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  • Morning Bell: Bringing Medicaid into the Debate

    Medicare is an emotionally charged program because it provides health insurance coverage for the elderly. But Medicaid covers America’s poor and disabled—and no one wants to see them harmed, either.

    However, like Medicare, Medicaid is also in desperate need of reform if it is to continue serving the people it was designed to serve. Nearly one-third of America’s doctors are already opting out of treating Medicaid patients—because their costs often outweigh what the program pays for care.

    States—which already have budget crises of their own—share the cost of Medicaid with the federal government. They can’t afford to simply add more people to Medicaid, which is one of Obamacare’s main ways to insure more people. (The Supreme Court’s Obamacare decision gave states some breathing room when it ruled that Obamacare’s Medicaid expansion must be optional for states.)

    The program already covers 62.5 million people—about 20 percent of America’s population—and federal spending on Medicaid has no limit. That’s right—there are no limits on federal spending for Medicaid. But there are limits on American taxpayers’ wallets.

    Simply adding people to Medicaid should not be the goal. Instead, like other welfare reforms, the goal should be helping people while they’re down—and helping them get back up.

    For those who are on Medicaid because of low incomes, the program should be reformed to empower them. Medicaid dollars should follow the individual, so that beneficiaries can choose the coverage they want and participate in the private market like the rest of their fellow citizens. They deserve to have more control over their health care and more personalized options. The Heritage Foundation has outlined such a reform in its Saving the American Dream plan.

    The Saving the American Dream plan starts by transitioning non-disabled individuals out of government-run Medicaid and into premium support, where they would have the same private health care options as others. “Premium support” simply means that the health care payment goes with the individual to the plan of his or her choice. For a low-income individual trying to get ahead, the premium support amount could be used to pay the employee’s share of an employer plan or to purchase individual coverage.

    For the low-income elderly, who are caught in a complex, bureaucratic combination of Medicare and Medicaid, the Saving the American Dream plan would provide a coordinated care model like Medicare Advantage, while allowing Medicaid to provide additional assistance as necessary. Again, the result would be more control for the individual over the health care dollars and decisions.

    Finally, the plan would restore traditional Medicaid to a true safety net—intended to help those with disabilities—while providing greater flexibility to the states to address the complex needs of these populations.

    Heritage’s Nina Owcharenko outlines three crucial steps to Medicaid reform:

    1. Repeal Obamacare. As noted, one of the health care law’s goals was significantly expanding Medicaid without offering any solid reforms to address its sustainability. Without repeal, the problems facing Medicaid and the rest of the health care system are extraordinary.
    2. Put Medicaid on a budget. Although states must balance their budgets, federal Medicaid spending has no limit. The more a state spends, the more federal taxpayers must pay out. Therefore, it is critical that federal Medicaid spending is put on a dependable and sustainable path. Block grants to the states, which would give them more flexibility in helping their populations, could be used for taking care of the disabled and elderly.
    3. Set core policy objectives. The policy objectives of Medicaid reform must be clear. It should establish patient-centered, market-based solutions that reduce dependence on government health care and improve care for the most vulnerable.

    Medicaid needs reforms that will give America’s poor and disabled the health coverage they need, without bankrupting taxpayers. This type of reform is possible, and the sooner we get started, the better.

    LEARN MORE:

    Medicaid: More Than a Block Grant Is Needed by Nina Owcharenko

    Don’t Expand Medicaid—One-Third of Doctors Are Already Opting Out of It by Alyene Senger

    The Supreme Court’s Medicaid Decision: The Obamacare Mess Just Got Messier by Nina Owcharenko

    Florida’s Medicaid Reform Shows the Way to Improve Health, Increase Satisfaction, and Control Costs by Tarren Bragdon

    Quick Hits:

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    Posted in Obamacare [slideshow_deploy]

    46 Responses to Morning Bell: Bringing Medicaid into the Debate

    1. sdfultz says:

