Medicaid is burdening the states with financial liabilities of hundreds of billions of dollars. Already Obamacare is making this problem far worse through its “maintenance of effort” clause, which forbids states from tightening their eligibility requirements even as their economies shrink.
And beginning in 2014, the states will be responsible for administering a Medicaid expansion: All families earning up to 133 percent of the poverty level will become eligible. An estimated 17 million more patients will flood the program. Even though services for these patients will be financed primarily by the federal government (over 90 percent of the long-term costs), the administrative costs (billions of dollars per state) will not be.
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The states simply can’t afford it. In fact, some argue that the mandated Medicaid spending is unconstitutional: In the forthcoming Supreme Court case that is best known for addressing the individual mandate, 26 states are also protesting the law’s Medicaid expansion, arguing that it will coerce them into assuming unworkable financial burdens.
Is it any wonder that states are already responding to Obamacare’s “maintenance of effort” clause and the anticipated 2014 expansion by cutting services? Of course, many of the cuts are unjust and bureaucratic and arbitrary. What would you expect of lawmakers instead of practicing physicians? Several states (including Florida, Alabama, and Hawaii) are limiting the number of hospital admissions a Medicaid patient can have in a given year. The patients or the hospitals have to bear the costs of additional visits, whether the patient is terribly sick or not. Other states are limiting dental work, eye care (Mississippi, North Carolina), or adult diapers (Nebraska).
So what should be done to the law outside of the Supreme Court? There is a surprisingly simple answer.
If the federal government wants to expand coverage to 17 million people who can’t afford to buy their own insurance, there is no reason that the product offered has to be as easy to overuse as Medicaid is. Medicaid is too comprehensive, and it doesn’t pay enough for the services it covers. This is why doctors are running away from it at an unprecedented rate. Surveys show that up to 50 percent of physicians restrict the number of new Medicaid patients they see.
Instead of contributing to spiraling health-care costs by expanding Medicaid to millions more people without the state funding or the doctors available to take care of them, the federal government should offer a more limited catastrophic and illness-based insurance to people who cannot afford to buy their own. There is no objective evidence that having a Medicaid card will help you stay healthy, but there is a rationale for ensuring that everyone who comes to the ER has coverage. This service should pay doctors and hospitals well. And this reform would still save the federal government billions of dollars.
At a time when the federal government is trying to contend with out-of-control deficit spending, we should not leave the Supreme Court to decide how much damage Obamacare will inflict on the nation. We should replace the Medicaid 2014 expansion with something more limited and practical.
— Marc Siegel is an associate professor of medicine at New York University and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical contributor and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.
This is a blunt but truthful column. Siegel nails the issue. It's a matter of market-based rationing of health care.
So: Do you want to live in a country in which at least some poor people who can't afford dental care don't get it? How about eye care? How about adult diapers?
That's why we call you folks heartless and selfish.
Siegel does nail the issue here. It's a need for market-based solutions to health care problems being exacerbated by Obamacare. Do you want to live in a country where your income is confiscated and doled out as "needed" by some bureaucratic flunky? (there was such a country which collapsed under its weight not too long ago). Even worse, what if some day this bureaucratic flunky is a Republican? Horrors!
That's why we call folks like you foolish and ignorant.
Florida's Medicaid Reform Pilot has been a decided success, improving the health of enrolled patients, achieving high patient satisfaction and keeping cost increases below average. Since then, Florida has passed its Statewide Reform, which promises to extend these benefits throughout the state. If Florida's Medicaid Reform Pilot experience were replicated nationwide, the outcomes in almost every facet of the program would be significantly improved and would offer participants meaningful reforms to a system that has been falling into decay, says Tarren Bragdon, of the Heritage Foundation. The pilot program, which was isolated to five counties in Florida, saved an estimated $118 million per year, with an aggregate estimated annual savings of $901 million when the reform is put in place statewide. Researchers suggest that if a similar program were to be put in place nationwide, it would save $28.6 billion annually. The pilot program's results can be fairly projected on the nation as a whole because the program served a diverse population of 2.93 million, which includes 290,000 Medicaid recipients (External Link).
Over the course of a life-time, my experiences have led me to conclude medical services are greatly over used. I have had a few instances where medical care made my situation worse. I have had a few instances where medical care did not make me better. I have had instances where I was too sick to get to a doctor and I recovered.
I worked with the federal disability program in several positions. As a result I find the concept of a government drone directing whether, where, what "medical" care and treatment I can receive repellant. I have learned how to severely "ration" the interventions I seek myself.
I would be the first to agree an effective physician's intervention can effect a cure.
On the other hand, I think our efforts, in a way consistent with Siegel's advice, should be to educate our citizenry on maintaining health and when to legitimately seek "Medical" care. As a Medicare recipient I severely limit the care I seek. I would prefer to have my moneys go to the type of "insurance" coverage, Siegel suggests. Informed decisions as to when to seek medical care, a great part of paying for it out of pocket and what investigation and treatments should be between my doctor and I.
