Head Start and Health Care Offer Examples of Rationing Resources by Lottery

I wrote a Budget Project Blog post Monday about how some Head Start programs in Indiana recently used a random drawing to determine which preschool students will be removed from the education program for low-income families. Head Start is heading backwards because of federal spending cuts resulting from the sequester. (Read more in this Fort Wayne Journal Gazette article.)

I speculated in the blog post that rationing government services by lottery could become much more common in the months and years ahead, as more Head Start programs start deciding which kids are going to have their early education cut short, and as federal budget cutting spreads into other areas and gets deeper. Nevertheless, it came as a surprise a few hours later to see Steven Colbert tackle the lottery issue on Monday Night’s Colbert Report. Colbert reports and comments on the semiannual process in Tennessee of opening the TennCare program for an hour to applicants with very high medical bills, and enrolling the first 2,500 people who can get through by phone and get an application. Rather than accepting 100% federal funding to expand TennCare to about 180,000 low-income adults, Tennessee gives them an hour of frantic dialing to see who will be the first 2,500 to take open slots in the program.

It wasn’t long ago that fiscal conservatives were railing against portions of the Affordable Care Act that are intended to hold down health care spending, claiming that those measures amount to “rationing” of health care. Apparently that criticism doesn’t apply to real rationing if the decisions are left to chance, or to very fast dialing.

Colbert offered a number of ideas on other ways that states could employ the lottery strategy. Considering some of the spending cuts that lie ahead, state and federal policymakers may have been taking notes.

Jon Peacock