Fox News dishonestly claimed that MIT economist Jonathan Gruber's comment that the Affordable Care Act (ACA) "was written in a tortured way" to minimize criticism proves that the law was passed deceitfully. In fact, Congress routinely crafts bills to fit legislative rules and politically acceptable limits, and health care reform was transparently debated for years with input from Republicans.
A Media Matters analysis of newspaper coverage of anonymously donated "dark money" in three battleground states shows that secret money's growing influence on elections has not necessarily translated to more awareness in the media. While some news outlets are reporting on the influence this new influx of money is having on politics, others are merely providing a platform for dark-money groups to further their causes.
The term "dark money" is used to describe organizations that do not disclose the identity of at least some of their donors and that use money from these anonymous donors to fund political ads, mailers, and staff to try to influence voters and policymakers. Even spending by these groups may be shielded from disclosure, depending on the type of ad they run. Dark-money groups focus heavily on specific policy outcomes and try to connect candidates to their desired outcome through advertising. These groups protect their donors by never officially endorsing a candidate and by limiting their political activity. This allows them to be classified as "social welfare" organizations under the tax code, which means they do not have to disclose their funding.
Spending by dark-money groups in this election cycle is nearing the $200 million mark and is expected to spiral even higher before Election Day. Much of the spending by these groups is focused on influencing Senate races in key states. Media Matters reviewed newspaper coverage in three states with competitive Senate races (North Carolina, New Hampshire, and Colorado) to see how they are covering this influx of anonymous outside funding. The results show large discrepancies in the quality of the coverage of dark-money groups, with some papers doing a significantly better job than others.
Of the three states analyzed, North Carolina's newspapers provided the best overall coverage of dark money influence. North Carolina's Senate race is expected to set a new record for outside spending, with $55.7 million spent so far, even without counting the non-disclosed money. The Raleigh News & Observer and The Charlotte Observer, the two largest papers by circulation in the state, went beyond reporting the existence of the groups and attempted to report which outside groups were spending money on which ads -- something these groups often fail to do themselves. The North Carolina papers also reported on how dark-money groups such as the Koch brothers-funded Americans for Prosperity (AFP) are using their influence to lobby for specific policies, such as the group's successful campaign to block a special legislative session on economic development.
The Colorado newspapers' coverage of dark-money activity proved to be far less extensive than that of the North Carolina newspapers, producing just 13 stories since July 15. Colorado's Senate race is also poised to break records in outside spending. The Denver Post's coverage did not go into depth the same way North Carolina's newspaper coverage did, but it did highlight efforts by groups like Americans for Prosperity to influence voters with their door-to-door outreach.
Colorado's second biggest paper, The Gazette of Colorado Springs, produced few reports on dark money during the period analyzed. However, a partnership with Rocky Mountain PBS I-News produced a report that covered many of the complexities of dark money. The article discussed outside spending by both conservative and liberal groups and explained the difficulty of tracking dark-money donors and the impact of their donations:
"Nonprofit political groups do not have to disclose donors," Viveka Novak, editorial and communications director for the Center for Responsive Politics said. "So we could only identify organizations that filed 990s (nonprofit tax forms) and that wouldn't include individuals or corporations, so there are still a lot of donors or donations no one would know about."
[Sheldon] Adelson, the Koch Brothers and many other politically active billionaires and multimillionaires across the political spectrum are able to maintain privacy and give endless funds after the U.S. Supreme Court's 2010 Citizens United decision, which held that political spending is a form of protected speech under the First Amendment.
"TV ads are number one, the overwhelming most important tool in winning one of these campaigns," Ciruli said.
In New Hampshire, dark-money groups have spent at least $4.3 million in the Senate race -- overwhelmingly in support of the Republican candidate, as of September 8. This subject has seen poor coverage from the state's largest newspaper, The Union Leader. While the paper mentioned dark-money groups in 11 articles, and another five articles mentioned the groups and specific policies, the paper's coverage mostly provided a platform for groups like AFP to spread their message and did not explain the groups' attempt to influence policy decisions or the Senate race. For example, in a September 30 article, the paper gave AFP state director Greg Moore a platform to attack the state's budget situation and blast the Affordable Care Act, something the group has also done in its advertising against Sen. Jeanne Shaheen (D-NH):
Greg Moore, state director for Americans for Prosperity, blamed Medicaid expansion under the Affordable Care Act for much of the shortfall in the two-year budget plan.
