Medicaid Reality Check

 Our job of correcting misinformation about Utah’s Coverage Gap got busier after a local chapter of AFP organized in May.

Ever since a Utah chapter of the Koch brothers-funded Americans for Prosperity (AFP) launched in May, the swirl of misinformation about Utah’s coverage gap has gotten cloudier. In June, the

AFP-Utah op-ed in the Deseret News (7/7/15)

AFP-Utah chapter organized the Sutherland Institute, Libertas Institute, and the Utah Eagle Forum to send a joint letter to the six policymakers debating Medicaid expansion options. The letter warned of "significant risks to the state’s most vulnerable residents” if we closed the coverage gap for 53,000 uninsured Utahns and their families. A July 7th op-ed by AFP-Utah director Evelyn Everton claimed that Ohio “scaled back its Medicaid eligibility for pregnant women” when they expanded Medicaid. But that isn’t true—Ohio kept the same Medicaid eligibility for pregnant women. Many more mistakes, out-of-context numbers, and exaggerated fears populate that op-ed and other AFP publications. You just can’t trust what they say and write.

We welcome AFP-Utah’s recent arrival to the now three-year effort to solve Utah’s coverage gap. But we also want to ensure the debate continues to be based on facts—not misinformation and fear. For that reason, we’ve developed the following responses to three statements by AFP-Utah that fall short of the policy standards of this discussion. 

AFP Says: “Medicaid expansion would add thousands of able-bodied, childless, working-age adults into a pool meant for impoverished families with children, the elderly, the disabled, and other vulnerable groups.”

“Able-bodied” is one of AFP’s favorite phrases. By using it, they make it seem like thousands of Supermen and Superwomen are trying to get insurance they don’t actually need.

But “able-boded” is just another one of AFP’s focus-group tested phrases designed to cloud the real issue. That’s because “able-bodied” means the same as “currently healthy.” Which means AFP’s statement is based on the absurd notion that health insurance should only be for sick people. Does that make sense? Of course not. We have health insurance in case we get sick. If people only got health insurance after they got sick, it would drive the private insurance market into a death spiral. Plus, having insurance year-round gives people access to preventive care, immunizations, check-ups, and counseling that keep us healthier and reduce strain on our entire healthcare system.

AFP’s statement is also factually wrong. We know that over 33% of the people in the coverage gap are parents with kids at home. Most of these children are currently covered by Medicaid, but somehow AFP doesn’t believe these kids would be more secure if their parents had insurance, too. Plus, two-thirds of the coverage gap population is currently working one or more jobs that don’t offer affordable health insurance. And of those not currently employed, we know that 25% are caregivers for a disabled or elderly loved one, 18% are disabled, and 13% are students. Far from being lazy couch potatoes (which AFP would like you to believe) the parents and adults in Utah’s coverage gap are working, taking care of family members, and trying to stay healthy and improve their lives.

AFP Says: “Supporters of Medicaid expansion cite the promise of federal dollars that eventually taper to a 90 percent federal match rate to pay for the new expansion population in perpetuity. As we all know, federal dollars come with strings attached and are being drawn from an already dry well.”

Funding is a sensitive issue for AFP, and rightly so because Utah is already sending $680 million a year in taxes to Washington, DC to pay for the Medicaid expansion we don’t have. (We do get some of that back in the form of tax subsidies for Utahns that enroll on healthcare.gov, but we are by no means getting the maximum amount of our federal tax dollars returned to Utah.)

So they attempt to deflect the issue by tapping into a strong local distrust of the federal government and concern about the national debt. But AFP’s argument is fear-based and speculative, while the $680 million a year Utah taxpayers are already paying for Medicaid expansion is real money that is leaving our state at the amazing clip of $50 million a month.

During the half century since the creation of Medicaid in 1965 (Utah adopted it in 1966) the program has always provided promised match-rate funds to states. Since 1966, the federal government has provided not less than 70% of Utah’s Medicaid funding and it has never wavered (except when it increased to 80% during the recent recession). Under the Healthy Utah plan, the federal match rate will start at 100% for 2016, and then gradually decrease to 90% federal funds by 2020. Plus, the Healthy Utah plan includes a provision that will cancel the program if and when the federal match rate ever falls below the enhanced match rate of 90%. Does this federal funding come with strings attached? Yes, just like Utah’s massive amounts of federal funding for highways, public universities, and drought control (which never seem to get the same scrutiny). The state must spend its Medicaid budget on healthcare for low-income families.

AFP Says: “Medicaid expansion could cost Utahns hundreds of millions of dollars. Even more concerning, other states have demonstrated that cost projections are often woefully inaccurate. For example, expansion in Arizona cost more than four times the state’s projections.”

This is just another speculative jab from AFP that has little relevance in Utah. First, the Healthy Utah plan will cost the state $78 million in 2021—not “hundreds of millions of dollars” as AFP would like you to believe. With $2.3 billion in the state’s general fund, the Healthy Utah plan would account for about 3.5% of that total—compared to the 12% we spend on prisons, and 5% we spend on courts. So AFP is just trying to scare you with some out of context numbers.

Second, we actually agree with AFP that several other states underestimated the number of Medicaid enrollees. Except, unlike AFP, we think this is good news for Utah. That’s because we have taken the time to ensure that our enrollment estimates are more conservative and more accurate.

During the last three years both national and local researchers have released multiple reports and studies to give Utah policymakers extremely reliable and conservative enrollment estimates. According to the Milliman Report, total enrollment in 2021 is predicted to be 146,000 lives under a full expansion plan like Healthy Utah, which would cost $77.8 million in state funds. We know that 109,000 would be newly eligible Utahns, and that 37,000 would be previously eligible for Medicaid—also known as the “woodwork” population (which by the way will be mostly children enrolling in health coverage). AFP would like you to believe we jotted these numbers down on a napkin, but they are actually the result of multiple and intensive research studies using the latest demographic and geographic data available. Perhaps AFP never mentions any Utah enrollment numbers because they don’t want you to know they exist.

Just as the Healthy Utah plan already incorporates key lessons from other states like Arkansas and Iowa, our enrollment projections also reflect a more conservative approach to estimating the final state cost.