Posted 10:49 pm Friday, October 09, 2009
Federal Unfunded Mandate Expands A Broken System
There is a way for Congress and the Obama administration to claim -- truthfully -- their health care reform plan doesn't increase the federal deficit.
That's by shoving the costs onto the states, through an unfunded mandate to expand Medicaid spending at the state level. Such a move could cost Texas billions of dollars.
The Senate Finance Committee bill proposes just that.
"Under the Senate bill and a similar House proposal, a patchwork state-federal insurance program targeted mainly at children, pregnant women and disabled people would effectively become a Medicare for the poor, a health-care safety net for all people with an annual income below $14,404," the Washington Post reports. "Whether Medicaid can absorb a huge influx of beneficiaries is a matter of grave concern to many governors, who have cut low-income health benefits -- along with school funding, prison construction, state jobs and just about everything else -- to cope with the most severe economic downturn in decades."
Texas is in better shape financially than most states, but that could change if Congress takes the easy way out and orders Medicaid to expand -- without sending more money.
"For those who manage state finances, news of any proposal to extend health care via an expansion of Medicaid -- the state-federal health insurance program for the poor and indigent -- is troubling," says the Texas Public Policy Foundation. "Many states are facing difficult fiscal situations and state Medicaid programs are a contributing factor. In fiscal year (FY) 2008, states spent, on average, 21 percent of their budgets on Medicaid - equal to the amount spent on elementary and secondary education, the single largest budget item. The pace with which spending has grown has also been considerable."
Texas has budgeted $44.8 billion for 2010-2011 for Medicaid -- about 25 percent of the "All Funds" biennial budget. That's up $4.5 billion from the previous biennium. Texas taxpayers fund about $19 billion of that, with the rest coming from Washington.
The Senate Finance Committee plan could add another $6 billion to the burden in the first three years.
What's worse, it would only fund failure. The Medicaid system is broken, and adding new enrollees would only make things worse.
"All this spending on Medicaid has failed to achieve access to health care for many enrolled recipients," the Foundation says. "Provider payments that were too low restricted the number of physicians and dentists willing to participate in the program. The resulting lack of access was the basis for the Frew v. Hawkins lawsuit that forced a 25 percent increase in rates for physicians in 2007. Even this substantial rate change has not sufficiently increased the pool of physicians willing to accept Medicaid patients."
In fact, a 2008 survey of physicians by the Texas Medical Association found that only 42 percent of doctors were willing to accept new Medicaid patients.
As the Canadian Supreme Court noted, "access to a waiting line is not access to health care."
No system is in more need of reform. But the Senate Finance Committee bill doesn't reform anything; it merely expands what's already broken.