"The legislature gave the administration $57 million from the last, fiscally-responsible budget to spend, and expected that surplus to last for the entire, two-year budget, but Governor Hassan took her eyes off the ball and spent even more," Moore said. "Keeping within the budget takes strong executive action and discipline, but we aren't seeing that right now in Concord."
While the use of dark-money groups is not one sided, conservative groups are far more likely to use this route to shield wealthy donors and ensuing spending. As the Brennan Center for Justice noted, in this election cycle, "Overall, 80 percent of pro-Republican nonparty expenditures came from dark money groups, compared to 32 percent of outside spending favoring Democrats." This is not a new trend for conservative supporters, as spending by nondisclosing groups has clearly favored Republican candidates over the past four election cycles:
The problem with dark-money groups, as the Brennan Center's analysis noted, is that "the lack of transparency in the majority of outside spending in competitive races leaves voters unable to evaluate the political messages they see" and that these groups "threaten to make a mockery of contribution limits and their prophylactic effect on corruption and influence buying." This sentiment was echoed by University of Louisville political science professor Laurie A. Rhodebeck in the Los Angeles Times, saying that the flood of dark-money spending is "detrimental to voters because if they don't know who is behind the money, they can't judge whether to trust the ad or not."
The scale of the problem is considerable. The Boston Globe reported on October 22 (emphasis added):
The impact is visible online and on television. One of every 16 television ads in US Senate races from January 2013 through August were paid for by a single group, Americans for Prosperity, according to the nonpartisan investigative Center for Public Integrity and advertising tracking service Kantar Media. AFP serves as a nonprofit advocacy arm of the political network backed by conservative billionaire brothers Charles and David Koch.
The Brennan Center found that during the 2012 election, "three-quarters of outside expenditures were made after September 30, and one-half were made in just the last three weeks of the campaign." This suggests that newspapers in these key battleground states still have the opportunity to report on how dark money is influencing their elections.
Media Matters searched Nexis transcripts of the top newspapers (by circulation) in three highly contested states. The papers analyzed were North Carolina's News and Observer in Raleigh and The Charlotte Observer, New Hampshire's Union Leader, and Colorado's Denver Post and the Colorado Springs Gazette. The Concord Monitor, New Hampshire's second largest newspaper, was excluded because it is not in the Nexis database. The search term "((outside or independent or nondisclos! or non-disclos! or undisclosed or dark or secretive) w/5 (money or expenditure or spending)) or (Americans for Prosperity) or (Crossroads GPS) or (U.S. Chamber of Commerce) or (Patriot Majority USA) or (Concerned Veterans for America) or (Freedom Partners)" was used to search for reports on dark-money spending from July 15, 2014, when the Federal Election Commission's quarterly report was released, through October 24. While dark-money groups do not have to disclose all spending to FEC, as other groups do, this date aligns closely with the increase in outside spending.
The publisher of the New Hampshire Union Leader penned an editorial attacking the Obama administration's response to the ongoing Ebola crisis and suggested the president apply a travel ban on the affected countries, advice that has been roundly rejected by major healthcare and infectious disease experts as detrimental to relief efforts.
In an October 7 editorial, Joseph W. McQuaid blasted the administration as "incompetent" for relying on screening to prevent the spread of Ebola and instead suggested that a general travel ban to the region be administered:
Sending American soldiers to West Africa to assist with the Ebola epidemic makes sense only if it helps contain the disease over there. That would include making as certain as possible that those troops are protected while there and properly quarantined when they return home.
As for allowing travelers from affected West African nations to enter the United States at this time, that is crazy. It is yet another example of the most incompetent President we have ever seen.
Screening for symptoms of a deadly infectious disease that may not show up for weeks is not the answer. A travel ban to and from West Africa is what is needed, now.
McQuaid and other right-wing pundits who have called for a travel ban are ignoring experts who say a ban would actually impede Ebola relief efforts. The heads of the Centers for Disease Control, the National Institute of Allergies and Infectious Diseases, and independent advisers to the World Health Organization (WHO), all argue that reactionary measures such as a travel ban are ineffectual and could actually destabilize affected countries, worsening the spread of the virus. The WHO, advocating against a travel ban in October 2014, explained that while exit screening is not 100 percent effective, "completion of a screening questionnaire and testing for the presence of fever represent the best available indicators of risk."
The New Hampshire Union Leader rejected the factually accurate claim that the Supreme Court's Hobby Lobby decision would result in gender discrimination while pushing the myth that the forms of contraception discussed in the case were actually abortion-inducing drugs.
