When I served on the Medicaid Commission from 2005-2006, one of the messages we frequently heard from Medicaid recipients who testified was that they wanted the dignity of private health insurance.
Many felt confined to a Medicaid ghetto where they had the promise of generous medical benefits on paper, but in practice, they had difficulty finding any private physicians who would see them. Too many of them were forced to go to hospital emergency rooms to get even routine care.
Why on earth would we want to expand this program to confine millions more people to this substandard access?
The Medicaid program also is rife with fraud, as documented by the Government Accountability Office and the Inspector General at the Department of Health and Human Services, as I recounted in my testimony in a 2008 hearing before the House Energy and Commerce Committee,Subcommittee on Health.
And expanding Medicaid to people up to 133% of poverty disadvantages the most vulnerable Medicaid recipients, most of whom have no other options for care, because they now must compete for dollars and benefits with millions more people.
Finally, the proposal to provide a larger federal match to states as they add people to Medicaid who are higher up the income scale is exactly the opposite of what we should be doing. The federal government should provide a more generous match to states for covering the poorest citizens and scale back the match as they add people further up the income scale to Medicaid.
As fellow Medicaid Commissioner Bob Helms of the American Enterprise Institute explained in his dissent to our commission report, “there is an inverse correlation between poverty rates and federal per-capita Medicaid reimbursement. States with the highest poverty rates–such as Alabama, Louisiana, and Mississippi–received much lower Medicaid payments per-capita than did wealthier states like New York and several New England states.”
Congress should head back to the drawing board on Medicaid reform. While millions of people rely on Medicaid and it is a vital safety net for many, expanding this program, which is greatly in need of reform, is not the way to provide coverage to millions more Americans. Providing direct credits to allow them to purchase the private coverage of their choice is a much better option.
Published in National Journal, Experts: Health Care blog, September 21, 2009