Kasich Wrong on Medicaid


Yet another Republican has entered the crowded field for the 2016 presidential election. This time it is Governor John Kasich of Ohio.

This blog is not intended to be a forum for picking winners and losers in the presidential field. But I will weigh in on where candidates in both parties stand on healthcare issues.

Governor Kasich is best known in the healthcare field for rejecting the view of most Republicans and expanding Medicaid in the state of Ohio. He did this despite Republican opposition in the Ohio legislature by imposing Medicaid unilaterally through an executive panel. Sounds a lot like our current president who does things by executive action when he can’t win over Congress.

Even worse, Kasich believes he has the high moral ground on Medicaid; and he’s unafraid to demean those who disagree with him. According to Kasich, “when you get to the pearly gates, St. Peter won’t ask you what you did to keep government small but he will ask you what you did to help the poor.” Sounds like a quote from the Democratic playbook; justify big spending with the argument that you’re helping the poor.

Medicaid Not the Solution

Without getting into a discussion of Kasich’s theology, I will take issue with his understanding of Medicaid. I’m all for helping the poor to get better healthcare – but expanding Medicaid is not the solution.

Clearly Kasich believes that giving Medicaid to the poor is better for them than having no insurance at all. This logical assumption has just one problem – it’s wrong.

Medicaid is the worst form of health insurance available in this country. It’s so bad that many studies show healthcare outcomes for people on Medicaid are worse than those who have no insurance at all.

How to explain this surprising truth? John C. Goodman, founder of The National Center for Policy Analysis, explains this in his book, Priceless. Goodman says having Medicaid is worse than having no insurance at all. That’s because most doctors do not accept Medicaid patients and the ones who do often ration their appointments making waiting times very long. Medicaid patients respond by going to the Emergency Room where they are sure to be seen the same day.

The uninsured actually have greater access to health care. They can see practically any physician any time by negotiating a discounted cash rate that will still pay the doctor more than Medicaid. The result is less need to use Emergency Rooms for primary care. Medicaid patients are barred by law from paying doctors more than Medicaid allows.

Most people assume that you have to have health care insurance to get good health care. But this assumption has been disproven by multiple studies. A RAND Corporation study found virtually no difference in the quality of care received by the insured and the uninsured among people who seek care. In a thorough study of the impact of health insurance, former Clinton adviser Richard Kronick found that insurance had virtually no effect on mortality.

Medicaid Outcome Studies

There are more perverse outcomes from having Medicaid. Avik Roy, health care blogger for Forbes magazine, has reported the following studies:

  • A University of Virginia study found that individuals enrolled in Medicaid are almost twice as likely to die after surgery as privately insured patients, and about one-eighth more likely to die than the uninsured!
  • A study published in the Journal of the National Cancer Institute found that Florida Medicaid patients were 6 percent more likely to be diagnosed with prostate cancer at less treatable, later stages than the uninsured. Medicaid enrollees were nearly one-third more likely to be diagnosed with late-stage breast cancer and 81 percent more likely to be diagnosed with melanoma at a late stage than the uninsured.
  • A study in the journal Cancer found that the mortality rate for Medicaid patients undergoing surgery for colon cancer was more than three times as high as for the privately insured and more than one-fourth higher than the uninsured.
  • A study in the Journal of Vascular Surgery found that Medicaid patients treated for vascular problems, including plaque in their carotid arteries and femoral arteries, fared worse than the uninsured.

These are not the only studies Roy has found that lead him to conclude, like Goodman, that Medicaid patients do no better and sometimes worse than the uninsured.

It seems that many in the Medicaid eligible population have figured this out. A report in The New England Journal of Medicine by Sommers and Epstein states that there are over nine million Americans eligible for Medicaid who are currently not enrolled. They could have Medicaid at any time just by signing up, but for various reasons they have failed to do so. Undoubtedly, some of the reasons include the inconveniences of enrollment, the long waiting times on telephones or in government offices. But some have already concluded, rightly, they may be better off without insurance at all.

If John Kasich really wants to do what’s best for the poor he’ll support repeal and replacement of ObamaCare with a system that actually delivers access to quality healthcare for those trapped in Medicaid today. Then he can actually stand before St. Peter and know he has done what’s best for the people he represents.

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