Senior Fellow, Manhattan Institute. Opinions my own.
Joined July 2017
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Everyone knows what conservatives don't like about the welfare state.
It's time for a right-of-center vision of what it *should* be doing:
amazon.com/dp/1630695432/
It's striking that Minnesota has such high Medicaid HCBS spending on under 65s, when its HCBS spending on seniors is unexceptional: medicaid.gov/medicaid/long-t…
Complaints about boomers are like those about any once-dominant group that's lost its power: cdn.www.census.gov/content/d…
The Great Society didn't significantly increase the generosity of welfare benefits, it mostly just expanded eligibility: ncbi.nlm.nih.gov/books/NBK23…
The policy world is full of ugly acronyms because people are too reluctant to create new words. In this, as in many other things, we need another Bentham... ucl.ac.uk/laws/research/rese…
The mechanics of Medicare for All are far less popular than its slogans.
Maryland's experiment with its payment reforms reduced the number of patients each hospital treated, while making care costlier for those whom they did see.
city-journal.org/article/med…
If the ideal of HCBS self-directed benefits for seniors is essentially close to cash, wouldn't it just better to just reform Social Security benefits (in a budget-neutral way) to adjust for ADL needs?
That would also avoid federalism abuse and inequities.
sciencedirect.com/science/ar…
Gaps in targeted programs can be filled at feasible budgetary cost.
Shortfalls in universal benefits reflect unavoidable hard limits on fiscal capacity.
wsj.com/world/europe/rioting…
Politicians want to expand HCBS benefits to seniors regardless of income. But middle-class seniors have incomes, assets, informal help, and prior careers to set aside for non-institutional LTC needs.
I/DD beneficiaries deserve help more because their needs are uninsurable.
Medicaid is a $900bn/yr program and we have very little idea of where the money is going.
Its long term care benefit has 5 main, largely mutually exclusive, eligibility pathways, and there's essentially no data on the breakdown of enrollment or spending by each.
Making HCBS a nationwide mandatory Medicaid benefit would surely be a non-starter due to: 1) NFIB v Sebelius, 2) moral hazard related to 90% match rate necessary to get states to accept it.
To be fair, the HCBS Access Act (with 19 Senate D sponsors) side-steps the first concern by establishing a 100% FMAP for HCBS (without any cap!) congress.gov/bill/119th-cong…
The scope of mandatory benefits it establishes is wild.
An R should ask for a @CBO score just for the LOLs...
It's amusing to see the Senate D report on LTC say there is no problem of fraud in HCBS on p28, and then on p29 warn that private equity owns most of the home health agencies in NY and could easily fleece the program to an extraordinary degree 🤔
finance.senate.gov/imo/media…
Medicare For All will get the media attention, but expanding HCBS looks like the mainstream health policy thrust if Democrats pick up Congress: finance.senate.gov/imo/media…
