The Milwaukee Journal Sentinel’s Guy Boulton, the Gannett chain reporter on health care and health policy, wrote a scathing criticism of a study by the Wisconsin Institute for Law & Liberty (WILL) on the private health care costs of Governor Tony Evers’ proposed Medicaid expansion. However, Boulton failed to include relevant responses from WILL and also failed to disclose the partisan leanings of the experts he quoted to the readers.
The WILL study, conducted with Noah Williams of the Center for Research on the Wisconsin Economy (CROWE) at the University of Wisconsin-Madison’s economics department, found that if Wisconsin accepts federal Affordable Care Act (Obamacare) money to expand Medicaid then overall private medical spending will actually go up $1.1 billion with a net loss in benefit to the state of $600.3 million in 2020.
Boulton found three critics of the study for his article, including one whose less-than-civil criticism ended up in the headline, “Study cited in Wisconsin debate on expanding Medicaid and taking federal money called ‘garbage.'”
“My real concern is they are trying to affect policy with such garbage work,” Boulton quoted Tim Classen, a professor of economics at Loyola University in Chicago.
However, Boulton does not mention that Classen, judging from his Twitter feed wherein he criticizes Republicans from former House Speaker Paul Ryan (R-WI) to Sen. Orrin Hatch (R-UT), is a partisan Democrat. Classen even signed a letter prior to the 2016 election urging voters to choose former Secretary of State Hillary Clinton over President Donald Trump.
Boulton also quotes Andy Schneider, a research professor at the Center for Children and Families at Georgetown University, questioning whether health care costs will be shifted to the private sector as the study describes.
“They are going to raise prices to the extent that they can anyway,” Schneider told Boulton. “If they have market leverage, they are going to raise prices.”
Undisclosed by Boulton, Schneider served in the Obama Administration as a Senior Advisor at the Centers for Medicare & Medicaid Services and would have a vested interest in seeing Medicaid expand in Wisconsin and elsewhere as originally planned when Obamacare was passed. Given the direct connection, Boulton’s readers would have benefitted from knowing Schneider’s background when weighing his statement concerning the study.
When asked why Boulton did not disclose the partisan leanings of the “experts” quoted in the article, Boulton responded in an email he didn’t see the need.
“I rarely ask economists and policy analysts their political leanings and try to avoid labels such as ‘conservative’ and ‘liberal’ or ‘right-leaning’ and ‘left-leaning,'” Boulton said. “What I care about is what they have to say.”
But Boulton was willing to label Robert Laszewski of Health Policy & Strategy Associates as “a sharp critic” of the Affordable Care Act. However, Laszewski is less of a “sharp critic” of the Affordable Care Act than he was of Republican efforts to repeal and replace Obamacare in 2017.
Unfortunately, Milwaukee Journal Sentinel Editor George Stanley did not respond to an email asking about Boulton’s failure to disclose the partisan leaning of his experts, so we do not know if Boulton’s failure was a violation of the newspaper’s policies.
Will Flanders, the research director for WILL, responded to the critics of the study in a blog post for the WILL website, reposted at RightWisconsin. In the blog post, Flanders noted two omissions by Boulton of answers by WILL that would have responded to the study’s critics.
The first concerned the time frame of the study because of the different starting points for expanded Medicaid coverage for different states.
“For example, New York, Delaware and Massachusetts expanded coverage before that year. And some other states did limited expansions before 2014,” Boulton wrote. “That said, more than 8 million people — a large number by any gauge — gained coverage through the expanded eligibility for Medicaid in 2014.”
What Boulton did not report was Flanders’ pointing out that the study did account for the different starting times for Medicaid expansion, as he wrote in the blog post defending the study.
“We were aware of these differences and used control variables to attempt to account for differences between states,” Flanders wrote. “Moreover, when we change the model to that suggested by critics, the results show that Medicaid expansion actually costs more!”
Boulton claimed that he didn’t include the recalculation in the story because Flanders could not say the reason for the change and Boulton did not want Flanders to appear foolish. Boulton claimed in an email to RightWisconsin the following was cut from the Journal Sentinel article:
Flanders did a reanalysis using only states that provided some Medicaid coverage before 2014 to the states that didn’t expand the health program. The model found that expanding eligibility in Wisconsin would result in a significantly higher cost than their previous estimate.
That doesn’t make sense, however, given that the number of people who gained coverage – and the purported cost shift — should be lower.
Flanders did not know why the model showed those results.
But Flanders did offer a number of possible explanations, as he explained in the blog post.
The estimated effect of expansion was a $299 increase in spending per person, compared to the $177 per person reported in our paper. This analysis has been uploaded to our website here. Although we can’t say for sure, there are a number of reasons that this could have happened. Perhaps the most likely is that states that offered more extensive benefits prior to expansion had less uncompensated care than states that expanded from a lower tier, and thus did not see the cost reductions that higher expanders could. But the bottom line: the model in our paper presents, if anything, conservative results.
As for Boulton’s claim that he did not want to Flanders to appear foolish, that lacks credibility in an article quoting a partisan critic describing the study as, “baloney” and “garbage.”
Boulton also claimed he was trying to protect the reputation of Flanders and Williams when he did not note that the reported error by the Kaiser Foundation repeated in the study did not change whether there was going to be a substantial impact to private health care costs if Medicaid was expanded in Wisconsin. Instead, Boulton said the error raised questions about the study.
“The study’s model also incorrectly used a ‘per-enrollee’ figure — average spending for people in private health plans — as a ‘per-capital’ figure, meaning everyone in the state,” Boulton wrote. “This was an honest mistake that came from an incorrect footnote. But it distorted the study’s conclusion because about a third of the state is covered by Medicaid or Medicare.”
In his blog post, Flanders criticized the newspaper for not properly explaining the effect of the error which was actually made by the Kaiser Foundation. “Kaiser’s error in misdescribing certain data as per-person rather than per enrollee, affects the amount of increased costs for Wisconsin residents from a Medicaid expansion but it does not affect our conclusion that the increases would happen and be very large,” Flanders wrote. “Again, the author of the Journal Sentinel piece knew this but failed to tell his readers.”
Boulton explained in an email to RightWisconsin why it was left out.
We mentioned the error only in passing and reported that it was an honest mistake. It was. But it also suggests that Dr. Flanders and Dr. Williams could have been more careful with their data.
It would have been perfectly reasonable to question why a figure on spending in private health plans would be reported as a per-capita figure and not a per-enrolled figure, and, certainly, it’s a question that a health economist would have asked if they have sought input on the model. They did not do that.
I saw no reason to embarrass Dr. Flanders or Dr. Williams by stressing the error but did have to mention it in the story.
However, Flanders explains in the blog post, the error was on the part of the Kaiser Foundation. And while the cost shift to the private sector was less, it was still very significant at $400 million.
We used data from the Kaiser Family Foundation that was described as the per capita cost of private health insurance. It has been noted that this is mislabeled data from the Centers for Medicaid Services, and should be described as “per enrollee.” If this is correct, our estimated statewide net effect, based on about two-thirds of Wisconsinites having private insurance, would be $400 million instead of $600 million. That is less than our initial estimate but it is still large and still significant. That said, it remains unclear if cost-shifting happens to those with other public insurance, such as Medicare, which could serve to further increase that figure.
In his rebuttal to the study’s critics, Flanders wrote that he had no desire to pick a fight with the newspaper. But Flanders is correct that the omissions by Boulton did leave readers “in the dark” about a serious public policy issue that could dramatically change both state government and private insurance.
(Note: You can read the entire WILL rebuttal to the study’s critics on RightWisconsin.)