The New Hampshire Union Leader used a widely criticized study to attack the Affordable Care Act (ACA), claiming that insurance premium rates will be increasing exponentially in New Hampshire. However, the study has been panned for its low response rate while the data found in the study is at odds with official data provided by the state.
A Union Leader editorial highlighted a survey first reported in Forbes and conducted by Morgan Stanley which purports to show that premium prices will increase nationally mostly due to the ACA. The Union Leader used one aspect of the survey's findings, that premium prices will increase 90 percent on the individual market in New Hampshire, to attack the ACA and claim it will not bring down premium prices as originally intended:
The stunning news this week was that health insurance premiums in New Hampshire are up 90 percent under the Affordable Care Act, according to a regular survey of health insurance brokers by Morgan Stanley's health care analysts. Dr. Scott Gottlieb, writing in Forbes, relayed that the Morgan Stanley team attributed the increase to four factors directly related to Obamacare: "the age bands that don't allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage, the new excise taxes being levied on insurance plans, and new benefit designs."
Despite the Union Leader and Forbes' ringing endorsement of the findings, the study has come under withering scrutiny. The study itself explains that "the trends among the individual insurers" are not as useful as the aggregate trends due to the fact the observations were much smaller. Indeed, for New Hampshire, there was only one registered response to the survey. Only two states produced double digit responses, California with 14 and Idaho with 31.
As a post by local television state WMUR 9 explained, "21 percent of all survey respondents were from Idaho" while in New Hampshire, "they said they talked to one person, who they don't name." The piece went on to explain that because of the study's low response rate for New Hampshire, WMUR did not run the story saying, "it's all based on one anonymous person's opinion."
Numerous local newspapers failed to identify the fossil fuel funding behind Thomas Pyle, president of the American Energy Alliance, while allowing him to publish op-eds across the country misleadingly attacking a potential tax credit for wind power, while ignoring subsidies for the oil and gas industries.
A New Hampshire Union Leader editorial attacked the gender pay gap as "complete hooey," ignoring several studies that show a clear discrepancy in wages between men and women while dismissing the benefits of equal pay.
The February 9 editorial criticized New Hampshire Gov. Maggie Hassan's decision to back an equal pay bill being considered by the state legislature, saying the gender wage gap is "complete hooey" and that "no serious scholar believes it." The editorial instead claimed women's' life choices were the biggest reason for the gap:
A 2009 Labor Department study of the issue reached "the unambiguous conclusion that the differences in the compensation of men and women are the result of a multitude of factors and that the raw wage gap should not be used as the basis to justify corrective action."
That "multitude of factors" consists largely of life choices -- work hours, number of children, etc. For instance, Bureau of Labor Statistics data on full-time employees show that never-married women earn 95.8 percent of what men earn, but married women with children under 18 earn 76.3 percent.
The legislation would disallow pay secrecy policies that keep employees from discussing their pay with co-workers, making it easier for women to ensure they are being paid equally. Currently, employers are required to pay equal wages to men and women but can prevent employee discussion of compensation. As the National Women's Law Center explained last month, pay secrecy policies "can keep women in the dark about their pay, making pay discrimination nearly impossible to detect." States like Vermont, New Jersey, and New Mexico have recently enacted this type of legislation, strengthening women's and workers' rights in their states.
The New Hampshire Union Leader relied on anecdotal evidence from past elections to revive the misleading threat of voter fraud to endorse voter ID laws that restrict the right to vote.
In a January 27 editorial, the Union Leader cited two cases of potential fraud that it claims justifies the paper's support for strict photo ID laws:
Adam Kumpu of Milford was fined $1,000 and his mother, Janine Kumpu of Milford, was fined $250 for the fraud. Janine Kumpu obtained an absentee ballot in her son's name, and he used it to vote in Milford last November. He also voted in person in Keene.
That was proven fraud. Then there is the mystery of a vote recorded in Caitlin Legacki's name in the 2012 general election. The bloggers at Granite Grok reported last week that someone voted in Manchester in 2012 under the name of former Jeanne Shaheen spokesperson Caitlin Legacki.
