Marc Kilmer

Marc Kilmer is a Maryland Public Policy Institute senior fellow specializing in health care issues. He began his career in public policy as a legislative assistant to U.S. Sen. Larry Craig (R-ID), where he worked on education, transportation, and housing issues as well as federal appropriations, public land policy, and gun rights.

After leaving Craig’s office, Kilmer served for three years as executive director/CEO of the American Congress of Community Supports and Employment Services, a Washington, D.C., trade association of nonprofits that provide services to people with disabilities.

Besides his work with MPPI, he also works with the Buckeye Institute for Public Policy Solutions, a free market think tank in Ohio.

Kilmer has a Bachelor of Arts in history and political science from Hillsdale College in Michigan and lives in Salisbury, Maryland, with his wife.


Monday, September 29, 2008

Maryland Budget Problems Not Really a Surprise 

By Marc Kilmer

Categories:  Maryland, SCHIP

The Baltimore Examiner published an article by me where I say "I told you so" to the General Assembly about Maryland's budget problems. I'm not sure why they expected anything different when they expanded Medicaid in the midst of projected deficits and relied on tobacco taxes to raise a significant amount of revenue.

...during last year's special session, the cigarette tax was increased. It was evident, based on other states that had raised their cigarette taxes, that this tax would likely raise less revenue than expected. Sure enough, the projected revenue from tobacco taxes for this fiscal year has been revised downward by $18 million.

Likewise, I testified before the special session that expanding entitlement programs like Medicaid and the Maryland Children's Health Insurance Program would be foolish when the state had a deficit and faced an economic downturn was foolhardy. The recession earlier this decade illustrated that when states have economic trouble their spending on programs like Medicaid increases much more than budgeted, while at the same time their revenue declines. But this information fell on deaf ears.

Thursday, September 25, 2008

Got Medicaid? 

Maryland advertising a program that has uncertain future funding

By Marc Kilmer

Categories:  Maryland, Medicaid

Maryland officials are undertaking an advertising campaign to get people to sign up for Medicaid:

Gov. Martin O'Malley and Baltimore health advocates announced the launch yesterday of a $150,000 advertising campaign designed to let uninsured Baltimoreans know that thousands more of them are eligible for Medicaid.

Under a law that went into effect in July, parents with annual incomes up to 116 percent of federal poverty guidelines, or about $20,500 for a family of three, are now eligible for Medicaid. Before the new guidelines were passed, only parents making less than 40 percent of poverty were eligible.

"It's not enough just to pass a law. ... We have to do the outreach," O'Malley said at a news conference outside a social services center in Pigtown.

The "Got Healthcare?" campaign features the Democratic governor and four Ravens players. Radio spots featuring O'Malley and Ravens safety Ed Reed will be heard on five area radio stations. Print ads will also run on more than two dozen billboards, 53 buses and 30 bus shelters.

The only problem? There's no money after two years:

Health Secretary John M. Colmers said the state can pay for the expansion for two years without taking money from the state's general fund. After that, Colmers said, funding will be linked to the success of November's slot machine gambling referendum.

Linking it to the slots referendum is a tricky thing. The law that allocates how slots revenue will be divided says nothing about funding Medicaid with it. The money is divided between education, horse racing corporate welfare, and a few other things. So the only way Medicaid can benefit is if the slots revenue supplants money that would have gone to these other things.

Also, the idea that this money isn't coming from the general revenue fund is absurd. I'm not sure if Colmers misspoke, but it's not like special funds (e.g., federal money) is paying for the entire Medicaid expansion. The fiscal report for the legislation that authorized this expansion very clearly noted that the money to pay for it was coming from the general fund.

What Colmers probably meant to say is that the General Assembly budgeted enough funds to pay for two years of Medicaid expansion. It also authorized further expansion in a third and fourth year but did not budget funds for this. It said that if funds were available this expansion would take place. Given the state's budget picture, I'd wager that funds won't be there. And given the way the General Assembly acts, I'd wager that the Medicaid expansion happens regardless.

Tuesday, September 23, 2008

Soda Ban Innefective 

By Marc Kilmer

It seems that one of the cornerstones of the health care nanny state -- banning soda in schools -- really doesn't do any good:

Does banning soft drink sales in elementary schools reduce how much soda children drink? Somewhat, but not much, a new study finds.

Researchers said that when they compared the soft drink consumption of children at schools where it was sold and children at schools where it was not, they did not find a big difference. Only about 4 percent fewer children from the no-soda schools said they did not drink it.

