Forbes: The Next Big Thing In Health Care

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.

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Forbes: AK Lawmakers Hire Star Lawyers to Stop ObamaCare Expansion

By Jonathan Ingram, Nic Horton, and Josh Archambault — Mr. Ingram is Research Director, Mr. Archambault is a Senior Fellow, and Mr. Horton is Policy Impact Specialist, at the Foundation for Government Accountability.

Alaska Governor Bill Walker (I) announced in mid-July that he was moving forward with plans to unilaterally expand Obamacare in the state. As we’ve previously written here at Forbes, Walker’s expansion plan is not only bad policy, it’s also likely illegal. Now, a courageous group of Alaska lawmakers – led by Senate President Kevin Meyer and House Speaker Mike Chenault –  are standing up to Gov. Walker’s attempted end-run around the legislature and hiring an all-star legal team to block Walker’s illegal actions.

Walker’s Unilateral Obamacare Expansion Violates Alaska Law

Alaska law clearly prohibits the governor from expanding Medicaid to any “additional groups … unless approved by the legislature.” This means that Gov. Walker could only expand Medicaid to a new class of able-bodied childless adults if this coverage group was already authorized by state law. Continue reading

Forbes: Restoring Work Requirements Is Important Fix For Food Stamp Crisis

By Nic Horton, Jonathan Ingram and Josh Archambault

Over the last several years, even as the economy has started to improve, more and more Americans have become trapped in the food stamp program, now called the “Supplemental Nutrition Assistance Program” or SNAP.  In 2013, food stamp enrollment and spending hit all-time highs.

But a new report from the Foundation for Government Accountability provides governors and legislators with a roadmap to reverse this trend. The first step: getting able-bodied adults work-oriented and eventually off of welfare.

Able-Bodied Childless Adults Drive Food Stamp Explosion

So what’s causing the rise in food stamp dependency?

One key contributor is the growth in able-bodied childless adults on the program. Between 2000 and 2008, the number of able-bodied childless adults receiving food stamps hovered at or below one million.

But by 2013, a record-high 4.9 million able-bodied, childless adults were receiving food stamps. Federal spending on food stamps for these able-bodied adults skyrocketed to more than $10 billion in 2013, up from just $462 million in 2000.

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Forbes: AR’s ‘Health Independence Accounts’ Are Making Obamacare Worse

By Jonathan IngramNic Horton and Josh Archambault Mr. Ingram is Research Director, Mr. Horton a Policy Impact Specialist, and Mr. Archambault a Senior Fellow at the Foundation for Government Accountability

Arkansas’s Obamacare Medicaid expansion has been a costly misadventure. The expansion has been so misguided in fact, that lawmakers voted earlier this year to end it, effective December 31, 2016.

That hasn’t stopped state bureaucrats from scurrying to institute a new component of expansion that makes the program even worse. Under this plan, some enrollees are asked to contribute nominal amounts to new “Health Independence Accounts,” or HIAs, which were supposed to mirror health savings accounts.

But these new HIAs are nothing like real health savings accounts and were destined to fail from the beginning. Now that the program is up and running, the evidence is mounting: so-called “independence” accounts are actually reducing enrollees’ “skin in the game,” and costing even more money for taxpayers.

Arkansas legislators meet in the House chamber at the Arkansas state Capitol in Little Rock, Ark. (AP Photo/Danny Johnston, File)

Health Independence Accounts Are Nothing Like Health Savings Accounts

Under this new Obamacare Medicaid expansion tweak, enrollees above the federal poverty line are “required” to make monthly contributions to HIAs. But the truth is that this “requirement” is more like a mere suggestion. If enrollees refuse to contribute to their accounts, they aren’t removed from the program.

These suggested contributions start at just $10 per month. But unlike real health savings accounts, Private Option enrollees will not use funds in their HIAs to pay for their own medical care. Instead, the money will simply sit in enrollees’ accounts until they leave the program. At that point, they can take the money with them and use it toward other health care costs. Continue reading

Forbes: Is AR Violating Federal Law By Not Verifying Eligibility For Its Obamacare Expansion?

