Simple Responses to ACA / Medicaid Expansion Claims

1. Claim Premiums Are Going Up

a. From 2008-2010, premiums increased an average of 10% a year.
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b. In 16 large cities where ACA is in effect, premiums will decrease by 0.8% for the
silver plan (the benchmark), and only go up 3.3% for those who get the bronze plan.
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c. In Arkansas, premiums will decrease in 2015.
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2. Claim Medicaid Expansion Would Crowd out the Budget
a. Medicaid is approximately 23% of our states budget.
b. HHSC projects if we keep doing what were doing now, that share could grow to 33%
by 2023. If we expand Medicaid its share of the budget will only be 25%.
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3. Claim The Federal Government Will Stop Funding their 90/10 Share
a. Of 100-plus cuts the federal government has actually made to Medicaid since 1980,
only once was the federal share of Medicaid financing reduced in 1981.
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b. This argument was raised in 1999 when Texas debated creating our CHIP program,
so we included a trigger in our Texas CHIP law to let the state opt back out if the
federal funding commitment is not kept. Several red states have followed our
example when enacting laws for Medicaid Expansion or alternative waivers.
4. Claim Block Grants are the Answer
a. President Bush refused Texas request for a waiver that would have offered very
limited, bare-bones benefits to uninsured adults.
b. Rhode Island got a waiver, not a block grant, and it actually hasnt worked.
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c. Senate HHS Chair Charles Schwertner said in a recent committee meeting that
talking about block grants is simply an unproductive debate
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:
Rather than having another unproductive debate about those two options, my
intention for this interim hearing is to start a conversation that will give us an accurate
picture of who the uninsured are, what services are currently available to those
individuals, and ways we can fill gaps and services in a fiscally responsible manner.
1
Commonwealth Fund: http://www.commonwealthfund.org/publications/issue-briefs/2014/jun/health-
insurance-premiums
2
Kaiser Family Foundation: http://kff.org/health-reform/press-release/premiums-set-to-decline-slightly-for-
benchmark-aca-marketplace-insurance-plans-in-2015/
3
Vox: http://www.vox.com/2014/8/27/6074033/arkansas-obamacare-poster-child-premiums-fall
4
Texas Impact:
http://www.texasimpact.org/docs/2013_Medicaid/Medicaid_Myths_Mistakes_And_Misunderstandings.pdf
5
Washington Post: http://www.washingtonpost.com/blogs/wonkblog/wp/2014/08/11/another-argument-against-
the-medicaid-expansion-just-got-weaker/
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Center on Budget and Policy Priorities: http://www.cbpp.org/cms/?fa=view&id=3428
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KUT: http://kut.org/post/although-texas-leaders-arent-expanding-medicaid-enrollment-numbers-slated-jump
5. Claim We Have an $18 Trillion Debt and We Cant Afford ACA
a. The ACA has controlled and lowered health care costs, which have led to a reduction
in long-term debt projections related to health care spending
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b. If we hadnt made the Bush tax cuts permanent, our debt would be 52% of the GDP
in 25 years. Since we made the Bush tax cuts permanent, our debt will be 100% of
our GDP in 25 years. The Bush tax cuts doubled our debt projections, not ACA.
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6. Claim ACA and Medicaid Expansion Will Increase the Federal Deficit
a. Since ACA has become law, experts have now calculated the projected savings in
federal health spending since the 2009 report at $7.9 trillion.
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b. Medicare spending is falling instead of rising, with reductions over the last 4 years
for 10-year savings totaling $715 billion, which dwarfs nearly every deficit-
reduction measure currently under discussion.
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c. In Texas, we're currently paying local taxes for health care for the uninsured plus our
federal taxes for Medicaid. If we would accept our share of the Medicaid funding
back into Texas, then we could save on local property taxes and stop paying twice.
7. Claim We Cant Be Paying for Health Care for Undocumented Immigrants
a. Undocumented immigrants cannot get coverage through Medicaid or CHIP
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b. Lawfully-present immigrant adults face a five-year waiting period for Medicaid
coverage everywhere in the U.S., except in Texas where they can never qualify for
Medicaid coverage even after five years
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8. Claim Medicaid Expansion Doesnt Reduce ER Visits
a. ER visits, heavy ER use (3-times a year), reports of non-urgent ER visits, and visits by
children all declined in Massachusetts after 5 years of Medicaid expansion.
