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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