A reality based independent journal of observation & analysis, serving the Flathead Valley & Montana since 2006. © James Conner.
First, the (sort of) good news. Last week the Republican governors of South Dakota and Wyoming endorsed expanded Medicaid, reports the Maddow Blog’s Steve Benen, who also reports that Alabama’s Republican governor seems headed that way, too. Louisiana, as red a state as there is, likely will expand Medicaid now that it has elected a Democratic governor, John Bel Edwards.
Don’t expect any of these states to have the good sense and decency to expand Medicaid as a government run single-payer system. They’ll all insist that the federal money for expanding Medicaid be used to purchase private health insurance for the poor. That’s the bail out the insurance companies and help the hospitals scheme that Montana adopted and Montana’s Democrats embraced with uncritical, indeed rapturous, joy. Yes, the scheme does insure some people not insured before, but it represents the triumph of ideology over common sense.
Now, the bad news. Benen reports a Kaiser Family Foundation poll found that 63 percent of Kentuckians approve of their state’s expansion of Medicaid — yet Kentucky’s voters elected as their next governor Republican Matt Bevin, who promised to repeal expanded Medicaid. Says Benen:
I can appreciate why this doesn’t seem entirely rational – because, well, it isn’t. If so many voters like, support, and have come to rely on Medicaid expansion, why in the world would they vote for a statewide candidate who vowed to destroy Medicaid expansion?
The answer, satisfying or not, is that other issues captured the public’s attention. What’s more, it seems many of these voters simply didn’t believe Bevin would do what he said he would do.
The result is an odd dynamic: about a month after Election Day, most of the governor’s constituents are left to hope that he’ll break one of his highest-profile campaign promises.
Kaiser Family Foundation CEO Drew Altman, told the [NY] Times that the survey’s findings: “‘We may not like Obamacare very much, but don’t take my brother’s or sister’s or niece’s Medicaid coverage away.’ It’s like there’s an ideological side of people’s brains but a practical side, too, that values the health benefits and the coverage.”
Something worse may happen five hundred miles northwest of Kentucky. Iowa’s Republican governor, Terry Bramstad, plans to kick off the New Year by kicking half a million Iowans off of traditional Medicaid, reports the Washington Post’s Dana Milbank:
In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.
Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.
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Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.
“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”
Bramstad says privatizing Medicaid will save Iowa $51 million, but he can’t produce data that substantiate his claim. That’s because his move isn’t about saving money. It’s about saving private health insurers from a single-payer health care program, and is predicated on a religious strength conviction that the private sector and the discipline of the private market always outperform government programs.
That ignores history — Medicare, the most cost efficient health care program in the nation, was adopted in part because health insurers didn’t like writing policies for the elderly, who had (and have) the bad habit of getting expensively ill before dying — but history and reality based policy making are anathema to Republicans. They have ideology, High Truth as revealed by Heaven, and need and want nothing more.
An Iowa-like attack on traditional Medicaid could occur in Montana if Montanans elect a Republican governor next year; if they send veto-proof teabagger GOP majorities to both houses of Montana’s legislature; or if a Republican wins the Presidency.