We confirmed with the city clerk's office that a vote under Legacki's name and address was recorded. But Legacki moved out of New Hampshire shortly after the 2008 election (in which she voted) and was in St. Louis on Election Day 2012, working for U.S. Sen. Claire McCaskill. "It certainly was news to me" that she was checked as having voted in Manchester in 2012, she told us last week.
The Union Leader's anecdotal evidence is futile since neither case was prevented by the voter ID law in place in New Hampshire prior to the 2012 election, nor do the examples prove the law's effectiveness in deterring the minuscule amount of fraud that occurs in elections. New Hampshire's voter ID law requires an eligible photo ID, or voters must sign an affidavit confirming their identity and intention to vote. The Kumpu family example would not be stopped by stricter ID laws as absentee ballots are counted after the polls close in New Hampshire, thus making the redundant vote unpreventable solely with voter ID legislation. The second case, as the editorial noted, could have been a simple mistake, and was not prevented by the ID law. In addition, it does not show any proof that anyone engaged in fraud.
The New Hampshire Union Leader attacked a push to expand Medicaid to the state's low-income residents, claiming that legislators should focus on job growth instead. However, studies show that expanding Medicaid will create jobs, spur economic growth, and cut health care costs for New Hampshire residents.
The New Hampshire Union Leader misleadingly used the findings of a study on Oregon's Medicaid expansion to attack the program, claiming it did not improve the health of patients and led to increased emergency room visits, and warning that New Hampshire "must not fall into that trap." However, contrary to the Union Leader's assertion, studies of Oregon's expansion show improvements in preventable diseases and mental health, and while ER visits were shown to rise initially, the number of people using the ER has dropped as people become more educated about their insurance coverage.
In a January 7 editorial, the Union Leader, which has a history of misinforming the public on Medicaid expansion, said Medicaid expansion is an effort to "move working-class and eventually middle-class Americans into government dependency." The paper claimed this would have a devastating effect on New Hampshire because the program is "poorly designed" and "does not even achieve its stated goals," using a recently released Harvard study of Oregon's 2008 Medicaid expansion experiment to show how the program "did not improve health outcomes or reduce health care costs" and "even increased visits to hospital emergency rooms."
But the Union Leader's claim that Medicaid did not improve health outcomes is inaccurate and fails to tell the whole story. A digest of the study published by the National Bureau of Economic Research contests the Union Leader's claims, saying the report found "higher healthcare utilization, lower out-of-pocket medical expenditures and medical debt, and better self-reported health." Past reports on Oregon's Medicaid experiment have also shown improvements in mental health and chronic disease detection among those covered by the expansion.
Two of New Hampshire's top newspapers, the Union Leader and Concord Monitor, ran weekly opinion columns from members of the Josiah Bartlett Center (JBC), a Koch brother-funded ally of the American Legislative Exchange Council (ALEC), but failed to disclose the authors' conservative funding allowing them a platform to air their conservative agendas and legitimizing the viewpoints of their special interest backers.
The New Hampshire Union Leader promoted a plan that would use Medicaid expansion funds available under the Affordable Care Act (ACA) not to expand Medicaid to cover more of New Hampshire's poorest residents, but to subsidize private insurance plans. However, under this plan, people would potentially pay higher premiums for their private plans or be left without health insurance.
In a November 17 editorial, the Union Leader advocated for using Medicaid expansion funds to extend New Hampshire's practice of providing subsidies for private insurance policies and mocked legislators who warned that this approach could leave consumers vulnerable to price hikes due to lack of marketplace competition:
That is why Senate President Chuck Morse's plan to use Medicaid dollars to subsidize private insurance for qualified Granite Staters is such a great proposal. He called the Democrats' bluff. Now they are throwing up every objection that they can, even ones that undermine the party's position on Obamacare.
State Senate Republicans had proposed moving newly Medicaid-eligible Granite Staters into subsidized private insurance plans purchased on Obamacare's state insurance exchange, and doing that by 2015. Last week Democrats hilariously complained that this was "unworkable" (Gov. Maggie Hassan's word) because there is no competition on New Hampshire's exchange, which is serviced by only Anthem and Delta Dental.
