Monotonous drumbeat behind Medicaid expansion
(Editor’s Note: A bill extending the Medicaid extension program for six years passed the Montana House on Thursday. Democratic Gov. Steve Bullock is expected to sign the bill into law.)
By Tom Burnett
In his 1935 State of the Union message, President Franklin Roosevelt spoke of the “human problem” engendered by what we now call “government welfare” programs: “The lessons of history … show conclusively that continued dependence upon relief induces a spiritual disintegration fundamentally destructive to the national fiber. To dole our relief in this way is to administer a narcotic, a subtle destroyer of the human spirit. It is inimical to the dictates of a sound policy. It is in violation of the traditions of America.”
So consider what he would have made of the current monotonous drumbeat to make Montana’s Medicaid expansion permanent. (Without new legislation, “MedEx” will lapse after June 30.) Presumably FDR would have been chagrinned.
That drumbeat illustrates a familiar public-policy dynamic: A welfare program starts out small and targeted, but pressure inexorably follows — a matter of “fairness” — to include new beneficiaries who just missed being eligible before. MedEx, for example, increases the cash-income cap for recipients to 138 percent of the federal poverty level from Medicaid’s prior cap. Further, able-bodied childless adults who didn’t qualify before now do.
Other pressures, too, contribute to this ratcheting-up pattern. The most powerful lobbyists for in-kind benefits like Medicaid are often the service providers whom the program helps fund. This plays out strongly in health care, wherein hospital administrators, doctors’ groups, and other health professionals drive governments’ coverage and reimbursement decisions.
Indeed, compensation for top executives at Montana’s eight regional hospitals (e.g. Bozeman Deaconess, Missoula Providence St. Patrick) rose 85 percent in aggregate from 2014 through 2016 — $17.9 million to $33.1 million — as MedEx began operation here. Correlation doesn’t always reflect causation, but the correlation here is at least worth noticing.
Welfare programs in general provide opportunities for abuse by their clientele. An Office of Public Assistance caseworker, testifying under oath before the Legislature in 2015, said, “We have numerous clients who are being dishonest about their living situations. For instance, clients are historically dishonest about living with a spouse or a boyfriend who is father of their children. Clients are also untruthful about spouses working out of state, because they know our ability to verify is limited.” In such cases, household income is understated.
At the same hearing, a recently-retired OPA supervisor added, “We rarely see any kind of a fraud prosecution. … When that used to happen — in Kalispell, anyway, it used to be on the first page [of the local newspaper] — the caseworkers within a couple of days of that publication were getting phone calls from their clients saying ‘Would you close my case, please?’”
Some abuses are flagrant. Orthopedic surgeon Al Olszewski, who is also District 6’s senator, told a Bozeman audience last year about one MedEx maneuver he encountered that’s helped by Montana’s lax enrollment standards: Texans move here and take hospitality-industry jobs and reside in the motels or hotels where they’re working. Using those local addresses and their first pay stubs from these low-paying jobs, they enroll in Montana’s MedEx. Soon after, they arrange for expensive surgery (e.g. knee replacement) that’s covered by Medicaid. After their surgeries, they recuperate here for a few weeks, then return to their expensive toys (boats and cars) and upper-middle-class lifestyles in Texas.
Worst, programs like Medicaid —and now MedEx — often fail as the intended “temporary hand up.” Instead, to quote former Michigan Congressman Thaddeus McCotter, they become a way of life, “a snare for people who should be able to be productive citizens, entrapping them in a soul-crushing cycle of governmental dependency. For a free republic built upon self-government, governmental dependence of able-bodied people degrades and debases them by sapping their desire and capacity for autonomy.”
Republican McCotter and Democrat Roosevelt would have seen eye-to-eye.
Rep. Tom Burnett, R-Bozeman