This weekend, via Twitter:

Ellis ‏@cole3llis May 17

@sophieslater my sister got a letter back from our Ed Emery from the pp petition she signed: he said she should move to another state. [….] 9:24 PM – 17 May 2014

Ellis ‏@cole3llis

[….] here it is for your reading pleasure! pic.twitter.com/NTw8pchIjr 9:43 PM – 17 May 2014

The text of Senator Ed Emery’s (r) constituent letter:

[….]

Missouri Senate

[….]

ED EMERY

31ST DISTRICT

May 13, 2014

[….]

I received your form letter about Medicaid expansion. Thank you for contacting my office. Although it is seldom possible to please every constituent, it is valuable to know what my constituents are thinking. I will not support Medicaid expansion in Missouri for several reasons. First, it does not deliver on its promises. The Oregon Medicaid experiment confirms what common sense would conclude – neither access nor health outcomes are improved.

Secondly, it has a significant negative impact on choice. Medicaid expansion represents contraction of choice. The state, not the individual, decides what treatments can be provided and by whom. Individual liberty is important to me and I understand my oath of office as a commitment to defend it.

There are additional reasons why Medicaid expansion is wrong for Missouri that you may discover with further study. They will also become more obvious as those state who have taken that course will begin to experience the consequences. Nevertheless, an invaluable aspect of our federation of states is that each state is like a laboratory for government policies. We live in a nation and an era that facilitates physical moves between states. Individuals and families are free to consider moving to states with differing and even contrasting government policies. That is the beauty of federalism.

Thank you for your input and allowing me to explain my position.

Sincerely,

s/

Ed Emery

“I received your form letter about Medicaid expansion…”

Irony challenged, eh?

“…Secondly, it has a significant negative impact on choice…”

Oh, definitely irony challenged.

“…Medicaid expansion represents contraction of choice. The state, not the individual, decides what treatments can be provided and by whom….”

Uh, people who need Medicaid and don’t have access to health care because they don’t have Medicaid and resources do have two choices. The first, do without and suffer. The second, when their medical condition gets bad enough, go to an emergency room and get medical treatment at its most expensive. Who pays for that?

“…There are additional reasons why Medicaid expansion is wrong for Missouri that you may discover with further study…”

Uh, it’s generally considered a bad idea to tell a constituent in a letter that you think they’re ignorant.

“…We live in a nation and an era that facilitates physical moves between states. Individuals and families are free to consider moving to states with differing and even contrasting government policies. That is the beauty of federalism…”

“Move elsewhere” now appears to be the embodiment of tenther philosophy.

Let’s take a look at the “Oregon Medicaid experiment”:

Here’s what the Oregon Medicaid study really said

By Ezra Klein

May 2, 2013 at 3:11 pm

The Oregon Medicaid experiment is an academic miracle born out of a human tragedy.

A few years back, Oregon found the money to add 10,000 residents to the state’s Medicaid program. The only problem was that there were 90,000 residents who qualified for the program and desperately wanted in. So the state held a lottery. Welcome to the American health-care system. Greatest in the world, folks.

But 80,000 Oregonians’ loss was science’s gain. The lottery gave researchers an opportunity that’s almost never available in policymaking: They could create a randomized controlled study — the absolute gold-standard of experimental design — comparing the health outcomes of the lucky Oregonians who received Medicaid to those who didn’t. It would be the first time that kind of study had even been used to compare the insured and the uninsured.

The initial batch of results was released in August 2012. The data covered the first year of the Medicaid expansion and found that the folks on Medicaid were getting more care, reporting better health (both physical and mental), and seeing fewer financial problems than the people who weren’t on Medicaid.

The second set of results was released Wednesday. The data now covers two years and, importantly, includes clinical measures of health rather than relying on the reports of the study participants. These results are more mixed, but also more telling.

Here’s what we can say with certainty: Medicaid works as health insurance.

That might seem obvious. It’s actually not. A big criticism of Medicaid is that it pays doctors so little that it’s essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care — including preventive health care — than the residents who lost it. They also saw catastrophic health costs basically vanish.

[….]

“…The Oregon Medicaid experiment confirms what common sense would conclude – neither access nor health outcomes are improved…”

“…the Oregon residents who won the Medicaid lottery got much more health care — including preventive health care — than the residents who lost it. They also saw catastrophic health costs basically vanish…”

Uh, getting “much more health care – including preventative health care” qualifies as increased access.

And:

The Oregon Experiment – Effects of Medicaid on Clinical Outcomes

[….]

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.

[….]

“…increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures…”

What effect do you think that would have on the quality of one’s life? Just asking.