What to do on Amendment 2
Jul 29, 2020 | Opinion |
How do you plan to vote on Amendment 2 next Tuesday?
At first blush, what’s there not to like? Extending Medicaid so that more needy people get medical care during these pandemic times seems like the thing to do. All the advertising on airwaves and in print tout the advantages of helping rural hospitals keep financially solvent while creating more jobs. Proponents of Amendment 2 even say Missouri will realize a financial net gain. The ballot language requires state agencies to maximize all actions to assure as many federal tax dollars as possible come back home to Missouri taxpayers.
Some estimates indicate Amendment 2 will expand Medicaid to deliver healthcare for 230,000 Missourians and bring back more than a billion dollars a year from Washington to keep rural hospitals open and boost the economy. Besides, more people on Medicaid means fewer people relying on the emergency room for less-than-emergency health issues, right?
If this sounds too good to be true, then maybe it is. As you consider how you will cast your vote next Tuesday, you might consider what follows.
What does Amendment 2 cost?
Those backing Amendment 2 like to point out how many other states have expanded Medicaid eligibility, as if “poor ol’ Missouri” needs to catch up. Thinking wisely, Missourians want to be shown the actual benefits. And the financial consequences of Amendment 2 are largely unknown. Read the ballot language carefully: “State government entities are estimated to have one-time costs of approximately $6.4 million and an unknown annual net fiscal impact by 2026 ranging from increased costs of at least $200 million to savings of $1 billion.” This makes passing Amendment 2 sound like rolling the dice!
Arizona may offer insight. Medicaid expansion there initially showed good results when enacted in 2002. Since that time, however, more childless adults enrolling in expanded Medicaid forced the state’s costs to increase two to four times more than the cost of covering low-income parents. Similar outcomes occurred in other expansion states like Oregon, Delaware, Maine, Utah and Vermont. Medicaid enrollees aren’t misusing the system but they certainly choose the best ways to milk the most dollars to their advantage. Nobody knows how many people will sign up for expanded Medicaid – which makes true cost estimates hard to figure.
Who’s in control?
MO HealthNet is Medicaid in Missouri, created and largely controlled by the federal government. Here’s the rub: the federal government can change its 90% reimbursement rate to the state at any time (remember, it was 100% when the expansion program was created as part of Obamacare). Decreasing reimbursement rather than increasing federal reimbursement is more likely in Missouri’s future. If COVID-19 (or anything else) creates economic pressures on the federal budget, don’t you expect that the feds will require the state to cover more of the cost? If that happens, then sooner or later taxes will increase – not just for the wealthy or average taxpayer but for the poor and certainly for Missouri’s working families as well.
Furthermore, Amendment 2 proposes to change the Missouri Constitution. If passed next Tuesday, then the only way to revise what’s done is through another vote of the people. How wise is it to lock up the state’s responsibilities in the state constitution beyond the power of our elected legislature to change it, no matter what emergencies may arise in the future?
Does it encourage fraud and misuse?
There is data suggesting that up to 10% of all Missouri Medicaid dollars – that’s billions of dollars – are lost to fraud. That’s according to the Missouri Medicaid Fraud Control Unit which reports that in 2015 alone, there were 15 criminal convictions and 29 civil settlements recovering more than $12 million from dishonest health care professionals. There are other concerns, if not about fraud then certainly about ethics. Amendment 2 will enable more young adult women to use Medicaid payments for “morning after” abortion pills. This alone is why some groups like the Missouri Right to Life oppose Amendment 2.
Missouri Gov. Mike Parson got it right. The governor says even if Amendment 2 is the right thing to do, it’s not the right time. The coronavirus pandemic is already pressuring state budgets, leaving legislators scrambling to find ways to cut costs. This is not only reality now but for the foreseeable future. Concerns are real that if voters choose to endorse Amendment 2, tax dollars spent (even when leveraging federal funds) will mean taking tax dollars away from public education or other services, including highways. Gov. Parson is correct in reminding us how state spending is already dramatically cut.
And then there’s a philosophical consideration. Amendment 2 is simply a means for more health care to be underwritten by tax dollars. President Ronald Reagan once warned us that socialized medicine will rob Americans of our future, noting how a medical program can so easily be disguised as a humanitarian project when, in effect, it contributes to creeping socialism. This depth in understanding is one reason why our 40th President is revered still today as “The Great Communicator.”
All this considered, here’s our view on Amendment 2: Vote no.
