DETROIT, MI — Would a Medicaid expansion in Pennsylvania cost the state millions? Billions? Or will it actually bring in a surplus of revenue, while simultaneously providing health coverage for more citizens? All these possibilities—and more—have been presented in the state’s media coverage. And while the range of numbers reflects real political and analytical disagreement among different sources, Keystone State reporters can do more to press officials for the source of their figures and help readers sort through a genuinely confusing picture.
As background: the national healthcare reform law calls for the expansion of state Medicaid programs, and provides for the federal government to bear most of the cost of that expansion—100 percent for the first three years, stepping down to 90 percent in 2022 and beyond. But the Supreme Court ruled that states must be allowed to choose whether to accept the expansion, and in early February, Gov. Tom Corbett, a Republican, signaled that Pennsylvania would reject the deal.
“Our initial estimates show that a Medicaid expansion … would cost Pennsylvania almost $1 billion of new state taxpayer dollars through fiscal year 2015-2016 — ultimately rising to a total cost of more than $4.1 billion of new state taxpayer dollars by the end of fiscal year 2020-2021,” Corbett wrote to Health and Human Services Secretary Kathleen Sebelius. (At the same time, Corbett has left the door open to negotiation. There is no deadline for states to agree to the expansion, though the longer they wait the fewer federal dollars they qualify for.)
The governor’s $4 billion estimate got picked up in early coverage, like this piece from the Pittsburgh Post-Gazette. But Corbett’s letter offers no data to support the cost estimate, and none has been forthcoming since—even as, as the Allentown Morning Call and The Philadelphia Inquirer report, Democrats challenged the governor’s budget secretary for data to back-up the figure at budget hearings that began this week.
Meanwhile, other economic projections are proliferating. A Feb. 21 post by David Wenner at PennLive, the website of The Patriot-News in Harrisburg and other central Pennsylvania papers, cites (and, gratifyingly, links to) a study from Families USA and the Pennsylvania Health Access Network that predicts federal funds tied to the expansion would lead to more than $5 billion in economic activity in the state in 2016, helping support more than 40,000 jobs.
And a report from the Pennsylvania Health Law Project and the Office of Rural Health at Penn State forecasts that expansion would actually save the state hundreds of millions in the first three years, while generating more than $50 million in new tax revenue. That analysis was written up by reporter John Finnerty for smaller outlets like New Castle News and The Tribune-Democrat, though it appears, alas, always without a link.
With so many numbers floating around, it’s hard to get a handle on what, exactly, is a substantive contribution to the policy debate, what is just political exaggeration, and what the numbers—if they are to be believed—really mean. How can reporters sift through all this, put pressure on public figures to use credible data, and give Pennsylvanians a sense of what they can trust?
Part of the trouble is that the cost-benefit estimates typically come from either partisan elected officials or advocacy groups, who have motives to cherry-pick figures to support predetermined positions—and who may or many not be forthcoming about how they made their calculations. The terms of the debate also get shifted, between the narrow effect of Medicaid on the budget and broader economic impact, in sometimes slippery ways.
In that context, credible projections from independent sources are a crucial resource for journalists. So it’s a little surprising that another report, released in November by the Urban Institute and the Kaiser Family Foundation, hasn’t gotten more coverage. That nonpartisan analysis examined the budgetary consequences of expansion in every state in the nation. It forecast that, by 2022, Medicaid expansion would provide 542,000 Pennsylvanians with health care they didn’t have before, and that expansion would cost the state $2.8 billion—not $4.1 billion, as Corbett claims—while the federal government would pay $37.8 billion.
Broadly put, the report says, “state costs of implementing the Medicaid expansion would be modest compared to non-ACA Medicaid spending and… many states are likely to see a small net budget gain.”
The Kaiser Foundation/Urban Institute report hasn’t exactly been ignored in Pennsylvania media—it was cited in a solid Feb. 21 article by Megan Lello for WITF in Harrisburg, along with Amy Worden’s Inquirer piece about Corbett’s initial announcement. But as the debate continues, the discrepancy between the Corbett and Kaiser estimates should get more attention—and it’s a key reason, beyond the partisan squabbling in the statehouse, for reporters to press the governor’s administration about where its numbers come from. (One puzzle for reporters to dig into is the disagreement about just how many people a Medicaid expansion will cover: in addition to Kaiser’s projection, the Corbett administration says it will be 800,000 people, the Pennsylvania Health Law Project puts the number at 475,000, and the Families USA/Pennsylvania Health Access Network report pegs it at 682,000.)
There are other ways in which Pennsylvania reporters would do well to broaden their sites beyond the state’s borders. For example, as CJR has noted before, a similar debate in Florida was upended when an editor there got a hold of emails demonstrating how Gov. Rick Scott’s costs had been refuted by the state’s own chief economist. Scott knew that, and used inflated numbers—which simply assumed the federal government would not make good on its funding commitments—anyway. After the story broke, Scott’s office began to use smaller estimates of Medicaid costs; this week, in a remarkable reversal, he announced that he’d accept the expansion after all. In Pennsylvania, Corbett’s numbers are nowhere near as far apart from independent estimates—but without a fuller accounting of where they came from, it’s not unreasonable to explore the possibility of similar antics.
Or, considering that one of Corbett’s chief complaints is that the federal government doesn’t allow states enough freedom to administer their Medicaid programs, reporters might note how new flexibility is being offered in other states—including Florida, where Scott got federal permission to move beneficiaries into privately managed care plans.
It’s important to note, of course, that there can be good-faith disagreements about these projections, and also that the wisdom of a decision on Medicaid expansion doesn’t necessarily hinge on getting the estimates just right. A Feb. 11 op-ed in the Inquirer accepts Corbett’s numbers, and argues it’s still an easy choice to take the money.
At the same time, as a good article in today’s New York Times describes, these dueling reports can be decisive: a separate Urban Institute study was central to Ohio Gov. John Kasich’s decision to embrace Medicaid expansion, a Times source says.
And more broadly, part of the press’s job is to help keep the political conversation grounded in realistic numbers. Whether or not the political players in Pennsylvania are operating in good faith, or just picking the Medicaid estimates that best suit their assumptions, it falls to the state’s journalists to plainly articulate the stakes. That means not just parroting the numbers in the latest report, or even noting in passing how they may be shaped by the agenda of lawmakers, budget secretaries, and advocacy groups. It means pushing further, to help readers understand which figures are credible—and setting the norm that when policymakers use numbers that don’t hold up, they will be called out for it.
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