Opinionated @ CFE

Utah should decline Medicaid expansion

Jan
24

One of the hot-button issues to be discussed at the upcoming legislative session is whether or not to expand Medicaid as part of the Affordable Care Act. The Act provides 100% funding to begin with, then drops back to 90% (or possibly less) in future years. That big sack of money makes for a pretty tantalizing offer, but I don’t think it’s a good idea to take it. Here’s why.

The obvious problem is that most of the Medicaid expansion money is only available via federal borrowing. It’s pretty easy to rationalize that the money will be spent anyway, so we should get our share. It’s also easy to justify as being a relatively small amount of money compared to the current budget deficit. To be fair, I think this is probably one of the weaker arguments against the expansion, but I do think that, even as a largely symbolic gesture, it’s a good idea to put our money where our mouth is on federal spending.

A deeper problem (and, indeed, the core problem with the ACA) is that a Medicaid expansion is subsidizing an overpriced healthcare system rather than attempting to resolve the cost issues that make even routine procedures unaffordable. True, using a subsidy may alleviate the symptom for some, but there is no mechanism to try and curb costs. This is a long-term recipe for requiring more subsidies to maintain the same levels of care. This turns into a vicious downward spiral where both costs and subsidies for that cost continue to rise. The end result is that more people end up relying on Medicaid and the cycle continues.

Since the Medicaid expansion doesn’t appear to be serious about either controlling costs or providing flexibility in doing so, I see no reason why Utah should get involved with it. There are much better solutions out there, such as targeting hotspots, that can both curb Medicaid spending and provide a much higher level of care while driving down costs across the board. Let’s do something smarter than tossing a multi-billion dollar bandage on the problem.

Yes, John Swallow, you need to resign

Jan
17

Most of us who play inside ball knew from the start that John Swallow was bad news. After a decade of questionable choices in his actions (all seemingly carefully crafted to be just on the inside of legal), he’s now finding himself caught up in a very serious accusation of being involved in a bribery scheme. While Swallow denies attempting to bribe US Senate Majority Leader Harry Reid, what he does admit to is enough that he needs to step aside for the good of the state and the office. A few highlights:

  • He transferred ownership of a consulting business to his wife in order to avoid including it on campaign disclosure forms. This business was allegedly setup to provide services to Jeremy Johnson.
  • There is both a recorded conversation and email record showing that Swallow knew he was walking right up to the line of barely being legal.
  • Most importantly, he has admitted to providing legal advice and referrals to Johnson despite knowing that he was the subject of an ongoing investigation. This breach of legal ethics, providing advice to a potential future defendant while serving in a prosecutorial role, is egregious enough to warrant potential┬ádisbarment.

All of these actions only further the accusations and rumblings that the AG’s office has been effectively operating a paid protection racket, allowing donors to write a check to make problems go away. Even if there is nothing to them, bringing this dark of a cloud with you should warrant that you leave immediately. Multiple newspapers agree. So do high-profile politicos.

And so do I.

Mr. Swallow, you need to put the good of the state and the office of Attorney General above your personal (and often transparent) political ambitions. It’s time for you to resign.

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