Public+Policy+-+Medicaid

Tamara Cox Healthcare is an issue that reaches every American. Unfortunately, not all Americans can afford healthcare or health insurance. The average hospital bill for one night in a non- critical unit can be five thousand dollars. Even simple surgeries like an appendectomy can cost up to twenty-five thousand dollars. Millions of American citizens have no access to even basic preventative care because they do not have medical insurance and cannot afford the bills. Last year 64.5 million Americans had no health insurance for at least six months. The problem that Medicaid attempts to solve is how to deliver healthcare to those people.
 * Medicaid**

The high cost in healthcare can be attributed to many things. The uninsured are actually part of why healthcare costs so much. If every patient in every hospital paid their full bill it would still cost the hospital a lot of money to pay its employees, purchase supplies, buy equipment, run tests, update facilities, and research new methods. But many people get hospital bills that are so far out of their ability to pay, they never bother. This cost still needs to be covered because even not for profit hospitals are not for loss. Even patients that are covered by some form of health insurance may not pay their part of the bill. The largest financial contribution that hospitals receive comes from those that are privately insured, but the insurance companies only pay about 80% of the bill. Medicare and Medicaid only pay about 70% of the bill, and the hospital cannot bill the patient for the difference.

So wouldn’t it be great if we could put every low-income family on a government insurance program to ensure that the people that cannot afford healthcare receive it and the hospitals are being reimbursed for cost? Not everyone thinks so.

Many view Medicaid programs as a way for the government to socialize medicine. Many people are reminding us about warning made in the Reagan administration that funding is a way for government to influence medicine and still look good. And this belief is not totally without merit. I can tell you as a healthcare worker in pediatrics (where about 70% of the patient population is covered by Medicaid) that we are constantly reminded of what Medicaid will and will not reimburse. Doctors often order tests and give treatments they may not think the patient needs because Medicaid will not reimburse the hospital stay if they don’t.

Most of the controversy comes from cost. Because Medicaid pays bills but does nothing to change how hospitals bill, it is a very expensive program. The Medicaid program is a federal-state cooperative program with some funding coming from both levels of government. Many state governors are speaking out against federally mandating the expansion of Medicaid in their states because they simply do not have the budget for it. This was a big topic of conversation at the summer meeting of The National Governors Association. Where Vermont Republican Jim Douglas said, “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates.” In Louisiana a state representative is even planning on introducing a constitutional amendment that would keep the state from having to accept any federal health care reform. In the state of Arizona a ballot was approved that would nullify “individual mandate” for state healthcare. Texas Governor Rick Perry said, “My hope is that we never have to have that stand-off. But I’m certainly ready and willing for the fight if this administration continues to try to force their very expansive government philosophy down our collective throats.” This came after Perry threatened to invoke the 10th amendment to resist national health care reforms in an interview.

Others that oppose the bill are concerned about the overall cost of the bill. It will cost 1.5 trillion over ten years and has no plan for decreasing the cost. Plans to offset the cost include extra taxes for the top earners in the nation and taxing healthcare benefits for those that receive employer health benefits. Neither idea is receiving much praise from people outside the poverty bracket.

Still others have complaints as well. Many argue that Medicaid fails to address the needs of lower middle class families that make too much money to qualify but not enough to pay for insurance or medical bills. Advocates for this group want some kind of partial Medicaid that could be offered with no premiums but leaves portions of the medical costs for the individual instead of covering everything.

So what exactly is congress’s plan for Medicaid in 2009? Well no one really knows yet. Medicaid is being addressed as part of the whole healthcare reform package that has been working its way through committees all year. A lot of pressure has been put on congress by the president to get the legislation finished. Though expanding Medicaid has upset some factions the controversies delaying the bill from gaining support have more to do with other aspects of the plan. But for Medicaid this plan will mean expanding the population of people that will qualify for it. They plan to expand provider participation giving those participants more physicians they can see (focusing on children from low-income families, Americans with disabilities, and those with mental illness). They also want to increase primary provider reimbursement and fund this with federal funding so that the states would not be burdened.

Many proposals are on the table. There is a House Democratic Bill, a bill from the Senate Health Education Labor and Pension Committee, a plan still being discussed by the Senate Finance Committee, a House Republican Proposal, and the president’s campaign proposal. Part of the holdup is that democrats do not want to just use their majority to get their proposals passed. This puts too much responsibility on them and would create problems if it was not a success; they need to get republicans on board. Compromises have to be made so that the final product will have a bipartisan backing. As a result 161 of the 197 amendments are Republican amendments.  As of now, four of the congressional committees that deal with health care have approved versions of legislation. The Senate Finance Committee left for recess on August 7th without finalizing a plan. Both houses have put off a vote for the measure until September. No matter what finalized plan gets voted on, an easy victory is predicted with Obama and his democratic majority behind passing legislation. As for execution, any initiative that is passed is likely to be phased in over the next few years. It will be left to the states to develop a means for implementation, and many state governments are already resisting.