In The Hill yesterday, Dick Morris, one-time Republican strategist and advisor to President Clinton beginning with the 1994 midterm elections, wrote about the looming social battle between state funding of Medicaid v. Education.
Even in those states that have chosen not to expand Medicaid through the Affordable Care Act’s benefit opportunity Morris believes they will be, “unable to provide decently for education without cutting back on the ambitious Medicaid expansion” as insurance exchanges provide coverage to individuals already eligible for Medicaid without the ACA.
He points out that Medicaid’s recently modest spending trajectory is set to increase substantially with increases in enrollment (spending is projected to rise 12.2 percent in 2014, 7.9 percent in 2015 and 2016, and 6.6 percent per year thereafter). But with state budgets overall not increasing commensurately, that means Medicaid spending must take a bigger share of the budget pie – and something else must get less.
Morris believes that will be education and has issued this dire warning: “we cannot afford both [education and Medicaid]. Of course, states can still raise taxes and join jurisdictions like Detroit into their slow spiral to oblivion.”
What really puts this suggested tradeoff on the razor’s edge is the evidence of failure that Medicaid expansion efforts have generated. Of course the Oregon Health Insurance Experiment is both timely and top of mind here. If you haven’t already, I encourage you to take the time to at least survey that research. In a nutshell, the experiment found that expanding Medicaid resulted, “in no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes.” It did result, however, in a significant increase in ER utilization, where relative costs are substantially higher than primary care settings.
Expanding healthcare coverage to those who cannot otherwise afford it is both a noble and moral obligation of a progressive society. But making choices to pursue noble pursuits with limited resources is a reality that becomes more urgent every day in the face of what we have seen happen in other countries due the lack of fiscal responsibility.
Mr. Morris has pointed out an important and challenging debate that states will have to wrestle with in the years ahead. It’s hard to make the argument for defunding children’s educations to support a program that has so far not achieved the desired ROI. But while we’re focused on relative social ROI we might also want to look critically at the success of state investments into educational programs.
Blog image from The Hill ~ Jenny Francis