      Simply put, when tax payer money and the health of the people collide the tax payers money trumps the health needs of the people. Sure we all feel empathy for the sick, but not enough to want to participate in paying for the health of strangers.
      Even when the sick are our relatives, Do we seek to pitch in?
      No, for surely there is other financial help somewhere out there.
      Perhaps we have never had a community of us, but instead we have always been a community of me and if and only if, I want to participate does, me and you become a we. American independence at it's best!
      So as we fight off the fiscal needs of the welfare programs and even the programs we swear we pay for, SS and medicare, lets prepare ourselves mentally to face the future of the stench of death in the streets, the homeless we try to avoid will be less imposing and grandma to, because they'll be dead. Let the Darwinism begin and may the survival of the strongest inherit this earth. Forget what the good book say's, Like many I want this earth for me! Lord forgive me. me, me, me

      • Ben C. says:

        Your argument centers on two conflicting philosophies – personal responsibility vs government dependence. I chose personal responsibility, not government dependence. I am responsible for myself. I chose to help others as my resources permit. Government dependence creates a nation of slaves controlled by the "central planners" who decide what is in your best interest. Socialism leads to tyranny which leads to anarchy. What you fail to mention is that the strength of a nation is the strength of the family unit. We are losing the family unit as the government inspired programs undermine our core strength. Yes, without the family unit we are on a path of civil chaos. The unintended consequences of well-intentioned legislation run amok.

        • sdfultz says:

          I agree, but our understanding of that social theory rolls over the majority of those unfortunate souls who depend of these government systems thru no fault of their own. These are the people we need to be prepared to walk over as we independent people carry on in our lives.
          We'll get used to it until we have to start cleaning them from the streets or removing them from society, much like some societies removed the lepers. I'm just saying get ready and be strong or else you'll find yourself being empathic to they're plight.

      • Your comment implies that if we don't do everything people could possibly need or want that we are doing nothing. This is not an all or nothing situation. EVERY wallet has budget limits. To ignore that fact is to destroy the entire support system by bankrupting it. That result serves absolutely no one. If you believe as you seem to state that the taxpayer wallet is bottomless then let you be the first one to blindly open and empty yours without any input on where it goes or how efficiently it is spent. That is what you are telling others that they should be doing!

      • Bobbie says:

        for you to put government as the spokesman and conductor of the bible shows your clear social engineered syndrome. The government isn't God and those conducting government clearly shows they have no connection with the bible. I've never heard any American suggest avoidance in pitching in when relatives are ill. Wherever that came from surely shows you mock the bible. Why do you put government that isn't within your control between you and the words of the bible? To guilt others of what you are guilty of, makes you pretty low! The government fails people like this government continues on a daily basis. Learn to help yourself/family/ neighbor and stop looking to the devil to do it for you!

        • sdfultz says:

          I agree, but our understanding of that social theory rolls over the majority of those unfortunate souls who depend of these government systems thru no fault of their own. These are the people we need to be prepared to walk over as we independent mind people carry on in our lives. We'll get used to it until we have to start cleaning them from the streets or removing them from society, much like some societies removed the lepers. I'm just saying get ready and be strong or else you'll find yourself being empathic to they're plight.

          • Bobbie says:

            If those running the American government wouldn't have fallen to expect less of those they see less of for pure government gain no matter the insult to humanity, we would be much stronger as a people and a nation. People on the government giveawagon, are only unfortunate because they've been manipulated by government leads who pity people because they're not white. No other reason. Government control induces personal weakness by manipulation, for their gain and your dependency.

            People learn real quick to do for themselves when there's no government resources to do it for them. It actually builds self esteem and personal respect from the core principle of America. What's that saying, you give a man a fish he eats for a day, you teach a man to fish and he eats for life? Too many people lower themselves to "play dumb" while the ones in sincere need go without.

            We are not under American government! We're under a government run by people who have immense insecurities and convince anyone who falls to have themselves belittled, the same. The saddest thing in all humanity and American tax payers are obligated their honest living to pay for it! huh! Who would've thunk America would have the majority, the weakest? huh…

          • Bobbie says:

            and "our understanding" refers to you alone seeing less in people as you don't feel they can learn like everyone else did instinctively!

