By Sam Kephart
The healthcare reform bill signed by President Barack Obama will impose burdens on financially strapped state governments’ ability to pay for Medicaid and could result in “a human and fiscal disaster.”
That’s the view of Douglas Holtz-Eakin, a former director of the Congressional Budget Office and president of the American Action Forum, and Paul Howard, director of the Manhattan Institute’s Center for Medical Progress.
Writing in City Journal, they outline the devastating effect Obamacare will have on Medicaid, the joint federal-state program for low-income, uninsured Americans.
Even before Obamacare goes fully into effect, the program is beset with difficulties. Medicaid often pays just 70 percent of what Medicare pays doctors, which itself is 20 percent below private rates.
As a result, more than half of primary-care physicians and 35 percent of specialists either limit the number of Medicaid patients they see, or refuse to accept new ones, the authors disclose. That means recipients must often wait before receiving a diagnosis or treatment, which can have deadly consequences.
Another problem: Medicaid currently consumes about 20 percent of state budgets, and the federal payout boosts the deficit. Federal and state governments will spend an estimated $466 billion this year on Medicaid, and under Obamacare “Medicaid will spend an additional $443 billion by 2019 — hardly evidence of the cost control that Obama promised for healthcare reform,” Holtz-Eakin and Howard observe.
Obamacare defenders point out that the federal government will pay 100 percent of the new costs for several years after 2014. But that will leave states liable for $21 billion in new costs by 2020, not including up to $12 billion in additional administrative costs.
Yet another problem: There are 11 million uninsured Americans who are eligible for Medicaid but have not signed up. The individual mandate requiring everyone to carry insurance or pay a penalty will likely push these people into Medicaid. And these enrollees would not be covered under the federal matching rate dictated by Obamacare, but under the pre-Obamacare rate, which “varies by state but is much more onerous” for the states, the City Journal article notes.
The authors propose several reforms they say would help free states from “Medicaid’s ruinous funding scheme.”
For one, states could be given more power to control Medicaid costs without losing federal matching dollars. “Washington would remove all strings from the program, so states could try different approaches in covering the low-income uninsured,” the authors say.
Another proposal is to let people eligible for Medicaid use their funding to purchase private health insurance.
And the United States could move to an interstate market system in which people could purchase healthcare coverage from any state.
Sorry about the typo on his last name. I think “paranoid” is a poor choice of words in this situation. At the risk of sounding arrogant, I’m one of God’s chosen people, mainstream S.D. and mainstream America are my political companions, as are the Constitution, Declaration and the men who authored them both. And I have nothing to fear at the hands of Mr. Kephart, or any other fundamentalist for that matter. Now, I would agree that my opinion is showing.
Mr. Gephart might command a little more attention if he wasn’t viewed as a religious zealot by a large segment of our population. I think he’d make a better preacher than politician. Food for thought.
Your food is spoiled. First, the gentleman’s name is Kephart. Second, your pronouncement of how a “large segment” of the population perceives Mr. Kephart is dubious at best. Is that according to the latest Rasmussen or the latest Inde pipe dream? Inde, I do believe your paranoia is showing.