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There’s often magic and meaning in round numbers: The Dow index passes 15,000, a baseball player hits .300, crime falls to 50-year lows.
Here’s a milestone that tells a different kind of story: The number of people on Medicaid in New York City has passed 3 million. As records go, this one carries a dubious distinction — and a red alert about the future.
The rise in enrollment, from 2.5 million in 2005, to 2.9 million in 2011, to 3.1 million today, adds another headache for the next mayor. In a city of 8.3 million people, that over 37 percent get health insurance under a poverty program shows both the decline of the middle class and the vast expansion of government benefits.
With ObamaCare expected to add hundreds of thousands more people to subsidized-insurance rolls, it is obvious that the current course is unsustainable. Less obvious is what to do about it.
Only 51 percent of New York workers get health insurance from their employers, against 59 percent in the rest of America, according to the city’s Human Resources Administration. New York state, unlike some other states, has no residency waiting period, so newcomers who qualify get benefits immediately.
All asset tests have been dropped, and hospitals and managed-care companies, which get paid under Medicaid, aggressively enroll new recipients.
Legal immigrants are eligible, and illegal immigrants get emergency care under Medicaid. Albany sets an expensive benefit package, and long-term care for the poor elderly is a big cost-driver. Overall, the average cost is about $8,000 a year for each recipient, about twice the rate in California.
Outside the city, 2.4 million state residents get Medicaid, for a state-wide total of 5.5 million.
“There’s been a bipartisan consensus for some time, both among governors and mayors, to make it easy to join the program,” Robert Doar, the HRA commissioner, told me. “We view it as using Medicaid as a work support. If people don’t have health insurance, they often won’t work.”
He pointed to the lopsided numbers: 360,000 city residents get cash welfare grants, meaning they don’t work, while 3.1 million get Medicaid. Also, 1.8 million get food stamps, and most of them work.
Medicaid costs city taxpayers $6.2 billion a year, with a total of $28 billion spent on the program in the five boroughs, with Albany and Washington picking up the remainder. Of course, city taxpayers contribute to all that spending.
Doar, when I asked how the next mayor could keep Medicaid from swamping the budget, offered two suggestions.
“I would fight to preserve the cap on local costs because the city can’t afford to be on the hook for growth,” he said. Under state law, the city’s share of costs can’t grow much beyond the current level, but the state can’t afford to increase its spending either, so the state might try to push the burden back to localities.
Doar also said the next mayor must be aggressive about cracking down on waste and fraud, citing two distinct concerns.
One involves managed-care companies that get a fee for each person they enroll, regardless of whether care is provided, and sometimes enroll the same person under different names. “Our enforcement team finds some people enrolled twice or more,” he said.
The second concern involves notorious billing procedures. “Multiple visits were billed when there was only one, or the patient was sent home on the subway and Medicaid was billed for carfare,” Doar said. But reforms, and prosecution, are not simple.
“Taking on the providers can be very political,” he said. “You are taking on a very powerful constituency.”
A recent Bronx case shows his point. Democratic Assemblyman Eric Stevenson was indicted for bribery with business owners who wanted a monopoly on Medicaid-funded adult day-care centers. Stevenson introduced legislation to make it happen.
“You really have to watch the people in this business,” Doar said.
He meant the providers, but he might as well have been talking about the politicians. They created this mess, yet seem to have no clue about how to fix it.
JOHN KERRY’S SORRY ‘STATE’
The claim that Hillary Rodham Clinton was a “great” secretary of state was propaganda cooked up from the start. But her successor is pulling off a more unlikely trick — making Clinton actually look good.
John Kerry lusted after the job for years, and it shows. His ideas are dated retreads with all the excitement of rotary telephones.
On Syria, he wants a big summit involving Russia to turn the killing fields into gardens. His fanciful idea for Israeli-Palestinian peace depends on private businesses investing $4 billion in the Palestinian economy.
Stop me when you find a plan with better odds than a snowball’s chance in hell.
Clinton ducked the hard problems, traveling the world as a celebrity while trying to avoid damaging her 2016 presidential prospects. Benghazi was an exception, where she was dragged into trouble, and her terrible performance could burn her.
Although Kerry jumped in where Clinton feared to tread, he gets no extra points for effort if he has only bad ideas.
With Iran and Hezbollah supporting Syria’s Bashar al-Assad, Kerry’s hope that Russia, Assad’s other benefactor, will broker peace is daffy. It supplies Assad with weapons, and likely agreed to Kerry’s summit to see if it could secure Assad’s survival. If not, it will keep the war going.
Meanwhile, the Syrian opposition is dominated by al Qaeda groups, and America could lose no matter which side wins the war. If Kerry has a goal beyond a cease-fire, it’s a secret.
On Israel, his investment plan puts the cart before the horse. With the region in turmoil, businesses won’t spend, yet Kerry told a conference his plan could expand the Palestinian economy by 50 percent in three years. Stay away from the hookah, man.
An Israeli report said the audience was silent, and a commentator concluded that Kerry made a fool of himself.
Bring back Hillary?
O, hell, that damn GOP!
To Dear Leader diehards, each failure by President Obama just proves he is a victim of Republicans or circumstances beyond his control. But a recent editorial in the New York Times takes the argument to a level of farce.
After accusing Obama of “throwing money at nukes” to upgrade our existing stockpile, the Times finds a way to shift the blame to the GOP. It says Obama “made a Faustian bargain with Senate Republicans” to fund the upgrade in exchange for Senate approval of a treaty he wants with Russia.
Poor Obama — the devil made him do it!
Jailhouse jihadis
Question for President Obama:
The London Times reports that Muslim inmates in British prisons were “inspired” by the gruesome public beheading of a soldier. Are you sure the war on terror is over?
Poli Sci 101: Art of Lying
From a press release:
“HANOVER, N.H. — Dartmouth has faculty experts in political scandal, lying and obfuscation… ”
Sounds like they hired Eric Holder.