Forget Politics and Ideology, Medicaid Expansion is Just Bad Policy

Ohio Governor John Kasich made national news with an Associated Press interview concerning Obamacare and Medicaid expansion.

“The opposition to it was really either political or ideological,” Kasich told the AP of Medicaid expansion. “I don’t think that holds water against real flesh and blood, and real improvements in people’s lives.”

We plead guilty to opposing the Affordable Care Act and Medicaid expansion, but on  purely policy grounds.  Doctors provide better care in a market-based system than a system controlled by the federal government. Medicaid remains a poor way to expand health care to low-income people.

The Buckeye Institute has repeatedly argued that Medicaid expansion is bad policy for Ohio. It places unsustainable financial liabilities on future taxpayers. It will provide an additional burden to a labor market that has already been reeling in Ohio, doing long-term damage to the economy and compounding the expansion’s direct impacts to the state budget. We have also pointed out that this economic sacrifice is for a program that has not proven to be able to obtain significantly better health outcomes for most recipients and fails to provide a real saving grace to the most vulnerable.

In the same interview, Kasich said,

“I have favored expanding Medicaid, but I don’t really see expanding Medicaid as really connected to Obamacare.”

But in fact, the two are inextricably linked. According to the Washington Post, “If every state opted into the program, it would account for about half of the expected coverage gains under the law.” The Heritage Foundation finds that so far, 71 percent of the 8.5 million individuals who gained coverage did so via Medicaid expansion.

Further, Ohio is unlikely to have considered expanding Medicaid in absence of Obamacare and its dubious promises of federal grants to fund it, at least for the time being. The CBO estimates the total cost of the ACA coverage provisions at $80 billion in 2015 alone, of which $29.5 billion or 37 percent is Medicaid. Approximately 43 percent of the added $1.8 trillion projected cost of the ACA to the federal government from 2015-2024 is due to Medicaid and CHIP.

A legislative decision to reauthorize the use of federal money to pay for Medicaid expansion will need to be reached next year, presumably during the biennial budget negotiations. Ohioans should urge their legislators to shun politics and ideology and instead consider whether this is really the best policy for our future.

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The Buckeye Institute Supports Healthcare Solutions Week

The week of October 13 is Healthcare Solutions Week, a collaborative campaign to examine new healthcare reform ideas. Along with our partners, we are promoting the central purpose of the campaign. As Healthcare Solutions Week organizers noted:

“For too long, we’ve had a debate about the politics of health care, not the solutions that bring better health. The fact is, our health care system had complex and serious issues that needed addressing, and while the ACA may have been a well-intentioned response, it’s time to move past the politics and acknowledge that the status quo isn’t working. We need a new solution for our health care problems.”

The Patient Protection and Affordable Care Act (ACA) features centralization of health care by the federal government and requires insurance exchanges that offer tightly regulated plans which Americans are coerced into buying via taxation. Supporters hoped the Act would provide health insurance to all Americans by overcoming what they perceived as failures in the health insurance market.

Unfortunately, the market for health insurance was hardly free when the ACA was passed. Many of the prior problems came from market-distorting regulations. Introducing more complex regulation, centralized decision-making, and price controls will make matters worse. Thus the ACA is fundamentally a vain attempt to fight the symptoms of big government with even bigger government. This has already produced or begun to produce several problems here in Ohio:

1. Premiums and deductibles have risen steeply for those previously insured, while many of the previously uninsured have still been unable or unwilling to obtain coverage. For example, the average Ohioan’s premium rose 41% from 2012-2013.

2. There is decreased choice among available insurance plans, including coverage of providers (doctors and hospitals) and prescription drugs. Further, while more people may have health insurance, the problem of access to actual health care is exacerbated by the increased demand on an already-strained system.

3. The law skews incentives so that businesses are discouraged from increasing payrolls while simultaneously reducing the employee’s rewards to work, which increases dependence and hurts families. This is particularly true of Medicaid expansion under the ACA and demands that Ohio reconsider expansion.

4. Higher government expenditures and a weaker labor force are troubling the future prospects of Ohio’s private economy.

But hope yet lingers on the horizon, and many individuals and organizations with interests in health care reform — including The Buckeye Institute — are working to implement more effective policies at the state and national level. These policies advocate for a system where a free and innovative market revolves around the wants and needs of individual patients — not arbitrary and ever-changing government mandates — and the most generous benefits are reserved for those who truly cannot support themselves.

For more information, including cutting-edge ACA reform ideas, stories of Americans negatively impacted by the ACA, and ways to get involved, please visit

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Transparency and Fiscal Accountability Go Hand in Hand

Does $787,637 sound like a reasonable salary for the public executive in a city of 38,000 people?