By Nic Horton, Jonathan Ingram, and Josh Archambault

Arkansas’ Obamacare expansion has been a policy disaster and a political landmine, but supporters may have to add violating federal law to their list of problems. Internal e-mails from the Arkansas Department of Human Services reveal that the state has not bothered to verify that individuals enrolled in Obamacare’s Medicaid expansion are still eligible for benefits. This revelation comes with several legal and policy implications and should serve as a wakeup call to state legislators across the country.

Arkansas Hasn’t Verified Eligibility Of Obamacare Expansion Enrollees

Internal e-mails from the Arkansas Department of Human Services reveal that Arkansas has yet to begin verifying whether individuals enrolled in Obamacare’s Medicaid expansion are still eligible for benefits.

Forbes King

Federal law requires states to verify Medicaid enrollees’ eligibility at least once per year, and more frequently if the state receives information indicating they may no longer be eligible. But John Selig, director of the Arkansas Department of Human Services, recently admitted that not a single redetermination had ever been done for those enrolled in the Medicaid expansion.

Selig explained that he hopes to begin eligibility verification later this month, but the state began enrolling individuals in the expansion in October 2013 – more than 18 months ago. Really, the state should have already begun checking eligibility. Continue reading

Forbes: New Poll Confirms Voters Don’t Want State Obamacare Exchanges

By Jonathan Ingram, Nic Horton and Josh Archambault – Mr. Ingram is Research Director, Mr. Horton is Policy Impact Specialist, and Mr. Archambault is a Senior Fellow at the Foundation for Government Accountability.

Last week, the Foundation for Government Accountability released a groundbreaking poll of voters in federal exchange states that provides valuable insight into how voters want policymakers to respond to the pending King v. Burwell Supreme Court ruling.

In short, voters don’t want their state legislators to rescue Obamacare should the Supreme Court rule that health insurance subsidies cannot flow through HealthCare.gov. They blame Congress for a poorly written law and don’t want or expect states to clean up Washington’s mess. In fact, they’re prepared to vote against state lawmakers who try to set up Obamacare exchanges.

Voters Don’t Want To Live in An Obamacare State

If the Supreme Court strikes down subsidies in federal exchange states, voters don’t want their state legislators to rescue Obamacare. They see the issues presented in the King v. Burwell case as a problem created by Congress and the IRS; they don’t think states should bail them out.
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Forbes: Latest Florida Proposal Is Still Obamacare

By Nic Horton, Jonathan Ingram, and Josh Archambault  Mr. Horton is a Policy Impact Specialist, Mr. Ingram is Research Director, and Mr. Archambault a Senior Fellow at the Foundation for Government Accountability.

The Florida hospital lobby is persistent, to say the least. Barely two years after the Florida Legislature defeated Obamacare Medicaid welfare expansion, the hospital lobbyists are back at it, rolling out yet another Obamacare expansion plan, this time with the help of local chambers of commerce and other groups. The hospitals’ new coalition even has a clever name for itself: “A Healthy Florida Works.”

These actions have prompted some speculation that Florida lawmakers may flip flop on their principled opposition to this massive expansion of Medicaid welfare. Insiders are also reporting that the hospitals are preparing to dump even more money and resources into lobbying for Obamacare expansion—on top of the more than 250 lobbyists hospitals already deploy to Tallahassee every year.

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In the past, lawmakers have taken a thoughtful, careful approach to the Medicaid expansion question. After setting up a special committee to study every aspect of the issue and gathering all the facts, they rightly rejected every effort to implement it – even when that meant standing up to a wavering Republican governor, the chairman of the Democratic National Committee, and the full force of the Obamacare lobby. Continue reading

Forbes: Obamacare’s Medicaid Expansion Could Cause 2.6 Million Able-Bodied Adults To Drop Out Of Labor Force

By Jonathan Ingram, Nic Horton and Josh Archambault.  Mr. Ingram is research director, Mr. Horton a Policy Impact Specialist, and Mr. Archambault a senior fellow at the Foundation for Government Accountability.

