During the CBS program “Face the Nation” on Sunday, moderator John Dickerson mentioned that among the Republicans who were critical of the Senate GOP’s Obamacare repeal bill was Ohio Gov. John Kasich, a former congressman. Kasich was especially critical of the bill’s drastic cutback in Medicaid spending.
In response, conservative commentator Ben Domenech took a shot at Kasich. “When Gov. Kasich, you know, pushed for the Medicaid expansion in Ohio,” Domenech said, “he ended up having 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.”
That sounded fishy. Throwing 34,000 disabled people off Medicaid would be hard to do without creating a major fuss, yet we’d never heard anything about it.
There is no evidence of any reduction in the disability caseload.
As it turns out, Ohio disability advocates say they didn’t see this effect. 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. There seems to be no solid documentation for Domenech’s claim, especially if one takes his implication to be that 34,000 disabled Ohioans suddenly found themselves without benefits. Domenech didn’t provide me with any, but referred me to a paper by a right-wing group, which also provided no documentation. At best, Domenech’s claim was highly misleading.
“There is no evidence of any reduction in the disability caseload” in the 2015-16 period, according to Brittany Warner, a spokeswoman for Ohio Medicaid. “In fact, Ohio actually increased the income eligibility requirement for the aged, blind and disabled from 64 percent [of the federal poverty limit] to 75 percent in 2016.”
In raw figures, Ohio raised the ceiling income for Medicaid eligibility for the aged, blind and disabled from $7,603 to $8,910. At the same time, the state liberalized the asset limit — that is, how much an enrollee could own outside of a car and house — to $2,000 from $1,500.
Domenech, who runs the Federalist, a conservative website, told me he found the claim in an analysis by the Foundation for Government Accountability, a right-wing organization with ties to the notorious ALEC, the American Legislative Exchange Council.
Domenech referred me to an FGA paper issued last year purporting to document excessive costs incurred by states that expanded Medicaid under the ACA, including Ohio. The paper says, “Kasich’s administration… eliminated Medicaid eligibility for more than 34,000 individuals with disabilities.” The assertion is footnoted, but the footnote says only that the source is “authors’ calculations based upon data provided by the Ohio Department of Health Transformation.”
Ohio essentially had changed its Medicaid program to bring it into line with federal standards, which had been more liberal than the state’s. The goal was to make things simpler and easier for enrollees and for the state, not to strip benefits from disabled enrollees. As long as Ohio’s standards differed from the feds, it had to make a separate determination on the eligibility for every disabled resident applying for Medicaid. This way, Ohio could simply accept federal officials’ rules and regulations for disability benefits.
The changes did create some complexity for Medicaid enrollees whose income placed them outside the Medicaid income limits. But almost all were served in other ways, according to a fact sheet the state issued. The fact sheet says that, rather than simply knock 34,000 disabled off Medicaid, the state actually expanded enrollment.
When the transition to the new standards took place, the state says, 380,435 Ohioans were covered in Medicaid as “aged, blind, or disabled” enrollees. Every one retained full Medicaid benefits. The state added to the program another 21,274 Ohioans who were disabled or suffering from mental illness but not previously receiving benefits.
Where could the FGA’s 34,000 disabled have come from? It’s possible that the figure refers to some people who had previously qualified for Ohio Medicaid under “spend down” rules, which allowed them to subtract their medical expenses from income in order to come within the income limits of the program. As part of its transition, Ohio eliminated the “spend down” program. About 34,000 people who might have qualified under spend-down now wouldn’t qualify for Medicaid.
But that doesn’t mean they were left uncovered. About 2,800 qualified for Medicare with a premium subsidy paid for by Medicaid. An additional 12,480 qualified for conventional Medicare — these included some who were 65 or older, and others who were receiving Social Security disability. And 18,285 qualified for subsidized premiums and deductibles enabling them to buy insurance on Affordable Care Act exchanges. That left 469 individuals who were younger than 65 and earned more than $47,520, which placed them out of the reach of ACA subsidies, but who were not actually ruled disabled under Social Security rules. They would have to “seek private insurance,” the state said.
Is this tantamount to “throwing” 34,000 disabled people off Medicaid? No. It’s not even clear that they were disabled—in fact, the indications are that most weren’t disabled, just needy. In any event, all but 469 had alternative sources of coverage, in some cases subsidized by the state. And the betting here is that Domenech didn’t know about them, since his source, the FGA, didn’t go into this sort of detail.
Disability agencies weren’t entirely happy with the way the state’s change was implemented, and it’s possible that some people fell through the cracks. But the goal was not to “throw” disabled people off Medicaid and that doesn’t appear to have happened on the scale that Domenech mentioned, if at all. Certainly few if any were left without any benefits because of Kasich’s actions, which is what Domenech implied. The state even added a new waiver program providing benefits for needy people with mental illness.
The FGA paper obviously is a very thin reed on which to base a factual assertion that Kasich had to “throw 34,000 disabled people off of the program,” as Domenech put it on national television. I reached out to the lead author of the paper, Jonathan Ingram of the FGA, but haven’t heard back.
This made Dickerson and CBS complicit in an outbreak of undocumented assertion with immense ramifications for viewers. We’ve reported before on Dickerson’s tendency to let bogus claims slide, as though he’s in a rush to get to a commercial. But he’s not alone among Sunday political chat show moderators.
There’s no excuse for any of them to countenance the retailing of non-facts as though they’re true. Domenech’s claim, as it happens, comes straight from the right-wing playbook of anti-Medicaid memes. It’s the one that demonizes the ACA Medicaid expansion as something that allows “able-bodied” Americans to suck up resources that should go to the genuinely needy and sick, who are supposed to be Medicaid’s core clientele.
It’s a corollary of an assertion by Trump White House aide Kellyanne Conway on Fox on Monday, that people thrown off Medicaid by the GOP repeal plans should just go out and get jobs. Subjecting adult Medicaid recipients to a work requirement is a popular conservative nostrum, but it overlooks that fact that nearly three-quarters of all uninsured adults eligible for Medicaid expansion already are in working families, and most of the others aren’t working because they’re caring for family members at home, going to school, are ill or disabled, or retired.
These assertions really are all about creating justifications for cutting millions of Americans off the Medicaid rolls, the better to hand over a tax cut to the wealthy. And the reason the Senate and House Republicans might get away with it is that programs like “Face the Nation” allow their “political panelists” to get away with it.
With the House and Senate repeal bills poised to deprive more than 20 million Americans of their health coverage, according to the Congressional Budget Office, and the way cleared to do so by the basic lack of knowledge many Americans have about their healthcare programs, it’s time to say: CBS, this isn’t a game anymore.