By pushing for Morse's proposal, the Union Leader failed to take into account two major impediments to the Senate plan. First, a special waiver must be proposed by the state and approved by the federal government before Medicaid funds can be used for private insurance. Knowing this could be a lengthy process, other states that have taken this route have already submitted proposals for approval. The Senate plan backed by the Union Leader forecasts only one year for federal approval, and would end expansion efforts if the plan had not been approved by the end of that year. A different proposal by the House also recommends using Medicaid expansion funds to offer private insurance subsidies, but that plan does not foresee moving people to private plans for at least three years.
The second problem with the Senate plan is the lack of competition in the state exchange marketplace. With only one provider on the marketplace so far, New Hampshire's exchange is not competitive enough to make the Senate private subsidy plan viable, nor does it have the time to grow competition before the Senate plan would be implemented. According to the Boston Globe:
Insurance Commissioner Roger Sevigny cautioned the Senate panel that its timeline is ambitious. Sevigny said he has not heard of any companies preparing to enter the marketplace as the Senate plan envisions in 2015 to join the lone provider, Anthem Blue Cross and Blue Shield.
The House plan rejected by the editorial is deemed more practical, because it would only shift Medicaid funds to private insurance if three providers are competing on the exchanges. According to Forbes, competition is vital to keeping prices low and quality of care high:
In the future, to stay competitive, insurers will need to increase value for their customers. They'll do so by including in their networks only those physicians and hospitals that provide higher quality at a lower cost. This will require providers to improve the processes and outcomes of the care they deliver.
This shift in competition will begin a virtuous cycle. The lower cost, higher-quality insurance plans will attract more people. A growing membership base will give them greater leverage to demand increased efficiency, higher quality and superior outcomes from doctors and hospitals in their networks. This, in turn, will result in further market-share growth as more consumers see the value.
As the Concord Monitor further explained:
Implementing Obamacare and expanding access to Medicaid, let alone doing so under an as-yet unwritten plan that requires federal approval, is enormously complicated. Almost every part of every endeavor is in flux. So without getting into the deep weeds, the sticking point is this: The governor and the House want the people newly eligible for Medicaid to be able to obtain coverage under the standard Medicaid programs now being overseen by three managed care companies until at least 2017 before shifting them to private plans with what amounts to a voucher to subsidize the cost. The added time could allow players other than Anthem, the only insurer signed up to participate in the health care exchange marketplace, to join, thus increasing competition and lowering costs.
Several local media outlets published editorials and opinion pieces highlighting and praising CBS' faulty 60 Minutes Benghazi report. Now that CBS has apologized and withdrawn its report, will local media follow suit?
On October 27, CBS' 60 Minutes aired a report highlighting comments from security officer Dylan Davies, who went by the pseudonym "Morgan Jones" and said that he was an eyewitness to the September 12, 2012, attack on the U.S. diplomatic facilities in Benghazi, Libya. After several inconsistencies surfaced in Davies' statements about the evening, CBS pulled its report, apologized to viewers, and said it would "correct the record" on the next edition of 60 Minutes.
Immediately following the 60 Minutes report, various local media outlets across the country published editorial and opinion pieces hyping the report and heralding it as evidence that President Obama and his administration were lying about the attacks. At least six local media outlets, including The Columbus Dispatch, The New Hampshire Union Leader, The Pittsburgh Post-Gazette, The Washington Times, The Charleston Post and Courier, and The Boston Herald, all hyped the CBS report with one outlet calling it a "damning report" while another said the administration's "coverup [is] being exposed." Pittsburgh Press writer Jack Kelly published a piece in the Post-Gazette claiming the report was "noteworthy for the new information provided -- in particular the interviews with 'Morgan Jones' and [Lt.] Col. [Andrew] Wood."