          • Mary A says:

            Geez, stop with the hyperbole, and playing the guilt card you liberals do so well, this country or world can never be transformed into the Utopian warm & fuzzy quazi heaven you liberals endlessly pursue, it's an impossibility, get it ? Dream up and support some realistic ideas and goals, like how to stop the millions and billions of $$$$$$ this over bloated gargantuan government doles out in waste fraud and abuse. Every week we hear of another fiasco of misused wasted taxpayer money, including abuse of assistance programs for the poor. Who the heck wants to flush another $1 down the eternal cesspool of mismanagement ? Any ideas ?

      • Guest says:

        The argument you pose, visions of hopelessness and cruelty, are compelling and reasons to pause and consider, but it is the STATE is where these efforts of compassion and caring are constitutionally legitimate. The system set up at the founding fathers of the United States provided for the community you speak of, but is is at the STATE level that we address these issues. You say "Sure we all feel empathy for the sick, but not enough to want to participate in paying for the health of strangers." is wrong… Yes we may very well "want to participate in paying for the health of strangers" but expressly not at the federal level! The federal level of government should not address these needs of the people. It is at the STATE level that we as a community and as a compassionate people need to address these issues. That is why Massachusetts can set up universal healthcare and a single payer system, but it should have been deemed unconstitutional at the Federal level, regardless of what John Roberts and the rest of the progressiveness side of the SCOTUS found in June.

      • Dnetle says:

        Ben C. identifies the real collision occurring between a portion of Medicaid recipients. There are those who have legitimate needs and should be given our help. Then there are those capable people who have enough funds to afford the luxuries of life but bleed the Medicaid system of it's much needed funds. If the people who can afford to contribute something to their care will then the very needy will continue to receive the care they currently receive without burdening the taxpayers beyond what is necessary and will receive better care. It is Obamacare that will ration the care given to the needy. Examine the statistics of Socialist nations compared to ours.

    2. alexander Ilnyckyj says:

      I like what Nina Owcharenko has written and that's because she is a smart Ukarainian. She needs a raise.

    3. Greg krips says:

      How about keeping more or most our tax dollars in state where we know more about how to care for our own. Instead of sending our tax dollars to a corrupt federal government which is clueless about most everything, especially states needs keep it home. Smaller federal government means more state control where we the people would have more say and control because it is our won back yard. In DC, there is no accountability of the billions and trillions they get from the states and us and no responsibility. DC is out of control and no one really knows where all our money is spent and no one there really cares, they are all wealthy and that is all that matters to them.

    4. @dboyerdr says:

      I am a retired general surgeon. I've been on our local county hospital for many years Most people don't know that hospitals actually lose money on every Medicare or Medicaid patient that is treated unless the patient has supplemental insurance. Medicare pays the hospital about 65% of the actual cost of treatment. Medicaid pays about 35% of the actual cost of treatment.and Medicaid patients almost never have supplemental insurance. If a hospital treated only Medicare & Medicaid patients it would have to declare bankruptcy. Our hospital "writes off" just over $1,000,000 in "uncollectibles each month. Under Obamacare Many small hospitals will go broke!!!

    5. One fact left out in the discussion concerning Romneycare in Mass was that the Feds failed to support his Medicaid reforms. Washington is good at passing expensive laws while never following up with finds to implement them.

    6. @dboyerdr says:

      Just because I'm retired doesn't mean I have all day to wait on admins approval!! Either hire enough admins to handle the load or close the website!!!

    7. Dick Quinn says:

      An admirable beginning but falling on the deaf ears of the Democrat controlled Senate and WH. The public must take up the cry and vote out of office those not committed to responsible repair of Medicare and Medicaid.

      Lastly, you failed to mention a key step in assuring the future solvency of a revised Medicare program, namely legislate an absolute prohibition on using the Medicare trust fund for any other purpose. Congress's dipping into the trust fund over the years helped create the current crisis.

