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Michael Hiltzik: Obamacare had a very good day at the polls, even as Trump officials stepped up their attack on the program

Michael Hiltzik, Los Angeles Times on

Published in Business News

A couple of points here. First, the evidence shows that Medicaid patients' access to care, the quality of their care and their satisfaction with their care are commensurate with that of patients with employer-paid coverage, and hugely superior to the experience of people without insurance. It's true that about 30 percent of doctors won't take Medicaid patients, but that means that 70 percent do. The reason for the minority's resistance, moreover, is that Medicaid's reimbursement rates are very low. To correct that, Verma's agency should raise the reimbursement rates; increased acceptance by doctors would surely follow.

Verma depicted Medicaid expansion as a drain on state budgets. But she used extremely deceptive statistics. She remarked that Medicaid has grown to "consume" some 29 percent of total state spending, diverting state resources from other areas such as education and economic development." What she didn't say is that more than half of that spending is provided by the federal government. In other words, most of it isn't coming from state funds for those other purposes. The truth was staring Verma in the face: The figures come out of a report by the National Assn. of State Budget Officers that she cited in a footnote to her own remarks.

Indeed, the Medicaid expansion coverage is more than 90 percent funded by the federal government. That's a remarkably good deal, and one that has been turned down by 19 states whose political leaders are addled by anti-Medicaid ideology. The voters in Maine plainly understand how the math works to their advantage.

The thrust of Verma's attack on Medicaid expansion came directly from the right-wing anti-Obamacare playbook. Its theme is that Medicaid expansion added "able-bodied" people to the program's rolls, ostensibly at the expense of the "seniors in need, pregnant mothers, children and people with disabilities" for whom the program was created. Medicaid expansion, it's true, added childless adults to these rolls, but nothing about that undermined the care of the other beneficiaries.

In any case, the "able-bodied" slam is merely a variation of the "undeserving poor" theme that has been cherished by conservatives for more than half a century. It was the same slam retailed by right-wing pundit Ben Domenech on CBS's "Face the Nation" in June, when he backed it up with an utterly bogus statistic (without any pushback by the news program's moderator, John Dickerson).

Verma shed crocodile tears over the fact that the federal match rate of Medicaid expansion costs is more than 90 percent, compared to the national average of about 63 percent for traditional Medicaid. "If the match rate is a reflection of the value we place on caring for our neediest citizens, this is backwards," she told her audience.

One can't argue with that. But here's a solution Verma apparently hasn't considered: Cover all Medicaid spending at more than 90 percent. That would show that we value caring for our neediest citizens very highly indeed.

What is Verma's answer? It's to place more obstacles in the way of Americans seeking coverage under Medicaid. She signaled that the Trump administration will be much more accommodating to states asking to impose work requirements and other mandates on Medicaid applicants. Typically for the Trump administration, she concealed this intention behind the phrase "community engagement requirements."

Let's be clear: As administrator of the Centers for Medicare and Medicaid Services, it's not Verma's job to manage the labor force participation rate, the figure she cited to justify work requirements for Medicaid. Her job is to maximize coverage, not place roadblocks in the way of enrollment. For her to advocate work requirements for Medicaid is nothing short of a dereliction of duty.

Not only that, it's a reflection of profound ignorance about the Medicaid population. The fact is that most people eligible for expanded Medicaid already are working. Most of the rest can't work even if they want to -- 29 percent are caring for family members at home, 18 percent are going to school, 17 percent are ill or disabled, 10 percent are retired and 20 percent can't find work. Verma's chatter about "community engagement" is window dressing for her real intention, which is to cut people out of Medicaid.

Verma's speech indicates that the Trump administration isn't letting up one bit in its campaign to undermine the Affordable Care Act any way it can. But Tuesday's election results suggest that the ground is shifting under its feet. Americans like having insurance coverage, and increasingly they see resistance to Medicaid expansion negatively. Trump should take note.

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