Whether congressional efforts to repeal and replace Obamacare succeed or not, there is plenty states can do to improve their Medicaid programs and make high-quality health care more affordable.
Heartland Senior Policy Analyst Matthew Glans explores state-based solutions to the troubled entitlement program in his new Policy Brief, titled “Don’t Wait for Congress to ‘Fix’ Health Care: States can implement real health care solutions today.”
Glans documents the failure of Medicaid to deliver quality care to the nation’s poor and disabled, even as it drives health care spending to unsustainable heights. The Affordable Care Act (ACA) has made a bad situation worse, by encouraging states to expand, rather than reform, this failing program. ACA offers large federal subsidies to states willing to provide Medicaid coverage to individuals with incomes up to 133 percent of the federal poverty level. Currently, 31 states and the District of Columbia have expanded their programs in exchange for federal subsidies. Subsequently, Medicaid enrollment and costs have been increasing faster than what was predicted.
Some of these states are now working to roll back Medicaid expansion. For instance, in Arkansas, lawmakers are applying for waivers from the Department of Health and Human Services (HHS), which would decrease Medicaid eligibility from 138 percent of the federal poverty level to 100 percent and add work requirements for adults who are still enrolled in Medicaid. State legislators in Ohio and Oregon are looking to pass similar reforms.
States that have not expanded Medicaid under ACA also can and should submit ambitious requests for Section 1115 waivers to HHS Secretary Tom Price to improve their Medicaid services. These waivers provide state lawmakers with the opportunity to have “experimental, pilot, or demonstration projects likely to assist in promoting the objectives of the Medicaid law.”
States can also apply for Section 1332 waivers, which permit state lawmakers to end numerous unpopular and ineffective Obamacare provisions, such as the individual mandate, employer mandate, and premium tax credits.
Lawmakers concerned about the effectiveness of waivers should consider the reform successes enjoyed by Florida and Rhode Island, who over the past decade improved their Medicaid programs through the waiver process. In 2006, Florida began offering different plans and premiums to its existing Medicaid enrollees. As Glans notes in his Policy Brief, “By providing existing Medicaid recipients with a range of premiums and plans from which to choose, a pilot program in Florida called the Medicaid Cure program dramatically improves health care competition and consumer choice.”
Rhode Island’s HHS waiver, which was first implemented in 2009, is estimated to have saved the state $100 million during its first three years. “The waiver replaces the traditional federal matching grant with a capped grant,” wrote Glans. “In exchange for the cap, the state received flexibility in administering its Medicaid program and an incentive to keep costs down.” The waiver was extended to remain active until 2018.
In addition to fixing their Medicaid programs, states also can implement a long list of other reforms that expand supply and reduce prices, including repealing coverage mandates, guaranteed issue, community rating, occupational licensure laws, and certificate of need regulations. States also can expand health savings accounts and encourage telemedicine, high-risk pools, and price transparency.
The time for reform is now. State lawmakers cannot afford to waste this opportunity while they wait for Washington, DC to solve their problems for them.
What We’re Working On
Energy & Environment
Data versus Hype: How Ten Cities Show Sea Level Rise Is a False Crisis
In this Nongovernmental International Panel on Climate Change Policy Brief, Dennis E. Hedke, a geophysicist and past president of the Geophysical Society of Kansas and the Kansas Geological Society, reports and analyzes data collected from 10 coastal cities with long and reliable sea-level records. Those cities are Ceuta, Spain; Honolulu, Hawaii; Atlantic City, New Jersey; Sitka, Alaska; Port Isabel, Texas; St. Petersburg, Florida; Fernandina Beach, Florida; Mumbai/Bombay, India; Sydney, Australia; and Stavanger, Norway. He concludes fear of rising sea levels is not a justification for reducing carbon-dioxide emissions or adopting policies that would have that effect. Read More
Budget & Tax
Why Sin Taxes Fail
In this opinion article, originally published in the Argus Leader, Matthew Glans discusses a proposed tobacco tax increase in South Dakota and explains how sin taxes across the country have failed to maintain tax revenue at the levels their proponents have promised. “Although reducing smoking rates may be a noble goal, raising tobacco taxes rarely works as intended and frequently causes many negative effects, especially on small businesses. When ‘sin’ taxes are implemented, retailers and wholesalers find themselves faced with decreased sales, as consumers seek to avoid the tax by purchasing products outside the county, city, or state imposing the tax,” wrote Glans. Read more
Research & Commentary: Mississippi Private Schools Eager for School Choice Programs, Have Thousands of Available Seats
In this Research & Commentary, Policy Analyst Tim Benson writes about a new survey of private schools by Empower Mississippi. The survey found there are approximately 10,000 seats currently available in private schools throughout the state that students in poorly performing school districts could take advantage of if private school choice programs were to be expanded. Further, 64 percent of respondents in the survey said they would likely participate in a school voucher program if one were made available to them, while only nine percent of respondents said they would likely not participate. Read More
Research & Commentary: Dental Therapists Could Help Solve Massachusetts’ Dental Shortage
In this Research & Commentary, Matthew Glans examines a proposal that would improve access to dental care for all Bay Staters by allowing dental therapists and hygienists to provide much-needed care. “Allowing dental therapists in more states would help to close gaps in dental care access and ensure patients receive preventive and restorative treatments when and where they need it,” wrote Glans. Read more
From Our Free-Market Friends
Pesticide Bans Are Anti-Science
Angela Logomasini, senior fellow at the Competitive Enterprise Institute, commends the decision by Environmental Protection Agency (EPA) Administrator Scott Pruitt to reject a petition to ban chlorpyrifos, a common pesticide used in nearly 100 countries. Seven state attorneys general have filed a challenge to Pruitt’s decision. Logomasini argues chlorpyrifos is safe to use in low doses for the purpose of crop protection. Current EPA regulations limit human exposure to the pesticide. Logomasini encourages safe pesticide use, but urges regulators and lawmakers not to go overboard. By implementing commonsense policies, government agencies can ensure healthy food is more affordable and accessible. Read more