    8. S mike says:

      RE: Medicaid. I recently had a requirement to go to an emergency room (broken rib) and while I was there I observed a number of other viisitors also in tyhe emergency room. Most with young children. But there didn't appear to be any real emergencies and I inquired of the doctor who handled my issue what happens in cases like those in the ER. He stated they basically have to handle them buut really they should be going to those quick care clinics but they generally don't as they dislike having to pay the $40 charge the ER imposes. He pointed out that the ER charges MEDICAid AS MUCH AS $900 for ER useage for "itinerants". What a nightmare.

    9. DD Meyers says:

      Hospitals & doctors who talk about "losing money" equal lawyers who garner millions and say no "profits" were garnered due to "expenses." They both manipulate the numbers in order to plead poor. It is a game of bookkeeping. Without the application of free market principles to the health care industry, costs will never decrease. Their salaries and benefits are too high! They are only worth what the market will bear. Unfortunately, for the customer, there is NO free market at play in this industry.

    10. glynnda says:

      I work in a small government social services division with mental health care as the focus. Ironically we are working on a service provision model called Wraparound that will greatly improve services for those who need care and reduce costs across the board for all social services long term as this is a prevention and crisis focused system.

      The ironic part is that I happen to be surrounded by libs in this environment and they are now facing the consequences of their own long term actions…..they cannot navigate the gigantic red-tape, bureaucratic nightmare that is the Florida Medicaid system-they do not understand it. No one has time to actually read the Medicaid Manual now in place. There has been a new manual in the making for FIVE years!

    11. glynnda says:

      The "coding" does not address the services we are trying to provide and therefore they are having problems finding billing codes for those clients who qualify for Medicaid. (Only about 30%….in 2014 it will be even less) The government is slowly ensuring that these programs get shut down and everyone has to go to Obamacare, rich, poor, young, old……we are being slowly herded like sheep to the Spring slaughter. The only ones who won't have to………legislators and the mega-rich who happen to have the favor of the government (via donations to campaigns, etc)

      This is but a taste of what will happen in 2014 if Obamacare passes,…..they don't want to admit it in meetings (I take the minutes) but their own creation has become a monster that is going to eat them in 2014. They think they can't get services set up for their clients now……..watch out!!!! Right now, they just talk about what a jerk Governor Scott is…they don't want to face the fact that throwing money at the issue for decades (we are a traditionally democrat/rino state up until 2010) has only made the situation worse. The legislature should have been looking for ways such as Wraparound long ago to deal with these issues.

    12. jmc says:

      SDFULTZ, Your comments raise an important issue. Unless we take a more rational and realistic approach to things people like you will continue to insist that workers are being cruel and inhuman when they say they are already paying too much. You totally ignore the problem that 50% of people pay nothing toward the social safety net. You totally ignore that money is a finite object and that when those paying see the money being misused and squandered they tend to put their collective feet down and say that they don't want to pay more. Perhaps one of the problems is that you don't have personal access to the scammers of our Society and have therefore accepted the notion that everyone who "collects" are the sick, the elderly and the deserving. I live in NY. You can't swing a dead cat around here and not hit someone who is a serial scammer. Fathers who actually help their children, but because the marriage license is in Mexico….. they claim no involvement so each anchor baby born is proclaimed "the poor child of a single mother." People who work for cash every single day doing nanny, cleaning and carpentry jobs while claiming on their social service applications that they are poor. There are hundreds of different ways to scam the system and divert much needed funds to undeserving people while the truly needy have to make do with getting so much less from the safety net then they would have if there were more investigations taking place. Most people, obviously not YOU are acutely aware that a major part of the stress on the safety net is due to lies and scams but you emotionally conclude that instead, we are all a bunch of mean-spirited monsters who are so greedy that we don't want to share any of our wealth. As long as people emote emotionally without any real analysis, we will not see change. We need to have an adult conversation about this without all the whiny references to how God will be angry at us if we don't pay more taxes.

