The right’s big lie about Medicaid

If there’s one thing you’ve got to hand to the modern American right wing it is this: they sure do follow orders and stay on message. Once Grover Norquist, Roger Ailes, Karl Rove or some committee of corporate bosses at ALEC hands down The Word, it’s usually only a matter of hours before it’s being dutifully repeated all over the country by radio squawkers, think tankers, newspaper columnists and bought-and-paid-for politicians.

Sometimes, there’s an almost Stepford-Wife-like quality to the whole thing. It doesn’t matter if the talking point is merely a distortion or literally has no basis in fact at all; if the Heritage Foundation or Fox News decrees that “government spending is out of control,” that public providers of education are henceforth to be referred to as “government schools” or that tax cuts for corporations and the wealthy are a magic elixir for all that ails an economy, then rest assured that conservative soldiers from Alaska to Florida will be parroting the message before you can say “we need to run government like a business.”

If you think this is an exaggeration, check out this video that North Carolina Justice Center health policy advocate Adam Searing put together last week in which a parade of conservative governors (including North Carolina’s Pat McCrory) repeat the patently false claim that Medicaid (the public health care system for low income people) is a “broken” or ‘failed” program.

Here in North Carolina, scarcely a day goes by in which some conservative politician or McCrory staffer doesn’t make such a claim. Heck, the other day, the chair of the state Board of Education told NC Policy Watch reporters Sarah Ovaska and Lindsay Wagner that North Carolina can’t pay teachers more or do more for our K-12 education system because of the supposed runaway costs of – you guessed it – Medicaid.

Busting the myth

Of course, it’s no big surprise that conservative southern governors are attacking Medicaid. These are the same people who have made the ideologically-based decision to reject the federally-financed expansion of the program that was included in the Affordable Care Act (aka “Obamacare”). When you’ve decided to deny your state access to billions of federal dollars and thousands of jobs and assure that your state’s taxpayers will be subsidizing the health care of Californians, Ohioans and Michiganders without getting anything in return, you have to have some kind of excuse.

Fortunately, simply repeating the slur against Medicaid over and over doesn’t make it true. The truth of the matter is that, for all of its many imperfections, Medicaid is not “broken.” To the contrary, it provides millions of Americans with decent, affordable healthcare at a fraction of the cost paid by those in the private insurance market.

And here in North Carolina, where Governor McCrory and his eccentric HHS Secretary Aldona Wos actually want not just to freeze Medicaid but sell it off to private, for-profit insurance companies, the program actually remains a model for the nation.

As Searing told 100 people at an NC Policy Watch Crucial Conversation luncheon earlier this week in Raleigh, cost growth in the North Carolina Medicaid program has been falling for two decades and is the lowest in the country. Indeed, between 2008 and 2012, cumulative fees paid by the North Carolina program for all services fell by 2.6%.

Here’s another powerful example Searing shared: In 2012, the average total cost for a U.S. newborn delivery, including hospital and physician fees, was $9,775. This number far exceeded the average elsewhere in the world – including advanced western countries like France ($3,541), the United Kingdom ($2,641), New Zealand ($2,386) and Switzerland ($4,039). Meanwhile, the average cost for U.S. newborn delivery under Medicaid was $3,347 – roughly a third of the overall U.S. average! That doesn’t sound like a “broken” system; if anything it sounds like it’s the American for-profit system that’s “broken.”

None of this is to imply that Medicaid is perfect; it’s certainly not. Many health providers have refused to take Medicaid patients down through the years because of perceived low reimbursements. And like all large insurers, Medicaid has its share of bureaucracy.

But it’s also true that North Carolina’s program has made enormous strides in recent years in coordinating care and facilitating treatment of the whole person. This is one of the reasons the state has made such measurable headway in the battle against infant mortality. It was just over two decades ago that North Carolina lunched a successful assault on infant mortality by expanding Medicaid eligibility for pregnant women (a move that the state Senate has proposed, hard-heartedly, to reverse). It’s also one of the reasons that North Carolina’s senior senator, the conservative Richard Burr, recently and publicly lauded the state’s Medicaid program for its overall outstanding performance.

The real story

So, why do they do it? Why do southern governors like Pat McCrory repeat the “Medicaid is broken” slander over and over even as eight of their conservative Republican siblings around the country – governors who themselves joined in efforts to have Obamacare declared unconstitutional – have rushed to embrace federally-funded expansion? Why would McCrory deny insurance coverage and healthcare to a half-million North Carolinians at no cost to state taxpayers (indeed, the deal would bolster the state treasury!)?

Setting aside the possibility that the Governor is simply not smart or attentive enough to grasp the facts of the situation, the obvious answer appears to be this: politics and ideology.

As Ron Pollack, the Executive Director of the national healthcare consumer advocacy group Families USA made clear at yesterday’s luncheon, governors like McCrory are the ultimate far right team players. The national conservative “brain trust” has made the intensely cynical calculation that anything that’s bad for the President is good for them and urged their followers to play along. Their message: “Combat, resist and undermine Obamacare at all costs.”

For at least eight governors, this was simply too big of an “ask”; the benefits of Medicaid expansion were simply too overwhelming to deny.

McCrory and the other naysayers, however, have decided to go along with the scheme. They’re cynically banking on the fact that most average voters in their states are simply too confused and overwhelmed by the whole discussion to really understand what’s going on. Add to this the cover provided by market fundamentalist think tanks that still manage to argue with a straight face that an unfettered private insurance market would somehow provide coverage to the millions of uninsured and the Governor’s strategy becomes even more plausible from a political standpoint.

Put simply, the Governor is doing what he is doing because he is willing to govern by ideological talking points rather than facts.

Going forward

So what happens next? Pollack is hopeful that as the readily evident benefits of the Affordable Care Act come into sharper focus in 2014, foot-draggers like North Carolina will, eventually come to their senses. At some point, goes the logic, even the hoodwinked voters of the old Confederacy will wake up and demand action. Indeed, Pollack provided encouraging polling data indicating that this shift is already underway.

Let’s hope he is right. Given the performance of McCrory and his legislative allies during the first half of 2013, however, this still seems a bit optimistic. Having snuggled securely in bed with the cynics and the far right ideologues, it may be difficult – even for opportunistic politicians – to extricate themselves anytime soon.