There You Go Again

Newblock Park, Tulsa.  ID’d by Greg Morris

That famous line uttered by then candidate Ronald Reagan during the final debate of the 1980 campaign with President Jimmy Carter supposedly helped propel him to victory a week later.  President Carter had just made an eloquent argument for the expansion of Medicare (downward in age) to the nation’s working population as the best way to control rising medical costs and assure a more productive workforce–almost as eloquent as the letter by E Carlton James I reprinted in Looking for Mr. James.  Carter concluded his statement by pointing out that Reagan had campaigned widely against the passage of Medicare in 1965, which history was what Reagan deflected with his charm and by saying he was for it but still against it, meaning that Carter was misrepresenting him.  Reagan won; providing a sensible system of heath care for working Americans continues to flounder now 37 years later.  Here is a video link to that famous exchange:

I’m using the phrase not as a cute deflection but as a direct scolding to Limited Thinker Trent England for repeating errors that I’ve previously taken the time to demonstrate for him in Unbelievable!  In that post I took England to task for showing, without footnotes, and relying upon an obviously misleading/erroneous table produced by the Oklahoma Senate in its publication at Page 17, FY 17 Appropriations Report.  Now, in his post The Bogus Budget: Medicaid Expanded Anyway, May 11, 2017, he wants to convince us that, despite Oklahoma’s refusal to accept Medicaid expansion under the Affordable Care Act, we have one of the fastest growing Medicaid programs around and the budgetary implications would be even worse if we hadn’t followed the Oklahoma Council of Public Affairs’ advice so aren’t we glad we did.  Here’s the table he shows, again from the Senate’s publication Appropriations FY ’17:

Source: Oklahoma State Senate

While to his credit he doesn’t make a lot of hay about it, look at the increase shown from FY ’16 to FY ’17, which visually supports his argument that even without Medicaid expansion Oklahoma’s program is now growing rapidly.  If the Oklahoma Council of Public Affairs is going to call itself a think tank, and enjoy a tax exempt status because they are supposedly doing real research in the public interest, then England shouldn’t display this Table that begs for an explanation about the $1 billion roller coaster ride in “Total Expenditures” from FY ’15 through FY ’17, without showing enough curiosity himself, and respect for his readers, to inquire whether the Table accurately describes what happened.  Here’s the Table with footnotes included.

I am not as familiar with Health Care Authority budgets as I am with the State Department of Education which was the topic in Unbelievable!, so I can’t speculate, except to say the footnotes don’t explain the $1 billion down then back up as far as I can tell.   So I looked at the same report for FY ’16 and found this Table:

Note there is not the up/down.  True there was a revenue failure in FY ’16 that lowered appropriations by a net $64 million, but that doesn’t explain a $1 billion decline.  Also look at this Table from the Governor’s Budget Book for development of the FY ’18 budget:

It also shows actual total FY ’16 expenditures for the Health Care Authority and there is no decline from FY ’15 by $1 billion, then back up in FY ’17 by $1 billion.  I think this demonstrates, coupled with what I showed in Unbelievable! where the Senate FY ’17 Appropriations report has an $800 million error for FY ’16 total K – 12 expenditures, that the Senate Appropriations reports are inconsistently and sloppily prepared and can’t be relied upon for longitudinal comparisons.  This is not a petty critique of England’s work; if you are going to produce real “research” then you need to be able to recognize when data is obviously wrong.  How can we get to smart government policies if we base decisions on data that clearly is inaccurate.

So his clueless use of another erroneous Table produced by the Oklahoma Senate is the basis of my “There you go again” scolding.  But he doesn’t stop there; he goes on to cherry pick data from national sources which, assuming the data is correct, appears to support his argument, but also can be easily debunked with fairly simple thinking.  Here is his statement:

“A higher percentage of Oklahomans are covered by either Medicaid or the related Children’s Health Insurance Program than in Texas, Kansas, Missouri, and a dozen other states. Looking at data from all states between 2000 and 2014, The Pew Charitable Trusts found Oklahoma had the 11th largest increase in state spending as a share of the total state budget.”