    13. muskegonlibertarian says:

      The cost of health care would be considerably less without government involvement. Without government, there would be no prescription laws. Without prescription laws, people would be free to purchase the medicine they need without first paying a doctor for the "privilege" of being allowed to go to their local drug store and buy the medicine they need or seek the assistance of the druggist in deciding what is needed. This was the way things were before the passage of prescription laws back during the Great Depression. Put the blame where it needs to be, upon the government and its laws that take away your freedom to take care of your health!

    14. Bobbie says:

      Everywhere the government took control of, needs reform because government makes corruption at will!

      I'd like to comment on the republican everyone is putting down when he stated his opinion regarding abortions. For one: planned parenthood does not promote abortions as remedies to the ruthless act perpetrated by another. For two: unless a woman is ovulating there isn't going to be a pregnancy and for three: A man was on the radio commenting that when stress is in play the human body does take a natural defense. I agree with him whole heartedly. It is rare to get pregnant from the disgusting violation of a man's rape! For four: no one but this man EVER talks about the other half of that pregnancy! THE MAN'S RESPONSIBILITY!!!!!!!! WHETHER RAPE OR CONDUCTING ACTS THAT BRING HUMAN LIFE INTO THE WORLD!!!!! The avoidance to include MAN, makes it seem sharia lawish that protect men from being or taking THEIR RIGHTFUL responsibility!

      I did understand what he was trying to say and being a woman I see no reason for men or women to oppose his opinion if they follow the content of what he was communicating. A woman doesn't automatically become impregnated if raped (which seems what is being tried here,) although women can always use it as an excuse when words don't have to prove truth! I believe in holding the RAPIST accountable not the women raped! HOW SHARIA PATHETIC!!!! It calls out to victimize women at the behest of pathetic men and their chosen weakness!

      • fred222 says:

        Akin said punish the racist not the baby. You are implying that Akin was weighing the rapist against the woman.he woman is victimized unless the baby is aborted. You should just saying the you are talking about an entirely different topic than Akin – Women under Sharia Law.

        • Bobbie says:

          I'm not understanding what you say? My point is that Akin is the only one from both democrat and republican that brought up the CAUSE of rape!!! THE RAPIST!! I'm implying the rapist accountable to the costs and treatments of the woman he RAPED and the choice he FORCED on her! It's only the government's role to ensure justice which isn't at all mentioned!!!

          A decent man holds himself accountable to the expense of the pregnancy he caused and the provisions of the baby brought into the world! Nobody talks about HIS responsibility, HIS lack of self control, HIS disrespect for the female gender. NONE OF THIS IS A FEDERAL ISSUE PURSUANT TO CONTROL!!! Highly reflective of sharia law!

      • sdfultz says:

        What is legitimate rape?

    15. Andre says:

      how about ending medical and instead raise how much the disabled get to a living amount let them buy their own health insurance and maybe have enough to live on invest and in 10 or 20 years pay it back with enough in the bank to live on the rest of their lives

    16. nj retiree says:

      One abuse of medicaid that I have never seen addressed publicly is the sponsored legal resident aliens over 65 who live with well off adult children, mostly from India and China, who are eligible for medicaid because they claim no income or assets and there is no way to verify what they still have in their home country. In the agency where I worked, we often would ask to inspect their passports when they appeared for review, and would see that they had been out of the US for large periods of time. Their children can continue to acquire their medicaid covered prescriptions here and send them overseas. Over the past 20 years, the numbers of US citizens over 65 who were newly eligible for medicaid dropped, because their Social Security was over the income limit, while the numbers of resident aliens appearing to qualify soared. The smart ones who were then able to become US citizens, stopped off at the Social Security office on the way home from the swearing-in ceremony to apply for cash benefits from SSI as well.

