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Author’s Note: This is the fifth in a series of articles about Nebraska’s Medicaid program, the Unicameral’s apparent intent to expand it, and the many reasons why expansion is an uncommonly bad idea. Although they don’t have to be read in order, here are links to the previously-published articles in the series:

• NE Medicaid Expansion: The Race is On
• Let’s See What Condition Our Condition is In
• People Don’t Walk Away From a Fool and His Money
• Sending Granny (and Gramps) to the Home

*  *  *  *  *  *  *  *  *  *

We’re still talking about whether or not social welfare programs affect individual behavior.  In previous articles, I concluded that they do and used Nebraskans as an example, based on the results of a study about the impact of Medicaid on people’s willingness to plan and pay for their own long-term care here in the state.  In the third article in this series, I promised to discuss the stereotype of the “welfare queen,” — you know, the unmarried woman, usually black, who has yet another child in order to increase the amount of her monthly welfare check — in a subsequent article.  Well, this is it.

I’m going to preface my remarks about this particular stereotype with some general comments about stereotyping as a psychological phenomenon.  Stereotypes are actually functional.  They enable us, as humans, to process the massive amounts of information we receive from the outside world and bring some order to what would otherwise be chaos.  Stereotypes develop as we classify and seek relationships between bits of information.  As they form and solidify, they guide attention, help us generate expectations, interpret new information, guide memory, and enable recall.  That’s the “up” side.

The down side is that stereotypes, as necessary as they are, are prone to overuse.  Because we are all fallible and human, the stereotypes we develop aren’t always accurate, we often use them as a substitute for observation, and we’re not quick to revise them, even when contradictory information is available.

The information provided in the previous article and in this one is not consistent with the stereotype of the “typical” person who games the system and/or commits welfare fraud.  For one thing, it’s a virtual certainty that most of the people behind the statistics discussed in these two articles are white, not members of any particular minority group.  Nebraska is anything but a racial melting pot, and white people make up the vast majority of its overall population and the sub-group within it that is Medicaid-eligible.  Nor are the people discussed in these two articles uniformly poor or otherwise disadvantaged.  For example, the practice of spending down assets to render yourself eligible for Medicaid is usually something done by members of the middle and upper-middle classes, as the authors of the study discussed in the last article explicitly state.

Bottom line?  It doesn’t matter what race, sex, or socioeconomic group you belong to, entitlement programs are incentives for you to behave badly, make bad decisions, and place the burden to pay for those bad decisions on the shoulders of others.  In short, they undermine self-reliance and personal responsibility.

That said, exactly how many of the births that occur in the State of Nebraska each year are paid for with Medicaid funds? For over two years, GiN has cited a statistic — 47 percent — which is startling, but only part of the story. To cop a great line from a famous broadcaster, this article places that statistic in context, revealing “the rest of the story.”

GiN was put on the scent to track down Medicaid-supported births data after I saw the nearby article published on February 12, 2010, in the Lincoln Journal Star. The article appeared to be just a little filler item crowded along the edge of the page with a number of other blurbs of approximately the same length on different subjects.  I don’t recall that any of them carried a byline. I can’t say what drew my attention to this particular article, but I do remember catching my breath when I read the title: “Medicaid pays for nearly half of all births.”

One of our cardinal rules here at GiN is to verify information, even (or, perhaps, especially) information published in the mainstream media, by going to original sources. Because the article specifically stated that the information came from the state Department of Health and Human Services (DHHS), I went to the DHHS website in an attempt to confirm the report. After wandering around that website for quite some time — (I don’t know how long I spent there before I found any relevant information, but let’s just say I had a whole new respect for Moses and the Israelites by that time) — I still could neither confirm nor deny the report.¹

It wasn’t until April of 2012, when I was writing “LB:599: The Procreation Protection and Affordable Sex Act,” that I pulled out my old research and braved DHHS, by telephone this time, to investigate the issue further. After being bounced from one bureaucrat to another quite a few times — all of whom were cordial and regretted their inability to answer my questions about the Medicaid births data — I finally reached someone who could. The statistics she provided are as follows:

What do these numbers tell us? First of all, it’s clear that, between 2000 and 2012, the number of babies born in Nebraska declined. If you do the math, you can quantify the amount by which births declined in the state — it was by a modest 3 percentage points.²

What’s interesting from a public policy standpoint as it pertains to Nebraska’s Medicaid program is this question: Who was giving birth to the babies who were born here? During the 13 years for which we have data:

• among women who paid their own way, either out of pocket or through private insurance, the birth rate declined by 16 percent; BUT
• among those women whose expenses were paid for with Medicaid funds — that is, by you and me — the birth rate rose by 34 percent over the same period.

Although that difference is stunning enough, sad to say, it’s understated. The decline that you’ll note if you refer to the birth rate figures for Medicaid births between 2010 and 2012 is largely attributable to the exclusion of certain groups of pregnant women from eligibility for Nebraska Medicaid benefits, a decision by federal authorities that sparked the Unicameral’s perceived need to pass LB599 over the governor’s veto to remedy the situation. Because the bill was passed at the end of the last legislative session to make women who are similarly situated eligible again, expect the numbers to bounce back beginning in late 2012 and beyond. In other words, the numbers of Medicaid births were, somewhat artificially, suppressed in 2011 and 2012 when those women were temporarily forced out of the system.

Information from another source validates the existence and scope of the problem revealed by the data discussed above: Federal census figures indicate that, on average, the birth rate among women in Nebraska who receive cash public assistance is roughly three times that of women who do not.³

What does this information have to do with the Unicameral’s intention to expand the state’s Medicaid program, ostensibly because expansion will save all of us money over the long haul? I’ll try to tie some things together for you beginning in the next article.

In the meantime, doesn’t what you know now give this old Paul Anka tune a whole new meaning?