What various media outlets have widely described as a gaffe on the part of Mitt Romney, actually matches up quite well with the latest government figures and with the actions of Gov. Lincoln Chafee’s administration in Rhode Island.
Romney, the Republican presidential nominee, told fundraisers during a closed-door session earlier this year, that 47 percent of Americans are too dependent upon government, and are therefore a sure vote for President Obama in the November election. He also said too many Americans did not pay any taxes at all.
Mother Jones magazine obtained and published a videotape of the event that was obtained from an anonymous source. Romney, the former governor of Massachusetts, is not backing away from his statements, but did issue a few clarifying remarks in a press conference on Monday.
If Gov. Chafee’s top officials successfully convert the health benefits exchange system into a “dependency portal” that can be adopted and modeled in other states, Romney’s comments may appear in retrospect to have been an understatement.
“There are 47 percent of the people who will vote for the president no matter what,” Romney said in his presentation to donors. “All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care of them, who believe that they are entitled to healthcare, to food, to housing, to you name it.”
Just a few hours after the U.S. Supreme Court issued its ruling upholding the federal health care law, top officials in the Chafee administration, including Health and Human Services (HHS) Secretary Steven Costantino, Lt. Gov. Elizabeth Roberts, and Health Benefit Exchange Director Christine Ferguson, told reporters that it would be possible over time to link health care services with other social welfare benefits through exchange system.
As a board member for the Rhode Island exchange, Linda Katz, the co-founder and policy director of the Economic Progress Institute (EPI), is well positioned to advance this agenda. In this year’s legislative session, EPI advanced bills in the state House and Senate designed to remove administrative hurdles that make it more difficult for eligible residents to take part in the Rhode Island Works program, which offers cash assistance, health care, and job training services to low income people with children.
State officials currently use a 30-year-old system known as “Inroads” to make eligibility determinations for applicants seeking benefits under RiteCare (the Rhode Island Medicaid managed care program), the childcare assistance program, and the SNAP program. It is far too cumbersome and antiquated to accommodate needy families, Katz explained in an interview.
“Right now, applications have to be sent to three different [government] workers with the same documentation attached to those applications,” she said. “This is a very inefficient way of doing business for both the consumer and the government.”
A critical first step involves moving the Rite Care program out of Inroads and into the health care exchange system, Katz added. This makes sense, she said, since Rhode Island is receiving a 90 percent reimbursement from the federal government for implementing the Medicaid expansion included as part of ObamaCare’s. Able-bodied residents with household income below 133 percent of the federal poverty level will be eligible for Medicaid for the first time.
The Rhode Center for Freedom and Prosperity has warned that the Medicaid expansion will ultimately burden state taxpayers once the federal subsidy diminishes.
“The federal aid covering the Medicaid expansion will have phased down from 100% in 2014 to 90% in 2020,” a policy brief from the Center says. “Therefore, in the unlikely event that total Medicaid spending does not increase from 2019 to 2020, the annual cost to Rhode Island taxpayers that year will be about $41.4 million.”
“We are looking at how best to streamline the process,” Katz said. “The idea is to be able to submit one application and to have everything wind up on one Web site where people will be able to access health insurance and to bring in other programs. We are not creating any new benefits, we are using the same eligibility requirements, but changing the process in a way that most people would say makes sense.”
During his joint press conference with other top state officials, Costantino, the HHS secretary, told reporters that once a “unified infrastructure” was in place that offered “one-stop shopping,” Rhode Island residents could use the system to access not just health care, but a range of social services. Costantino specifically mentioned food stamps and the TANF program, which stands for Temporary Assistance for Needy Families (TANF). When Costantino was asked if the “unified health information” approach was unique to Rhode Island, he responded by saying that it was, as did Ferguson, the benefit exchange director, and Lt. Gov. Roberts.
Organizations that are closely connected with Katz’s EPI, such as Center on Budget and Policy Priorities (CBPP), have argued in favor of creating additional entitlement pathways with no exit points. Stan Dorn, of the Urban Institute, and Elizabeth Lower-Basch, of the Center for Law and Social Policy, on behalf of the Coalition for Access and Opportunity, have described how they would “modernize eligibility requirements.” They have called for:
“No wrong door” policies through which, when an application is submitted to one agency, data from the application is forwarded to other agencies to see whether consumers qualify for additional assistance — in effect, using an application for one program as an “on ramp” to other programs.
The Heritage Foundation recently published an Index of Dependence on Government that measures government spending on the federal programs that lead to government dependency. The report concludes that:
“Today, more people than ever before depend on the federal government for housing, food, income, student aid, or other assistance once considered to be the responsibility of individuals, families, neighborhoods, churches, and other civil society institutions. The United States reached another milestone in 2010: For the first time in history, half the population pays no federal income taxes.”
If Rhode Island’s approach to health care “reform” catches on other states, the trend toward greater government dependency will only accelerate.
Under the Patient Protection and Affordable Care Act (PPACA), otherwise known as Obamacare, states are expected to have exchanges established come January 2014, but this not a strict requirement. In those states that decline, the feds will step in to create the exchange themselves. But they cannot offer tax credits or subsidies on those exchanges. The federal law only provides for tax credits and subsidies for those exchanges created by the states. Gov. Chafee issued an executive order creating the exchange in Sept. 2011.