Medicaid policies don’t make sense

According to The Advocate article appearing Wednesday, Feb. 6, “Letter urges Medicaid expansion,” Gov. Bobby Jindal’s response to the dozens of advocacy groups and individuals that signed the letter was to say: “Medicaid relies on an outdated model that costs taxpayers billions of dollars and produces poor outcomes.”

Let’s get one thing straight in all this discussion over expanding Medicaid. It’s the state that controls the “model” for delivering those services. Yes, CMS (Center for Medicare and Medicaid Services) has to approve the state’s model, but for the past few years — in fact predating the Obama administration —- CMS has been giving the states wide latitude in developing their model through the Medicaid waiver program. If the state’s model is outdated and produces poor outcomes, it’s the state’s fault, not the federal agency.

Just because Department of Health and Hospitals Secretary Bruce Greenstein wants even more flexibility to design the Medicaid program than he already has, doesn’t mean he doesn’t have enough. There are massive changes happening in the delivery of health care in Louisiana, and much of it is happening because of Louisiana’s new Medicaid waiver program championed by Gov. Jindal and Secretary Greenstein.

According to the governor and the secretary, these changes will bring about much more efficiencies in the system and provide better health-care outcomes. If efficiencies translate into cost savings, then where’s the financial argument for expanding services? If it also means improved outcomes, what’s the financial and moral issue with expanding services to cover 400,000 more Louisianans?

Stewart Clark

medical practice management consultant

New Orleans

Comments

1) Comment by [e-mail] - 14/02/2013

If you or your organization would like to sign the letter urging Gov. Jindal to accept Medicaid expansion, please visit: www.lamedicaidexpansion.org

2) Comment by crazycajun - 10/02/2013

The key to L'il booby's reign of terror has been his knowing he didn't have to be too smart to fool the low information voter. Louisiana seems to have an over abundance of such. All you need is some shiny keys and a pocket full of lies. LOL

3) Comment by agagent - 10/02/2013

By expanding Medicaid the government will shift some 50 to 70% of new enrollees from private insurance to government-provided health care, so we will not be lowering the uninsured by 400,000. The federal government cannot sustain its irresponsible spending. It already has trillions of dollars in unfunded liability in the Medicaid program. If we want to save the program, Medicaid must be reformed, not expanded. If the federal government continues spending and adding to its $16.5 trillion debt, we could have another recession or possibly worst . . . A collapse of the financial system.

4) Comment by beabea - 09/02/2013

DHH Secretary Greenstein is paid $236,000 a year plus a vehicle allowance. For that kind of salary don’t we, the taxpayers who pay for it, have a right to expect him to be able to effectively run our Medicaid program? But effectively running a government program so that taxpayers get good value for their money, doesn't seem to be the priority does it. Instead of fixing the problems with how the government does things, they just throw up their hands and sell off the government functions piece by piece, so the well-connected cronies can make a profit from doing the things the government can, and should, be doing on a non-profit basis for the benefit of the people who pay for it.

5) Comment by beabea - 09/02/2013

Very informative letter Mr. Clark, thank you. I already thought Gov. Jindal's argument against the Obamacare Medicaid expansion was weak (not to mention morally indefensible) but now I realize his complaints about “one size fits all” and “lack of flexibility” aren't even grounded in reality. It’s as if he’s counting on us to be too uninformed to know that he’s really saying “Please don’t give us free money for three years, and then 90 cents for each dime we spend every year after that, because we just wouldn't be any good at doing anything with it.” In that case, maybe it is better for all that federal money to go to other states, including the growing number of states with Republican governors who apparently don’t have all these issues and have decided to sign on. Better, except of course for the 400,000 Louisiana residents who could have gotten health care from this program but will instead have to suffer, get sicker, and in some cases die waiting for Gov. Jindal and Mr. Greenstein's promised "efficiencies and better health-care outcomes” to materialize. Given their track record, I certainly wouldn't be willing to bet my health or life on that.

6) Comment by tradewinns - 09/02/2013

when it comes to "FREE" our government just flat out lies. if the fed. govt. pays 100% forever, it's still the taxpayer who pays and, as statistics show every time, the "middle class" is the biggest part of the word Taxpayer. there are those who need help occasionally and a very few who need help continuously, but we have a large segment of society who are using the system because they can, not because they need it. the taxpayer is the only one who can stop this. the politicians are not interested in stopping a vote buying system, the "poor" have no intention of leaving their lifestyle. so that leaves the middle class who have to decide to either stop it or shut up and pay for it. i'm for stopping it.

7) Comment by Attila - 09/02/2013

I don't agree with Lil Booby on much these days, but I hope he sticks to his guns on the expansion of Medicaid. He is correct in his opinion that after the first three years of "free" government money, the 10% state share thereafter will cost the state over a billion in 10 years. That is the way the feds work. They dangle a carrot in front of a starving horse and when he takes the bait he gets whipped and ridden into the ground. This is just another example of the agenda of the left attempting to make the states totally dependent of the federal government.

8) Comment by agagent - 09/02/2013

We know that the federal government cannot sustain its share of Medicaid costs, as the annual deficits have added about $6 trillion to our $16.5 trillion national debt since Obama first took office.

9) Comment by agagent - 09/02/2013

We have witnessed the frequent cutbacks to higher education and health and hospitals just to fill Medicaid’s midyear deficits. Expanding Medicaid will take money from the rest of the state budget, especially from higher education and health and hospital which are typically cut midyear to fund Medicaid.

10) Comment by agagent - 09/02/2013

The federal government currently provides $12 billion to hospitals which treat indigent patients. Obamacare reduces that payment by about one-quarter each year through 2020. An estimated 23 million will still be uninsured under Obamacare, while the federal government takes back $12 billion it is currently paying hospitals serving the uninsured.

11) Comment by agagent - 09/02/2013

Medicaid only reimburses providers about 59% of what private health insurance pays. Private health insurance makes up the costs of what Medicaid does not. The low Medicaid reimbursement rate is one reason our state hospitals are unsustainable. It is also a reason that Medicaid recipients find it difficult to find providers who will take them as patients.

12) Comment by agagent - 09/02/2013

Research has shown that expanding Medicaid eligibility shifts as many as 50 to 75% of new enrollees from private health insurance to Medicaid and not so much from the ranks of the uninsured. The same was true when SCHIPS was expanded. A MIT study in 2007 showed that about 60% of the new enrollees shifted from private insurance to SCHIPS. If your goal is to eliminate private insurance you would count this as a success.

13) Comment by gary - 09/02/2013

Mr.Clark, how correct you are.Even the finger shaking in your face governor of Arizona has agreed to take the additional medicaid funding. The national media needs to keep asking our fearless leader why does he refuse. to accept these funds.