We Must Demand the Truth about the Federal Budget: It’s Important for Funding Medicare, Medicaid, and Other Federal Programs for the Elderly

By:

Dave Kingsley

Political Economy Accounts for the Effects of Propaganda – Orthodox Economics Do Not

The focus of this blog is on economics, finance, and politics – we could more aptly say that we conduct research and write about “political economy.”  As opposed to orthodox economics – overwhelmingly taught in the academy and practiced by most professional economists these days – political economy considers the cultural, historical, and political, context of the economy.

In the current cultural context, an increasingly high tolerance of lying, and intentionally misinforming the public has been developing since the Reagan Revolution. A survival of the fittest, winner take all, hyper-competitive capitalism has become intertwined with money in politics, boosting venal politics. This is having a major effect on how federal spending is presented to the public.

Propaganda

 Propaganda has become a noticeable feature of public discourse on federal funding. By propaganda, I’m referring to intentional disinformation, i.e., lying, plus the individuals and organizations that wittingly and unwittingly disseminate it. As the venality of politics increases, there is a proportional increase in significant amounts of propaganda. For instance, in the past few decades, the late Wall Street mogul Peter G. Petersen funded several “inside-the-Washington, D.C.-beltway think tanks” for the purpose of selling the public on the belief that this country – the richest country on the planet – can’t afford to fund a decent level of retirement security, e.g., Social Security, SSI, medical care, e.g., long-term care, housing, and other programs for a dignified and humane old age.

I have already blogged somewhat about Petersen’s phalanx of organizations such as The Committee for a Responsible Federal Budget, The Concord Coalition, and The Bipartisan Policy Committee.  The boards of these organizations include prestigious individuals from government, the military, business, and super-rich families. Former congresspersons who have behaved suitably while in office often serve as board members or high paid executives of these special interest “think tanks” which pass themselves off as legitimate research institutions, when in fact they are propaganda machines.

Petersen’s Billions for Propaganda Have Had a Huge Impact on Budget Beliefs

If you are looking for information on the federal budget, you can find some nice looking, colorful, pie charts online that are simple, easy to understand, and wrong.  The pie chart below is nothing less than a lie. This representation of the 2019 budget has been typical of what has been disseminated over the past several decades. The 2020 budget will be atypical due to COVID and would muddy the waters somewhat on this post, which addresses enduring concerns.

The above chart illustrates the percentage of “federal spending” that is allocated to major categories such as Social Security and defense.  This is typical of what one finds when Googling the federal budget.  This chart is disseminated by the Committee on Budget & Policy Priorities (https://www.cbpp.org/research/policy-basics-introduction-to-the-federal-budget-process).  The CBPP is usually on the progressive side of issues, but they are on board with the pervasive misinformation regarding the budget.  Unfortunately, misinformation about the federal budget dominates public discourse.

Social Security is “Off Budget” by Law:  It Only Makes Sense that it Would Be.

What’s wrong with the information on the above chart?  Although the data are purportedly “budget data,” they are not.  The title of the chart is “Federal Spending FY 2019,” which is a rather slick maneuver, because it appears in a document entitled “Introduction to the Federal Budget Process.”  No doubt, Social Security is a component of federal spending, but it has nothing to do with the budget.  “In the 1983 Social Security Amendments a provision was included mandating that Social Security be taken “off-budget” starting in FY 1993” (https://www.ssa.gov/history/BudgetTreatment.html#:~:text=Research%20Notes%special%20Studies%20by%20the%20Historian%27s,%20%24567%20billion%20%201%20more%20rows%20).

Expenditures on Social Security are from a dedicated payroll tax, benefits are actuarially determined based on individual accounts, and no general fund transfers are made to the program, which cannot run a deficit or borrow money. Benefits would be reduced if revenue could not meet payout earned by beneficiaries.  So, to display it as 23% of the federal budget is false. Furthermore, prior to 2020 and the COVID crisis, Trust Fund balance of $3 trillion had accumulated.  This was not counted against the deficit.

In 2019, Only 42.6% of Medicare ($339.8 billion) was Transferred from the General Fund.

The pie chart above pertains to a mythical budget of $4.4 trillion (see bar chart below).  Medicare is shown as 14%.  However, only 42.6% ($339 billion) of total Medicare expenditures of $796.2 billion is appropriated through the federal budget process. 

Instead of 14% of the total federal budget of $4.4 trillion, Medicare is less than 8%.  That is, if the federal budget is actually $4.4 trillion, which it isn’t.  Social Security must be eliminated.  There can be no argument about that.  Approximately $1.5 trillion in tax expenditures should be added, which would result in a total budget of nearly $5 trillion.

Tax expenditures are subsidies provided to corporations and individuals through the tax code.  “The Congressional Budget Act of 1974 (Public Law 93-344) requires that a list of “tax expenditures” be included in the budget” (https://home.treasury.gov/system/files/131/Tax-Expenditures-2021.pdf, p. 1).  You may have noticed that they never show up on impressive pie charts? So, for instance, subsidies to employers for health insurance provided by employers to their employees ($228 billion – the biggest tax expenditure) are not included in charts provided by think tanks.  Capital gains, employer defined benefits and defined contribution programs, accelerated depreciation, and a large number of other tax subsidies, most of which benefit high net worth individuals and corporations (including the long-term care industry), are major subsidies that cost taxpayers and put pressure on other forms of revenue.

