Raleigh film-flammers trying to confuse voters on MedicAID vs MediCARE

Opposition to Medicaid expansion was one of the few good moves former governor Pat McCrory made while he was in office.  He stated his belief that Medicaid needs to be seriously cleaned up and reformed before there is any serious consideration given to expanding Medicaid.  We were right there with him on that point.  It’s long been well-known that North Carolina has some of the most generous Medicaid benefits in the southeastern United States.

Legislative leaders in Raleigh stood strong with McCrory for a while.  Then, the pressure got to be too much for cash-whores like Tim Moore and Phil Berger. Hospital and insurance industry lobbyists and their deep pockets soon took over the discussion. The folks who would eventually pay for an expansion-related mess — US — got kicked to the curb and completely left out of the debate.

Roy Cooper replaced McCrory.  He and his lapdogs in the stupid, lazy legacy drive-by media kicked into high-gear with hysterics about the importance of pouring more money into Medicaid RIGHT NOW.  *You would be cruel to poor people and seniors if you did not comply.*

Moore and Berger took the cash and hugged up to Cooper in a spectacular reversal-of-course (180-degree sellout) on expanding Medicaid.  Those two cash-whores put the NCGOP on record as supporting big government, more government and more welfare spending.

But, wait — what about helping grandma and grandpa?  It’s easy to confuse Medicaid and Medicare.  Special interests — like a dark money group called NC Business Leaders for Health — are counting on you being confused.  They – in their mailers defending legislators who went along with Berger and Moore – are trying to pass off voting for Medicaid expansion as protecting grandma’s health care.  *Total lie.*

MediCARE gets deducted from your paychecks and is used to pay for your healthcare when you are older, retired, and in not as-good health as you are now.  YOU paid for it all your working life. You reap the benefits.

Medicaid IS welfare. Plain and simple.

Better, yet.  Let AARP – the chief lobbyist for old folks – explain the difference:

[…] Medicare and Medicaid may sound alikeand are spelled similarly, but the government health insurance programs are very different.

Both were established July 30, 1965, when President Lyndon B. Johnson signed the Medicare and Medicaid Act — also known as the Social Security Amendments of 1965 — into law. Medicare is a health insurance program for older Americans while Medicaid provides health insurance for people with limited incomes. […]

See? MedicAID is income-based.  Medicare is something we each paid for through our work and benefit from when we retire.

MORE:

[…] Medicare covers medical expenses for more than 68.5 million Americans age 65 and older as well as younger people who qualify because of a disability. Medicare eligibility is not based on income or assets, and you can’t be denied coverage or charged more because of preexisting medical conditions.

Medicaidis run jointly by federal and state governments to provide health care and long-term care coverage for more than 78.5 million Americans, including children, parents, low-income adults, older adults and people with disabilities. The government sets general standards for Medicaid, but specific eligibility requirements and coverage details vary by state. 

Your income must fall below certain levels to qualify. [….]

Did you catch that?  Medicare is run by DC.  Medicaid is a joint state-federal program.  Medicaid is the only one of the two that a state legislator could impact. 

Way back in 2019, we presented you with a warning from a Duke scholar about the perils of expanding Medicaid.  We found his warning about unaffordability most interesting:

[…] All previous Medicaid expansions simply promised states that expanded their Medicaid programs that they could draw down federal funds at the same matching rate being used to fund the existing Medicaid program, but the ACA was quite different. It offered states the opportunity to get 100% federal funding for the expansion in the first few years, with this federal matching rate gradually declining to 90%, purportedly in perpetuity.

This is a promise Uncle Sam almost certainly cannot keep. As of 2014, the federal government faced a fiscal gap of $210 trillion [11]. That amount represents 58% of the present value of projected future taxes, meaning that in order to close the gap, we would have to increase federal taxes by 58%. It should be patently clear to any impartial observer that securing a political consensus to raise taxes on Americans by such a gargantuan amount is unlikely. Given that health entitlements account for more than half of the fiscal gap, it is equally obvious that, at some point, Medicaid policy is going to have to adjust to these inconvenient facts, however much today’s politicians appear reluctant to touch this issue.

Even in the short term, fiscal realities forced President Obama to propose reductions in the federal matching rates for the Medicaid expansion as part of his fiscal year (FY) 2013 budget. These reductions were designed to reduce Medicaid spending by $100 billion over 10 years [12]. Indeed, Medicare public trustee Charles Blahous has written, “Every serious bipartisan budget discussion in recent years has envisioned reductions in future federal Medicaid outlays” [13]. These fiscal pressures can only be expected to grow. The most recent annual report on Medicaid’s finances issued by the US Department of Health and Human Services (HHS) showed that the average cost of the ACA’s Medicaid expansion enrollees was nearly 50% higher in FY 2015 than HHS had projected just 1 year previously [14]. Additionally, enrollment exceeded projections in states that elected to expand Medicaid by 110% nationally, and this problem has been much more severe in some states. Expansion enrollment exceeded projections by 322% in California, by 276% in New York, and by 134% in Kentucky [15].

Medicaid Financing Encourages Fiscal Irresponsibility

Part of the reason we face $210 trillion in unfunded liabilities relates to perverse incentives created by Medicaid’s formula for open-ended federal matching.For decades, this formula encouraged wasteful spending and discouraged states from economizing; this creates a one-way ratchet effect that fuels ever-rising Medicaid spending. The 90% federal matching rate under the expansion puts such incentives on steroids; now, states that save $1 of Medicaid funds get to pocket only 10 cents, while states that waste $1 pay only 1 dime more.

Equally troublesome are the perverse incentives this formula creates for states to take from one another and to transfer obligations to future generations. The formula encourages states to expand their programs as much as possible, knowing that a majority of the cost will be exported to neighbors. This gold rush mentality likewise minimizes whatever concerns state policy makers might otherwise have about the burden being placed on future generations by profligate entitlement spending.

If we can justify an expenditure only when someone else pays for it, then we ought to be thinking very hard before incurring that obligation. We can do better. State policy makers would be far better served by resisting the urge to take federal money now and instead waiting until Medicaid financing is reformed along the lines of a more sensible capped entitlement. […]