Wednesday, September 1, 2010

Senate Democrat Talks about Medicaid “Stigma”

Earlier this week, Sen. Ben Nelson – he of the infamous Cornhusker Kickback – made the startling admission that the Medicaid program, which the health care law expands dramatically, carries a “stigma for some.”  The statement came in response to Nebraska Governor Dave Heineman’s outreach to education groups encouraging them to support repealing the health law, as its Medicaid unfunded mandates would squeeze out state funds for education.

On Monday, Sen. Nelson’s office put out a release calling the Governor’s accusations overblown.  Specifically, Sen. Nelson alleged that Milliman’s independent analysis of the health care law’s impact on the Medicaid budget was “seriously flawed,” for two reasons:

The Milliman study anticipates 100 percent participation in the Medicaid program under health reform.  Medicaid is voluntary and voluntary programs never see 100 percent participation.  Also, the governor’s new study assumes that about 60,000 people who have private insurance now will switch to Medicaid.  Will that happen when private insurance generally is better than Medicaid, which also comes with a stigma for some?

This remarkable statement leads to some interesting questions for Sen. Nelson, and Democrats generally:

  1. What exactly is voluntary about forcing individuals to purchase “government-approved” health insurance, and then taxing them if they do not do so?  How is the message that Medicaid is a voluntary program consistent with the mantra of “personal responsibility” used for the past year to justify the unpopular individual mandate?
  2. Given that their supposed goal in health “reform” is universal coverage, shouldn’t Democrats WANT 100 percent participation in the Medicaid program?  Or do Democrats merely want to CLAIM they have created universal coverage, while hoping that individuals do not sign up at rates that will overwhelm the fiscal capacity of states and the federal government to finance this new entitlement?
  3. According to the Medicare and Medicaid chief actuary, most individuals obtaining new health insurance coverage as a result of the law will do so via Medicaid.  Why should these projected 18 million individuals be “stigmatized” by what Sen. Nelson himself called an inferior form of health insurance?
  4. The health law’s expansion of Medicaid PROHIBITS individuals eligible for the Medicaid expansion (i.e., those with incomes under 138 percent of poverty) from receiving federal subsidies to cover the cost of private insurance.  In other words, poor people weren’t granted a choice of health care plans, and were instead dumped on to the Medicaid rolls.  If Sen. Nelson believes that the inferior Medicaid program carries a “stigma,” why did Democrats not only not fix this troubled program, but instead perpetuate and deepen the “stigma” attached to it by giving poor people no other choice of coverage?
  5. Is Sen. Nelson’s belief that private insurance “generally is better than Medicaid” the reason why he, along with the rest of his Senate Democrat colleagues, opposed an amendment offered by Sen. LeMieux to enroll Members of Congress in Medicaid?  Do Democrats want to “stigmatize thee, but do not stigmatize me” by enrolling others – but not themselves – in what Sen. Nelson called an inferior Medicaid program?

The comments above illustrate how Democrats are attempting to “have it both ways” when it comes to the health care law – trumpeting supposedly universal coverage, while simultaneously arguing that the law will not bankrupt states and the federal government because many individuals eligible for free entitlements will not enroll in them.  Similarly, the majority consigned 18 million Americans into a health “insurance” program that they themselves refused to accept – not least because, as Sen. Nelson admitted, the program is inferior to private insurance.  This latest example of Democrats’ double-talk, and double standards, once again illustrates why the health care law does not constitute health reform.