The 60 Minutes report reinvigorated the widely debunked myth that there are "lingering questions" about the Benghazi attack and continued to push a right-wing media narrative that the Obama administration has engaged in a cover-up in response to the attacks. The pervasiveness of the myth even hit Congress as Sen. Lindsey Graham (R-SC) threatened to hold up presidential nominations until questions surrounding Benghazi were answered.
Now that CBS has retracted its report, will local media outlets who also injected this misleading myth into their opinion pages do the same, or will they continue to rely on debunked information that misleads their readers?
The New Hampshire Union Leader argued against a proposal to expand Medicaid in the state and instead advocated for using the federal expansion funds to enact a voucher system. However, numerous studies have found that traditional Medicaid provides more coverage for less cost.
In a November 6 editorial discussing a state initiative to expand eligibility for Medicaid, the Union Leader claimed that Medicaid offered few health benefits and denounced the low reimbursement rates for doctors. The editorial went on to suggest that Medicaid expansion dollars should fund a voucher system:
Studies of Medicaid enrollees show that the program improves health care access, but not measurable health outcomes. And because it pays doctors and hospitals a fraction of what it actually costs for treatment, it does not solve the problem of cost-shifting. Nonetheless, there is pressure to expand eligibility from the state's current 63 percent of the federal poverty level to the Obamacare-demanded 138 percent.
[Sen. Chuck] Morse [(R)] and [Sen. Jeb] Bradley [(R)] have proposed a better way. Rather than throw people onto Medicaid, they would use Medicaid funding to enhance the state's premium support program. Low-income families would get better-quality private insurance, which pays full hospital and doctor reimbursement rates. And unlike straight Medicaid expansion, eligible people who are already privately insured would not be lured onto Medicaid.
Contrary to the Union-Leader's assertion that Medicaid doesn't show "measurable health outcomes," a study of Oregon's 2008 Medicaid expansion published in the New England Journal of Medicine found that while certain health outcomes were not achieved -- such as lowering cholesterol and hypertension -- expansion had other benefits such as lowering rates of depression and increasing the rate of diabetes detection and treatment.
Moreover, the American College of Obstetricians and Gynecologists has argued that expanding Medicaid is a key strategy to improving women's health, as Medicaid "is the largest payer of pregnancy services, financing between an estimated 40% and 50% of all births in the United States, and family planning services, accounting for 75% of all public expenditures."
Reimbursement rates under Medicaid expansion will increase as a result of the ACA, a fact the Union Leader failed to mention. As part of the law, provisions were included to raise rates so that doctors are more likely to accept new Medicaid patients. Rates will increase across the country by an average of 73 percent according to the Kaiser Family Foundation, and in New Hampshire, rates are expected to increase 50-99 percent:
In lieu of support for Medicaid expansion, the editorial advocated for a plan proposed by state Sens. Morse (R-Salem) and Bradley (R-Wolfeboro) that would use Medicaid expansion funds to further expand the state's voucher program. Yet, as Kaiser Health News explained, it is inherently cheaper to enroll more people in Medicaid than to give them subsidies for private insurance. Since HHS requires voucher programs like Morse-Bradley's to provide Medicaid-level benefits, the voucher program would promote more expensive plans but offer identical benefits to Medicaid. Furthermore, according to a study appearing in the Journal of General Internal Medicine, Medicaid offers better protection against underinsurance -- measured as out-of-pocket health care cost over 5% of income -- than basic minimum plans that low-income individuals can afford on the private market:
Greater than one-third of low-income adults nationally were underinsured. Medicaid recipients were less likely to be underinsured than privately insured adults, indicating potential benefits of expanded Medicaid under health care reform. Nonetheless, more than one-quarter of Medicaid recipients were underinsured, highlighting the importance of addressing cost-related barriers to care even among those with public coverage.
The New Hampshire Union Leader hyped a report on insurers discontinuing policies to accuse President Obama of lying about existing health coverage, despite evidence which shows that health care coverage isn't being canceled as the Union Leader suggested and the decision to transition beneficiaries was made by insurance companies, not the president.