In 2010 a major scandal erupted when the Los Angeles Times revealed via a public records request that the Chief Administrative Officer of tiny Bell, California made over twice as much money as the Chief Executive of Los Angeles County. Bell is not an affluent area — per-capita income is roughly half the national average. Yet, other public Bell city employees were similarly overpaid.

While certainly an extreme case, this example highlights the importance of government transparency. Because elected officials and other public employees are paid through taxes on the incomes of hard-working private citizens, it is important for those citizens to know how much public employees are being paid. This allows the citizens to address any issues through the democratic process.

The Buckeye Institute has long argued for more transparency of government information, and we host transparency databases that include the salaries of many of Ohio’s public employees. In addition to our efforts, the office of Treasurer Josh Mandel has proposed that it host the state’s checkbook in a similar online database. The office of Auditor Dave Yost has a trove of financial data and information online. And DataOhio is another proposal to help citizens stay informed. The common theme is the belief that a better-informed citizenry can hold their public officials accountable.

A recent working paper from the National Bureau of Economic Research, “Does Transparency Lead to Pay Compression?”, confirms that transparency initiatives such as these actually do produce tangible positive results by helping to reduce the costs of government. Princeton researcher Alexandre Mas compared the pay of California local government employees before and after a law that required California’s cities to publish employee salaries in an online database. He found that the increased transparency reduced salaries of city managers by 8 percent, and led to a 75% increase in voluntary terminations of employment.

The government provides necessary services for all of us, but sometimes people in government abuse the use of tax dollars that citizens work so hard to earn. One of the ways they abuse tax money is through excessive compensation — that is, salaries and benefit packages that can be far higher than those in the private sector. Often compensation costs comprise over 75% of government expenditures. Transparency efforts are critical if concerned citizens are to keep public officials in line by using such information to help vote abusers out when necessary.

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Keeping our Talents in Ohio

Four years after Lebron James famously “took his talents to South Beach”, he decided to bring them back to Ohio. In his essay announcing his decision, he said “Our community, which has struggled so much, needs all the talent it can get.” In that respect, he’s right. Ohio’s share of the American population has steadily declined in the last few decades.  As a result, Ohio has lost several seats in the House of Representatives.  More worrisome is that a disproportionate amount of high-skilled college educated potential workers are leaving the state.  Over 47 percent of people over 18 years old who left Ohio for another state in 2012 had at least some kind of college degree.  Conversely, only 41 percent of new arrivals over the same time had a college degree.  This net loss in education level is an additional burden for the Ohio economy since college educated workers are least likely to be unemployed.

Data from the Bureau of the Census’s American Community Survey (ACS) provides a detailed look at migration into and out of the state. The 2012 ACS generates estimates that help answer migration questions like who, where, and how many.  Around 400,000 people migrated into or out of Ohio from/to another U.S. state in 2012. Estimates show the outward migration number to be larger than new arrivals to Ohio. The graph below illustrates an estimate of the percentage of Ohioans in each age group that moved between Ohio and another U.S. state in 2012.

In 2012, approximately 4 percent of Ohioans in their twenties, moved to another U.S. state.  It appears Ohio gains from inter-state migration during peak earning years (30-59) though.  These families are likely bringing kids in tow, which drives up the rate of under 20’s migrants into the state.  People moving to or from a foreign country are not included in this analysis.

The map below illustrates the destination or origination of the migrating population.  Shades of red indicate a net loss of population for Ohio and green indicates a net gain.

Overall, this fits with the national narrative of Midwest states gradually losing population to the South and West.  However, in 2012 at least, Ohio stemmed that loss by attracting population from many surrounding states and even the northeast.

Total volume of migration in either direction between Ohio and each state is not visible in the map. Adjacent, and other high population states around the country are predictably the ones to top the list of states that share the most migrants with Ohio.  Below is the top 20.

The numbers are estimates using ACS weighting procedures and each should be given a margin for error, but a few points previously hidden in the map are important.

  • Florida is not just a one-way drag on Ohio’s population.  According to these estimates, Florida provided the second most domestic immigrants to Ohio, behind only Michigan.
  • Despite being a net drain on Ohio’s population, Kentucky also provided a large number of migrants to Ohio.
  • Although there was no significant net change in migrants between Ohio and Texas, it still represented one of the largest volumes of traffic between states.

A key component of migration is education level.  Ohio (or any other state) wants to keep and attract, the best and the brightest.  Below is a look at domestic migrants by education level, with all Ohioans included as a benchmark.  For the education analysis, each group is restricted to adults, over 18 years of age.

Each color displays the educational distribution of that entire group.  All states as a whole will be less educated than their migrants.  Education is one of the leading factors of greater mobility.  Unfortunately though, the education level of the people leaving Ohio appears to be greater than the group moving in. Using the same data, it’s estimated that about 64,000 people with a Bachelor’s degree or higher moved out of the state during 2012, while only around 52,000 moved in.

