States are being strongly pressured to expand Medicaid to families earning up to $30,000 a year, as the Affordable Care Act allows.
While several high-profile governors have agreed to expand this broken program, many others governors and state legislators are cautious. They are correct to be concerned.
They don’t want to deny people access to health care. But they do want to halt expansion of a program that provides limited access to quality care while devouring state budgets. Many political leaders are demanding that Washington allow states to improve Medicaid for their most vulnerable citizens.
Medicaid — the joint federal and state program designed to finance health care for the poor — has not been fundamentally changed since it was created in 1965. Legislators know Medicaid desperately needs to be modernized for the 21st century, and even President Obama argued the case during the debate over ObamaCare. “It is not sufficient for us simply to add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform,” Mr. Obama said, adding that “another way of putting it is we can’t simply put more people into a broken system that doesn’t work.”[1]
The health overhaul law did not improve Medicaid, but instead it offers a generous but temporary 100% federal match to encourage states to expand Medicaid to families earning up to 138% of poverty.
“Medicaid was designed as a safety net for our nation’s poorest and sickest people,” Rep. Joe Pitts, R-PA, chairman of the Energy and Commerce Health Subcommittee, said during a hearing on March 18, 2013.[2] “States are already struggling to serve this core population.
“Increasingly, doctors simply can’t afford to treat Medicaid patients. Is it fair that the president’s health care law will force millions of disabled and sick Americans to compete with able-bodied 25-year-olds for appointments with those doctors who will still see them?”
If all states were to go along with the optional Medicaid expansion, nearly 90 million people would be enrolled in the program by the end of the decade, including those newly-eligible under the ObamaCare optional expansion. However, as many as 60% of these new enrollees[3] are likely to drop private coverage in order to sign up for Medicaid, moving from private to public insurance that will be funded by taxpayers. That will strain not only federal and state budgets, but would also shred the safety net for the poor as they are forced to compete with millions more people to get care from the limited number of providers who see Medicaid patients.
1. Medicaid harms the poor.
The Medicaid program actually harms the people it is intended to serve. Expanding Medicaid means that patients who are already enrolled in the program -– many of whom have nowhere else to go for coverage –- will be competing for medical services with up to 20 million more people being added to the program. And the most vulnerable patients who have the greatest needs are likely to have the hardest time getting care.
A father in Iowa writes[4] that his handicapped daughter, who is on Medicaid, has to wait 2½ months for a doctor’s appointment to treat her bladder problems. “By adding 150,000 people to the Medicaid rolls in Iowa, she will have to wait six months next time,” he says. “No one takes into consideration what will happen to those who are currently on Medicaid.”