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b. One study found a 12.2% reduction in the lowest income quartile zip codes.
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c. Through alternatives allowed by ACA, Oregon has reduced ER visits by 9% among the
Medicaid population and decreased emergency department spending by 18%.
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8
Center on Budget and Policy Priorities http://www.cbpp.org/cms/?fa=view&id=4139
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Id.
10
Time: http://time.com/2993605/health-care-debt-deficits-budget/
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NY Times: http://www.nytimes.com/2014/09/04/upshot/per-capita-medicare-spending-is-actually-
falling.html?partner=rss&emc=rss&smid=tw-thecaucus&abt=0002&abg=0&_r=1
12
Kaiser Family Foundation: http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8279-02.pdf
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Id.
14
Study, The effect of the Massachusetts reform on health care utilization.
http://www.thefreelibrary.com/The+effect+of+the+Massachusetts+reform+on+health+care+utilization.-
a0320845612
15
National Bureau of Economic Research: http://www.nber.org/papers/w16012.pdf?new_window=1
16
Washington Post: http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/03/new-research-shows-
medicaid-increases-er-trips-oregon-has-a-plan-to-stop-that/
9. There Arent Enough Doctors in the System to Treat Medicaid Patients
a. Low reimbursement rates for seeing Medicaid patients are why there arent enough
doctors in the system and those rates are set by the Legislature, which cut
reimbursement rates by 10 to 20% in 2011.
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10. Claim: Most of the 734,000 Texans Who Used the Exchange Already Had Health Insurance
a. Right now we have no way of knowing the actual figure, but a national survey found
that 57% of those who signed on through the exchange didnt have insurance
already which comes out to 418,000 Texans with new insurance
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11. Claim: Millions of People Lost Their Plans
a. The government is allowing anyone to stay on their plans until 2016; however it is
important to remember insurance companies used to discontinue, without notice,
insurance plans for things like pre-existing conditions which they no longer can.
b. The Texas Department of Insurance had worked out a solution on this issue before
open enrollment began; thus, the fear of canceled plans never came to Texas
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12. Most People Who Have Enrolled Havent Paid Their Premiums
a. Once people sign up, it can take up to six weeks from the point of enrollment to the
point at which they are first billed, so there is lag time.
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b. Insurance companies have estimated that 85-90% of individuals have paid their
premiums. If people arent paying, they, not the government, are the ones lacking
personal responsibility.
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13. Workers are Shifting More Employees to Part-Time Due to ACA
a. The Congressional Budget Office found that there is no compelling evidence that
part-time work has increased as a result of the ACA
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b. The Great Recession, not ACA, has forced some shift to part-time workers
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c. In early 2013, the number of workers putting in over 30 or more hours a week
increased, dispelling the notion that employers are reducing hours for employees.
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d. The study most often-cited by conservatives about this fromthe Federal Reserve
Bank of New York is not a study, but a self-selected response survey from 100
CEOs. It is not a credible collection of scientific data.
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17
Texas Tribune: http://www.texastribune.org/texas-weekly/vol-30/no-18/medicaid-providers-biennial-battle-cry/
18
Kaiser Family Foundation http://kff.org/private-insurance/report/survey-of-non-group-health-insurance-
enrollees/
19
Dallas Morning News: http://www.dallasnews.com/news/state/headlines/20131129-why-has-wave-of-
obamacare-insurance-cancellations-mostly-missed-texas.ece
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LA Times: http://www.latimes.com/business/hiltzik/la-fi-mh-todays-obamacare-freakout-20140324-story.html
21
LA Times: http://www.latimes.com/business/hiltzik/la-fi-mh-the-insurers-speak-20140507-column.html
22
CBO: http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-breakout-AppendixC.pdf
23
Plain Dealer: http://www.cleveland.com/business/index.ssf/2014/09/obamacare_not_forcing_workers.html
24
Center on Budget & Policy Priorities: http://www.cbpp.org/cms/?fa=view&id=4028
25
New York Fed: http://www.newyorkfed.org/survey/empire/empiresurvey_overview.html#tabs-4