A recent Union Leader editorial suggested Fmr. Secretary of State Hillary Clinton and Senator Jeanne Shaheen (D-NH) were partly to blame in failing to prevent the mass kidnapping of Nigerian schoolgirls by the terrorist group Boko Haram, because they did not designate the group as a Foreign Terrorist Organization (FTO) in 2012. However, Clinton was the first to designate top Boko Haram leaders as terrorists, and many international organizations and experts on Africa agreed that designating the group as an FTO at that time was premature, as it would cut off foreign aid to the region, negotiation lanes with the group, and raise the profile of the organization.
The May 14 editorial accused Secretary Clinton and Senator Shaheen of delaying FTO designation of Boko Haram in an attempt to protect President Obama's al Qaeda-focused foreign policy agenda. The editorial continued by praising then-Senator Scott Brown's sponsoring of a 2012 bill seeking to list Boko Haram as an FTO, and claiming Secretary Clinton and Senator Shaheen were unwilling to prevent a "real war on women":
Designating Boko Haram as a terrorist organization, like admitting Benghazi was a terror attack, would have undermined -- during a presidential election year -- the President's narrative that he had curtailed the spread of Islamist terror. The Senate Foreign Relations Committee aided the President by killing the Boko Haram Terrorist Designation Act. Shaheen, ever the loyal partisan, sat in silence as a few senators tried in vain to weaken the group that two years later would kidnap hundreds of schoolgirls in an actual war on women, not the imaginary one in which Democrats accuse Scott Brown of taking part.
What does Scott Brown have to do with this? He was the sponsor of the Boko Haram Terrorist Designation Act. The man who tried in vain to stop a real war on women and on education (Boko Haram means Western Learning Forbidden) is accused of being anti-woman by allies of a senator who did nothing to stop those wars.
Despite the attempt by the Union Leader to cast Scott Brown as the real hero by attacking Shaheen and Clinton, the paper glossed over key facts which explain why the Senate Foreign Relations Committee and Secretary Clinton decided, at the time, not to designate the group an FTO.
The New Hampshire Union Leader used a widely criticized study to attack the Affordable Care Act (ACA), claiming that insurance premium rates will be increasing exponentially in New Hampshire. However, the study has been panned for its low response rate while the data found in the study is at odds with official data provided by the state.
A Union Leader editorial highlighted a survey first reported in Forbes and conducted by Morgan Stanley which purports to show that premium prices will increase nationally mostly due to the ACA. The Union Leader used one aspect of the survey's findings, that premium prices will increase 90 percent on the individual market in New Hampshire, to attack the ACA and claim it will not bring down premium prices as originally intended:
The stunning news this week was that health insurance premiums in New Hampshire are up 90 percent under the Affordable Care Act, according to a regular survey of health insurance brokers by Morgan Stanley's health care analysts. Dr. Scott Gottlieb, writing in Forbes, relayed that the Morgan Stanley team attributed the increase to four factors directly related to Obamacare: "the age bands that don't allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage, the new excise taxes being levied on insurance plans, and new benefit designs."
Despite the Union Leader and Forbes' ringing endorsement of the findings, the study has come under withering scrutiny. The study itself explains that "the trends among the individual insurers" are not as useful as the aggregate trends due to the fact the observations were much smaller. Indeed, for New Hampshire, there was only one registered response to the survey. Only two states produced double digit responses, California with 14 and Idaho with 31.
As a post by local television state WMUR 9 explained, "21 percent of all survey respondents were from Idaho" while in New Hampshire, "they said they talked to one person, who they don't name." The piece went on to explain that because of the study's low response rate for New Hampshire, WMUR did not run the story saying, "it's all based on one anonymous person's opinion."
Numerous local newspapers failed to identify the fossil fuel funding behind Thomas Pyle, president of the American Energy Alliance, while allowing him to publish op-eds across the country misleadingly attacking a potential tax credit for wind power, while ignoring subsidies for the oil and gas industries.
A New Hampshire Union Leader editorial attacked the gender pay gap as "complete hooey," ignoring several studies that show a clear discrepancy in wages between men and women while dismissing the benefits of equal pay.
The February 9 editorial criticized New Hampshire Gov. Maggie Hassan's decision to back an equal pay bill being considered by the state legislature, saying the gender wage gap is "complete hooey" and that "no serious scholar believes it." The editorial instead claimed women's' life choices were the biggest reason for the gap:
A 2009 Labor Department study of the issue reached "the unambiguous conclusion that the differences in the compensation of men and women are the result of a multitude of factors and that the raw wage gap should not be used as the basis to justify corrective action."