The October 29 editorial relied on a NBC report that said the administration was aware of the fact many in the individual market would not be able to keep their plans, and asserted the president was "lying" when he said "if you liked your health insurance, you could keep it":
When President Obama said in 2009 that if you liked your health insurance, you could keep it, he was lying. This was no secret. It was pointed out repeatedly at the time. U.S. Rep. Tom Price, R-Ga., an orthopedic surgeon and professor of medicine, did a whole Republican weekly radio broadcast on it back then.
Price and others pointed out that Obamacare created strong incentives for insurers to cancel people's coverage. That is exactly what has happened -- just as the Obama administration knew it would.
As NBC News reported on Tuesday, "the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them."
First, the idea that consumers are having their policies cancelled is misleading. As the Center on Health Insurance Reforms (CHIR) explained, an insurance company discontinuing a policy is not anything new and the term "policy cancellation" is a "misnomer." These plans are not being cancelled, rather insurance companies are "exercising [the] option to discontinue the policy at the end of the contract year."
Currently, insurance companies generally have year-long contracts with consumers. At the end of the contract, companies can decide to no longer offer a specific policy -- which has nothing to do with the ACA. As CHIR further explains, under the Health Insurance Portability and Accountability Act (HIPAA), individual policies are "guaranteed renewable" but insurance companies can "increase premiums, increase cost-sharing, and/or reduce the scope of benefits covered." The ACA allows companies to continue offering plans that do not meet minimum standards -- known as "grandfathered" plans -- if they were created before March 23, 2010. Yet, as ThinkProgress reported, given the naturally high turnover rate among individuals enrolled in the individual marketplace, it is highly unlikely individuals would be enrolled in the same plans from 2010 in 2014.
As Sarah Kliff at The Washington Post explained, the number of grandfathered plans has steadily reduced since ACA's passage because insurance companies view them as a "dead end." She explained: "They can't enroll new subscribers and are really constrained in their ability to tweak the benefit package or cost-sharing structure," so many companies have instead made the business decision to drop the plans instead of retaining that coverage for their consumers.
Therefore, the Union Leader's accusation that the president lied about people being able to keep their coverage ignores the fact that under the law, people who liked their insurance could keep it, so long as their insurance company decided to retain that policy. Understanding changes in the insurance marketplace, the administration did predict that insurance companies would likely drop grandfathered plans. However, the changes to insurance plans are actually much better for consumers, as they will now have access to more complete coverage and access to tax credits that could result in lower premiums.
Prior to the ACA, private health insurance was referred to as "Swiss cheese" coverage because insurers could create policies with policy holes that would never pass employee benefit standards. These inferior insurance plans have failed customers in the past and helped inspire the minimum benefit coverage under the ACA, including a prohibition against increased premiums due to illness and the ability to get insurance even with a pre-existing condition. According to the CHIR:
For most people shopping on the marketplace, the policies available there will be a better value than anything they have been able to buy on the individual market. First, they will no longer have to worry that if they get sick, their insurer will jack up their premium - that's prohibited under the ACA. Second, many will be eligible for premium tax credits to make their plan more affordable. And, as noted above, all the plans will meet minimum standards for benefits and cost-sharing - no more swiss cheese coverage.
As the Department of Health and Human Services explained in a release, six out of 10 Americans who enroll in coverage on the exchanges could find plans that cost less than $100 per month, all that include the 10 essential health benefits mandated by law.
The New Hampshire Union Leader promoted a CBS report that rehashed a long-answered "question" on the attacks on the U.S. mission in Benghazi, Libya, claiming the Obama administration knew the facility was a target and chose to ignore warnings, despite evidence and testimony to the contrary.
The October 28 editorial applauded a 60 Minutes report for "expos[ing] the coverup" and echoed its claim that the administration had been "warned repeatedly" that the Benghazi mission would be attacked:
This past Sunday, "60 Minutes" aired a report on Benghazi that was a year in the making. It showed, among other things, that the security contractor hired to run the mission's unarmed guard team had warned repeatedly that the mission would fall to an attack because the armed Libyan guards could not be trusted. A Green Beret commander based in Tripoli had warned Washington that al-Qaida was preparing to attack Americans in Benghazi and the only option was "leave Benghazi or you will be killed." Those warnings were ignored.