One of the biggest myths pushed in statehouses across the country is that Obamacare’s Medicaid expansion will be an engine of economic growth. The Obama administration promises that more than 350,000 jobs would be created nationwide in 2015 if all states opted into Obamacare expansion.

But the truth is that expanding Medicaid to able-bodied adults will discourage work, create massive new welfare cliffs and ultimately shrink the economy, not grow it. A new report by the Foundation for Government Accountability outlines how Obamacare expansion could affect the labor force.

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Obamacare Expansion Discourages Work

Obamacare’s perverse design discourages work by creating a massive new welfare cliff for able-bodied adults. In states that expand Medicaid under Obamacare, single adults moving above 138 percent FPL would face premiums, deductibles, copays, coinsurance and other out-of-pocket costs nearly $2,000 higher (on average) than those they were subject to under Medicaid.

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Forbes: How The New Congress Can Thoughtfully Repeal Obamacare’s Expansion

By Jonathan Ingram, Nic Horton and Josh Archambault — Mr. Ingram is Research Director, Mr. Archambault is a Senior Fellow, and Mr. Horton is Policy Impact Specialist, at the Foundation for Government Accountability.

Tomorrow, a new Congress convenes, with the largest Republican majorities in nearly a century. These Republicans, elected on the promise of rolling back Obamacare, are ready to start chipping away at the law. One of their first targets? Obamacare’s immoral funding scheme that prioritizes able-bodied adults over the truly needy.

Obamacare Values The Able-Bodied Over The Truly Needy

The Federal Medical Assistance Percentage (FMAP) rates determine how the cost of Medicaid will be divvied up between the federal government and the states. FMAP rates vary by state, depending on states’ per capita personal income. Under the traditional Medicaid rules, federal taxpayers reimburse states an average of 57 percent of the cost of providing Medicaid to poor children, pregnant women, seniors and individuals with disabilities. The match rates for these populations don’t change under Obamacare.

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PA as an illustration of the immoral funding formula under Obamacare’s expansion.

However, Obamacare introduced a new “enhanced” funding formula for its expansion population. If states expand Medicaid to working-age, able-bodied adults, federal taxpayers will pay for 90 percent of the cost of covering those adults. (The matching rate starts at 100 percent for most states and gradually declines to 90 percent by 2020.)

But the vast majority of the able-bodied adults covered under Obamacare expansion have never been considered among the most vulnerable, have no disabilities keeping them from work, have no dependent children and don’t typically qualify for other types of welfare, including cash assistance and long-term food stamps. Why should federal taxpayers pay states nearly twice as much to cover able-bodied adults as they pay to cover the truly needy? Continue reading

Forbes: How States Can Unwind Obamacare Expansion And Restore The Working Class

By Jonathan Ingram, Nic Horton and Josh Archambault — Mr. Ingram is Research Director, Mr. Archambault is a Senior Fellow, and Mr. Horton is Policy Impact Specialist, at the Foundation for Government Accountability.

In November, voters across the country elected new Republican governors and legislators, many of whom campaigned heavily against Obamacare’s Medicaid expansion. Although some of these new leaders (including Governor-elect Asa Hutchinson in Arkansas) will be taking control of states that have opted into Obamacare expansion, there is new hope that these governors and state legislators will work to reduce government dependency and restore the working class.

One idea rapidly gaining currency among legislators and new governors’ transition teams is the possibility of renewing Medicaid expansion on a temporary basis for those who have already signed up, but immediately freezing enrollment going forward. This approach would stop the bleeding, but allow for a more gradual wind down of the program and allow enrollees to keep their plans until they increased their incomes, transitioning out of eligibility. Continue reading