That "multitude of factors" consists largely of life choices -- work hours, number of children, etc. For instance, Bureau of Labor Statistics data on full-time employees show that never-married women earn 95.8 percent of what men earn, but married women with children under 18 earn 76.3 percent.
The legislation would disallow pay secrecy policies that keep employees from discussing their pay with co-workers, making it easier for women to ensure they are being paid equally. Currently, employers are required to pay equal wages to men and women but can prevent employee discussion of compensation. As the National Women's Law Center explained last month, pay secrecy policies "can keep women in the dark about their pay, making pay discrimination nearly impossible to detect." States like Vermont, New Jersey, and New Mexico have recently enacted this type of legislation, strengthening women's and workers' rights in their states.
The New Hampshire Union Leader relied on anecdotal evidence from past elections to revive the misleading threat of voter fraud to endorse voter ID laws that restrict the right to vote.
In a January 27 editorial, the Union Leader cited two cases of potential fraud that it claims justifies the paper's support for strict photo ID laws:
Adam Kumpu of Milford was fined $1,000 and his mother, Janine Kumpu of Milford, was fined $250 for the fraud. Janine Kumpu obtained an absentee ballot in her son's name, and he used it to vote in Milford last November. He also voted in person in Keene.
That was proven fraud. Then there is the mystery of a vote recorded in Caitlin Legacki's name in the 2012 general election. The bloggers at Granite Grok reported last week that someone voted in Manchester in 2012 under the name of former Jeanne Shaheen spokesperson Caitlin Legacki.
We confirmed with the city clerk's office that a vote under Legacki's name and address was recorded. But Legacki moved out of New Hampshire shortly after the 2008 election (in which she voted) and was in St. Louis on Election Day 2012, working for U.S. Sen. Claire McCaskill. "It certainly was news to me" that she was checked as having voted in Manchester in 2012, she told us last week.
The Union Leader's anecdotal evidence is futile since neither case was prevented by the voter ID law in place in New Hampshire prior to the 2012 election, nor do the examples prove the law's effectiveness in deterring the minuscule amount of fraud that occurs in elections. New Hampshire's voter ID law requires an eligible photo ID, or voters must sign an affidavit confirming their identity and intention to vote. The Kumpu family example would not be stopped by stricter ID laws as absentee ballots are counted after the polls close in New Hampshire, thus making the redundant vote unpreventable solely with voter ID legislation. The second case, as the editorial noted, could have been a simple mistake, and was not prevented by the ID law. In addition, it does not show any proof that anyone engaged in fraud.
The New Hampshire Union Leader attacked a push to expand Medicaid to the state's low-income residents, claiming that legislators should focus on job growth instead. However, studies show that expanding Medicaid will create jobs, spur economic growth, and cut health care costs for New Hampshire residents.
The New Hampshire Union Leader misleadingly used the findings of a study on Oregon's Medicaid expansion to attack the program, claiming it did not improve the health of patients and led to increased emergency room visits, and warning that New Hampshire "must not fall into that trap." However, contrary to the Union Leader's assertion, studies of Oregon's expansion show improvements in preventable diseases and mental health, and while ER visits were shown to rise initially, the number of people using the ER has dropped as people become more educated about their insurance coverage.
In a January 7 editorial, the Union Leader, which has a history of misinforming the public on Medicaid expansion, said Medicaid expansion is an effort to "move working-class and eventually middle-class Americans into government dependency." The paper claimed this would have a devastating effect on New Hampshire because the program is "poorly designed" and "does not even achieve its stated goals," using a recently released Harvard study of Oregon's 2008 Medicaid expansion experiment to show how the program "did not improve health outcomes or reduce health care costs" and "even increased visits to hospital emergency rooms."
But the Union Leader's claim that Medicaid did not improve health outcomes is inaccurate and fails to tell the whole story. A digest of the study published by the National Bureau of Economic Research contests the Union Leader's claims, saying the report found "higher healthcare utilization, lower out-of-pocket medical expenditures and medical debt, and better self-reported health." Past reports on Oregon's Medicaid experiment have also shown improvements in mental health and chronic disease detection among those covered by the expansion.