These two sentences read casually together make it sound like Oklahoma is some kind of national leader in providing Medicaid coverage for working families—were that it is so.  My not-researched guess is that two major determinants of the rate of Medicaid coverage within a state are whether the state accepted Medicaid Expansion (yes = more coverage) and the incidence of low-income families in a state (higher percentage of low income = more Medicaid coverage).  When I read the first sentence I immediately speculated that Texas, Kansas and Missouri are also states that declined Medicaid expansion because only states with a very low incidence of poverty would have less Medicaid coverage than Oklahoma if they had accepted Medicaid expansion.  Here is the Medicaid Expansion list that confirms my speculation; England’s three state example was intentionally cherry-picked.

So all his first sentence really says is that Oklahoma has a greater incidence of poverty/low income families than do Kansas, Texas and Missouri, which proves nothing about our state’s decision to avoid Medicaid expansion except our people were hurt more proportionately than the people in those three states.

The second sentence also says nothing in support of his argument, rather it is a simplistic statistical slight of hand.  It is like arguing that Mighty Casey should be named 1927 home run champion of the league over Babe Ruth because his share of Mudville’s home runs increased from 25% in 1926 (10 of 40) to 50% in 1927 (10 of 20), while the Babe’s percentage of his Yankees’ home runs actually declined from 39% (47 of 121) in 1926 to 38% (60 of 158) in 1927—what a loser the Babe was.  You see, the two largest components, and only billionaires, of the Governor’s FY ’18 proposed appropriation budget are K-12 education ($2.55 billion) and the Health Care Authority ($1.10 billion).  So in our Nation’s league of state budgets where Oklahoma leads the pack for decline in appropriations to K-12 education, you’ve seen this before:

We become Mudville and our Medicaid spending, having changed hardly at all I suspect, is like Casey’s home run output—basically flat.  But with a budget base (Mudville’s home runs) that’s declining compared to the rest of our league, our percentage of Medicaid of our state budget, which is the statistic he cites from Pew, shows a nice increase.  Whoop de do!  Don’t read much about Casey being the 1927 home run champ either.  Nice try Limited Thinker England.

Two last words.  Remember that the larger component of Medicaid spending is for old folks in nursing homes, see Not An Old Geezer Yet, a fact the Oklahoma Council of Public Affairs won’t remind you of.  What they will say, and is quite misleading, is this by their President Jonathan Small in his 2013 drivel Oklahoma Health Care Authority should stop expanding Medicaid:  “Not all of these Oklahomans are poor. (Did you realize that a person can have up to $500,000 of equity in a home and still qualify for Medicaid?)”.  What he is referring to is the provision to prevent “spousal impoverishment”.  If old Geezer Adam requires skilled nursing assistance and is single then his income must be low enough and his assets cannot exceed $2,000 in order for Medicaid to pay the difference between his income and the nursing home expenses.  But if Adam is married and his wife Eve lives in their house they own jointly, the spousal impoverishment protection that Small deplores allows her to keep the house (I’ll accept Small’s $500,000 limit in equity) and additional assets and a share of the income, clearly as a matter of public policy to allow her the opportunity to continue living independently and without assistance.

Apparently if the Oklahoma Council of Public Affairs had its way then Eve would be required to divest of all her assets, applying everything to Adam’s care, and live where and how our limited thinker Small doesn’t say.  In reality, even with the spousal impoverishment protections, Adam’s nursing home stay can easily leave his Eve in a financially precarious position.  In my law practice, especially when counseling couples about late in life second marriages, I often pointed out the better financial choice would be to live in sin rather than to marry.  As a measure of the human spirit, in short supply at the Oklahoma Council of Public Affairs, none ever heeded my advice.

As always, lunch on me for the first to ID the photo location.

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