No regrets on Medicaid expansion

No regrets on Medicaid expansion

It’s been five years since Medicaid expansion became a federal option for states, and a review of states that have opted in suggests that state governments are, by and large, happy with their decisions.

Number of the Day

112,000 - The number of FEMA-verified disaster loss cases in Louisiana that are now eligible for state tax relief under House Bill 10 from the special legislative session. (Source: The Advocate)

It’s been five years since Medicaid expansion became a federal option for states, and a review of states that have opted in suggests that state governments are, by and large, happy with their decisions. Mark Hall of The Brookings Institution looked at the data and disproved claims that higher-than-expected enrollment has strained state budgets. Even in cases where enrollment in Medicaid expansion was higher than projected, many states (including Louisiana) have saved money as a result of expansion:

One reason new enrollees do not substantially burden states’ Medicaid budgets is that expansion absorbs some of the costs states were already bearing prior to expansion. Various categories of previously covered Medicaid recipients can now enroll under the ACA’s expansion program. This shift in enrollment reduces the state’s share of their Medicaid expenses. Also, expanded Medicaid pays for various costs that states previously were absorbing outside of Medicaid. Accordingly, several credible and expert evaluations (including one in the New England Journal of Medicine) show that states such as Arkansas, Indiana, Kentucky, Louisiana, Michigan, Montana, New Mexico, Ohio, and West Virginia (among others) have actually reduced, not increased, state spending as a result of expansion.

 

The future of TOPS

With Louisiana facing at least a $700 million budget shortfall for the 2018-19 fiscal year due to expiring taxes, Gov. John Bel Edwards has reluctantly proposed eliminating state general fund support for the popular TOPS college scholarship program. With costs of the scholarships escalating as the state has become more reliant on tuition to fund its public colleges, several bills – up for debate this afternoon in the Senate Education Committee – have been proposed to restructure the program. The Hechinger Report has a useful overview:

The resulting debate has produced multiple ideas from legislators to reduce the size of the scholarship, in three broad categories: Cut the size of the scholarship for all 52,000 recipients, which critics say would make the scholarships too small to be useful. Raise the scholarship’s eligibility requirements to prioritize retaining the state’s best-performing students, meaning even fewer low-income students from low-performing schools would qualify. Or re-focus the scholarship to target teenagers like Moore, who are trying to lift themselves out of poverty. … “This is a state that needs its brightest students to stay here over the long term so our economy grows, so that educational opportunities grow,” said Vincent Rossmeier, the director of policy for Tulane University’s Cowen Institute for Public Education Initiatives. “If you see TOPS cut, you are going to see a lot of students leave the state and a lot of students not be able to afford college, and both of those are not good outcomes for the state of Louisiana.”

 

Relief for flood victims

Gov. John Bel Edwards signed the only two bills passed by the Legislature during the February special session. House Bill 10 by Rep. Ted James of Baton Rouge will allow Louisianans impacted by disasters to deduct their losses from the floods of the past few years on their federal taxes. The bill — which was necessary in order to allow Louisiana taxpayers to take advantage of federal recovery changes — would have been impossible to file during the regular non-fiscal session. Mark Ballard of The Advocate reports:

U.S. Rep. Garret Graves, R-Baton Rouge, said the new law complements efforts he and U.S. Rep. Cedric Richmond, D-New Orleans, made to ensure those impacted by the flood disaster could claim more losses as deductions to their federal taxes. Louisiana’s tax system is linked to federal returns, which means that taxpayers claiming those write-offs — and hence owe less in federal taxes — would have ended up with more taxable income and the likelihood of having to pay more in state income taxes, James said. HB10 precludes that from happening and holds Louisiana tax liabilities to the levels that would have otherwise occurred had there been no federal tax relief.

 

Slowdown in New Orleans’ population growth

For the second year in a row, more people moved away from New Orleans than moved to the city, according to the latest U.S. Census Bureau estimates. Since Hurricane Katrina, New Orleans’ population has been growing steadily toward its pre-Katrina population level, but the city still has just 81 percent of its pre-Katrina population. Some of those leaving New Orleans, however, might not be going too far, as Jennifer Larino of Nola.com/The Times-Picayune explains:

The Census Bureau appears to have revised its initial net migration estimate for 2016. It originally guessed the city had about 759 more people leaving than moving in that year. That number was adjusted to 457 in the latest estimates. Another thing to note about the domestic migration number is that it tracks people who are moving into and out of the city from other parts of the U.S. and Puerto Rico. That includes someone who may have moved from New Orleans to a neighboring parish like Jefferson Parish and St. Tammany Parish. So, a loss for New Orleans doesn’t necessarily equate to a loss for the region as a whole. It could simply mean more people were finding homes and jobs in the suburbs.

 

Opioid addiction in prison
As states grapple with the growing opioid epidemic, some are emerging as leaders in treatment, recovery, and harm reduction. For example, when a person suffering from opioid addiction ends up in a prison or jail, Rhode Island offers them three different opioid treatment medications. Louisiana, by comparison, only offers one, which still places us among states doing more than most. German Lopez at Vox.com investigated the opioid epidemic and how state officials are working to address it in their prison systems. His research found that one of the greatest concerns is a lack of continuum of care. While treatment is offered to people while they’re incarcerated in many states, re-entry often means being cut off from care:

First, there’s the risk of overdose within prison. Although studies suggest that drug use is actually lower in prison (since it’s simply much harder to obtain drugs), there is still some drug use — which, obviously, carries the risk of overdose and death. But if someone gets treatment for opioid addiction, he’s going to be less likely to use drugs or overdose while incarcerated. A bigger concern, though, is the risk of overdose once someone is released from prison — a time period when someone’s risk of death is massively increased.

 

Number of the Day

112,000The number of FEMA-verified disaster loss cases in Louisiana that are now eligible for state tax relief under House Bill 10 from the special legislative session. (Source: The Advocate)