Studies have shown that Medicaid patients fare worse in many cases than the uninsured. In many states, Medicaid pays doctors so little, recipients can’t find a private physician to see them so they must wait, sometimes for hours, in hospital emergency rooms to get care. They deserve the dignity of private insurance, which states could provide if they were freed from Medicaid’s mountains of red tape.
Further, the Medicaid expansion will harm the poorest and most vulnerable patients already on the program as they are forced to compete with millions of new patients seeking care from this limited pool of providers.
Many governors are rightly resisting adding another 16 million more people to Medicaid and are demanding that Washington give them more flexibility to improve the program.
They are reaching the breaking point with their state budgets as they try to meet competing demands for spending on education, transportation, and public safety with Medicaid entitlement costs that consume the biggest share of revenues in many states.
Even with the generous match rates the health overhaul law offers, the Medicaid expansion would cost them at least $118 billion through 2023, according to a 2011 congressional report by Utah Republican Sen. Orrin Hatch and Michigan Repubican Rep. Fred Upton.
And if states were to expand coverage with the promise of an initial 100 percent federal match for the expansion, there are no assurances that Washington would be able to keep its promise to continue the generous funding. They are rightly concerned that the health law’s initial offer could be a bait-and-switch.
There already is evidence that could be the administration’s plan. President Barack Obama proposed reducing federal Medicaid spending by $100 billion over 10 years during last year’s “supercommittee” budget negotiations. He proposed changing the traditional federal Medicaid matching rate in a way that would lead to a smaller overall federal contribution to the program—and a larger state-based one.
States are right to worry about whether Washington would keep its promise to fund the expansion, and they are also right to use the leverage the Supreme Court has given them to demand much-needed reform of the program. States, taxpayers, and especially vulnerable Medicaid recipients deserve better.
Posted at U.S. News & World Report: Debate Club, July 24, 2012