Two of New Hampshire's top newspapers, the Union Leader and Concord Monitor, ran weekly opinion columns from members of the Josiah Bartlett Center (JBC), a Koch brother-funded ally of the American Legislative Exchange Council (ALEC), but failed to disclose the authors' conservative funding allowing them a platform to air their conservative agendas and legitimizing the viewpoints of their special interest backers.
The New Hampshire Union Leader promoted a plan that would use Medicaid expansion funds available under the Affordable Care Act (ACA) not to expand Medicaid to cover more of New Hampshire's poorest residents, but to subsidize private insurance plans. However, under this plan, people would potentially pay higher premiums for their private plans or be left without health insurance.
In a November 17 editorial, the Union Leader advocated for using Medicaid expansion funds to extend New Hampshire's practice of providing subsidies for private insurance policies and mocked legislators who warned that this approach could leave consumers vulnerable to price hikes due to lack of marketplace competition:
That is why Senate President Chuck Morse's plan to use Medicaid dollars to subsidize private insurance for qualified Granite Staters is such a great proposal. He called the Democrats' bluff. Now they are throwing up every objection that they can, even ones that undermine the party's position on Obamacare.
State Senate Republicans had proposed moving newly Medicaid-eligible Granite Staters into subsidized private insurance plans purchased on Obamacare's state insurance exchange, and doing that by 2015. Last week Democrats hilariously complained that this was "unworkable" (Gov. Maggie Hassan's word) because there is no competition on New Hampshire's exchange, which is serviced by only Anthem and Delta Dental.
By pushing for Morse's proposal, the Union Leader failed to take into account two major impediments to the Senate plan. First, a special waiver must be proposed by the state and approved by the federal government before Medicaid funds can be used for private insurance. Knowing this could be a lengthy process, other states that have taken this route have already submitted proposals for approval. The Senate plan backed by the Union Leader forecasts only one year for federal approval, and would end expansion efforts if the plan had not been approved by the end of that year. A different proposal by the House also recommends using Medicaid expansion funds to offer private insurance subsidies, but that plan does not foresee moving people to private plans for at least three years.
The second problem with the Senate plan is the lack of competition in the state exchange marketplace. With only one provider on the marketplace so far, New Hampshire's exchange is not competitive enough to make the Senate private subsidy plan viable, nor does it have the time to grow competition before the Senate plan would be implemented. According to the Boston Globe:
Insurance Commissioner Roger Sevigny cautioned the Senate panel that its timeline is ambitious. Sevigny said he has not heard of any companies preparing to enter the marketplace as the Senate plan envisions in 2015 to join the lone provider, Anthem Blue Cross and Blue Shield.
The House plan rejected by the editorial is deemed more practical, because it would only shift Medicaid funds to private insurance if three providers are competing on the exchanges. According to Forbes, competition is vital to keeping prices low and quality of care high:
In the future, to stay competitive, insurers will need to increase value for their customers. They'll do so by including in their networks only those physicians and hospitals that provide higher quality at a lower cost. This will require providers to improve the processes and outcomes of the care they deliver.
This shift in competition will begin a virtuous cycle. The lower cost, higher-quality insurance plans will attract more people. A growing membership base will give them greater leverage to demand increased efficiency, higher quality and superior outcomes from doctors and hospitals in their networks. This, in turn, will result in further market-share growth as more consumers see the value.
As the Concord Monitor further explained:
Implementing Obamacare and expanding access to Medicaid, let alone doing so under an as-yet unwritten plan that requires federal approval, is enormously complicated. Almost every part of every endeavor is in flux. So without getting into the deep weeds, the sticking point is this: The governor and the House want the people newly eligible for Medicaid to be able to obtain coverage under the standard Medicaid programs now being overseen by three managed care companies until at least 2017 before shifting them to private plans with what amounts to a voucher to subsidize the cost. The added time could allow players other than Anthem, the only insurer signed up to participate in the health care exchange marketplace, to join, thus increasing competition and lowering costs.
Several local media outlets published editorials and opinion pieces highlighting and praising CBS' faulty 60 Minutes Benghazi report. Now that CBS has apologized and withdrawn its report, will local media follow suit?
On October 27, CBS' 60 Minutes aired a report highlighting comments from security officer Dylan Davies, who went by the pseudonym "Morgan Jones" and said that he was an eyewitness to the September 12, 2012, attack on the U.S. diplomatic facilities in Benghazi, Libya. After several inconsistencies surfaced in Davies' statements about the evening, CBS pulled its report, apologized to viewers, and said it would "correct the record" on the next edition of 60 Minutes.
