benson examines a rule proposed by the New York Department of Agriculture and Markets that would mandate motor vehicle fuel be blended with up to 15 percent ethanol. The 15 percent blended fuel is commonly called E15. If the proposed ruling goes into effect, it would create demand for an extra 825 million gallons of ethanol, requiring 295 million bushels of corn. Benson argues ethanol and other biofuels do not produce environmental or economic benefits that justify this proposed rule, and he says it is wrong to assume New York State will be immune from the same forces that have raised fuel costs and reduced labor income in neighboring states that have already been lured into introducing renewable fuel standards. Benson says giving the green light to E15 fuels is nothing more than a well-intentioned mistake. Read more
Research & Commentary: New Study Finds Teens Vape Because of Flavoring, Not Nicotine
Electronic cigarettes, commonly called “e-cigarettes,” have quickly become one of the most popular nicotine replacement products and a key building block of many modern tobacco harm-reduction strategies. According to The Wall Street Journal, sales of e-cigarettes have doubled in the United States over the past five years, moving from $250 million to $500 million in total sales. Despite these benefits, some public-health crusaders argue e-cigarettes should be banned.
In this Research & Commentary, Government Relations Coordinator Lindsey Stroud examines a new study that analyzed data from a 2015 youth survey. Stroud argues attempts to limit or ban e-cigarettes will, according to the available data, cause unnecessary harm and lead to the opposite conclusion proponents of e-cigarette restrictions say they desire: better public health. “Policymakers should be aware of the evidence that has been and will be presented in the wake of the federal government’s overreaching ruling, much of which has and will expose problems in with rationale used by FDA,” wrote Stroud. Read more
From Our Free-Market Friends
Green Overload: New York State’s Ratepayer-Zapping Renewable Energy Mandate
New York’s Clean Energy Standard (NYCES) will cost ratepayers more than $3 billion during its first five years, but its effect on global carbon-dioxide emissions will be minimal, according to a recent Issue Brief by Ken Girardin, policy analyst for the Empire Center. Girardin says the Clean Energy Standard will require New York electric utilities and, by extension, their customers to heavily subsidize renewable energy. NYCES will require 50 percent of the state’s electricity to come from renewable-energy sources, such as solar and wind power, by 2030. The standard also subsidizes money-losing nuclear power plants outside Rochester and Syracuse. “While the governor and the [Public Service Commission] have portrayed the financial impact on ratepayers as minimal, the Clean Energy Standard is likely to add nearly $3.4 billion to New York utility bills in just the next five years,” wrote Girardin. Read more