BuckeyeBlog

President Obama has said that under his health care reform, “if you like your doctor, you keep your doctor.” While President Obama wants to create a new government-run “insurance” program, there are already government-run health care programs for the poor and elderly. Perhaps the President is unaware of it, but in one of these programs, Medicaid, some patients are having to sue the government in order to keep their own doctors:

Some desperate patients went to court in Hamilton County Monday, begging a judge for help.

They say the state won’t let them see their longtime doctors anymore.

The patients are so sick, they’re in the state’s Medicaid program for the aged, blind and disabled.

They’ve sued to keep their Health Alliance doctors and hospitals after the state’s Medicaid provider, Buckeye Insurance, dropped the Health Alliance in April.

If the government is already forcing people in government health care to choose new doctors, can we really believe that this will change under a new government health care program?

The headline in the Columbus Dispatch trumpets Governor Strickland’s talking points that more people will gain health coverage because of a variety of new regulations in the state budget. A more accurate headline would have indicated that these changes will actually raise health insurance rates in Ohio, leading to more Ohioans going without insurance.

By imposing government price caps on how much insurance can charge those who have pre-existing conditions, legislators and the governor have mandated that everyone pay more for insurance. People with pre-existing conditions are guaranteed to cost insurance companies a lot of money, almost certainly more money that these individuals pay in premiums. Insurance companies must pay for that coverage by raising the rates for everyone else.

The Dispatch story goes on to discuss how rates for health insurance premiums are increasing dramatically. The regulations being celebrated in this article are a huge part of why premiums are going up. It’s unfortunate that the reporter didn’t make this elementary connection.

As the article also points out, many of the uninsured are young adults. Let’s consider why a young adult wouldn’t want to buy insurance. For one, young adults are a pretty healthy group. They don’t go to doctors or use health care as much as older people. So they have less need for insurance than others. Two, with insurance rates going up, it costs a lot to pay for that insurance. So healthy people don’t want to pay a lot for something they have little chance of using? Makes sense to me (and it did when I was a twenty-year-old and I decided I wasn’t going to purchase health insurance. As a result, I went without for two years). The only way to tempt these people into paying for insurance is to keep its cost down. Too bad the governor and General Assembly didn’t do that.

Governor Strickland thinks you’re too fat. But don’t worry, the Healthy Ohio Plan is here to save you. All that’s needed is your tax money and your willingness to submit to social engineering. Among other things you’ll be paying for:

• Supporting farmers’ markets (don’t farmers get enough welfare already?)
• A social marketing campaign to tell you how to lose weight (funny, I thought that the variety of weight loss TV shows, magazines, and websites could do this. What’s next? A tax credit for joining Jenny Craig?)
• Creating the Ohio Community Wellness Alliance to coordinate weight-loss efforts across the state (how does funding more jobs for bureaucrats help Ohioans lose weight?
• Developing a comprehensive database to track obesity in the state (Big Brother is going to make sure you’re not so big)

It’s not that these goals (and the others proposed by the plan) are so bad. It’s just that we don’t need a government bureaucracy to implement them. If you want to lose weight, you can exercise more or eat healthier. You can enter a program. You can get gastric bypass surgery. You can do a variety of things. Even with all these options available, though, people are still overweight.

Governor Strickland and his health bureaucrats don’t like that some Ohioans have failed to live a thin lifestyle, though, and so tax dollars are going to be spent in what is almost certainly a vain effort to make Ohioans shape up. No aid to farmers’ markets or government help lines with weight loss tips will make people lose weight who do not have the desire to do so. Does the governor really think people are overweight because they can’t find a farmers’ market or don’t know that eating healthier and exercising more is good for them?

The governor should spend less time worrying about your bloated waistline and more time worrying about the state’s bloated budget.

The Columbus Dispatch reports that almost 98,000 children in Ohio will soon be eligible for government health care when the governor’s plan to extend the program to middle class kids goes into effect on July 1. I don’t think this number tells the whole story, though.

First, a little background: in 2007 policymakers approved an expansion of the state’s children’s health insurance program to cover children who live in families between 200% and 300% of the federal poverty level, or FPL (that’s around $63,000 a year for a family of four). Because of federal action, this expansion will not go into effect until this year.

In anticipation of the new eligibility levels, the Dispatch looked into how many new children would be eligible for the program. The reporter uses data from a new state survey of Ohioans’ health coverage (the data is in pretty rough form and isn’t entirely complete). In that survey, the 98,000 number is the number of uninsured children who live in families below 300% of FPL. And while these children would be eligible for the new government health care program, they are not the only ones who would be eligible. Every child in the state who lives in families that make below 300% of FPL is theoretically eligible for the program, even ones who now have private insurance. By my figuring, that’s 1.73 million Ohio children eligible for government health care out of 2.6 million children in the state.

The numbers given by the state differ substantially from those given by the Census Bureau, which makes comparisons with its data useless. It appears the state will be releasing a full report on this data next month which will hopefully have more useful comparisons. But from what I can tell, over 2/3 of Ohio’s children are now eligible for government health care. And some people still think we have “free market” health care in this nation.

The Cincinnati Enquirer discusses a way Ohio could save millions of dollars from its Medicaid program. Currently most funding for Medicaid long-term care is spent for nursing home care, which is extremely expensive. Many in long-term care would prefer to stay in their homes or communities instead of moving to a nursing home. Home and community-based care is also less expensive. Since people prefer it and it’s less expensive, it seems to make sense to care for people in this setting, right? Unfortunately, Medicaid rules prefer nursing home care, forcing many into expensive institutions when they do not want to move (keep that in mind when anyone says government-run health care will save money and serve people better).