Immediately following the 60 Minutes report, various local media outlets across the country published editorial and opinion pieces hyping the report and heralding it as evidence that President Obama and his administration were lying about the attacks. At least six local media outlets, including The Columbus Dispatch, The New Hampshire Union Leader, The Pittsburgh Post-Gazette, The Washington Times, The Charleston Post and Courier, and The Boston Herald, all hyped the CBS report with one outlet calling it a "damning report" while another said the administration's "coverup [is] being exposed." Pittsburgh Press writer Jack Kelly published a piece in the Post-Gazette claiming the report was "noteworthy for the new information provided -- in particular the interviews with 'Morgan Jones' and [Lt.] Col. [Andrew] Wood."
The 60 Minutes report reinvigorated the widely debunked myth that there are "lingering questions" about the Benghazi attack and continued to push a right-wing media narrative that the Obama administration has engaged in a cover-up in response to the attacks. The pervasiveness of the myth even hit Congress as Sen. Lindsey Graham (R-SC) threatened to hold up presidential nominations until questions surrounding Benghazi were answered.
Now that CBS has retracted its report, will local media outlets who also injected this misleading myth into their opinion pages do the same, or will they continue to rely on debunked information that misleads their readers?
The New Hampshire Union Leader argued against a proposal to expand Medicaid in the state and instead advocated for using the federal expansion funds to enact a voucher system. However, numerous studies have found that traditional Medicaid provides more coverage for less cost.
In a November 6 editorial discussing a state initiative to expand eligibility for Medicaid, the Union Leader claimed that Medicaid offered few health benefits and denounced the low reimbursement rates for doctors. The editorial went on to suggest that Medicaid expansion dollars should fund a voucher system:
Studies of Medicaid enrollees show that the program improves health care access, but not measurable health outcomes. And because it pays doctors and hospitals a fraction of what it actually costs for treatment, it does not solve the problem of cost-shifting. Nonetheless, there is pressure to expand eligibility from the state's current 63 percent of the federal poverty level to the Obamacare-demanded 138 percent.
[Sen. Chuck] Morse [(R)] and [Sen. Jeb] Bradley [(R)] have proposed a better way. Rather than throw people onto Medicaid, they would use Medicaid funding to enhance the state's premium support program. Low-income families would get better-quality private insurance, which pays full hospital and doctor reimbursement rates. And unlike straight Medicaid expansion, eligible people who are already privately insured would not be lured onto Medicaid.
Contrary to the Union-Leader's assertion that Medicaid doesn't show "measurable health outcomes," a study of Oregon's 2008 Medicaid expansion published in the New England Journal of Medicine found that while certain health outcomes were not achieved -- such as lowering cholesterol and hypertension -- expansion had other benefits such as lowering rates of depression and increasing the rate of diabetes detection and treatment.
Moreover, the American College of Obstetricians and Gynecologists has argued that expanding Medicaid is a key strategy to improving women's health, as Medicaid "is the largest payer of pregnancy services, financing between an estimated 40% and 50% of all births in the United States, and family planning services, accounting for 75% of all public expenditures."
Reimbursement rates under Medicaid expansion will increase as a result of the ACA, a fact the Union Leader failed to mention. As part of the law, provisions were included to raise rates so that doctors are more likely to accept new Medicaid patients. Rates will increase across the country by an average of 73 percent according to the Kaiser Family Foundation, and in New Hampshire, rates are expected to increase 50-99 percent:
In lieu of support for Medicaid expansion, the editorial advocated for a plan proposed by state Sens. Morse (R-Salem) and Bradley (R-Wolfeboro) that would use Medicaid expansion funds to further expand the state's voucher program. Yet, as Kaiser Health News explained, it is inherently cheaper to enroll more people in Medicaid than to give them subsidies for private insurance. Since HHS requires voucher programs like Morse-Bradley's to provide Medicaid-level benefits, the voucher program would promote more expensive plans but offer identical benefits to Medicaid. Furthermore, according to a study appearing in the Journal of General Internal Medicine, Medicaid offers better protection against underinsurance -- measured as out-of-pocket health care cost over 5% of income -- than basic minimum plans that low-income individuals can afford on the private market:
Greater than one-third of low-income adults nationally were underinsured. Medicaid recipients were less likely to be underinsured than privately insured adults, indicating potential benefits of expanded Medicaid under health care reform. Nonetheless, more than one-quarter of Medicaid recipients were underinsured, highlighting the importance of addressing cost-related barriers to care even among those with public coverage.