The White House said for as long as a week after the attack that there was no evidence it had been premeditated. But numerous people on the ground at the time knew it was a planned al-Qaida attack and told Washington that.
However, the State Department's investigative review body, the Accountability Review Board, found no clear evidence of intelligence that could have been used to prevent the attack:
The Board found that intelligence provided no immediate, specific tactical warning of the September 11attacks. Known gaps existed in the intelligence community's understanding of extremist militias in Libya and the potential threat they posed to U.S. interests, although some threats were known to exist.
Then-Secretary of Defense Leon Panetta corroborated the findings of the State Department in Senate testimony. Appearing before the Armed Services Committee in February, Panetta explained that the lack of "specific intelligence" made crafting a timely response impossible:
In response to a question from Sen. Kelly Ayotte, R-New Hampshire, Defense Secretary Leon Panetta said he was aware of a cable sent in August by Ambassador Stevens that said security in Benghazi was not adequate.
"Unfortunately, there was no specific intelligence or indications of an imminent attack on that -- U.S. facilities in Benghazi," Panetta said. "And frankly without an adequate warning, there was not enough time given the speed of the attack for armed military assets to respond."
He also noted that the National Counterterrorism Center had identified some 281 threats to U.S. diplomats, diplomatic facilities, embassies, ambassadors and consulates during the six months before the attack in Benghazi.
The New Hampshire Union Leader rehashed debunked myths about the Affordable Care Act (ACA) to misleadingly claim the law isn't working and is growing in unpopularity among Americans, even as polls show the law is gaining support despite initial flaws in rollout of the exchanges.
The October 22 editorial discussed a speech given by President Obama earlier this week in which he expressed disappointment in the exchange rollout's obvious issues but explained that the "essence of the law, the health insurance that's available to people, is working just fine." The piece disagreed, explaining that not only is the website flawed, but the entire law is not working:
The insurance can't be "working just fine" if people can't access it. Nor can it be "working just fine" if it costs more, is not what the insurance people want or need, and causes employers to drop coverage either because it does not meet the Obamacare insurance mandates or because paying the Obamacare fines is cheaper than covering employees.
Nothing about this law is "working just fine." Nor is the President's pathetic spin, which fewer Americans believe every day.
While there are flaws with the online enrollment system, which President Obama has acknowledged and his administration is in the process of fixing, the other accusations leveled by the Union Leader are misleading.
First, several studies have shown that costs for people purchasing insurance have gone down. According to a release by the U.S. Department of Health and Human Services, nearly 6 in 10 uninsured Americans will be able to pay less than $100 per month for health insurance coverage on the exchanges. In addition, the health care advocacy group Families USA found that up to 26 million Americans would be eligible for subsidies to reduce the cost of insurance. In fact, as a study by the Center for American Progress explains, the lower-than-projected premiums "will save the federal government $190 billion over 10 years and increase the law's deficit reduction by 174 percent to almost $300 billion. Lastly, a study by the RAND Corporation found that the law will help consumers lower their out-of-pocket costs in some cases by more than $1,000.
Local conservative blogs and opinion sections seized on reports of initial technical glitches with the online health care exchanges to broadly slam the Affordable Care Act (ACA), and failed to recognize similar challenges with implementing Medicare Part D.
The online health care exchanges opened on October 1 to assist people in selecting an insurance provider in compliance with the ACA. Since the launch, several local opinion outlets have framed the story to maximize frustrations over technical glitches and paint the federal government as incompetent in preparing for enrollment. These same outlets have been repeatedly critical of the ACA.
For example, the Las Vegas Review-Journal ran an editorial that called the exchange launch "an information-technology disaster." Other outlets have been openly rooting for the exchanges to fail, such as North Carolina's Civitas Institute which called for readers to submit "Obamacare horror stor[ies]." Watchdog.org published a reporter's first-hand "maddening" experience with trying to log onto the New Mexico Health Insurance Exchange.
