by admin | Aug 16, 2016 | News and Updates
It has been six years since the sweeping healthcare legislation “Obamacare” passed. In that time states have grappled with the prospect of instating their own exchanges to cover all adults living within 138 percent of the federal poverty line. The feds have dangled 100 percent matching funds until 2016 and 90 percent after that for the states that expand Medicaid. Thus far, 32 states have taken the bait, including Arizona. And as many of the critics predicted, expansion has failed to deliver on any of its promises and has now trapped states into a fiscally unsustainable program.
Higher than Expected Costs
The financial architecture of the Medicaid expansion was predicated on a larger pool of new enrollees being cheaper than that of current Medicaid members. This premise has proven to be a complete miscalculation. According to a recent report by the Department of Health and Human Services, new ACA enrollees cost an average of $6,366 annually, 49 percent higher than their initial predictions. Apparently not factored into the costs were the states’ response to economic incentives – given the feds were flipping the bill – most states have exceptionally high capitation rates. This economic fact never changes, if someone doesn’t have to personally pay for it, they will spend more. This apparently applies to states as well as individuals. Once again, the government has under-estimated the costs of their healthcare bureaucracy.
Lower than Expected Benefits
Proponents often cite the metric of new insured individuals as the evidence of Obamacare’s success. There is no debate here. Without a doubt, under penalty of a fine, more people have insurance. However, the data surfacing reveals a deeper truth about the healthcare law. A study conducted by economists at MIT found every one dollar of government spending on Medicaid resulted in 0.20 – 0.40 of benefit to Medicaid recipients. Not only are the costs ($425 billion in 2011 alone) to fund Medicaid extraordinary, but the efficiency of those dollars are so low, one must ask the question, what are we even paying for?
This corroborates what past studies have already demonstrated. In 2008, Oregon conducted an expansion of its Medicaid program, prior to the advent of Obamacare. What was deemed as “The Oregon Experiment” showed simply insuring more individuals did not correspond to improved health outcomes for those individuals. And yet we continue to dump more dollars into a system which does not deliver the health results for Americans.
Competition is Disappearing
Even with high capitation rates, private insurers are losing money on ACA plans. The gorilla of private insurance, UnitedHealth Group, reported $200 million in ACA losses just in the second quarter of this year. They are pulling out of most state exchanges. Anthem is in the midst of acquiring Cigna Corp, they are threatening pulling out of the exchanges, should the feds stymy their merger plans. Centene who recently acquired HealthNet, is facing structural financial woes as HealthNet has suffered extreme losses of its ACA plans. Humana too is fleeing many of its exchange plans. Aetna anticipates $300 million in losses on marketplace plans this year and has since stalled plans to enter into new markets. Many of the Blue Cross Blue Shield Insurers are losing money in exchange states as well. One fact is for certain, the private insurance industry is bleeding out in the public exchange market. As higher risk consumers flood the exchange and low-risk, healthy consumers hedge their bets with no insurance, private insurers are either cutting their losses or eliminating popular PPO plans in lieu of thin network, high deductible and co-pay plans as well as higher premiums. In rural areas, like Gila County in Arizona, the lack of choice is particularly acute. This obvious crisis of competition is spurring the Obama Administration to call for Congress to develop its own public plan. What could possibly go wrong with that?
The deficiencies of heavily subsidized public healthcare systems are well documented. In the 1990’s several states tried their hand at developing their own state systems. They provided “guaranteed issue” and “modified community ratings” which eventually led to the squeezing of the individual health market, the decline in the number of private carriers, and eventually a bust of the system over all. Kentucky, Maine, Massachusetts, New Hampshire, New Jersey, New York, Vermont, and Washington have all been down this road before; all have suffered the same obvious disastrous results. Furthermore, though the Obama Administration and supporters had a rosy outlook of the Medicaid expansion effort, critics at the time were spot-on accurate with the consequences we are seeing today.
