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Dennis Smith: From the Heritage Foundation to the Wisconsin Dept. of Health Services

In a statement released on January 25th, 2011, Dennis Smith offered the following:

I would like to thank Governor Scott Walker for the honor and privilege of joining his Administration as Secretary of the Department of Health Services. I also want to thank Senator Vukmir for her leadership of the Senate Health Committee as well as all of the Committee members; Senators Galloway, Moulton, Erpenbach and Carpenter and all of the Senate leadership members for their courtesy and support. I look forward to a successful working relationship with all members of the state legislature – especially the health care related committees.

There is no question that these are challenging times but we are ready to meet these challenges head on. I have dedicated my career to public service and I am proud to have the opportunity to serve the people of the great state of Wisconsin.”

While this appears to be a relatively normal statement released by a newly appointed public official, the implications of Dennis Smith taking this position deserve serious consideration. This statement was accompanied by a brief history of Dennis Smith’s employment:

Dennis Smith previously served as the head of the U.S. Centers for Medicare & Medicaid Services under Secretaries Tommy G. Thompson and Michael Leavitt. Smith has also worked as Medicaid director in the Commonwealth of Virginia and as Chief of Planning for the California Department of Developmental Services.”

One interesting omission in this history of Dennis Smith’s employment is the time he spent as a Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation. As a Senior Fellow, Smith wrote extensively on government-run health insurance programs, something extremely relevant to his new position. Let us now begin looking into Dennis Smith’s published writings on Medicaid and how they are relevant to his new position.

Attacks on Medicaid and Medicare from the Heritage Foundation are largely based on misleading, intellectually dishonest arguments. Arguments against these programs are almost exclusively fiscal in nature, claiming we cannot afford to operate these programs. It is a noteworthy argument once one considers that, for example in the 2010 Federal Budget, Medicare and Medicaid combined cost $793 billion while the Defense Department alone was allotted $693 billion. Total spending on military efforts brings this figure closer to a trillion dollars. You can spend days reading through The Heritage Foundation’s statements on how unaffordable these healthcare programs are, yet the subject of why such defense spending is necessary is strangely given less attention. These fiscal arguments are only remotely reasonable if considered in a vacuum, in which no other aspect of federal spending or taxation could be adjusted.

More specifically, some of Dennis Smith’s work at the Heritage Foundation attacks Medicaid under the misleading argument that those in Medicaid would be better off with no insurance at all. In his October 21st, 2009 WebMemo (No. 2662) published by the Heritage Foundation, Dennis Smith states:

It is now clear that roughly half of the projected reduction in the uninsured will be due to putting more than 14 million individuals into Medicaid. Congressional liberals’ passion for Medicaid expansion may be puzzling to those who view health care reform as a means to improve the quality of care and achieve superior medical outcomes.”

The remainder of this WebMemo furthers this argument with more dishonest analysis. Jonathan Cohn debunks many of these claims concisely and clearly in his March 10th post “The Conservative Assault on Medicaid” in The New Republic. For brevity’s sake, I leave the debunking to Jonathan Cohn here. The fact that Dennis Smith seems to believe that providing 14 million poor Americans with health insurance through Medicaid is such a disturbing prospect speaks for itself.

All the more troubling is that in the Legislative Financial Bureau memo on the recently passed SS SB/AB 11, it states that the bill “.. could potentially give broad authority to the Department of Health Services, with approval of the Joint Committee on Finance, to significantly modify the medical assistance program and supersede most statutory provisions regarding the program.” Page 7 of the text of SB 11 specifically details how this would occur. Amendments made to SB 11 before passage removed the requirement that changes made by the DHS be approved by the Joint Finance Committee. This is interesting given that Dennis Smith wrote another WebMemo (December 1st, 2009, No. 2717, titled “Medicaid Meltdown: Dropping Medicaid Could Save States $1 Trillion”) in which he repeatedly attacks the “erosion of state authority” resulting from the Patient Protection and Affordable Care Act. Strangely enough, Dennis Smith, as an unelected appointee in the Wisconsin government, will now have direct  control over Medicaid and BadgerCare spending while less than 2 years ago he warned of the opposite situation.

Dennis Smith, who has a history of attacking Medicaid through intellectually dishonest arguments, will now have unprecedented control over spending on BadgerCare and Medicaid in the State of Wisconsin. If he uses this authority to deny healthcare to those who need it, or disrupt the care of those already benefiting from BadgerCare and Medicaid, it will result in deaths. This sounds like a radical statement, but there is a mountain of evidence suggesting that health insurance indeed saves lives.  While SB/AB 11 contains a plethora of unprecedented, shameful provisions, few are as disturbing as putting Dennis Smith in direct control over spending on BadgerCare and Medicaid.

We are now beginning to see the first consequences of Dennis Smith’s tenure as DHS secretary. On March 18th, 2011 the Wisconsin DHS announced that it was freezing enrollment and increasing premiums for the BadgeCare Plus Basic plan, which caters to individuals without dependents who are on the waiting list for the Core program. While the Wisconsin Republicans managed to pass $142 million in tax breaks in the first month of 2011 (SS SB2, SS AB 3, SS AB7, SB/AB 4) they are already willing to begin denying healthcare to some of our most vulnerable citizens.

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Thomas M Bird

Thomas M Bird