Medicaid Expansion Bad Deal for Patients

Health care interest groups took to the press in Pittsburgh and Harrisburg to argue for expanding Medicaid in Pennsylvania, but these advocates overlook the program’s flaws and its long-term unsustainability.

Medicaid, or government-provided health care coverage for the poor, began in 1966 as part of the “War on Poverty.”  While intended to help the poor, Medicaid has failed to reduce poverty and offers episodic and disjointed care.

For instance, if your child has an ear infection there’s only a 38 percent chance you’ll be able to get an appointment with an otolaryngologist (ear, nose and throat doctor), according to one recent study.

Moreover, Medicaid is growing at an unsustainable rate, about twice the rate of personal income in the past decade. Stuart Shapiro of the Pennsylvania Health Care Association? captured the conundrum of the Medicaid expansion well in his editorial last week:

The irony of health care reform is that in its backers’ zeal to provide health care to millions of uninsured Americans, they actually put some of our most vulnerable residents at risk. Without new tax revenues or program cuts, there is simply no way to expand Medicaid.

So why in the world would health care advocates want to sentence more people to this failing program? Hospitals and health care providers made a deal with the Obama administration. Hospitals agreed to support the Affordable Care Act because the billions in Medicare and Medicaid payment cuts through 2021 would be used toward more spending on Medicaid expansion and subsidies in the insurance exchange.

Now that the Medicaid expansion is optional, hospitals could see their payments cut without new tax revenue to supplant it.  Instead of working to expand a failing program, hospitals and health care professionals should be on the front lines of efforts to promote patient-centered reform.

States like Rhode Island and Florida received federal waivers and were able to restructure Medicaid spending to save money and improve the quality of services.  And state-based insurance reform to give patients more control over their health care dollars—such as allowing them to shop across state lines or purchase plans without a host of coverage mandates—would lower the cost of insurance, reduce the number of uninsured and improve the health of residents across the commonwealth.