At the end of the day, the failings of Obamacare and Medicaid expansion should be a surprise to no one.
by admin | Aug 9, 2016 | News and Updates
As many will recall, last month Governor Ducey announced in an executive order a prohibition on state agencies using taxpayer money to hire contract lobbyists. Now it appears that the publicly funded Citizens Clean Elections Commission (CCEC) is asking for a special exemption, claiming that contract lobbyists are essential to carrying out their mission.
What is the CCEC’s mission? According to the 1998 initiative and their own website, the entire program exists in order to reduce the influence of special interest money in politics. Yet they want an exemption to hire more lobbyists to expand their own influence. The hypocrisy is stunning, but not surprising.
The truth is the CCEC believes that they should be the only group with a voice in the political process. That is why they see no problem with asking for the exemption; since they are the only “legitimate” special interest, it is OK for them to hire contract lobbyists. The ends, therefore, justify the means. This follows a pattern for the CCEC, who believe they are exempt from all sorts of administrative oversight including the formal rule making process that governs all other state agencies.
This is a tremendous amount of arrogance for an agency that was approved with only 50.1% of the vote 18 years ago and has had their authority curtailed by the Supreme Court. The fact that the CCEC now thinks they are carrying out the will of the voters by contracting hired guns to lobby for them is absurd.
The elimination of contract lobbyists for state agencies is a win for taxpayers. Besides the actual money the state will save, more importantly it stifles the government’s ability to lobby for their own expansion and funding, which is more often than not contrary to the interests of the taxpayer. The Citizens Clean Elections Commission is no exception to this principle and so should be swiftly denied any exemptions.
by admin | Jul 28, 2016 | News and Updates
Small businesses in Arizona are under siege as of late, enduring a slew of Americans Disability Act (ADA) lawsuits brought on by trial attorney sharks and serial plaintiffs.
The ADA is a relatively new civil liberties law which requires businesses make “reasonable accommodations” in both employment practices and physical public accessibility to individuals with disabilities. The ADA was passed in 1992 and includes provisions for new construction as well as modifications to existing structures if those modifications are not “unduly burdensome.” These rules are so technical in nature there are over 100 specifications in a bathroom alone in order to meet the standards.
Given the newness of the law and the hundreds of ways in which to be even slightly out of compliance, small businesses are especially ripe targets for litigation. Within Scottsdale, Phoenix, Mesa, Chandler and Gilbert, almost 1,000 lawsuits have been filed against businesses over the past six months. Many of these cases wind up not going to court but instead businesses pay a settlement check to the plaintiffs.
The organization behind the suits, Advocates for Individuals with Disabilities, look for any violation; including parking lot signage, hotels without pool lifts, and bathroom toilet paper dispensers that are hung even an inch below the required height. Partnered with the same couple plaintiffs who in most cases do not even visit the specific facilities, AID has sent tens of thousands of letters to businesses in the valley threatening suit and forcing inspections.
This is an ongoing problem and endemic in states such as California that represent a shocking 40 percent of all ADA lawsuits and yet only 12 percent of the nation’s disabled population. California law is especially punitive as it allows every ADA violation, no matter the severity, to be subject to penalty and allows the plaintiff to collect $4,000 in damages plus attorney fees.
California seems to be the hotbed for the country’s trial lawyers’ schemes. This year The American Association for Justice (an organization for trial lawyers) holds their annual convention in Los Angeles where attorneys will plot as to how they can manipulate the legal system to get rich off small and big businesses.
Like so many political and legal plagues of California, these tactics have spilled over into Arizona and now threaten the very livelihood of our small businesses and harm our economy. As evidenced by a series of lawsuits filed by an Arizona woman against over 30 hotels in Coachella Valley at which she seemingly never intended to stay. It is clear these suits are not about compliance as much as they are about trial lawyers getting a quick dollar from as many well-intentioned businesses as possible.
