Pence presumably had two goals. The first was to silence Kasich, the loudest voice among GOP governors opposed to congressional Republicans’ efforts to drastically roll back Medicaid as part of their ACA repeal plans. The second was to justify that rollback by claiming that the Medicaid expansion eroded services for the program’s traditional beneficiaries, including the disabled.
Pence acknowledged that Kasich wasn’t on hand to defend himself, but proceeded anyway in full crocodile-tears mode: “I know Gov. Kasich isn’t with us, but I suspect that he’s very troubled to know that in Ohio alone, nearly 60,000 disabled citizens are stuck on waiting lists, leaving them without the care they need for months or even years.”
Pence and Kasich have been shooting at each other over Medicaid for some weeks, since Kasich is fully alive to the fact that the Obamacare repeal Pence is promoting would tragically affect thousands of his constituents. As it happens, a column of mine published June 26 has become part of the crossfire. The column, which conclusively refuted one element of the conservative attack on Medicaid employed by Pence, has been cited by the Kasich administration in its defense, along with further analysis demonstrating that Pence’s claims aren’t true. It’s worth revisiting the affair, because it shows how the conservative attack on Medicaid has been erected behind a bodyguard of lies.
The column dealt with an episode the previous day of the CBS program “Face the Nation,” in which a conservative pundit named Ben Domenech asserted that after expanding Medicaid in his state, Kasich had to “throw 34,000 disabled people off of the program because it incentivized adding these working, able-bodied adults over people who actually were in the system who had disabilities or had other dependence.”
I checked this out and showed it was untrue. “Ohio disability advocates say they didn’t see this effect,” I wrote. “Ohio Medicaid officials say it didn’t happen. In fact, in 2016, when this carnage supposedly occurred, Ohio liberalized standards for Medicaid enrollment of the disabled.” When that transition began, 380,435 Ohioans were covered in Medicaid as “aged, blind, or disabled” enrollees. Every one retained full Medicaid benefits, and another 21,274 Ohioans who were disabled or suffering from mental illness but not previously receiving benefits were added to the rolls.
The claim about 34,000 ejected disabled persons was independently examined by the Columbus Dispatch, which also accepted that it was bogus. Our column and the Dispatch article both were cited in a tweet on Friday from Kasich’s spokesman, who also called Pence’s claim “fake news.” (The Federalist, a conservative website where Domenech is publisher, demanded a retraction of my column. They didn’t get one.)
During his speech Friday at the governors’ conference, Pence stepped up his attacks on Kasich and the Medicaid expansion. This time, his claim was that 60,000 needy Ohioans have been stuck on Medicaid waiting lists, “leaving them without the care they need for months or even years,” because Medicaid expansion has shoved them to “the back of the line.”
Kasich’s spokesman tweeted out a rebuttal, again citing my column and the Dispatch piece and calling Pence’s claim “fake news.”
Greg Sargent of the Washington Post expertly places Pence’s misstatements—and related claims by President Trump and Health and Human Services Secretary Tom Price—in the context of their efforts to pass a repeal bill despite the deep antipathy Americans are showing for a measure aimed at “gutting Medicaid and subsidies to lower-income people to facilitate tax cuts” for the rich.
But Pence’s statement deserves a separate, fuller refutation.
Pence was referring to a waiting list for Medicaid home- and community-based services, or HCBS. As its name implies, this program allows services to be delivered at home or locally, rather than in an institution such as a nursing home. Although it’s effective, it’s also expensive, and in 35 states the slots available weren’t enough to serve all the target population, most of whom are intellectually or developmentally disabled. As of 2015, more than 640,000 Medicaid enrollees were on waiting lists in 35 states—including Ohio, where the waiting list numbered more than 62,000.
Pence aimed to tie these waiting lists to states’ Medicaid expansions. This assertion has become common in the ACA repeal camp, but that isn’t what’s happened. Indeed, the Kaiser Family Foundation thoroughly demolished the assertion in February. The waiting lists, and their growth, pre-dated the 2014 Medicaid expansion by years, the foundation reported.
Moreover, expansion states generally had a much better experience reducing or clearing their waiting lists than non-expansion states. Most of the 30 expansion states as of 2015 had either no waiting list that year, the latest year available (11 states), or a reduction (nine states). Of the remaining 20, waiting lists increased in 13. On average, the size of the increase was 2.5 times greater in non-expansion than in expansion states. In other words, the trend was exactly the opposite of what Pence implied.
So what’s going on here? Pence was retailing what has become the preferred argument conservatives make against Medicaid expansion. The giveaway is the term “able-bodied.” Remember Domenech’s assertion on “Face the Nation” that expansion “incentivized adding these working, able-bodied adults” to Medicaid; it perfectly matches Pence’s assertion at the governors’ meeting that “Obamacare has put far too many able-bodied adults on the Medicaid rolls, leaving many disabled and vulnerable Americans at the back of the line.”
This is a variation on that old right-wing chestnut, the “undeserving poor.” The implication is that recipients of traditional Medicaid are deserving, but those getting coverage via expansion are layabouts who should be out working, not collecting benefits. That perception underlies the campaign to add work requirements to Medicaid.
Yet it’s false. About three-quarters of those eligible for Medicaid expansion, which covers those with household income up to 138% of the poverty line (or about $16,640 for an individual) are in working families and more than half are working themselves. Of the rest, about one-third were taking care of family members at home and the others were looking for work, disabled or retired. Not only that, Medicaid coverage enhances this population’s ability to find and hold work, by removing the impediment created by lack of healthcare.
Pence’s assertions, like the right-wing’s other attacks on Medicaid, have taken on an aura of desperation because governors such as Kasich know that the repeal effort’s Medicaid rollback is bound to hit them right in the budget. A presentation at the governors’ conference by the healthcare consultancy Avalere delivered this message in stark terms. Under the Senate GOP’s repeal bill, the federal share of Medicaid spending would decline by 2036 by 24% for the disabled, 31% for children, 37% for the aged, and 53% for the currently served adult expansion population.
Whatever Pence is trying to sell by telling the governors that the Medicaid rollback is about “ensuring for the long run that Medicaid will be there for the neediest in our society,” Kasich, along with many other governors from both parties, isn’t buying. They’re smart shoppers.
4:21 p.m.: This post has been updated with a link to Greg Sargent’s Washington Post analysis.