The type of social engineering typified by the soda ban is simplistic and ultimately ineffective. I'll bet that the public officials who are pushing for this ban will continue to do so, however, mainly because I suspect the bans are supported more for symbolic reasons rather than for any good they will accomplish. I'll also bet that policy makers will fail to learn the lesson that trying to ban products to improve health (trans fat, anyone?) just doesn't work.

Monday, September 22, 2008

Big Business Behind SCHIP Expansion 

By Marc Kilmer

Categories:  SCHIP

The Kaiser Daily Health Policy Report has this interesting item:

The Pharmaceutical Research and Manufacturers of America has contributed $11.3 million to the advocacy group America's Agenda: Health Care for Kids for advertisements supporting SCHIP expansion, CQ HealthBeat reports. The ads will appear in at least 25 lawmakers' states and congressional districts. The ads do not name SCHIP specifically but commend lawmakers who supported a bill (HR 3963) that would have expanded SCHIP. President Bush vetoed the bill, citing cost concerns.

Those of us who advocate for free market health care solutions are often accused of being in the pocket of Big Business (or am I the only one?). Stories like this indicate the reality: big business likes government health care programs. Medicaid, Medicare, SCHIP, etc., are an easy source of money for them. 

So the next time advocates of expanding government programs accuse you of doing the bidding of Big Business, ask them where their money comes from.

Tuesday, September 16, 2008

The Politics of SCHIP 

Renewal likely next year

By Marc Kilmer

Categories:  SCHIP

It doesn't seem that SCHIP reauthorization will be happening this year:

Advocates of reauthorizing and expanding SCHIP "are warily training their eyes on next year with a mix of anticipation and anxiety" as it seems unlikely that there will be another vote on the legislation during the current congressional session, CongressDaily reports. Congressional Democrats recently said they will not hold a vote on SCHIP legislation this year, citing an inability to override a promised veto by President Bush. In January, the House fell 15 votes short of overriding Bush's veto of SCHIP legislation, CongressDaily reports.

Given the views of both Barack Obama and John McCain, I'd wager that Congressional Democrats will generally get their way on SCHIP legislation when it is finally reauthorized.

Interestingly, some liberal advocates are concerned that because of a delay in SCHIP reauthorization, some states "may decide to forgo expansion." If only. States like Maryland and Ohio have expanded their programs even without state money being available to pay for them. Does anyone really think they care about the status of federal reauthorization? They will expand their programs and then blame the feds for standing in the way of helping "the children."

Tuesday, September 16, 2008

See the Connection? 

Maryland expands govt. health care, now facing a deficit

By Marc Kilmer

Categories:  Maryland, Medicaid

Two recent news items from Maryland illustrate how some fail to see how expanding government programs strains state budgets. First, the Frederick News-Post celebrates the state's new health care programs:

Small firms can find a break on one of the most expensive parts of operating a business -- health care.

The state launched its Health Insurance Partnership, which can give small businesses up to 50 percent of health insurance premiums....

In July, the state launched its Medical Assistance to Families program, an expansion of Medicaid that covers parents with incomes up to $20,500 for a family of three, or 116 percent of the federal poverty level.

Earlier this year, the state also launched a prescription drug assistance program for seniors that helps close the gap between the federal Medicare Part D and full costs.

But, as the Annapolis Capital reports, all is not well with the state budget:

The struggling national economy continues to take a toll on Maryland government, with the state facing a $1 billion hole next legislative session. That sets the stage for possible reductions in education, health care and transportation spending.

Medicaid is one of the largest single items in the state budget and yet legislators and the governor expanded eligibility last year in the midst of a special session called to fix the state's deficit. I guess we can see how well that worked.

Thursday, September 4, 2008

More Health Care Regulation Proposed for Ohio 

By Marc Kilmer

Categories:  Individual Mandates, Insurance Regulation, Ohio

A task force convened by Ohio Governor Ted Strickland recently recommended that the state enact a wide variety of new regulations on health care in the state. In a piece put out by the Buckeye Institute this week, I explain why less regulation, not more, should be the approach used by Ohio:

Among [the recommendations was] the proposal that the government mandate individuals purchase health insurance and require insurers to sell health insurance to all that apply (known as "guaranteed issue" in the health insurance world). Oh, and the state should also impose regulations to make this health insurance "affordable."

What this task force seems to have missed is the fact that you can force insurers to sell people insurance, or you can have affordable health insurance, but it is very hard to have both. Insurance companies stay in business by bringing in more money than they pay out. As part of that, companies may not choose to insure people whom they know will cost a lot.

