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  • New York Times Highlights Medicaid’s Problems

    Recently in The New York Times, Robert Pear highlighted the major problems with the Medicaid program. His findings reveal that having a Medicaid card in one’s wallet is of little use if it doesn’t give beneficiaries access to the care they need.

    A woman with several herniated discs and pain in her neck and arms told Pear that her Medicaid card is “a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”

    Pear interviewed doctors and Medicaid enrollees in Louisiana and reported that access problems are systemic due to low provider payment rates. In fact, Obamacare makes this problem worse by preventing states from reducing program eligibility. This leaves states with the options of either cutting provider payments or slashing benefits. Oregon Governor John Kitzhaber is proposing a 19 percent across-the-board cut for Medicaid providers. These cuts represent a top-down attempt to control Medicaid costs that will only worsen the program and harm its enrollees.

    Ignoring Medicaid’s problems, Obamacare expands the program to cover over 20 million additional individuals. Pear reports that Louisiana officials expect to enroll an additional 467,000 people in Medicaid, and the state estimates that 40 percent of individuals added to Medicaid’s rolls will use it as a replacement for private insurance. This “crowd out” effect on private insurance already exists: Dr. Kim Hardey, an obstetrician-gynecologist in Lafayette, said that many of his patients have jobs with private insurance but switch to Medicaid when they become pregnant to avoid premiums, deductibles, and co-payments.

    Medicaid’s existing shortcomings may lead some to conclude that we need to spend more money on the program. However, the Centers for Medicare and Medicaid Services estimates that the U.S. spent $427.3 billion on Medicaid in 2010, a six-fold increase from 1990 ($73.7 billion). Medicaid is increasingly crowding out spending on other state priorities, such as education and transportation.

    The fundamental problem that drives increases in Medicaid spending is the open-ended federal reimbursement of state Medicaid spending. The reimbursement rate is at least 50 percent, and it increases as state per-capita income decreases. Being able to pass at least half of the costs for the state program to federal taxpayers has led states to expand Medicaid beyond what is affordable. Over the past decade, this has led to three Medicaid bailouts, which only delayed the inevitable day of reckoning for irresponsible and unsustainable Medicaid growth.

    Thus, we arrive at the great Medicaid paradox: out of control spending coupled with limited access and low quality of care for beneficiaries. President Obama’s solution was to expand Medicaid and temporarily increase the federal government’s share of Medicaid spending.

    Real reform should consist of four pillars that move the program in the opposite direction:

    1. First, Congress should replace the open-ended federal reimbursement with fixed payments to the states to discourage unsustainable spending growth.
    2. Second, it should allow states the flexibility to tailor their programs to their individual populations and engage in experimentation and learning.
    3. Third, children, their mothers, and pregnant women should be transitioned out of traditional Medicaid and into a program of premium support that offers greater choice.
    4. Finally, eligibility for the program should be limited to individuals that each state determines are in need of taxpayer assistance.

    By following this path, Congress could put Medicaid on a sustainable path while also improving quality of care for those it already serves.

    Posted in Obamacare [slideshow_deploy]

    4 Responses to New York Times Highlights Medicaid’s Problems

    1. Bobbie says:

      All current problems and complaints are from the past failed government of democrats. Probably intentionally set up to filter in obamacare as faultless, but just a manipulation into his intentional consequential trap to make it worse and people desperate! Obviously Obama's will is not the interest of the peoples will which is ignored to enhance his own. He is unacceptable.

    2. gail morris says:

      Your recommendations do not create a more cost effective health care system but suggest a shell game similar to the Ryan Road Budget. You transfer costs to the States, the disabled ( the largest user group of Medicaid), children, the elderly and the adult poor.

    3. 4TimesAYear Iowa says:

      "Medicaid is increasingly crowding out spending on other state priorities, such as education and transportation…"

      Don't you believe it – cities are building all kinds of expensive "amenities" like bike paths at the expense of roads, sewers, etc., then they go to DC with their hands out for those items. Here in Iowa, they reclassified the trails as part of the Iowa Department of Transportation road system so they could use stimulus money to pave the trails. Where is the outrage about this??? In June we have the Carroll Area Development Corporation going to DC to talk about emergency management, infrastructure, a trail project expansion in Coon Rapids, sewer and water, training for volunteers, and telecommunications issues – none of which is a federal issue. This is why the country is broke – it just makes me sick to think about all the municipalities going to DC with their hands out like this.

    4. Nurs6022, Colorado says:

      I am a school nurse and a student in an APN program. I am not knowledgeable of all states and all Medicare/Medicaid programs. The second bullet regarding allowing states to tailor programs, I see as part of the problem. When I have families move across state lines, they loose their Medicaid/Medicare benefits. When a family moves within the state and changes their county of residence, they loose coverage and must start over with the application process. Would there be a benefit to having a National or a state standard of coverage rather than having coverage county by county. With families trying desperately to stay ahead of financial disaster, they are moving and when the move takes them across county lines, they are often unaware that the medical coverage they had is no longer valid.

      I am also concerned about the length of time it takes for M/M to authorize medical equipment, if it is even covered by person's "policy". I have asthmatic students that can not afford the cost of a holding chamber (for use with metered dose inhalers) Medicaid will not cover these, even though research supports the use of chambers for better medication delivery. I currently have an 11 year old student with multiple diagnosis and a wheelchair and a walker are essential for him to safely navigate at school. Both have been ordered by his physician, but Medicaid has not authorized them. I am told it will be 8 to 12 months for the Medicaid authorization! In the meantime the school district was informed we are out of compliance with ADA if we can not provide him access to the school. I whole heartedly agree with your 3rd point of premium support.

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