If you or someone close to you is on Medicaid, the conversation about repealing and replacing Obamacare is personal. If not, it might just be an out of sight, out of mind government program for other people.
Colorado is one of the states that expanded Medicaid to cover more adults after the passage of the Affordable Care Act (ACA) a.k.a. Obamacare. Experts estimate that one in four Coloradans is enrolled in Medicaid, up from 1-13 Coloradans in 1995.
Even if you never enroll in Medicaid, the health of the program matters to everyone. If Congress does not take steps to update Medicaid, everyone will be forced to pay more for health care — and get less — whether they use the program or not.
There’s two major problems with Medicaid today that put both patients and non-patients alike at risk.
Problem #1: Quality of Care (or lack thereof)
Medicaid has been called “the medical equivalent of public housing” and for good reason. Patients on Medicaid have a harder time finding a doctor and even emergency room care.
According to one Colorado health care expert, “Academic work on the subject even suggests that states that expanded Medicaid between 2010 and 2013 had more emergency department closures. Researchers speculate that hospitals did this in order to make their costs match Medicaid payments from Obamacare’s Medicaid expansion.”
Given the low reimbursement rate, some doctors are not willing to see Medicaid covered patients. One survey found nearly a third of doctors unwilling to take on new Medicaid patients. These patients would have greater access and care if they could get private insurance.
As more people move from employer-based health care coverage to Medicaid at the same time a lack of choices and market competition pushes prices up, patients on Medicaid have a harder and harder time getting access to quality health care that produces successful outcomes.
Problem #2: Increasing Costs
Created in 1965, Medicaid is a government health insurance program for lower income adults and children. In Colorado, Medicaid is primarily funded by federal (60%), and state (29%) tax dollars. This year, the state will have to increase the amount it spends because the federal government is reducing its share. As Medicaid costs rise, funding the program competes with other state responsibilities such as education, roads, correctional facilities, and parks.
Taxes aren’t the only way Coloradans pay for Medicaid. Because hospitals are only reimbursed 75% of their costs to serve Medicaid patients, hospitals charge everyone else more to make up the difference. In some cases, hospitals have cut services for everyone to make up the difference.
When Colorado expanded Medicaid, it included a provision that allowed “able-bodied adults” to be eligible for coverage. This is where a lot of the cost expansion has come from.
In order to protect coverage for the most vulnerable among us, Congress is considering updating Medicaid to give states greater control over the program. States could offer to ease able-bodied adults off of the program so that it could serve primarily the truly needy. Such a reform should go hand in hand with ACA reforms that increase the number of affordable insurance options. Also, individuals with modest incomes could get a tax credit to purchase health insurance, making sure that affordable, high-quality options are available to low-income families.
Transitioning able-bodied adults from Medicaid to private insurance would 1) improve access of care for low income individuals, 2) decrease pressure on the state budget, and 3) improve reimbursement to hospitals and decrease pressure to increase costs to non-Medicaid patients. It’s just one of the potential solutions to get Medicaid off of life-support.
What are your thoughts?
Should we let Medicaid continue to expand, cutting off funding for education, transportation, and other priorities, or should Congress reform Medicaid for the sake of participants and non-participants alike?
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