...

One of the main reasons that health insurance is unaffordable to some in the state is because government mandates and rules have raised its cost. The Strickland task force recommendations will only raise this cost further. Instead of looking for ways to meddle in the market, this task force should have explored reforms that Georgia is pursuing, which hold the promise of lower insurance prices through less government regulation.

Affordable health insurance is a noble goal. But you do not reach that goal through more government interference in the market. The experience of other states with this type of regulation shows that if the task force plan is put in effect, it is likely to put health insurance out of reach for even more Ohioans.

Wednesday, August 13, 2008

Tightening the Screws on Business in Massachusetts 

By Marc Kilmer

Categories:  Massachusetts

The state of Massachusetts is targeting businesses to help cover the shortfall in revenue to pay for the state's health care plan:

Current law requires most employers with more than 10 full-time equivalent employees to offer health coverage or to pay an annual "fair share" penalty of $295 per worker. It gives companies an option of paying at least 33 percent of full-time workers' premiums within the first 90 days of employment or making sure that at least 25 percent of their full-time workers are covered by an employer plan.

But the new regulations would require employers to meet both requirements, or pay the penalty.

So let me get this straight -- companies are facing a new mandate to provide insurance for their workers, which may add up to thousands of dollars per worker, or they can opt out for $295 per year? Who wants to bet that a good number of employers stop offering insurance altogether? Of course, I'll guarantee when this happens there will be a call to increase the penalty payment. It seems that Massachusetts businesses just can't win.

This quote from an advocate of this plan kills me:

But Health Care for All, one of the state's largest consumer groups, applauded the proposals. Brian Rosman, the group's research director, said consumers were required this year to pay higher premiums and deductibles to help cover the funding shortfall.

"We think this implements the shared responsibility concept that was the hallmark of healthcare reform," he said. "It makes sense to us to say to companies that offer minimal or no benefits, 'You have to make a small contribution.' "

A "small contribution"? Spoken like someone who is completely unfamiliar with the travails of businessmen. Many businesses cannot afford to provide health insurance, due in large part to the regulation of the small group market. But Mr. Rosman seems to think they are just being selfish and greedy. I guess it would be better for everyone if they just went out of business, huh?

Friday, August 1, 2008

Advocates Fight Efforts to Move Kids to Private Insurance 

By Marc Kilmer

Categories:  SCHIP, Utah

In Utah there is a move to expand a subsidy program to help people purchase private insurance. It makes sense that if people have access to private insurance and can use this subsidy to purchase it that they should be denied the ability to enroll in government insurance. Of course, it seems that some think that would be unfair to the children:

In written and spoken testimony at a public hearing Tuesday, advocates said a waiver being sought by the state Department of Health to permit more low-income families into Utah's Premium Partnership will in effect push out children now covered by Children's Health Insurance Program (CHIP).

If the federal waiver is approved, children whose parents enroll in the premium subsidy plan, which helps a family pay premiums of a private insurance plan offered at work, would be denied CHIP coverage. The waiver would also extend the time a family must remain uninsured before enrolling in either plan — six months instead of the current 90-day waiting period.

These self-appointed children's advocates also laughably (and somewhat confusingly) claim that CHIP coverage is "richer" and "more efficient" than private coverage. How is it "richer"? It costs more? That's a good thing? And it's more efficient? Apparently they need some lessons from John Goodman.

In opposing this common-sense plan, these advocates are showing their true colors. Their first goal it to expand government health care, not obtain coverage for children.

Thursday, July 31, 2008

SCHIP Reauthorization Back? 

By Marc Kilmer

Categories:  SCHIP

The Hill had an editorial predicting the resurgence of SCHIP in September and the possibility that President Bush's veto of the measure could be overridden:

In January, 42 House Republicans voted for the override of Bush’s veto on SCHIP. Since then, the political climate has soured for the GOP, and there are three Democrats who replaced Republicans in special elections this year. It’s also fair to assume that more Republicans will vote for SCHIP in September.

If this happens it may not be the worst thing in the world. The current SCHIP legislation isn't quite as bad as it was in its earlier forms. And if Sen. Obama is elected and SCHIP reauthorization takes place on his watch, we're likely to see an even worse bill.

If Senator McCain is elected I would not be surprised if he would sign a "generous" SCHIP bill into law, too. McCain's record in the Senate has shown him to be a fan of expanding government's reach on health care, notwithstanding his halfway-decent health care platform today. Perhaps it may be best to settle for a pretty horrible bill today instead of a reallly awful bill next year.

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