Yes, Virginia, Medicaid Expansion Will Harm the Poor

Last week, Virginia’s general assembly voted to expand Medicaid under the auspices of Obamacare. The commonwealth’s legislators had wisely resisted doing so for years, but four GOP state senators broke ranks to vote for this bill in exchange for a provision stipulating an anemic work requirement. The “news” media have, of course, touted this betrayal as a victory for the poor. It is however, precisely the reverse. Expansion will consign thousands of truly poor and disabled Virginians to purgatorial Medicaid waiting lists while advancing able-bodied adults with incomes above the federal poverty level (FPL) to the front of the line.

Why would Virginia pursue such an obviously unjust policy? Like all Democratic programs, it’s about power and money. Obamacare incentivizes expansion states to shift Medicaid’s focus to able-bodied adults by paying over 90 percent of their coverage costs, while the federal share of costs for traditional Medicaid patients remains below 60 percent. This does not mean, however, that doctors and hospitals will receive more money. Providers will continue to be paid less by Medicaid than the cost of treatment whether the patients are expansion or traditional enrollees. The extra money will go to political slush funds and insurance companies.

Medicaid expansion doesn’t work like the original program, which was administered by the states as a safety net for poor children, pregnant women, the disabled, and the elderly. Management of Obamacare’s corrupted version of the program is farmed out to insurance companies. A typical example is Wellcare, which accrued over $10.6 billion in 2017 from its coverage of able-bodied adults. The company plans to reinvest $2.5 billion of that revenue in the acquisition of Meridian Health Plans of Illinois and Michigan, which will increase its Medicaid portfolio by 37 percent. Meanwhile, truly poor patients die on waiting lists.

This is not conjecture. A recent study, conducted by the Foundation for Government Accountability (FGA), revealed that at least 21,904 Americans have withered away and died on Medicaid waiting lists in the states that expanded the program under Obamacare. Even worse, the 21,904 figure reported in the study almost certainly understates the true death toll. A number of expansion states were somehow “unable” to provide FGA with death totals, while others implausibly claimed that there were none to report. It is nonetheless clear that Medicaid waiting lists in expansion states constitute a kind of death row for the genuinely poor.

The worst carnage has occurred just north of the Beltway. Maryland is easily the deadliest state for traditional Medicaid applicants, chalking up no fewer than 8,495 deaths among individuals languishing on its waiting list. During the same time period, even as these patients were left to die, the bureaucrats of the Old Line State enrolled very nearly 300,000 able-bodied adults under the aegis of Obamacare. Louisiana took second place in killing its traditional Medicaid patients. The Pelican State reported 5,534 deaths among the unfortunates who wound up on its waiting list, while 451,000 able-bodied adults were enrolled under Obamacare’s expansion.

Additional states whose Medicaid waiting lists have killed a thousand or more people include New Mexico, where 2,031 poor and disabled patients died while the state signed up 259,537 enrollees under Obamacare’s expansion scheme. Michigan left 1,970 of its residents to die while enrolling 665,057 in its new and improved Medicaid program. West Virginia allowed 1,093 patients to die on its waiting list while signing up 181,105 able-bodied enrollees. The remaining expansion states are mere also-rans with death tolls ranging from Iowa’s paltry 989 down to Minnesota, which managed to leave only 15 of its poor and disabled citizens for dead.

This is the august company Virginia’s General Assembly chose to join last week. The Old Dominion will become the 33rd state to take Obamacare’s Medicaid expansion bait, demonstrating that the commonwealth’s politicians have learned little or nothing from the deadly experiences of the previous states that were gaffed by their own greed. Those Medicaid expansion states still have nearly 250,000 poor, disabled, and elderly individuals wasting away on waiting lists. Yet Obamacare advocates in Utah, Idaho, and Nebraska — blissfully unaware of the death tolls quoted above — are working to pass expansion in November via referenda.

Maine activists have already tricked the voters of the Pine Tree State into passing a referendum approving expansion, but the program hasn’t been implemented because Governor Paul Lepage has refused to go forward: “My administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families.” This speaks to one of expansion’s most profound ironies. Even if Washington continues footing most of the bill, herding the able-bodied into Medicaid is a budget buster for the states. It nearly broke Maine the last time they tried it.

Medicaid expansion under Obamacare privileges able-bodied adults with incomes above FPL, states can’t pay for it in the long haul, and it causes the genuinely poor to be dumped onto waiting lists where they quietly die in their thousands. Yet the Old Dominion’s newly-minted Governor, Ralph Northam, will gleefully sign an expansion bill into law this week as the leaders of his party and the media beam benevolently from on high. His name may even be uttered by the Great Mentioner as potential presidential material. For any Democrat, that’s certainly well worth a little inequity, the occasional budget deficit, and a few thousand human sacrifices.

