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The Red Line

Medicaid’s Federal-State Partnership is Subverted by States’ Hospital Tax Scheme

The Medicaid program was established as a federal-state partnership, but it has become a partnership in name only as the result of a complicated maneuver in which states impose taxes on health care providers in order to extract tens of billions of dollars yearly from the U.S. Treasury via an arcane Medicaid financing mechanism. The scheme renders Medicaid almost entirely a federally financed — or over-financed — program.

Almost every state employs this tax maneuver to
trigger the annual release of matching funds over and above the money the
federal government sends as its share of reimbursements to hospitals for
medical services they provide to Medicaid patients. In a 2014
report
, the General Accountability Office
criticized these so-called provider taxes, which fall most heavily upon
hospitals.

One might wonder why the government is taxing
hospitals, which raises the cost of the nation’s primary providers of health
care services. Many are nonprofit organizations; why tax nonprofits? Many are
for-profit organizations and already pay corporate income taxes; why levy a
second tax? It is truly strange and wonderful.

Take Connecticut, for example.


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Don’t count out Michael Bloomberg — his unconventional strategy might work

Michael Bloomberg’s entry into the presidential race about a week ago was panned almost universally. Political pundits dismissed his bid, many with trite “truisms” about political tradecraft. First, that money can’t buy the presidency. Second, that his late entry is fatal. Third, that by skipping the first four contests, he will fall hopelessly behind. Fourth, his policy stands are all over the map, so he has no natural following or base.

But maybe Bloomberg has a strategy. After all, if he’s so dumb, why’s he so rich? Let’s hazard some thoughts on possible strategy. Maybe Bloomberg is crazy like a fox.

First, let’s be realistic, his $50 billion provides him a tremendous advantage.

Second, pundits have deemed his late entry to be fatal, as if late entry alone were as fatal as stage four pancreatic cancer. What has passed as analysis has been limited to references to the failure of other late entrants. Yet, none of the referenced candidates had Bloomberg’s money, and virtually all failed for reasons other than late entry — and the same reasons have felled early entrants.

In 2016, late entrant Rick Perry was felled by momentary brain freeze about the third in his trademark list of three federal agencies he’d shutter. However, the earliest entrant in the 1968 contest, George Romney, was eliminated well into his campaign by just one word, “brainwashed,” and in 1972 another early contender, Ed Muskie, by a single sob on the campaign trail just days before the New Hampshire primary.

Third, skipping the first four contests has an obvious and compelling rationale. To flip a popular saying: You can’t lose it if you’re not in it. This is a variant of the successful strategy of American revolutionaries: They ran away to fight another day. Bloomberg will survive the first four contests. Every other candidate, except four at most, won’t.

There are virtually no delegates at stake in these early contests — just 4 percent of the total. The winner(s) of those contests will have virtually nothing to show for the enormous effort entailed, except bragging rights, which then must be defended in the next of the four contests to meet elevated expectations and to maintain momentum.

Bloomberg won’t have lost any meaningful ground, unless one candidate rolls the table, winning all four early contests. What are the odds of that? South Bend, Ind., Mayor Pete Buttigieg has surged into the lead in Iowa and New Hampshire, but is mired in single digits in the following contest in South Carolina, where former vice president Joe Biden holds a commanding 19-point lead.

If Bloomberg hasn’t lost anything, what has he gained by skipping the first four contests? Here it gets interesting.


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The Endless Game of Whack-a-Toll-Mole

Highway tolls in Connecticut have become a game of whack-a-mole. Gov. Ned Lamont’s toll mole has popped up again, just two weeks after having been whacked summarily by General Assembly leaders of his own party. The current mole is a variant of the governor’s original trucks-only campaign proposal. Things have gone full circle.

The game started with candidate Lamont’s vague trucks-only plan. Once inaugurated, Lamont whacked his own proposal, saying that truck tolls alone wouldn’t raise enough money. He added cars, and presented a sketchy eight-page plan with a smothering network of as many as 80 gantry locations on interstate and state highways.

Fierce public opposition and insufficient Democratic support whacked this proposal, but Lamont’s toll mole popped back up again as about 60 gantries in a system stripped of all state highways, except the Merritt Parkway.

When this mole was whacked by continuing public opposition and Democratic intransigence, Lamont gave his own plan another good whack, this time by threatening his fellow Democrats that he’d adopt the GOP’s toll-less transportation plan if Democrats didn’t accede to tolls. Curious. The captain threatened to abandon his own team in favor of the opposing squad. Predictably, but to the freshman governor’s surprised chagrin, his threat didn’t revive his toll mole.

That’s where the game was at the end of the legislative session before intermission over the summer.

The Lamont team spent halftime preparing a much smaller and more detailed mole … ah, plan. After Labor Day, the governor spent weeks trying fruitlessly to secure Democratic support in closed door meetings. Finally, in November, Lamont introduced the new plan, with a drastically reduced number of just 14 gantries and a new rational of using toll revenue only to fund repair and replacement of bridges at which tolls were to be placed. A few days later, Democratic leaders in the General Assembly held a formal news conference to wield the hammer and pound the living daylights out of the new mole.

Then, in a marvel of Newtonian physics (every action has an equal and opposite reaction), Lamont’s toll mole popped back up just days later with the full support of the Democratic legislative leadership team. It is the same 14-bridge plan, except it is now back to the trucks-only scheme. Good grief.

The surprising income equality in America

This is a column about a column.

