OP-ED: Variables go beyond mere forecasts

While proponents justify Medicaid expansion with economic arguments, the truth of the matter is economics is not that simple. The glossy numbers and promises that those who support expanding Medicaid have touted do not, in fact, factor in a wide swath of variables. The data is, for the most part, too, incomplete to assert such bold promises.

This is not to discount the need to help those in need, but expanding a broken system as costs rise is not sound public policy.

So what are the facts? Well, here are just some of the myriad problems that seem to slip through the cracks in the ongoing debate of this issue:

• Economic forecasting is not an exact science. The consensus revenue estimate – the number produced by the legislature and the governor used to set the state budget – has varied dramatically since fiscal 1992. Records of the past 21 years show we have overestimated 55 percent of the time and underestimated 45 percent of the time.

• Medicaid cost continues to rise:  $71 million is the average annual growth, based on the last seven years, in general revenue. That covers 880,000 people as of fiscal 2014, and if we add another 250,000 people, that cost will go up to an unknown amount.

• Medicaid utilizes 21.5 percent of the general revenue operating budget, as of fiscal 2014, and education spending is 35 percent of the general revenue operating budget. These two programs alone take up 56 percent of Missouri’s operating budget as a portion of general revenue.

• Expecting the federal government to keep its 90/10 cost-sharing promise past 2020 is something we as a body and taxpayers should be cautious about.

I want to further emphasize the $71 million in average annual growth for the portion of general revenue spent on Medicaid. Remember, that is an average and the cost can be far greater. What proponents also fail to mention is the “woodwork” effect when eligible individuals suddenly enroll. The federal money the state would receive will not cover those currently eligible and not enrolled.

Another factor is the number of primary care physicians. Their numbers are not increasing, but the demand for their services is.

How do proponents plan to address that potential crisis?

A floundering economy, slow growth, rising health care costs due to an aging population, and the decreasing number of doctors accepting Medicaid patients are all important factors seemingly never mentioned by supporters of Medicaid expansion. The outlook is not as rosy as contended.

Having all the facts, both positive and negative, is important for open and honest debate about pressing policy issues.

That is the essence of good government.

—Rep. Tom Flanigan, R-Joplin, House Budget Committee vice chairman