The post Yes, Virginia, Medicaid Expansion Will Harm the Poor appeared first on The American Spectator.

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Will the Supreme Court’s gambling ruling help or hurt sports and budgets? – AEI – American Enterprise Institute: Freedom, Opportunity, Enterprise

“A true Englishman,” Jules Verne once quipped, “doesn’t joke when he is talking about so serious a thing as a wager.”

After the Supreme Court’s ruling two weeks ago effectively legalizing sports wagering, Americans, too, are starting to take gambling seriously, both inside and outside the world of sports.

Alex Ovechkin controls the puck against Vegas Golden Knights defenseman Nate Schmidt in the first period in game one of the 2018 Stanley Cup Final. Credit: Gary A. Vasquez-USA TODAY Sports via REUTERS

In Murphy v. NCAA, the Supremes held by a 7-2 margin (more or less) that a congressional act forbidding state legislatures from authorizing sports gambling violated the “anti-commandeering” doctrine of the Tenth Amendment and therefore was unconstitutional.

Under the Professional and Amateur Sports Protection Act of 1991 (PASPA), instead of prohibiting sports gambling outright, Congress declared it “unlawful” for a state to “advertise, promote, license, or authorize by law or compact . . . a lottery, sweepstakes, or other betting, gambling, or wagering scheme” based on competitive sporting events.

In 2011, voters in New Jersey approved a state constitutional amendment authorizing just that, and the following year, the state legislature formally authorized sports betting. Shortly thereafter, the major sports leagues and the NCAA challenged the legislation in court, arguing it was barred by PASPA. New Jersey countered that PASPA itself was unconstitutional because the Tenth Amendment prohibits the federal government from “order[ing] the State to regulate in accordance with federal standards” — a principle known as the anti-commandeering doctrine.

After further judicial and legislative maneuverings, the case found its way to the Supreme Court, where Justice Alito, writing for the majority, explained that the anti-commandeering doctrine derives fundamentally from the Framers’ “decision to withhold from Congress the power to issue orders directly to the States.” This “structural protection of liberty” helps “promote political accountability” and “prevents Congress from shifting the costs of regulation to the States.”

And in the case of PASPA, the high court held that by purporting to tell legislatures not what they must affirmatively do but what they must not do, Congress overstepped its bounds and violated the doctrine.

Thus, New Jersey and the 49 other states found themselves suddenly liberated to enable sports betting within their borders. Anticipating the ruling, several states, including New York, West Virginia, Connecticut, Mississippi, and Pennsylvania, did exactly that. Another 15 states have taken steps in this direction.

But the Supremes’ Murphy decision nevertheless left sports fans and others alike wondering whether sports will benefit or suffer from the ruling.

Predictably, libertarians celebrated, and with good reason. Americans are already betting enormous sums of money on sports, they reckoned, so why not legalize it outright and at least capture some tax revenue?

According to statistics cited by the Competitive Enterprise Institute, while Americans legally wagered nearly $5 billion in 2017, they bet $123 billion per year on sports, almost all illegally. At the same time, the overwhelming majority of states conduct lotteries and permit some form of casino gambling, generally on Indian reservations.

But doesn’t widespread, legalized sports gambling run the risk of interfering with the integrity of games? Worse, wouldn’t the prospect of, say, in-seat touchscreens in sports arenas, on which spectators could place bets on all aspects of the game they’re watching, ruin the stadium experience?

The four major sports leagues, which had joined the NCAA in the original suit against New Jersey, wasted little time in calling for uniform national standards, with the National Basketball Association emphasizing that “the integrity of our game remains our highest priority” and the National Football League reportedly “focusing on getting paid for selling rights to its own data and video footage — intellectual property that legal betting operators will want to pay for in order to help them set lines and prop bets.”

What also remains uncertain is whether sports wagering will benefit local and state coffers.

Interestingly, misery and ecstasy have blended on the Strip: Las Vegas sports bookmakers stand to lose big as the city’s juggernaut National Hockey League expansion team, the Golden Knights, has overcome tremendous odds to reach the Stanley Cup Finals.

In addition, a 2016 report from the State University of New York’s Rockefeller Institute found that “state authorizations and promotions of gambling offer little long-run relief to state revenue problems” because while “new gambling activities may generate short-run increases in public revenues . . . these increases are getting smaller and their duration shorter, perhaps as more and more states compete for a limited pool of gambling dollars.”

Thus, many questions remain as we enter the brave new world of sports gambling. Jules Verne wasn’t joking around.

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