On November 4, 2019, the Wall Street Journal published a column entitled “The Truth About Income Inequality,” by Phil Gramm, former U.S. Senator from Texas, and John Early, twice Assistant Commissioner of the U.S. Bureau of Labor Statistics.

The column makes a convincing case that the U.S. enjoys remarkable income equality –  not inequality.

This reality flies in the face of the almost universal belief that the U.S. suffers from gross income inequality, which notion serves as the foundation of all the extravagant proposals from one side of the political spectrum, ranging from free college and Medicare for All to the wealth tax that Elizabeth Warren and Bernie Sanders advocate.

There are better ways to cut traffic congestion than tolls

Gov. Ned Lamont is poised to re-launch his highly unpopular tolls plan, revised to reduce tolling to a rumored 16 to 18 gantries located only on bridges in need of repair. So what happened to the governor’s concern with traffic congestion? Repairing bridges, however necessary, won’t relieve congestion.

It could be that Lamont is holding a Tolls 2.0 plan at the ready, including the remainder of his original 59 gantries and his trademark congestion pricing scheme, ready to be sprung on the public once he’s established his 16-18 gantry beach head.

In anticipation of Tolls 2.0, it’s worth reminding our wealthy governor of the obvious: Most people on congested rush hour roads are driving to work. So, tolls are effectively a payroll tax. Moreover, congestion pricing wouldn’t reduce congestion, because people can’t be late to work — they can’t wait for lower toll rates later on.

Ironically, there’s a simple tax-free way to reduce congestion, and it is already in use across the state. School districts employ staggered “school bell times.” Preschools start at one time, elementary schools at another, and middle schools and high schools at yet other times. This avoids local traffic jams and optimizes bus utilization

The state could follow the same approach, mandating that municipalities and major employers collaborate to devise staggered work days. In Hartford, Aetna could begin its day at 8:15 a.m., while CIGNA in neighboring Bloomfield could start at 9 a.m. and most state employees might be required to show up at 7:30 a.m.

If local school boards can accomplish this kind of system planning, why can’t local governments and major employers?

How state worker staffing hurts Connecticut

Once widely used, the now arcane term “featherbedding” describes perfectly the modus operandi of public sector unions in the state of Connecticut.

Webster’s dictionary defines featherbedding as “the requiring of an employer, usually under union rule or safety statute, to hire more employees than are needed or to limit production.” Wikipedia offers the same definition, elaborating that featherbedding involves “work procedures which appear pointless, complex and time-consuming merely to employ additional workers.”

A recent CT Mirror article on staffing in one of the state’s 15 prisons reported “According to figures provided by DOC [Department of Corrections], there were 139 corrections officers and supervisors for 78 inmates one day last month. That does not include medical or mental health staff assigned to the facility [Northern Correctional Institution].”

An isolated aberration? No.

Dannel Malloy was unpopular, but his legacy is worse than you think

There’s a strange ongoing media fascination with former Democratic Gov. Dannel P. Malloy, including a Sept. 5 article “State employee OT is up, but salary costs are lower than a decade ago,” focusing upon his efforts to downsize the state labor force and negotiate wage concessions from state unions.

It’s a marvel that anyone is interested in someone who left office as the least-popular governor in the country.

But that’s the point. The recent article implies that Malloy’s unpopularity reflects an unfair assessment of his performance and that he deserves a resurrection. He doesn’t. He mismanaged the state labor force, achieving insignificant downsizing and perpetuating overgenerous wages.

Diversion, interception and conjury with state funds

First, it was diversion. Now it’s “interception.”

First, Gov. Ned Lamont diverted car sales tax revenue that his predecessor Democrat Dannel Malloy committed to the Special Transportation Fund (STF). Lamont’s diversion completely undermined public confidence in the “lockbox” that is supposed to protect transportation funds in the STF and destroyed any possibility for tolls.

At the very beginning of the budget process, Lamont announced that he would divert $1.2 billion of car sales taxes over five years, but, in face of a huge public outcry, he backed down, diverted only the $58 million in the current budget and promised not to divert funds from the STF in future budgets, Scout’s Honor.

Yet, now, we discover that Lamont is “intercepting” (diverting) revenue that is supposed to go into the General Fund and redirecting it to fund his off-budget, public-private partnership with billionaire Ray Dalio.

Single-use plastic bag ban could be costly for taxpayers

What if every smoker in Connecticut stopped smoking? What a boon to the health of the citizenry! However, the state would be out about $365 million in annual cigarette tax revenue.

Virtually the same thing just happened. The state’s largest retailers stopped offering disposable plastic check-out bags to customers Thursday, rather than begin paying Governor Lamont’s new 10-cent tax on each bag. The new state budget includes $55 million in plastic bag-tax revenue over the next two years. With the state’s retailers going cold turkey, that revenue is unlikely to materialize.

Driving holes through Gov. Lamont’s budget

Gov. Ned Lamont made much of delivering a budget on time this year. It may have been on time, but it wasn’t balanced, and still isn’t. And tolls wouldn’t balance future budgets, either.

Connecticut citizens may recall that Gov. Lamont promised hundreds of millions in current budgetary savings from a reduction of the state’s current contribution to the State Employees Retirement fund (SERS), without much mentioning that this entails even greater overall pension contributions over the 30-year span of amortization.

This scheme is a classic case of kicking the can down the road, with the can getting bigger in the process. Nevertheless, this past Thursday the governor announced triumphantly that he had union approval of the scheme, which “saves” roughly $2 billion through 2032 (about $270 million in the current two-year budget), but increases costs by almost $5 billion from 2032 to 2047.