Although Social Security & Medicare are a Small Part of the Federal Budget – they are Blamed for the Deficit

Social Security is not part of the $5 trillion federal budget.  So, the $339.8 billion transfer from the general fund for Medicare, which had total expenditures of $796 billion, mostly paid for with premiums, co-pays, deductibles (out of pocket or OOP expenses), and the payroll tax is on budget.  Hence, the entire $1.8 trillion expended on Social Security and Medicare only accounts for 6.8% of the entire federal budget.

The media will parrot press releases produced by the organizations responsible for budget propaganda.  Advocates, and activists have a duty and obligation to debunk and rebut these lies about cherished programs for the elderly.

The Financial Performance of “Nursing Home” Corporations during the COVID Pandemic, Part I: The Ensign Group

By:

Dave Kingsley

Introduction

The long-term care industry is paid by federal and state governments to care for medically fragile patients. That is an awesome responsibility. Historically, the industry has failed to provide the level of quality expected in a wealthy, humane, democratic society.  But the irresponsibility and negligence of so-called “nursing home” corporations in the face of a deadly pandemic has resulted in a human tragedy of incomprehensible proportions. Let’s call what happened what it is: gross negligence.

The public needs to know about the providers who have failed the patients in their care.  Hence, with this post, I will commence a series of highlights of companies in the business.  These posts are designed to illustrate the variety of corporations structured as publicly listed corporations, family trusts, private equity firms, family offices, sole proprietorships, and real estate investment trusts (REITs). One purpose of this series is to demonstrate the wide variety of ownership structures.

Throughout the COVID pandemic, I have been interviewed by various journalists about facilities with egregious amounts of COVID infections and deaths.  One task that I assisted members of the press with was tracking down ownership, which is often opaque and somewhat difficult to determine.  Initially, I’m highlighting two of those facilities and their owners: (1) Riverbend in Kansas City, Kansas, owned by The Ensign Group (ENSG) and Avocado Acute Care in San Diego, California, owned by the Jacob Graff Family Trust. This first post pertains solely to The Ensign Group.

The Ensign Group & the Riverbend Post-Acute & Rehabilitation Center

Riverbend Post-Acute & Rehabilitation Center came to the attention of the Kansas City media early in the sweep of the COVID pandemic through long-term care facilities.  According to the Kansas City Star, thirty patients had died from COVID in the facility as early as April.  I was contacted by Fox4 television reporters working on a story about a notorious loss of life in the facility early in the pandemic.

I was interviewed on air about the industry in general, but at the time I was not that knowledgeable about Riverbend ownership.  However, it did not take long to pin down The Ensign Group (ENSG) as the ultimate owner, which is a “holding company” and one of a handful of publicly listed owners in the business.

With over 200 facilities, The ENSG is one of the major players in the long-term care industry.  Given that it wasn’t formed until 1999, it is a rather young company.  Nevertheless, its revenue recently surpassed $2 billion.  Furthermore, a review of its annual 10-K and quarterly 10-Q reports filed with the SEC suggests that it has had robust earnings per share, has accumulated several hundred million dollars in cash and equivalents, and has very little debt (debt to equity ratio is at .15 versus 1.45 for the industry) – a very good position to be in these days.

How is it doing in this pandemic?  According to its third quarter 2020 10-Q filing, revenue was $599,255,000 compared to same quarter of 2019, which was $512,109,000.  It is doing stunningly well.  The ENSG reported 3rd quarter long-term debt of $113,322,000 compared to $325,217,000 as of December 31, 2019.

…earnings per share for the quarter was $0.77, representing an increase of 97.4% over the prior year quarter and adjusted diluted earnings per share for the quarter was $0.78, an increase of 95.0% over the prior year quarter.


https://investor.ensigngroup.net/news-releases/news-release-details/ensign-group-reports-third-quarter-results

At last check today I noticed that ENSG stock today was listed at $74.37 per share – near an all-time high. Here is what the Forex website had to say about the stock:

We wrote about the Ensign Group (ENSG) back in September and stated that gains may be only starting. The premise for our bullishness was the fact that earnings were increasing significantly and the technicals were following suit. Well, this momentum continued in the third quarter as the company reported adjusted net income of $44 million on sales of just under $600 million. In fact, record earnings over the past few quarters have resulted in management increasing its 2020 guidance significantly. Updated guidance for this year comes in at $3.12 per share on sales of approximately $2.435 billion. The maintaining of the top-line numbers illustrates that margins continue to increase. Management expects to do $3.50 in earnings per share in 2021 which would be a 12% increase over this year if met.


https://www.forexabuzz.com/2020/12/ensign-group-market-continues-to-love-this-stock-nasdaqensg/

The annual 10-K reports and 10-Q filings are hundreds of pages of financial and other information. Suffice it to say that the ENSG has been an excellent investment. It is difficult to understand the lack of preparation by management for a pandemic they knew was coming. The 2020 proxy report indicates the CEO’s 2019 compensation was $6 million. Lobbyists for the industry will claim that providers are operating on a low margin, which is a lie and needs to be debunked by advocates. I suggest that advocates never buy the excuse that low quality and grossly neglectful care is caused by a provider’s financial hardship.

 I will conclude with this:  providers have received an immense injection of federal funds through the CARES act and other supplemental payments from the Center for Medicare & Medicaid Services.  No doubt the ENSG has taken advantage of the lending facility provided by the Federal Reserve and Treasury Department and has probably received some outright grants worth $millions.  It is not feasible at this time to sort out just how these programs have enhanced cash flow, but I will be working on this issue in the months ahead.