In states across the country, governors and state legislators are being pushed by the Obama Administration and special interest groups to expand Medicaid. Ironically, a federal government running massive deficits is enticing these governors and state legislators with the promise of 'free money.' States have a choice to make: trust the promises coming out of Washington, D.C. and commit themselves to spending billions of their state budgets on a one-size-fits-all Medicaid bureaucracy in exchange for some funding from D.C. or reject the federal money, protect their taxpayers but risk the potential political fallout of appearing to not care about many Americans in need.
But, there is another consideration for these state policymakers. Is funneling millions of additional American citizens into Medicaid a good thing for those citizens’ health? Detailed studies by respected academic and medical organizations including the Journal of the American College of Cardiology and the University of Virginia have demonstrated that those in the Medicaid program die at a higher rate from heart problems, surgical outcomes and cancer than Americans receiving private insurance, Medicare or even the uninsured. That's right. Medicaid recipients have worse health care outcomes, according to the studies, than Americans who have no insurance at all.
According to a recent study by an economist at the National Center for Health Statistics, people on Medicaid currently can expect one in three doctors to turn them away as new patients because of their insurance, which pays about half of private plans for the same services. This is a problem across the country that’s getting worse, as forty-seven of the 50 states have cut doctor payments in the last two years.
Because these individuals struggle to find doctors willing to accept their insurance plan, these people receive substandard care. The University of Virginia study found that those who finally are accepted by doctors tend to have far lower “health outcomes” (an academically-correct way of saying more people die) than patients on private insurance, and even worse outcomes than elderly Americans receiving Medicare.
A different study from the Journal Cancer, found Medicaid cancer patients are two to three times more likely to pass away than other patients. Other studies found that Medicaid patients who have coronary artery bypass surgery are 50% more likely to die than those with private insurance or seniors on Medicare. Surgical patients on Medicaid are 13% more likely to die than even uninsured patients and 97% more likely to die than privately-insured patients.
With an outlook this grim the federal government should not be trying to push more people into a system that does not provide an acceptable level of healthcare for our country’s most vulnerable; but that’s what’s happening. The reality is that Medicaid – once considered an essential platform of our social safety net – is fast becoming a fiscal and humanitarian train wreck that threatens to dry up state budgets and hike taxes, all while fundamentally failing to provide quality health care for our most poor and vulnerable citizens. For years the program’s costs have risen dramatically while quality of care has deteriorated just as dramatically. Increasingly, doctors and medical practices are refusing new patients on the program as reimbursements fall. Worst of all, Medicaid patients themselves are suffering from being forced into a top down Federal program with dwindling options for treatment.
From a financial perspective, Medicaid expenditures are expected to grow by nearly 120% over the next ten years, which will have an enormous impact on state and federal budgets. In fact, it is already a looming disaster for the states, many of which already spend huge percentages of their budgets on this single program. To entice governors to accept the expansion, the federal government is offering to provide 100% funding for newly eligibly Medicaid recipients for the first three years, after which the funding starts to drop off. By 2020, state tax dollars would have to cover 10% of the cost of new enrollments, assuming federal reimbursement levels don’t change, which they could at any time. States that are choosing to expand have nothing more than a promise from this current administration that they’ll keep getting subsidized. But a promise is not a check especially from a President who has himself proposed cutting this reimbursement. Recognition that Medicaid is a boondoggle- disliked by both patients and doctors- is a primary driver of why many states have decided against expansion. States like Texas, Pennsylvania, North Carolina, and a dozen others should be applauded for understanding that expanding a broken system only makes the problems worse. Medicaid needs repair and reform with a focus on empowering patients and their doctors to make more of their own health care decisions which will result in better health and lower costs. Rather than being lured into Medicaid expansion by the short-term promise of ‘free’ federal funding and the fear of perceived political pain, states should demand the program be reformed. The reforms must happen before states consider trapping even more citizens in a Washington bureaucracy that is failing our most vulnerable Americans.
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