In an effort to curb this litigious abuse, a Republican United States Representative from California Ken Calvert, has sponsored federal legislation to give businesses 120 days to correct any ADA violation before a lawsuit may be filed. This would put the onus on the person who claims to be aggrieved to notify the business of the specific violations and allow the business time to respond, investigate, and if required comply.
If passed, this legislation would mirror the ADA guidelines for employment opportunity. Currently, businesses are encouraged to have a dialogue with persons with disabilities who are either interviewing or employed with the business, in order to make reasonable and necessary accommodations. This is a civil approach that promotes an equal and fair work environment while affording businesses time, predictability, and a way to curb excessive costs. The “ACCESS” legislation is a common sense approach that respects the business owners’ rights, honors the spirit of the law and improves accessibility, and discourages the frivolous congestion of our states’ courts.
by admin | Jul 21, 2016 | News and Updates
The streets have been flooded this summer with California-bred, Big Union ballot initiatives. Although we celebrated a big win when the disastrous “Clean Elections” initiative failed to gather enough signatures, two others were filed at the deadline: the Minimum Wage Initiative, and a measure that seeks to cap the pay of hospital executives. Both submitted over 250,000 union bought signatures.
What is the impetus behind the Hospital Executive Compensation Act? The main driver/funder is the Service Employees International Union – United Healthcare Workers West (SEIU-UWW) out of California. They have led an effort of ballot initiatives and legislation over the past five years in several states to cap executive pay at hospitals. After losing a court case in El Camino County, California in 2013, where their ballot measure was ruled unconstitutional, the big union group has brought their bad ideas to Arizona.
Proponents argue hospitals receive enormous public subsidies, some in the way of property, income, and sales taxes exemptions, as well as by compensation through Medicaid and Medicare patients. Therefore, they ought to be able to prove they are providing more uncompensated care to the community than they are paying in salaries to top executives.
While there are a lot of problems associated with government subsidized medicine (the Club opposed Medicaid expansion in 2013), the fact is CEO compensation represents a fraction of the billions of dollars of these large hospital organizations’ total budget. Their salaries are determined by the market of supply and demand and for non-profits generally by the 50th percentile of CEO compensation of all hospitals. Many of these administrators are not only managing complex facilities with hundreds of beds and professional staff, but multiple hospitals as well.
Additionally, the metric of percentage of uncompensated care is misleading and unrelated to executive compensation. In order for hospitals to provide charity care, they must first have margins; revenues must exceed expenses. In order to accomplish this, many hospitals including non-profits, must establish services and technologies to attract private patients. Indigent care is driven by how many qualified patients come to a hospital.
It is in fact the government that has caused this problem. Over time, with the introduction of Medicaid, Medicare, Obamacare, and a tax and regulatory structure that impairs consumer choice and price signals, the government has inflated the cost of healthcare. By providing generous healthcare subsidies in the billions of dollars, they have displaced those costs onto everyone else. As they have turned the ratchet on socialized medicine over the past 50 years, costs have soared, and they have had to scramble to institute more “cost containment” measures – executive pay caps are just the latest. It is not generous pay scales that hinder charity care – it is a whole system wrought in bureaucracy where administrators are forced into economic decisions based upon government reimbursements and regulations.
Unmentioned by the initiative proponents is the IRS already requires non-profit hospitals to disclose executive salaries and benefits. The Treasury Department does a review and audit every three years to ensure that pay is reasonable and to ensure compliance with their status requirements. If they are found to be out of compliance, their exempt status can be revoked, forcing them to apply as a private hospital and to remit the applicable taxes. Hospitals are already highly regulated entities.
This initiative isn’t only antithetical to free markets principles; it will be a power grab for the state. The Attorney General will have the authority to audit a hospitals’ books – if found guilty of “excessive pay”, they could lose their state licenses as well as be charged under state consumer fraud laws. Furthermore, the AG will be allowed to place a representative on the hospital in question, board of directors. This is a gross infringement by the state into private organizations.
