By JIM WATERS
The Bluegrass Institute
A favorite tactic of opponents to the Bevin administration's attempt to rein in Kentucky's Medicaid expansion is to predict health-care Armageddon for 100,000 Kentuckians if able-bodied adults without dependents or disabilities are required to work, train for jobs or volunteer at least 20 hours per week in order to continue receiving benefits.
Progressive crusaders are buoyed by attempts by Judge James Boasberg of the U.S. District Court for the District of Columbia to dictate Kentucky's Medicaid policy from his courtroom 560 miles away from Gov. Matt Bevin's office.
Except the judge isn't offering meaningful guidance for addressing unsustainable costs imposed by Medicaid on states' budgets; he's only saying "no" to all proposals from outside the Beltway.
In his March ruling -- his second striking down Kentucky's proposed work requirements and first addressing similar rules implemented by Arkansas -- Boasberg wrote he "cannot concur" that Medicaid law leaves the Trump administration "so unconstrained, nor that the states are so armed, to refashion the program Congress designed in any way they choose."
This judge absolutely wants to prohibit states from having any power to refashion an entitlement program that's more than a half-century old and has ballooned into a costly boondoggle by implementing incentives reducing the number of recipients and saving billions.
Somewhere, Madison and his fellow founders -- who believed states hold the upper hand of political power -- are cringing at such anti-federalism.
Medicaid's costs, meanwhile, continue to rise.
Betsy McCaughey, former lieutenant governor of New York and author of "Beating Obamacare," claims families with private insurance pay up to $2,000 more in added premiums yearly just to keep Medicaid afloat and that hospitals and doctors make up for lower government-reimbursement rates "by shifting the costs onto private insurance patients. Ouch."
How much higher could those premiums rise if Medicaid enrollment soars from the current 75 million to 86 million by 2026, which the Congressional Budget Office has warned could happen without substantial reforms?
McCaughey notes that Obamacare has caused Medicaid enrollment in her state to spike by a third to 6.3 million; Kentucky's increases have been just as impactful, if on a smaller scale than New York's.
Nationwide, Medicaid's enrollment growth and associated costs among able-bodied adults alone -- from fewer than 133,000 and less than $670 million in 2013 to more than 633,000 and $4 billion in 2015, according to the government's own numbers -- is staggering.
Past evidence suggests allowing states to lead offers the best chance for solving the Medicaid problem and saving the program.
After Tennessee Gov. Phil Bredesen disenrolled 170,000 able-bodied adults from the Volunteer State's Medicaid program in 2005, there were lots of doomsday prophets coming out of the wilderness to prophesy future ruin for these former government dependents.
Instead, a large majority returned to the labor force where they obtained employer-based insurance.
A follow-up study in 2013 by economists from Columbia University, University of Chicago and Northwestern University found "a steady rise in both employment and health insurance coverage following (Tennessee's Medicaid) disenrollment."
Few new ideas come from Washington about anything these days, including how states should reform Medicaid so that it remains affordable and sustainable.
States have offered most of the proven plans, and, in fact, should be encouraged to do so.
The most dramatic -- and yet perhaps most necessary -- suggestion of all has come from Bevin himself, who pledged that without being allowed to implement work requirements, which would save the commonwealth more than $2 billion during their first five years, he would end Kentucky's Medicaid expansion altogether.
If that happens, opponents of reform will have no one to blame but themselves.
Jim Waters is president and CEO of the Bluegrass Institute for Public Policy Solutions, Kentucky's free-market think tank.