Reality Check: Haley Barbour, BMWs and Medicaid Recipients

It seems old lies never die—especially when it comes to entitlement programs for the poor.

In the contentious debate over how to reduce spending in state Medicaid programs, Mississippi Gov. Haley Barbour (R) insisted that one solution for his state is to have Medicaid recipients pay a larger share of their medication costs, saying, "We have people pull up at the pharmacy window in a BMW and say they can't afford their co-payment."

That ridiculous comment harkens back to Ronald Reagan’s use of "Cadillac-driving welfare queens," to refer to a fictitious cadre of black mothers living the high life while collecting public assistance. Tinged with racial undertones, Reagan’s characterization of welfare recipients—including a 1976 reference to the typical food-stamp user in the South being  a ‘strapping young buck’ buying T-bone steaks—helped bolster support for his overall attack on social welfare.

As Steve Benen writes in Washington Monthly today, “In other words, when Barbour claims ‘we have people’ who pick up prescriptions in Mississippi in a BMW — as if this is somehow common — he's lying.

“But I suspect Barbour doesn't much care. The point of a quote like that one isn't to draw attention to a legitimate policy concern; it's to appeal to right-wing voters on an emotional level.”

According to Glenn Kessler, who writes “The Fact Checker” column at the Washington Post, Barbour is schooled in communicating with his public on an emotional level: he worked for Reagan as director of the White House Office of Political Affairs in 1985-1986. Kessler asks, “Could Barbour have picked up some tips from the Great Communicator?”

Kessler’s attempts to get someone from Barbour’s office to answer questions about the source of his statement went unanswered for two days, “so we can't tell if his assertion about the BMW-driving patient is based on a documented study, an anecdote from a single pharmacist or a figment of Barbour's imagination.”

Instead, Kessler decides to work out the financial feasibility of such a scenario—and in the process, highlights the draconian eligibility requirements for someone to qualify for Medicaid in Mississippi. You can read the entire piece here; I’ve excerpted some highlights below:

“Mississippi provides some of the lowest Medicaid benefits to working adults in the nation. A parent who isn't working can qualify only if annual family income is less than 24 percent of the poverty line. Working parents qualify only if they make no more than 44 percent of the federal poverty level. Seniors and people with disabilities are eligible with income at 80 percent of the poverty line. Pregnant women do better — they're eligible with income up to 185 percent of the poverty level.

“Translated from the federal poverty guidelines, that means a working Mississippi couple with one child could earn no more than $8,150 a year and still qualify for Medicaid, seniors and people with disabilities could earn no more than $8,700, and a pregnant woman could earn no more than $20,000 a year.

“Meanwhile, the German-engineered BMW is a pretty fancy car. Edmunds.com says that new BMW car prices range from nearly $30,000 to more than $120,000. That seems out of the price range of someone making $8,000 a year.

“Checking used BMWs worth less than $5,000 in Mississippi on Yahoo Used Cars finds 10 available within 300 miles of Jackson, the state capital — but all carrying lots of miles. Four grand, for instance, would get you a 1996 BMW 328i with 237,000 miles on it. But even that, for many of Mississippi's Medicaid recipients, would be half a year's salary.”

During this crucial time for Medicaid—the beleaguered health care program for 53 million poor and disabled Americans—it’s important that the country get an accurate picture of the population in question. In my post yesterday, I went through the standard methods states have used to cut spending on Medicaid; all result in reducing the number of the program’s beneficiaries.

These are not BMW-driving folks—many of those covered by Medicaid are children, some are low-income pregnant women, most are extremely poor and/or living in institutions. If politicians need any more convincing that Medicaid patients are not living high off the hog, they need look no further than a new report from the Kaiser Commission on Medicaid and the Uninsured. The report finds that in 2010 most states were “holding steady” with their Medicaid programs, thanks primarily to the addition of $90 billion in federal stimulus funding that will run out in June. But even with this extra federal support, Medicaid is hardly generous: According to the report, as of January 1, 2011, “33 states do not cover parents up to 100 percent of the federal poverty level ($18,310 for a family of three in 2010). The median eligibility threshold for parents remains at 64 percent of the federal poverty level and 16 states limit eligibility to below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).”

In the vast majority of states, single adults—working or non-working—do not qualify for Medicaid even if they are completely destitute. And parents don’t have it much better. The report surmises, “In the absence of further expansions, these restrictive eligibility levels will leave most uninsured, low‐income parents without an affordable coverage option until the health reform expansion goes into effect in 2014.”

Haley Barbour’s off-the-cuff reference to unworthy Medicaid recipients only amplifies an already-contentious situation. There is a serious problem brewing: States are struggling to cut ballooning budgets at the same time that more Americans have lost their jobs and need health coverage. Medicaid is growing at just the time that federal stimulus funding is petering out and states are begging for relief. Dismissing this problem with glib jabs at “welfare queens” or “BMW-driving” Medicaid recipients only injects partisan—and frankly, racial—overtones into the debate and keeps us further from a solution.