There has been movement to change this and make it easier for people to stay in their homes and communities when they receive Medicaid long-term care. This is good for both recipients and taxpayers. It’s unclear what Governor Strickland’s budget proposal dealing with this will be, but it would make a lot of sense if he were to expand home and community-based care. While not all people are better served in it, there is no reason for 79% of Ohio’s long-term care spending to be allocated towards nursing homes.

The U.S. House yesterday voted to expand the State Children’s Health Insurance Program (SCHIP), which helps fund state government health care program. Originally intended for children of the working poor, it has evolved to pay for adult health coverage (in some states more adults than children are served by the program), health care for middle class kids. Now, if this legislation becomes law (as it almost certainly will), states will get even more money to provide health care coverage and, in a reversal of the 1996 welfare reform law, children of legal immigrants will be allowed to enroll. To pay for this smokers will be forking over another 61 cents for every pack of cigarettes they buy.

What this all means is that states will be tempted to expand spending during a time where they should be cutting spending. Sure, proponents say it’s “for the kids,” but in reality most of the kids being covered by this program expansion would have had health insurance anyway. For many (up to 60% of recipients), all it does is move children (and adults) off private insurance onto insurance paid for by your tax dollars.

And anyone who thinks the cost of this program will be funded by a cigarette tax is deluded. Spending on government health programs like Medicaid and SCHIP increase year to year. Cigarette tax revenue usually decreases. There is no way that a declining revenue source like cigarette tax revenue will pay for the ever-increasing burden this SCHIP expansion will place on governments. So where will government get the rest of the money? From everyone else who pays taxes.

SCHIP is a bad program that makes little fiscal or policy sense. But, hey, it’s for the kids, so let’s not oppose it. After all, a program’s intentions are more important than than the actual content of the legislation, right?

As the Cleveland Plain Dealer reports, the federal government approved (in a roundabout way) Ohio’s expansion of the state government’s health insurance plan for children. Governor Strickland pushed to expand the program to families up to 300% of the federal povery level and the General Assembly gave unanimous approval last year. With the state facing a huge deficit, however, there are questions about whether this is a good use of taxpayer money.

Last year I wrote an article explaining why this type of health care expansion is a bad idea:

it is likely that a large number (perhaps a majority) will either leave or refuse to sign up for private health insurance to use the government program. A few studies have been done recently about how government health care programs “crowd out” private insurance. That is, having a free or essentially free government program leads people to choose it over private coverage. One estimate put this number as high as 60 percent — or, six out of ten children signed up either had or would have had private coverage. Others put the number between 25 percent and 50 percent. …

Unfortunately, for those children who lose private insurance and switch to government health care, they will find that the quality of their care will decrease. Patients with Medicaid often have trouble finding doctors and report they would rather be on private insurance. It makes no sense for the government to set up incentives to move to lower-quality care.

While it may sound like a good idea, the reality is that the kids being covered by this expansion don’t really need it. The vast majority already have coverage and it’s very likely that most of those covered by this program expansion would be used by families that would otherwise have insurance coverage. It’s a bad idea even if the state had a surplus. In a fiscal climate like Ohio is facing today, however, it’s ridiculous that anyone would even entertain it.

The state is having severe budget problems. There is the potential for a $7.3 billion shortfall over the next two years. That’s a significant chunk of the state’s budget. With 27% of the state budget being devoted to Medicaid, and with that program growing rapidly, it’s time the state take a serious look at reforming the program.

The Buckeye Institute’s Mike Bond has written a fine study outlining ways to reform Medicaid to both improve outcomes and slow the growth of the program. Instead of constantly expanding eligibility, the favored method of Columbus lawmakers which only increases the cost to the taxpayers, fundamental Medicaid reform is needed. Addressing this huge budget item will go a long way towards reining in Ohio’s potential deficit.

As the editors of the Cleveland Plain Dealer point out here, Medicaid’s burden on Ohio’s taxpayers is growing:

Medicaid enrollment by Ohioans has risen by 27,488 people since July 1, with roughly 16 percent of the new patients in the most expensive category (elderly, blind or disabled).

Thus, overall Medicaid spending is up sharply. From July 1 through Oct. 31, Ohio spent $3.97 billion on Medicaid. For the 2007 period, the tab was $3.62 billion. That’s a 9.7 percent increase — and a cold welcome for spenders’ letters to Santa Claus, care of Strickland’s Statehouse workshop.

This shouldn’t come as a surprise to anyone. I predicted as much here:

Expanding Medicaid can lead to large increases in Medicaid spending when states can least afford it – during recessions. Ohio saw this earlier this decade when Medicaid spending increased dramatically during the recent recession. Spending grew at 11 percent annually during 2001 and 2004, squeezing other budget priorities at a time when the state was seeing reduced revenue. Expanding Medicaid now will only repeat this cycle during the next recession.

That “next recession” is now. Of course, the expansion pushed by the governor and approved by the General Assembly last year has been stalled by the federal government. Imagine what Medicaid would be costing if it actually took effect. We may not have to imagine, as Governor Strickland is pushing the feds to approve the expansion. When Senator Obama assumes the Presidency, it’s likely that Strickland will get his wish. That means even higher Medicaid spending next year.

Michael Cannon of the Cato Institute has a short, informative video on the problems with Senator Barack Obama’s health care plan: