I am responding to last week’s op-ed from the Thomas Jefferson Institute of Public Policy (“Reforms must precede Medicaid expansion,” Fairfax County Times, Sept. 6-8).
Can the efficacy of a program be determined simply by a survey, especially one that focused only on six of the 95 counties in the state of Virginia? Perhaps, but I have some serious doubts about that.
Surveys regarding what people dislike or like can be misleading. This becomes evident when reading the report produced by the Thomas Jefferson Institute and then comparing that to the recent report by The Henry J. Kaiser Family Foundation regarding the health care legislation of 2010.
First of all, with respect to surveys concerning the Affordable Care Act (Obamacare) that expands Medicaid, there is considerable confusion about the legislation, according to the Kaiser Health Tracking Poll in August 2013.
“Roughly half the public (51 percent) continues to say they don’t have enough information … to understand how it will impact them and their family ... The share who feel they don’t have enough information is particularly high among Hispanics (64 percent), the uninsured (62 percent), young adults (62 percent of those ages 18-25), and those with lower incomes (60 percent of those with family incomes less than $40,000 a year),” according to kff.org.
Regardless of whether or not a majority surveyed have an unfavorable opinion of the new health care legislation that includes the expansion of Medicaid, it is indisputable that a majority of Americans, especially the uninsured, do not have “enough information” to understand how it will effect them. Although many Americans have opinions on the health care legislation, it is evident that many of those opinions cannot be considered informed opinions, based on the survey by Kaiser. In addition, the Kaiser study also noted this: “Still, a majority of Americans (57 percent) say they disapprove of the idea of cutting off funding as a way to stop the law from being implemented, a finding that has been consistent in Kaiser Health Tracking Polls since January 2011.”
In light of the fact that a majority of Americans do not have sufficient information (and I have to believe this includes the majority of Virginians), the report carried in the Fairfax Times would have been much more helpful to readers if it would have cited research that has been done regarding both the human and fiscal impact of expanding Medicaid. Such research has been done by Center on Budget and Policy Priorities (cbpp.org) and the Commonwealth Institute (thecommonwealthinstitute.org).
In Virginia, the Medicaid expansion would provide coverage to about 400,000 uninsured Virginians — this would include 25,000 to 30,000 individuals in Fairfax County. Virginia currently ranks 43rd in Medicaid enrollment as a proportion of the state’s population and 47th in per capita Medicaid spending. In fiscal year 2012, 996,835 Virginians were enrolled in Medicaid (17 percent were adults, 57.2 percent children, 17.8 percent people with disabilities, and 8 percent older adults), and the state spent approximately $7 billion.
In addition, to be considered is the research by the Commonwealth Institute, which argues persuasively that: “While expansion is forecast to cost the state $1.60 billion from 2014 to 2022 — with most of that cost coming in the later years — the $1.64 billion in savings from expansion would offset (from 6 key sources) all of the costs and ease state budget pressures.”
In the first three years (2014-2016), the federal government will pay for 100 percent of the costs of the expansion of coverage under Medicaid, and no less than 90 percent thereafter.
With respect to the fear expressed in the article that the federal government would not honor its commitment, a column in The Washington Post’s Wonkblog on March 5 explained that the federal government cutting support for Medicaid would be an unprecedented move — the government has only increased its share of expenditures since Medicaid’s conception, and it has never reduced support to states below the original percentage.
John Horejsi is coordinator of Vienna-based Social Action Linking Together.