George Gibbs Center for Economic Prosperity

Human Even⁠t⁠s: Flor⁠i⁠da leg⁠i⁠sla⁠t⁠ure rejec⁠t⁠s ObamaCare Med⁠i⁠ca⁠i⁠d expans⁠i⁠on

By: The James Madison Institute / 2013

Reuters reports a hitch in Governor Rick Scott’s plans to expand Medicaid coverage, as directed by the ObamaCare plan he once vowed to oppose:
On the eve of convening of the 2013 session, the House Select Committee on the Patient Protection and Affordable Care Act rejected the expansion. A Senate counterpart committee postponed consideration of the issue, which is sure to be one of the biggest controversies of the session.Scott, a Republican who bitterly fought President Barack Obama’s national healthcare plan as a candidate and in his first two years as governor, stunned conservative supporters on February 20 when he endorsed a three-year expansion of Medicaid, provided the federal government picks up the full cost for the first three years as promised.“There’s definitely a fight between the governor and the (state) legislature over this. The Republicans in the legislature are much more fiscally conservative than his actions have shown him to be,” said Susan MacManus, a Tampa-based political scientist at the University of South Florida.Republican legislative leaders have been openly hostile toward the plan, emphasizing that state lawmakers will make the final decision in drawing up a budget for next fiscal year.
The conservative James Madison institute released a statement partly quoted by Reuters, but reproduced here in full:
The House made the right decision today to not draft a committee bill expanding Medicaid under PPACA provisions. Many Members expressed valid concerns that this could hurt the people that it is aimed at helping. State leaders should focus on providing more access to quality care — expanding a program that is inefficient in this effort is not a way to do that.Additionally, in our recent poll of 600 registered Florida voters more than 63 percent said they are wary that the federal government would keep the funding level promises made, and clearly many House Members share this worry. If history is any indicator, costs of such programs are often underestimated and there has been examples of the federal government going back on their promise before. These issues cannot be ignored.
Well, those issues shouldn’t be ignored, but a lot of people seem intent on doing so, with eyes firmly fixed on that pot of federal subsidy gold.  In a previous policy brief on Medicaid expansion, the James Madison Institute expressed skepticism that promises of 100 percent federal funding for three years, followed by 90 percent indefinitely, will stand the test of time: “Of course, all of these projections are based on the assumption that the federal government — currently plagued by record deficits and alarm over the growing national debt — will keep its pledges with regard to matching funds.”Fueling this skepticism is the Institute’s description of Medicaid programs across the nation as “plagued by bureaucracy, ballooning expenditures, poor access, and low quality care.”  And that could lead to a pointedly counter-productive outcome:
As Medicaid costs explode, regulators and legislators at- tempt to restrict costs by reimbursing providers less and less. Low reimbursements severely impede the access of Medicaid beneficiaries to timely and appropriate high quality care. Some studies even suggest that Medicaid patients receive worse care than the uninsured.A costly expansion of means-tested eligibility for Medicaid will not rectify the deeply-rooted problems with the program. In fact expanding the program will not only expand these problems and impact more people, but it will likely put more strain on the system and could very possibly worsen the already grave access problems and poor quality care that Medicaid patients encounter.
That sounds like a much more likely outcome than the government that can’t stand a 2.3 percent spending cut happily ladling out billions of dollars to cover cost overruns, long into a future where mandatory entitlement spending and debt service will soon consume the entire current budget baseline.