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When it comes to the evidence, ObamaCare’s proponents don’t have a leg to stand on

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ObamaCare’s Medicaid expansion has been a proven disaster. More than twice as many able-bodied adults have signed up as states thought ever possible, leading to massive and growing cost overruns. Those cost overruns leave less money to fund services for the truly needy, including seniors, poor children, and individuals with disabilities. And we’re already starting to see states prioritize ObamaCare expansion over services for the most vulnerable. It’s no surprise that several states are now looking for the ObamaCare exit.

These facts are undisputed. But that hasn’t stopped some ObamaCare advocates from closing their eyes to them. The latest example is a report from the Brookings Institute critical of the Foundation for Government Accountability’s (FGA) work highlighting the fiscal and moral disaster ObamaCare expansion has wrought on taxpayers and the truly needy.

{mosads}The piece, which was authored by Brookings Senior Fellow Mark Hall, referred to itself as a “rigorous, evidence-based analysis” of the issue. The reality could not be further from the truth. ObamaCare’s proponents are long on ad hominem attacks, but the one thing they do not have is solid evidence.


Brookings’ main contention was that ObamaCare’s Medicaid expansion has not been vastly more expensive than initially expected. That’s a strange argument to make, as a review of projections and actual results from expansion states shows that the expansion has been more than twice as expensive as anticipated. It also contradicts reports and data published by the Congressional Budget Office, actuaries at the Centers for Medicare and Medicaid Services, and state Medicaid agencies.

So what’s the “evidence” that expansion hasn’t been more expensive than expected? ObamaCare proponents cite an outdated report about state Medicaid spending in fiscal year 2015, two years before states even began paying a portion of ObamaCare expansion costs. He may as well have cited a report about state Medicaid spending in fiscal year 1965.

By definition, the state share of expansion costs couldn’t be higher than expected when the federal government was still paying the entire cost. But that doesn’t mean that states’ expansion costs aren’t overbudget today, nor does it mean that taxpayers — including federal taxpayers — haven’t paid far more than officials projected. In fact, quite the opposite is true: according to state and federal spending data, ObamaCare expansion has cost taxpayers more than twice what was expected.

Brookings also claimed that ObamaCare expansion is “saving” states money by shifting state costs to federal taxpayers. He points to a special deal in ObamaCare that provides states like Arizona, Massachusetts, New York, and Vermont — which had expanded Medicaid to able-bodied adults long before ObamaCare was enacted — with higher matching funds, even though their enrollees aren’t newly eligible under the law. The law’s supporters always seem to forget that these states are the exception, not the rule.

Worse, Brookings relied on outdated reports claiming states that opt into ObamaCare will experience an economic “stimulus” from more government spending. Those reports — which claimed “savings” would come from higher tax revenues generated by thousands of new hospital jobs — have been discredited by states themselves.

Here’s how the Kentucky Cabinet for Health and Family Services  explained it while seeking federal approval for proposed changes to the expansion:

The actual results of the implementation of Medicaid expansion differ dramatically from the projections set forth in the original study. The reality is, the number of Kentuckians who have enrolled in Medicaid expansion is more than double the number projected, while the number of new jobs created and the economic impact from Medicaid expansion has been significantly lower than forecasted … The reality is that Medicaid expansion does not pay for itself as envisioned by the prior administration, and the Commonwealth of Kentucky cannot afford the cost of the Medicaid expansion program without this demonstration waiver.

Even the reports Brookings cites undermine its central claim, as one report concluded that the state share of expansion costs were nearly triple what was expected. The reality is that ObamaCare expansion has been far more expensive than initially promised.

That’s the conclusion drawn not only by FGA, but by the Congressional Budget Office, actuaries at the Centers for Medicare and Medicaid Services, a review of actual spending data provided by state and federal agencies, and by state agencies themselves. ObamaCare advocates have a hard time acknowledging this reality.

Brookings concluded by bizarrely claiming there is no evidence that states now regret expanding ObamaCare. That must be news to legislators in Ohio who voted 59-40 in the House and 24-8 in the Senate to unwind the expansion and to implement a work requirement.

It must be news to legislators in Arkansas who voted 55-32 in the House to freeze enrollment, and who voted 69-21 in the House and 23-9 in the Senate to reduce expansion eligibility and adopt work requirements for expansion enrollees.

It must be news to governors and legislators in Arizona, Indiana, Kentucky, and New Hampshire, which have all submitted work requirement waivers.

And it must be news to legislators in Colorado, Iowa, Michigan, Minnesota, Pennsylvania, and West Virginia, where Medicaid work requirements are also under discussion.

ObamaCare expansion has unleashed a fiscal nightmare on taxpayers and prioritized welfare for able-bodied adults ahead of services for the truly needy. It’s no wonder state policymakers are now looking for any escape hatches they can find—whether it be through freezing enrollment, reducing eligibility levels, or adopting commonsense work requirements. These facts are undisputed — except, apparently, by those who cannot acknowledge the immense failures of ObamaCare.

Jonathan Ingram (@IngramLaw) is vice president of research at the Foundation for Government Accountability (@TheFGA), a non-profit research organization dedicated to replacing failed health and welfare programs nationwide.

Tags ACA Affordable Care Act Brookings Institution Healthcare reform in the United States Jonathan Ingram ObamaCare

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