If passed, we can expect many of these executives to seek employment elsewhere, most likely out of state – taking their wealth with them. Just as countries such as Canada have experienced severe “Brain Drain” when they limited the compensation of its doctors and surgeons – Arizona will see the same. Experienced and talented hospital executives will be replaced with less qualified administrators. This will have a direct effect on the quality of care patients receive.
Executive compensation is in the end a red herring. This is just a means to in increase unionization in the health care industry and to distract people from the real culprit of high healthcare costs. Arizona voters should reject this very bad idea.
by admin | Jul 19, 2016 | News and Updates
Over the weekend, Free Enterprise Club President Scot Mussi and Heritage Foundation Senior Fellow Steve Moore published an op-ed responding to the misleading “Job Creation Progress Meter” being touted by the Arizona Commerce Authority. Judging by the cherry picked data used in the meter, it is obvious they are attempting to downplay the current and future prospects of job growth in Arizona while pushing their agenda of more targeted incentives and crony capitalism.The fact is Arizona’s future is very bright. Here is the op-ed in its entirety:
By: Stephen Moore and Scot Mussi
Arizonans might be surprised by a new report which suggests that Arizona is limping behind other states in economic development and attractiveness as a destination.
A new report called “Job Creation Progress Meter” by the Arizona Commerce Authority and Center for the Future of Arizona (re: How Arizona Can do Better on Jobs) uses highly misleading data to suggest Arizona is falling behind on jobs and growth.
Sure there is a lot of room for improvement in the schools, the tax code, regulations, and the state’s treatment of job creators. The two of us have been dedicated to educating Arizona’s political leaders on how to improve business conditions and create more good paying jobs for years.But this new report gets the story wrong. For example, one of the measurements used in their report is the state’s per capita income. While this can be a useful measurement, most economists recognize that you should take into account cost of living, since living in Arizona is much more affordable than living in states such as New York.
The “job creation” report fails to make this adjustment, thus making Arizonans’ living standard lower than it really is. New York, New Jersey and Connecticut are portrayed by this measure as prosperous. But these three states that were once prosperous are now bleeding jobs, businesses and workers. Many of them have come to…Arizona. These newcomers apparently see more opportunity in Arizona than the academic researchers. Maybe they need to get out of the ivory towers.
Additionally, the “job creation” report seems to ignore every economic indicator that would portray Arizona in a favorable light. Nowhere does it include vital economic data such as population growth (Arizona ranks the 4th most attractive destination of any state in terms of domestic migration). The state’s tax burden is low (but should get lower). New business startups and relocations into the state are high.
The report instead focuses on fairly obscure ratings that are interesting but not central indicators of growth. These include international exports and venture capital investment per capita, two very narrow data points that tell us little about the overall health of Arizona’s economy. Arizona is a major tourist state. So relatively, the state has fewer jobs in areas like manufacturing. That doesn’t make us poor. Look at Florida for goodness sakes.
Incidentally, California does well in both exports and venture capital investment. Does anyone believe that we should emulate their policy model where the rich are very rich and the poor are very poor and the cost of living for the middle class is through the roof? We hope not. The middle class is fleeing the Golden State in droves with many coming here.
The truth is that Arizona is headed in the right direction. Arizona continues to have a pro-growth climate and ranks in the top five of states in terms of economic outlook according to ALEC, a membership organization of state legislators. Recently, Forbes magazine ranked Arizona the best state for future job growth in the nation.
For Arizona to do even better in the years to come means building on our current successes and staying ahead of our competitors by continually improving the tax, regulatory and fiscal policy of the state. It also means remaining focused on broad based reforms – like cutting tax rates – that benefit all taxpayers and employers, not targeted solutions that cater to a select few politically connected industries.
Stephen Moore is a Senior Fellow at the Heritage Foundation. Scot Mussi is President of the Arizona Free Enterprise Club.
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