A fierce critic of Medicaid expansion has joined the White House team working on repealing and replacing the Affordable Care Act.
White House staffers are expected to play a key role in helping craft the upcoming budget reconciliation bill to repeal and replace the ACA. One of those key aides is Brian Blase, who recently left the conservative Mercatus Center at George Mason University to serve as health policy adviser to Gary Cohn, director of President Donald Trump's National Economic Council and former president of Goldman Sachs.
Cohn is consulting with House Republican leaders to determine which parts of the ACA are worth keeping and which parts should be junked, according to a recent New York Times article. A Mercatus Center spokeswoman confirmed that Blase recently joined Cohn as his special assistant, but said he's not doing any media interviews at this time.
Blase, who previously served as a staffer for the Senate Republican Policy Committee and the House Committee on Oversight and Government Reform, is a PhD economist whose 2013 dissertation was a critical analysis of Medicaid.
He's clearly no fan of traditional Medicaid, the ACA, or the law's expansion of Medicaid coverage to nearly 11 million low-income adults. That's consistent with the views of the billionaire, libertarian Koch brothers, who have funded the Mercatus Center, where Charles Koch serves as board chairman. The advocacy group Americans for Prosperity, established by Charles and David Koch, has lobbied in many states against Medicaid expansion.
In a number of articles for Forbes magazine, Blase has blasted the ACA and the Medicaid expansion as a waste of taxpayers' money and wrote that it is damaging to the economy. He stresses that enrollment and costs for the expansion have been sharply higher than projected.
In an argument that many healthcare providers would disagree with, he writes that the Medicaid expansion “makes the country worse off,” and that the value of Medicaid coverage to beneficiaries is much less than what the government pays for it.
He cites a study published by the National Bureau of Economic Research in 2015 that found Medicaid enrollees value program benefits at between 20 cents and 40 cents for each dollar of spending. “That finding, coupled with the Medicaid expansion cost explosion, means that tens of billions of federal taxpayer dollars are being wasted while health-care interest groups gain excess profits,” he wrote.
Blase also argues that the enhanced federal Medicaid matching contributions to the states for expansion enrollees have prompted states to pay excessive rates to Medicaid managed care plans and providers. Most plans and providers, however, constantly complain about low Medicaid rates.
Among health policy experts, Blase has both admirers and critics.
Dr. Avik Roy, a prominent conservative analyst and Blase's editor at Forbes, said Blase was “one of the sharpest health policy minds” when he worked on Capitol Hill and was Forbes' “most prolific writer on the technical aspects of the Affordable Care Act, Medicaid and GOP healthcare reform proposals.”
Another conservative expert, who spoke on background, said Blase is “better at developing criticism than coming up with policy change,” and that he's “not particularly nuanced or deep once he gets beyond the negative statistics.”
Leighton Ku, a Medicaid expert at George Washington University, said Blase makes some valid points about states' gaming of federal Medicaid funding but that overall he cherrypicks facts in criticizing the ACA based on his political views.
As far as Blase's argument that the Medicaid expansion has been a waste of money, “that's a value judgement,” Ku said. “If more people are getting health insurance than anticipated, is that good or bad? I think that's good thing.”
The NBER study Blase cited examined how much low-income people value Medicaid benefits versus cash benefits such as earned income tax credits, given that they may be able to get charity care from hospitals or community health centers.
Ku said it's a common talking point that Medicaid has limited value to enrollees compared to cash. “But does that mean conservatives who criticize Medicaid are willing to give poor people the same value in cash?” he said. “No, they don't want to do that either.”