Combining the age and education of migrants to look at the peak earners, where Ohio had a net gain, doesn’t change the story.  The pie charts below show the distribution of education among migrants aged 30-59.  This is a population which has most likely completed their entire undergraduate and graduate level of education.

Over 56 percent of peak earners moving into Ohio in 2012 had no college degree of any kind, compared to less than 49 percent of those moving out.  Each of these numbers are estimates with margins of error as well, but the edge at each education level for those moving out over those moving in paints a clear picture.

Ohio has college enrollment rates that usually match or exceed the national average.  It needs to do a better job creating an environment in which those graduates want to stay after their education is done. Identification of “population rival” states such as Florida and others that top the list of Ohio migrant traffic volume, could be a starting point for policymakers to target the right strategies for attracting and keeping talent in Ohio. Ohio policymakers need to continue to create policies that create job opportunities for individuals and small businesses.

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Revenue Sharing Reform: On the Road to Ohio’s Recovery

The Buckeye Institute for Public Policy Solutions announces the release of a new report, Revenue Sharing Reform: On the Road to Ohio’s Recovery. The report shows that reductions in state spending on local government revenue sharing plans have not endangered the balance sheets of counties and local governments.

Key points include:

  • Local government tax revenues, particularly municipal income and county sales tax, have been increasing, not decreasing as the critics claim. Aggregate municipal income tax revenue rose by $230 million in 2012, and aggregate county sales tax revenue increased over $80 million in 2013. In both cases, only a handful of local governments implemented new taxes or raised rates;
  • Nine out of ten Ohio counties have a surplus in unassigned General Revenue reserve funds greater than the 5% reserve that the state must maintain in its “rainy day” fund. Nearly 90 percent of local municipalities do as well;
  • Ohio’s Local Government Fund (LGF) – one of the state’s revenue sharing programs subject to recent cuts – represents a very small percentage of what the state spends supporting local governments; roughly 2.5 percent of the $13.6 billion expected to be spent in 2014.Even before any of the Administration’s revenue sharing cuts, the LGF was less than 5 cents of every dollar in total state support for local governments and a little over 1 percent of total local revenues.

Report author and Buckeye Institute Policy Analyst, Greg R. Lawson states:

“Local governments should take advantage of increasing general revenues and embrace shared services and, in some cases, consolidation. This, not the revenue sharing of old, will allow Ohio to more aggressively implement the free market reforms needed to improve its economy.”

The full report can be found by clicking here.

Additional local data can be found in appendices to the report at the following links:

Appendix I: County Sales Tax General Revenues, 2012-2013

Appendix II: Municipal Income Tax General Revenues, 2011-2012

Appendix III: Township General Revenues, 2011-2012

Appendix IV: County Unassigned General Revenue Fund Balances, 2012

Appendix V: City Unassigned General Revenue Fund Balances, 2012

Appendix VI: Village General Revenue Fund Balances, 2012

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Has Ohio Lost its Labor Force Edge?

On Friday August 1, the Bureau of Labor Statistics (BLS) released its national jobs numbers for July. The report contained a familiar narrative: a modest increase in total employment and a slowly declining unemployment rate. However, because the unemployment rate is calculated as a fraction of the labor force (those who are employed or actively seeking employment), it does not accurately reflect the percentage of the total population that remained unemployed. That number remains stubbornly stagnate. The BLS estimates that only 59% of the U.S. civilian (16 yrs & older) population was employed in July, only one percentage point higher than in June 2011, the low point of the last 30 years. The employed to population ratio remaining steady as the unemployment rate drops can be explained by the declining labor force participation rate, a problem Ohio shares.

In July 2014 less than 63% of Ohioans aged 16 and over declared themselves to be part of the labor force. This is lower than in any month since October 1978, before women had fully entered the workplace. Traditionally, Ohio has exceeded the national average, but the gap has disappointingly closed over the last few years. In particular, 2014 has seen a steep drop, with more people dropping out of Ohio’s labor force during the months of March, April, and May than in any other three month span since the height of the recession in October 2009. Similar to the United States as a whole, here are three major reasons for the declining labor force in Ohio:

Demographic changes:  An aging population results in a natural decline in available workers. The graphic below is based on a combination of U.S. Census and American Community Survey data and illustrates the changing age demographics of Ohio between 2006-2013.

According to the BLS, in June 2014 about 54.7% of people in the U.S. aged 16-24 participated in the labor force, compared to 80.9% of people aged 25-54 and 40.0% of people 55 and over. Ohio has seen over 4% of its 15 and over population shift from 25-54 into the 55 and older segment over the past 7 years. Similar demographic changes are happening all around the country. According to some estimates, the changes account for about 25% of the nationwide labor force decline.

