• Medicaid expansion paper now ungated

    Hey, remember way back to Tuesday when I posted on the paper I wrote with Aaron on Medicaid expansion? (If not, go read that post.) Well, the paper is now ungated. Find the PDF here.

    Unfortunately, the counter-point by Joe Antos is still gated. Best I could do.

    Joe Antos’s counter-point paper is ungated here. Harold Pollack’s introduction is also ungated.

    UPDATE: Joe’s and Harold’s papers now ungated.


    • I love when people follow-up on things they said they were going to do, even without explicit rewards being given for staying true to their word.

      I’m looking forward to reading it. I hope state legislators/governors end up doing the same…

    • P.S. I was able to find what I believe is an ungated copy of Antos’ counterpoint by googling it. The link is as follows: http://jhppl.dukejournals.org/content/early/2012/10/09/03616878-1898848.full.pdf

      Here are some choice quotes from Antos: “[Austin and Frakt] show that even the states indicating they will not expand Medicaid would spend less than half of 1 percent of their gross state product to cover everyone to 138 percent of poverty through Medicaid, while the federal contribution would be many times that. That may be true, but that does not make the expansion free.”

      Reasonable interpretation: Something that does an enormous amount of good isn’t entirely costless.
      Antos’ interpretation: Anything that increases the spending by state governments by even a penny is a mistake.

      “Frakt and Carroll raise the concern that the political battle over whether to expand Medicaid eligibility places “the poorest of the poor — those with incomes below 100 percent of the [federal poverty level]” at greatest risk of not having access to affordable insurance. That is a serious issue, but it could have been avoided. If there is a gap in coverage for people below the poverty level, it is at least partly due to the PPACA itself, which creates generous subsidies for private insurance for some but not others.”

      Reasonable interpretation: This political battle puts the most vulnerable at greater risk.
      Antos’ interpretation: Because this political battle could have hypothetically been averted it is OK to put the most vulnerable at risk.

      “Health insurance gives people a sense of entitlement to clinical inves- tigation and treatment when, in some or perhaps many cases, the patient would be better off without medical intervention.”

      Reasonable interpretation: Health interpretation gives people clinical investigation and treatments.
      Antos’ interpretation: In some cases, medical intervention isn’t the appropriate option. So why provide the option to the poor?


      But enough criticisms. I’m most interested in the implications of the paragraph you guys wrote: “The waiver necessary for [expanding Medicaid only to 100% of the FPL] would not be routinely granted; according to policy, waivers must be [federally] budget neutral (National Health Policy Forum 2009). In principle, a state might attempt to craft a partial expansion that is lean enough to offset the additional federal costs (e.g., by paring back benefits), though it is uncertain that would be viewed favorably by DHHS.”

      I’m curious: do you think this is even possible? It seems to me that the difference in costs to the federal government make this a fantasy, but because it is raised a serious possibility I feel like I’m missing something.