It's early -- we have 362 days to go -- and so there will undoubtedly be competition. But as of Jan. 3, your leader in the clubhouse for most revealing quote of the year is this one reported by the Washington Post:
"[Saving money] was sometimes a misleading motivator for the Affordable Care Act. The law isn't designed to save money. It's designed to improve health, and that's going to cost money."
The speaker being quoted was Jonathan Gruber, an MIT health economist and one of the authors of -- you guessed it -- the Affordable Care Act.
Does anyone recall Gruber cautioning back in 2009-2010 that the law he was helping to craft and sell to the public was so blatantly misnamed? That all the Democratic claims during that time about deficit reduction, bending the cost curve downward, etc. were not really so truthy? That opponents of the law who said more or less what he is now admitting were right? Because I don't.
The last time I remember hearing from Gruber, it was in October when he authored a study saying the Affordable Care Act was ... well ... saving money:
"The Affordable Care Act is already working: Intense price competition among health plans in the marketplaces for individuals has lowered premiums below projected levels. As a result of these lower premiums, the federal government will save about $190 billion over the next 10 years, according to our estimates. These savings will boost the health law's amount of deficit reduction by 174 percent and represent about 40 percent of the health care savings proposed by the National Commission on Fiscal Responsibility and Reform -- commonly known as the Simpson-Bowles commission -- in 2010." (emphasis added)
Now, the real experience of many Americans is quite different. And let's note, once again, that the "savings" Gruber cites above were actually lower increases than what was previously projected. Which is standard practice in Washington accounting, but not exactly what most people think of when they hear of costs going down.
But in any case, that was a lot of talk of savings -- three instances in that paragraph alone -- by someone who now admits the Affordable Care Act is really designed to cost more money.
In any case, the reason the Post was quoting Gruber was to get his reaction to a new study in the journal Science suggesting new Medicaid patients are more, not less, likely to visit the emergency room than when they were uninsured:
"As the health-care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment in public program significantly increases enrollees' use of emergency departments.
"The research, published Thursday in the journal Science, showed a 40 percent increase in emergency department visits among those low-income adults in Oregon who gained Medicaid coverage in 2008 through a state lottery. This runs counter to some health-care law supporters' hope that Medicaid coverage would decrease this type of costly medical care, by making it easier for low income adults to see primary care providers."
Another key line:
"The researchers also looked at the types of visits and found no decline in use of the emergency department for primary care treatable conditions among those who had enrolled in Medicaid coverage." (emphasis added)
So, this is not just a case of these patients having more emergencies, or being better able to get treatment when they have emergencies. It's an indication having Medicaid doesn't change people's behavior in the ways we've been told it would.
The study period was 18 months, and it is possible this is just a case of old habits dying hard. Or maybe it's a sign one of the underlying premises of expanding Medicaid is turning out to be wrong.
Treating people for non-emergencies outside the emergency room is a worthy goal that probably would reduce health spending. But the results of this study -- which is part of a broader research effort in Oregon I have written about before -- suggest it might be better to direct money toward expanding those non-ER options for more people than providing or subsidizing coverage for fewer people.
That's something for Georgia policymakers to think about as they are being bombarded by pro-Medicaid expansion folks.
