Medicaid Expansion Means Less Healthcare, Not More

Posted: Sep 10, 2013 12:01 AM

All across the country, state governors are under tremendous pressure to accept federal funds for expansion of their state Medicaid programs. Most of this originates in Washington and the Obama administration, but much is local and comes from special interests such as hospitals, which stand to profit from an expected increase in business with more patients covered under this healthcare plan.

Twenty one states have decided (for now) not to expand their Medicaid programs. Four are still debating this issue. 25 states will accept the money and expand their Medicaid programs. The latest state to succumb was Michigan, where centrist Republican Governor Rick Snyder has pushed hard to get this pot of money. He, like many of the GOP Governors who initially decided not to participate in this expansion, but later flip flopped, believed that they could not afford to let this money dangled before them slip through their fingers unclaimed. This short term gain where the federal government picks up the tab for the expansion through 2017, will turn into long term pain for the states when Washington pays for 90% of the expansion, and the states are on the hook for the balance. Governors need to look at the “long game” and resist the urge to grab the cash.

The Medicaid expansion is a Trojan horse, to get more people covered by a Federal health program. This is a necessary step in order to achieve the ultimate goal as stated by President Obama, Sen. Harry Reid, Minority Leader Nancy Pelosi, and others, which would be the creation of a single payer, government controlled healthcare system.

Unfortunately, achieving this goal will be at the expense of the patients that these individuals claim to be trying to help. Medicaid, as it currently exists, is a failed system. Each day, an increasing number of physicians are refusing to see these patients. All that the Medicaid card does is to give an increasing number of patients, an opportunity to wait on an ever increasing line to receive care. A number of studies have reported that Medicaid patients have worse health care outcomes and higher death rates than patients who have no health insurance coverage at all.

As businesses decide that the only way to survive the financial pressures on them caused by Obamacare is to lay off workers, or to cut their hours and make them part time employees, the Medicaid rolls will swell as these people lose their insurance coverage.

In some states, the Medicaid expansion has already occurred. Several years ago, Georgia teachers were forced to switch their dependent children from excellent private insurance coverage to a managed Medicaid program, as the state attempted to save money. Unfortunately, many of these children needed to find a new doctor who accepted Medicaid- often in a less convenient part of the city for the family. The quality of the care for many of these patients was not at the same level that it was with their previous pediatrician.

Also in Georgia, the only genetic testing laboratory in the state is located at Emory University. The Department of Community Health, which oversees the state Medicaid program, has decided that it will no longer cover these tests. Consequently, Medicaid patients no longer will receive these services, unless they pay for them out of their own pocket. For many families who have children with severe and debilitating problems, these are essential services which may impact the ability of their children to thrive or perhaps even survive.

This is the beginning of what people can expect under government controlled healthcare. Medicaid for all is substandard healthcare for everyone. This is the dirty secret pertaining to the Medicaid expansion. There is a better way to take care of the indigent, but growing a program which is an abject failure is not the answer.

The solution is to give Governors the flexibility to spend the Federal Medicaid dollars using creative and innovative strategies that best suit the patients in their own state, like in Indiana or Rhode Island. Both of these states have cut Medicaid costs by emphasizing personal responsibility and giving patients more involvement in their healthcare. Unfortunately, Obama wants states to have less flexibility, not more, as healthcare policy is centralized for everyone out of Washington. It is important for people to recognize what the Medicaid expansion really is all about and realizing that the big losers will be the people who need this safety net the most.

Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.

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