By Josh Archambault and Nic Horton
Why should the exact same treatment for pneumonia cost $5,000 in one building and $124,000 in another? Or the exact same infusion drug for a chronically ill patient that requires them every six weeks cost $14,000 per shot in one setting, but $28,000 down the street? Why should patients have to pay so much more, simply based on where they park their cars? The answer is simple: they shouldn’t.
But the black box of pricing leaves patients in the dark. As a result, the financial futures of too many American families are in jeopardy as their paychecks fail to keep up with skyrocketing health care costs.
In state capitols across the country, health care lobbyists and consultants are pushing a relatively unknown provision of the Affordable Care Act (ACA): Section 1332. According to some proponents, these waivers will “turbocharge state innovation” and will provide states with an “exit strategy” from the ACA. But is the hype true? Will Section 1332 waivers be as truly transformative to our health care system as suggested?
As policy practitioners who work daily with state policymakers around the country, we have seen proponents be overly dismissive—or perhaps even unaware—of the large practical and political challenges surrounding the implementation of these waivers. A serious, objective examination of the new Section 1332 federal guidance sparks far more questions than answers for policymakers. Continue reading
Arkansas’ Obamacare expansion, commonly known as the “Private Option,” has been a nightmare. Costs have run significantly over budget and the truly needy are being pushed to the back of the line. The Government Accountability Office reported that Arkansas’ approach was simply a more expensive way to expand Obamacare. And, surprise, the promised economic stimulus from expansion never materialized.
The program has proven wildly unaffordable for taxpayers and has become a political landmine for state legislators. Facing mounting cost overruns and serious questions about long-term sustainability, the legislature and governor agreed last year to terminate the expansion at the end of 2016.
But now Governor Asa Hutchinson has decided that the state desperately needs to keep Obamacare expansion and has called a special session that will begin April 6th to extend it. Hutchinson’s plan will also make cosmetic tweaks to the expansion and give the program a new, Orwellian name: “Arkansas Works.”
One of the key bugs, errr, “features” of this new plan is to begin utilizing employer-sponsored health insurance plans for Medicaid expansion enrollees. But there are several elements of this proposal that are cause for serious concern. Continue reading
For years, hospital lobbyists have promised that Obamacare’s Medicaid expansion would kick start states’ economies and produce thousands of new jobs. (Expanding welfare always stimulates the economy, right?)
This piece of their Obamacare sales pitch is critical because, according to their calculations, these new jobs will generate the necessary revenue to pay for states’ share of the Obamacare expansion costs. The Arkansas Hospital Association, for example, made a similar guarantee, promising that most of the state’s share would be covered by new tax revenue generated by new jobs.
But now that expansion has been up-and-running for more than two years, the data is starting to paint a clearer picture of the real economic impact. And, believe it or not, Obamacare expansion isn’t living up to the hype. Continue reading
I appeared on The Paul Harrell Program on March 16th to talk about the future (and past) of ObamaCare Medicaid expansion in Arkansas. You can listen to our segment below.
Co-authored by Nic Horton, Jonathan Ingram, and Josh Archambault
Nebraska legislators are currently considering another plan to bring Obamacare’s Medicaid expansion to the Cornhusker state. The proposal would create a new welfare program, dubbed the “Transitional Health Insurance Program,” for more than 130,000 able-bodied adults, costing taxpayers nearly $15 billion over the next ten years.
Nebraska policymakers have rejected all previous attempts to expand Medicaid under Obamacare. With expansion costs exploding in other states and federal funding now on the chopping block, it’s clear that their decision was the right one. And nothing in this new proposal should give them reason to reconsider. In fact, the latest plan, modeled after Arkansas’ “Private Option,” is Nebraska’s worst expansion proposal yet.
This model has failed to deliver on its promises everywhere it has been tried and would cost taxpayers billions of dollars more than a traditional expansion. In fact, Iowa has already scrapped its own version of this model and Arkansas’ expansion is scheduled by law to terminate later this year. Worse yet, the plan would also prioritize welfare for this new class of able-bodied adults over services for the truly needy. Continue reading
According to state law, Arkansas’ failed Obamacare expansion is set to expire at the end of this year. But Governor Asa Hutchinson has proposed overriding that deadline – which he signed into law last year – to continue providing welfare to able-bodied adults forever.
Hutchinson’s chief argument is that ending the program would create “a $100 million annual budget hole” due to lost budget “savings.” It’s a familiar refrain, used by former Democratic Governor Mike Beebe for years. There’s just one problem: it’s not true.
Arkansas’ so-called Private Option Medicaid expansion isn’t saving taxpayers money and allowing it to end won’t necessitate a massive tax increase or trigger the zombie apocalypse. In fact, allowing expansion to sunset would save taxpayers billions of dollars. Continue reading
Co-authored by Nic Horton, Jonathan Ingram and Josh Archambault
For too long, thousands of Kansans have languished in welfare, without hope of a better life. But thanks to one simple policy change, many Kansans are now on the path to a better life.
Under federal law, all able-bodied, childless adults in the food stamp program are required to work or train for work at least 20 hours per week. But with help from the Obama administration, most states have been waiving those requirements in recent years. Last year, for example, more than 40 states waived these critical requirements, fostering a culture of long-term dependency.
But in 2013, Kansas Governor Sam Brownback bucked the trend and instructed state officials to reinstate work requirements and time limits for able-bodied adults. Within three months, half of all able-bodied adults on food stamps had cycled off the program. Enrollment is now 75% lower for this group of adults than it was before work requirements took effect. Continue reading
A new paper by Jonathan Ingram and Nic Horton examine the impact an Arkansas-style Medicaid expansion would have on Nebraska:
Nebraska legislators have taken a thoughtful approach to the Affordable Care Act, carefully reviewing the evidence and ultimately declining to expand Medicaid to a new class of able-bodied adults under the law. Nevertheless, a small group of legislators lobby their colleagues each year to expand the program. The latest proposal, offered by Senator John McCollister, would copy the expansion models used by Arkansas and Iowa, homes of the highest profile “alternative” expansion models.
Under this approach, able-bodied adults receive regular Medicaid benefits through private health insurance plans sold on the Exchange, rather than through traditional Medicaid managed care. But these expansions have been unmitigated disasters and replicating the results in Nebraska would move the state backwards.
This new approach to Medicaid expansion is unaffordable and unpredictable, pushes adults out of private insurance and into taxpayer-funded welfare, puts the truly needy on the chopping block, discourages work, and shrinks the economy. So it should be no surprise that, last year, Iowa policymakers scrapped the model entirely and Arkansas enacted legislation to repeal the expansion altogether at the end of 2016. Nebraska policymakers should learn from these mistakes, not repeat them.
Read the full paper here.
Last week, with little fanfare, the U.S. Senate passed a bill to begin dismantling Obamacare. Some pundits have spun the move as little more than “political posturing” or a toothless act that simply fulfills the campaign promises of a newly elected GOP majority. The truth is that this Senate vote is much bigger than Obamacare supporters would like you to believe. In fact, the Senate vote has literally changed the Obamacare debate forever.
The Senate bill repealed the employer and individual mandates, repealed the Cadillac and medical device taxes, eliminated exchange subsidies, and removed the federal government’s authority to run the Obamacare exchanges. All good things.
But what may be the most significant—and least discussed—change is sure to send shockwaves through all 50 state capitals: the U.S. Senate voted to repeal Obamacare’s Medicaid expansion entirely.
To paraphrase Vice President Joe Biden, “This is a big freaking deal.” Continue reading