Editor’s Note: The following is an interview with Rep. Tom Burnett, a Republican member of the Montana House of Representatives from District 67. He previously represented District 63 in the Montana House from 2011 to 2013. Burnett serves on the Appropriations and Health and Human Services Committees.
Artz: How much does Medicaid cost your state annually, and how is it affecting your state’s budget?
Burnett: Medicaid costs $1.2 billion this fiscal year, 23 percent of our total state budget. It pays for the births of 43 percent of our babies, and enrollment has grown from 77,000 to 125,000 since 2002. This represents tacit [Medicaid] expansion, just without the official title.
Montana reimburses providers like doctors, hospitals, psychiatrists, pharmacists, social workers, and group homes at a higher rate than all but four states. For example, Montana pays $43.63 for a 10-minute office visit, whereas Utah pays only $31.15 for the same visit. The Urban Institute reports that our reimbursement rates are 33 percent above the national average. Why a state where wages are 49th out of the 50 feels it can afford this baffles me.
Artz: What is the per-enrollee spending for Medicaid in your state, and by how much would burden go up if Montana expanded the program?
Burnett: Montana’s per-enrollee spending is $1,350. Montana’s per enrollee costs were above the national average in 2011, according to the Kaiser Family Foundation. Multiply that by 125,000 enrollees and you arrive at $168 million a year, or $506 for each state taxpayer.
In 2008, Montana’s per-enrollee costs were the 10th highest of all the states, while our median household income languished near 46th place. Expansion will likely reduce per-enrollee costs, as the most needy populations are already in the program, but program growth, in absolute terms, is expensive.
Artz: Are fraud and waste in the program a problem in Montana?
Burnett: Misdirected resources vex taxpayers. Two examples of measures we take to minimize misspending are state audits of providers to correct miscoding and attention to applicants’ records to thwart shielding of assets when an elderly person seeks Medicaid for nursing home placement.
These program abuses likely pale in comparison with the phenomenon of applicants failing to report the income of all household residents as the program requires. A boyfriend in the household may have substantial income that the girlfriend fails to report, for instance. The number of children actually residing in the household is another opportunity for incorrect statements. The more children listed, the easier it is to meet federal poverty guidelines and qualify for benefits. Eligibility workers say household composition is lied about on a daily basis.
A federal rule change in October of 2013 allows a person to self-attest pregnancy, no doctor statement needed. This allows an applicant to obtain “full Medicaid,” as opposed to basic Medicaid, receiving a better package of benefits.
Eligibility workers were aghast at hearing about the rule change. Medicaid’s problems leave a great deal of room for improvement so that benefits can go to the truly needy and taxpayers can have confidence their desire to help is being met appropriately.
Artz: Should Montana have fixed Medicaid before expanding the program?
Burnett: Medicaid should definitely be fixed, though the Montana Legislature instead recently enacted Obamacare Medicaid expansion, unwisely in my opinion. Up to 70,000 people—and there’s no assurance that’s actually an upper limit—will be added to the dependency rolls, weakening the self-reliance aspect of the pursuit of happiness.
At its core, Medicaid is a health care welfare program for our society’s most needy. It is clear to eligibility workers that there is tremendous abuse of the system. We should put more effort into fixing the current system so that it provides benefits to the most needy instead of increasing spending to grow the program.