School Enrollment:  When the economy dips and the job market suffers, the opportunity costs associated with school enrollment decline and the perceived necessity of greater education rises. More potential workers return to school to complete a degree (or add one), and a higher percentage of teenagers complete high school. This effect is illustrated below by the percentage of Ohioans aged 18-24 who were enrolled in college between 2006 and 2012. Data is from the American Community Survey with the Ohio labor force participation rate overlaid.

Higher school enrollment causes a temporary decline in the labor force. However, in the long run it creates a better educated and more productive and efficient labor force. The bad news for Ohio is college enrollment rates did not rise as dramatically as the rate of the nation, likely meaning much of Ohio’s labor force reduction has come from a third major factor.

Increased Disabled Beneficiaries:  Since the Great Recession, disability claims have skyrocketed, and unfortunately Ohio has outpaced the national average in this category. The worst news is that unlike school enrollees, people claiming disability insurance rarely return to the labor force.

Between 2006 and 2012, Ohio’s population aged 18-64 saw almost no change, but in 2012 there were over 93 thousand more disabled beneficiaries within that age range. With disability claims rising to all-time highs, policymakers will need to confront reform. The Social Security Disability Insurance trust fund is projected to be empty by the end of 2016.

Ohio may have lost its historical edge on the nation in labor force participation rate among its population. In order to counteract that Ohio will need to attract a younger generation into the state, or face the challenge of increasing production among a permanently smaller and continually aging labor force.

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Celebrate National Employee Freedom Week!

Should a person be forced, against their will, to reach into their own pocket and give money to a cause with which they disagree?  This is the question that thousands of union members in Ohio are confronted with every year.  Unfortunately, their freedom to make this decision is severely restricted since Ohio is a Forced Union state.

This is why The Buckeye Institute has once again partnered with the Nevada Policy Research Institute (NPRI) and more than 80 other groups in 45 states to raise awareness for National Employee Freedom Week that runs August 10 through August 16.  National Employee Freedom Week is a national effort designed to educate union members about their legal rights concerning membership as well as the use of member funds for purposes other than collective bargaining.

According to a national poll commissioned by NPRI, nearly 30 percent of union households nationally would opt out of union membership if given the chance.  In Ohio, the number of people that believe employees should have the right to decide, without the use of force or penalty, whether or not to join a union is a staggering 80.5 percent.

While many union members are pleased with their representation, there are also many who feel compelled to pay dues to an organization that spends their hard-earned dollars on issues with no connection to their union’s stated purpose of collectively bargaining on behalf of its members.

And many of the issues that are supported by unions that have nothing to do with collective bargaining are controversial among union members.  For example, the National Education Association (NEA), the national affiliate for the Ohio Education Association, has approved a laundry list of controversial resolutions, including:

  • Urging participation by the United States in deliberations before the [International Court of Justice];
  • Supporting the nuclear freeze;
  • Promoting DC statehood;
  • Opposing efforts to legislate English as the official language; and
  • Supporting efforts to abate climate change.

And the NEA puts its money where its mouth is, donating through its PAC, to give but one example, $200,000 to the Sierra Club in 2010 as it promotes its green agenda, including “Retiring one-third of the nation’s more than 500 coal plants by 2020.”

The NEA is not alone.  Unions frequently take positions and use PACs to promote causes and candidates that may be contrary to the views of members.

People can have reasonable disagreements about the controversial issues listed above, but should union members be compelled to support their organization’s stance on these issues, even if they have a deeply felt objection?

Fortunately, union members who do not want their money going to support these types of causes without their consent do have options-and National Employee Freedom Week seeks to assure that union members are aware of these options.  In Ohio, union members can block their money from being used for political activities by becoming what is referred to as an “agency fee payer.” This will mean that they are paying only for the direct representation offered by the union in collective bargaining.  To learn more about this option, click here. One can also become a “religious or conscientious objector” where the dues are deducted but made payable to a charity.  Click here to learn about this option.

Despite these options, there is only one way that current and prospective union members can assure themselves of complete employee freedom, and this is for Ohio to become a Right to Work state.

The Buckeye Institute has published numerous reports showcasing the economic benefits Ohio can reap from becoming a Right to Work state, including our 2012 report,

Ohio Right-to-Work: How the Economic Freedom of Workers Enhances Prosperityand our monthly Ohio by the Numbers reports.  However, this issue is about more than economics; it’s about right and wrong.  No one should be forced to pay to join an association against their free will, much less so if that association uses their money to promote causes that are against their personal beliefs.  This is the message of National Employee Freedom Week, and it is a message the Buckeye Institute hopes you will spread around the state, especially to those who may be unaware that there is a path to freedom.

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