Kerby Anderson

If you want to understand why the debate over Obamacare isn’t going well, all you need to do is look at the debate about Medicaid. In a recent commentary, Michael Tanner says: “Democrats have dug in over any change to the current program, solemnly declaring that changing so much as a comma or semicolon in the ACA’s expansion of the program would immediately sentence millions of children to death.” Obviously, we can’t have a productive debate if we cannot even agree on the facts. Here are a few that need to be stated. First, Medicaid is unaffordable without reform. It is the third-largest federal spending program and is scheduled to nearly double in cost by 2027. Anyone looking at the cost projections (which may be understated) would surely conclude that the current growth line is unsustainable. Second, the Medicaid expansion had nothing to do with women and children. It might make for a good political commercial to scare voters, but the Medicaid expansion didn’t apply to pregnant women and children. Eligibility for them was raised as far back as the 1970s and 1980s. Third, Michael Tanner reminds us the “cuts are in the eye of the beholder.” Even after Republicans were accused of cutting, slashing, or destroying Medicaid, the program will still be growing at a rate of 2 percent per year. As I often say on my radio program, only in Washington, D.C. can an annual increase in a government program be considered a cut. Finally, we should acknowledge that the value of Medicaid is debatable. Michael Tanner cites a number of studies that question whether Medicaid results in better health outcomes. While you can say that Medicaid is better than no insurance at all, it certainly does not provide coverage as good as provided by private insurance. Medicaid reform will be hard to accomplish given the fact that the Medicaid debate ignores so many important facts.