The user complaints are not completely unwarranted, as very real technical issues attributed to heavy traffic on the sites and software problems have been reported. High demand to access the health care exchanges drove 8.6 million unique victors to HealthCare.gov in the first 72 hours after the exchanges went live.
However, much of the negative local coverage of the rollout fails to take the exchanges in perspective. Few reports question whether it is reasonable to expect such a large and complex undertaking to run smoothly right out of the gate. The 2005 enrollment of millions of seniors in Medicare Part D - the government program to subsidize the cost of prescription drugs for Medicare patients - is the closest way to put the ACA exchanges in perspective.
The Union Leader published a misleading op-ed written by Greg Moore, state director of the Koch-funded Americans for Prosperity (AFP), which promoted tired conservative myths surrounding Medicaid expansion in New Hampshire.
Moore's op-ed in the September 30 Union Leader attempted to discredit Medicaid expansion currently being debated by a panel of state lawmakers who are expected to make a final recommendation by October 15. The piece pushed previously debunked claims that Medicaid expansion would force people off private health care and onto Medicaid, would create long wait times to see doctors, and that the government will be unable to pay for expansion:
According to a report commissioned for the state Department of Health and Human Services by the Lewin Group, expansion would result in 20,500 people being dropped from their high-quality private health insurance into a substandard Medicaid program.
With expansion, we will also need to be prepared to wait longer to see our doctors. A study of Oregon's expansion published in May's New England Journal of Medicine showed that under Medicaid, with its lack of deductibles and minimalist co-payments, health care utilization of those covered exploded. With a major new demand in doctors' time and no new supply of doctors, it means that under expansion doctors will be stretched thin and we should all be prepared to wait more to get an appointment or a referral.
Then there's the question of money. Obamacare supporters claim that the federal government will pay for the entirety of expansion for three years and the vast majority as far as the eye can see, and that the federal government will "always" keep its promise.
With a nation that's $17 trillion in debt, it's just a matter of time until the federal government steps away from the high cost of expansion, which starts at more than $350 million each year in New Hampshire and then grows. If state taxpayers have to pick that up, it's hello to a state income tax.
Moore's first point concerning the 20,500 people expected to move from private health care to Medicaid, according to the Lewin Group study, fails to explain the whole story. While denying Medicaid expansion would keep the estimated 20,500 on private insurance, it would also deny 58,000 people any sort of coverage. According to the Lewin Group, failing to expand Medicaid would also result in a need to provide higher uncompensated care:
Although health systems would see more of an improvement in their bottom line, they would need to provide a greater volume of uncompensated care without the Medicaid expansion.
Uncompensated care costs hospitals millions of dollars each year, and with recent cuts to state reimbursement, this could cancel out savings that hospital systems see from denying Medicaid expansion. According to New Hampshire Public Radio:
"Uncompensated care cost our members a little over $300 million this past year," Steve Ahnen, president of the New Hampshire Hospital Association, says, "and obviously the state did not pay out anywhere close to that to hospitals."
Furthermore, the Lewin Group study estimated health systems -- which include hospitals, physician groups, skilled nursing facilities, freestanding surgical centers, and home health agencies - would "see an increase in net income of about $113.1 million" under expansion.
Moore's second point dismissed benefits of giving the uninsured access to health care, claiming that when Oregon expanded care to those in need, "health care utilization of those covered exploded." He continued, making the case that the newly covered would create backlogs in the health care system that would mean limited access to doctors. However, according to The Washington Post, a survey in Michigan found that doctors were willing to take on more patients in the event of Medicaid expansion. Furthermore, New Hampshire has more doctors per capita than Michigan, meaning there are more doctors available for each person.
Finally, Moore suggests that the federal government may not be able to pay for its share of the Medicaid expansion, thus shifting costs to the state; however, this myth has been previously debunked. According to The Washington Post, "there just isn't a history of the federal government 'dumping' new spending on the state."
Moore's organization, Americans for Prosperity, is a notorious media manipulator that is funded by the conservative billionaire Koch brothers. The Union Leader's op-ed page continues a pattern of support for AFP by repeatedly publishing its misleading talking points.