    17. Utopia is great, but it is not free. This is a great article, the author should be put in charge of Medicaid or Medicare or both or something that is broken in Washington DC. This article has, at least, the semblance of “thinking” about ways to begin to reform the system. Nobody in the current administration has a clue. Nobody in the Senate has a clue. What you have in Paul Ryan is a very brave reformer because he is, at least, ADMITTING that we have a problem of sustainability in the Medicare program. Yes, yes, shameless politicians (like you know who) will never even admit we have serious fiscal problems with Medicare, Medicaid, Social Security, the national debt, etc. etc.

      • Leith N. Wood says:

        The author should replace Ms. Sebelius, who would fit right in in Cuba or Russia. Paul Ryan is a gift from God! How refreshing and hopeful.

      • sdfultz says:

        His argument is not new, we hear this every four years, he just said what many have been thinking.
        I understand his point, but whats wrong with the other ideal that everyone needs to buy insurance?

    18. Morgan says:

      At one time there were charity wards for those who couldn't pay. Now because of lawsuites everyone gets AAA service. If government were to owe medical care to anyone I would suggest that it is the people who were injured as the result of crime. Then the government should then sue the criminal for payment when they are apprehended. At one time a doctor would have a sliding fee schedule. The poor were charged less. But they were charged. Too many people don't appreciate the gifts and tax benifits that they recieve from others. They want more and more and still more.

    19. Blair Franconia, NH says:

      The Democrats love to do what they do best____demagogue.

    20. Jeanne Stotler says:

      Medicaid hs been abused from the onset. I was making a house call on a patient (nurse supervising CNA's) when The mother handed he medicaid card to someone else, this other person was taking her child to a doctor under another child's name. I reported this to my supervisor but don't knnow the outcome. There are doctors who overbill, providers of equiptment that do so also, worse abuse is by people who work under the table, have a live in spouse, but claim to be a single parent and most of all imigrints, legal as well a illegal, they find out quickly how to milk the system. Most seniors have medicare, but there are some who have to use Medicaid as the supplement, they worked in most cases or were widows and and living on Soc. sec. alone.

    21. fred222 says:

      You should mention that Medicare patients are in exacting the same boat. More and more doctors and other health providers are refusing to accept assigment of Medicare (meaning they agree to accept what Medicare pays). This all has to do with the low reimbursement rates. I end up spending thousands additional each year because of this situation. And I can't insure myself against the extra costs because Medicare rules prohibit it. Medicare should be abolished and give us money to pay our providers directly without rules, rules, and more rules and the arbritrary enforcement of these rules by incompetent staff at the federal level.

      • Mary Larsen says:

        Fred, I feel your pain, my mother is in the same boat, but as a nurse I totally understand why doctors can not take medicare for assignment, at best the pay 65%, but for a lot of things it's more like 50%. I would much rather take Ryan's "premium support" and buy her a good policy that reimburses her doctors a living wage!!

    22. Mike says:

      Too many abuse medicaid.

    23. O2BMe says:

      One of the problems with government programs is that one size fits all. Of course some poor cannot afford anything toward health care, but some could on a sliding scale to their income and bills. This leaves them some self-pride and encourages them to try to get off the government programs. The same could apply to Medicare. There are a few people out there with enough income from retirement plans that really don't need full medicare payments like Mr Buffet.

    24. B Cannon says:

      One of the he real problems with Medicare/Medicaid/Insurance is that there is no oversight by the patient on what they are being charged for. Since there not paying it, who cares is the mentality. This certainly in not the only problem but it is a big problem that I don’t see anybody discussing. Currently the mentality is you go to the doctor, the doctor checks a bunch of boxes on a form, they collect your co pay and you’re out the door. This mentality needs to stop and that will help to start to reduce the cost of medical care. Empower the patient to keep the system honest.

    25. PooKooKin says:

      Why does it cost so much anyway if I never see a Doctor anymore. It's been years since I was able to see anyone but a Nurse practicinar. The Billing lady took my blood pressure last time. Oh and I was in and out in less than 6 min. But I got a 120 bill.

    26. PooKooKin says:

      My daughter has all kids care, and I pay 15.00. a month. She's old enough now that she never uses it. So they will probably make money from some kids to make up for those kids, whos parents take advantage.

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