Both the House and Senate health bills add about 18 million more people to the Medicaid rolls by raising the income limits on eligibility. It’s a nice way to make the $1 trillion-plus bills look cheaper by shifting part of the cost to the states. And as might be expected, Congress isn’t about to supply any extra funding to the states–nor does Congress take into account the fact that many poor and near-poor people on Medicaid often have high-risk lifestyles that make them expensive patients with more health problems than members of the middle class.
Writing in the Wall Street Journal, Dr. Edward Miller, dean and CEO of Johns Hopkins Medicine, the university-affiliated hospital that operates a state-reimbursed HMO serving Baltimore’s poor, predicts that expanding Medicaid without adequate funding will spell fiscal disaster for state budgets, and, possibly, health-impairing cutbacks in medical treatment for Medicaid patients:
The Senate bill would increase eligibility for Medicaid to those who make 133% or less of the federal poverty level. The Kaiser Family Foundation reports there are 308,000 people who meet that threshold in Maryland.
Even if only half of those individuals seek Medicaid coverage, such a large expansion would likely have an excruciating impact on the state’s budget. And Maryland is not alone. According to a Kaiser Foundation survey conducted earlier this year, three-quarters of the states have expressed concern that expanding Medicaid could add to their fiscal woes. Already, as Kaiser notes, 33 states cut or froze payment rates to those who deliver health care to Medicaid patients in fiscal year 2009; even more states (39) are slated to cut or freeze rates for fiscal year 2010.
We’ll meet the demands placed on us because serving poor and disadvantaged populations is part of our century-old mission. But without an understanding by policy makers of what a large Medicaid expansion actually means, and without delivery-system reform and adequate risk-adjusted reimbursement the current health-care legislation will have catastrophic effects on those of us who provide society’s health-care safety-net. In time, those effects will be felt by all of us.
So it won’t be just senior citizens on Medicare who will be paying for Congress’s idea of reform, but poor people on Medicaid as well.