Financing for Medicaid, the national entitlement program providing health care for the poor, is shared with the states under a specific formula, with the federal government paying about 60 percent of the total costs. Under President Barack Obama, provided with a rocket boost from Obamacare, spending on Medicaid is exploding.
Total future costs to state governments are estimated to exceed the costs picked up by the federal government by an additional 66 percent. The National Association of State Budget Officers reports states spend more taxpayer money on Medicaid than anything else, including public education.
As Medicaid consumes ever-larger portions of state budgets while delivering declining quality of care, the need for solid reforms is becoming apparent to policymakers across the nation.
Despite astronomical overall spending, Medicaid pays the doctors and hospitals actually providing the care only 60 cents for each dollar of healthcare costs they incur. As a result, the poor on Medicaid face grave difficulties in obtaining timely and essential health care, suffering worse health outcomes as a result.
Contrary to rhetoric from supporters, Medicaid is far from compassionate. Writing in the Wall Street Journal, New York University School of Medicine Clinical Assistant Professor Scott Gottlieb, M.D. noted, “in some states, they’ve cut reimbursements to providers so low that beneficiaries can’t find doctors willing to accept Medicaid.
“Dozens of recent medical studies show that Medicaid patients suffer for it,” Gottlieb added. “In some cases, they’d do just as well without health insurance.”
However, this tragic problem can be solved completely, by applying to Medicaid the lessons from the enormously successful 1996 reforms to the Aid to Families with Dependent Children (AFDC) program. As with the reforms to AFDC, each state would be granted broad discretion to redesign its Medicaid program to best serve the poor of its state.
Help Out, Not Handout
Thanks to the reform and replacement of the old welfare system, two-thirds of those formerly dependent on AFDC were successfully helped off of government dependence, resulting in a 25 percent increase in former dependents’ financial well-being. With the program quantifiably helping people back onto their feet, taxpayer costs declined by 50 percent.
Under a similar reform plan, the federal financing for Medicaid would again be provided in the form of a fixed, finite block grant. That financing would no longer vary in proportion to the state’s spending on the program, which currently amounts to paying each state to spend more on Medicaid.
If a state’s redesigned Medicaid program cost more than the value of the federal block grant, the state would bear all those overages. Conversely, if a state’s new Medicaid program spent less than the allotted block-grant money, the state would be allowed to pocket the difference, encouraging efficiency.
Similar block grant Medicaid reforms, proposed by House Budget Committee Chairman Paul Ryan (R-WI), were “scored” by the nonpartisan Congressional Budget Office as potentially saving nearly $1 trillion over 10 years.
More aggressive proposals include the State Health Flexibility Act, cosponsored by Representatives Todd Rokita (R-IN), Tim Huelskamp (R-KS), Paul Broun (R-GA), and Jim Jordan (R-OH). Due to the stricter limits on federal Medicaid funding in their proposal, CBO scores it as saving nearly $2 trillion over 10 years.
Consumers in Charge
Ideally, states would reform their Medicaid programs by providing vouchers to the impoverished, to help pay for the private health insurance of their choice in the marketplace. Among those choices would be Health Savings Accounts (HSAs), which maximize consumers’ choice over their own health care and maximize consumers’ control, rather than the insurance company’s control, over the funds.
Such HSAs, backed up with catastrophic health insurance, provide powerful, proven-effective incentives for consumers to decide for themselves how to reduce costs to preserve maximum funds for the future.
These health insurance vouchers would free the poor from the “Medicaid ghetto,” enabling them to obtain the same quality of health care as the middle class, because they would be able to buy the same health insurance in the same market. Market competition would force private insurers to pay doctors and hospitals sufficiently to ensure those covered by their insurance can obtain timely and effective health care.
The road to enacting Medicaid block grants, however, must start with a repeal and replacement of Obamacare, because its Medicaid expansion and other provisions prevent the fiscally responsible, consumer-friendly policies that would release the poor from the Medicaid ghetto. Under the Medicaid block grant system, states would each be free to expand the program as much as they want, given state governments’ realization they alone are responsible for funding such program growth.
Peter Ferrara ([email protected]) is a senior fellow for entitlement and budget policy at The Heartland Institute.
“Liberating the Poor from the Medicaid Ghetto,” Peter Ferrara, the Heartland Institute: http://heartland.org/policy-documents/liberating-poor-medicaid-ghetto