Sunday, November 7, 2010

Will Texas Drop Out of Medicaid?

Filed under "unintended consequences," comes this report in today's NYT that Texas is considering dropping their Medicaid program.

They've been bandying this consideration around for several months now but as Texas looks at its looming budget shortfall the idea is gaining steam.  It would not be an easy move.  Dropping out of Medicaid, a voluntary program, would mean forfeiting the federal contribution to the program which equates into a chunk of sizable change for Texas coffers.

For Texas, the problem lies partly in the fact that the state has narrow eligibility rules for enrollment.  Under ObamaCare, that threshold would change; by 2014 there could potentially be millions more Texans enrolled in the Medicaid program adding to the state's financial woes; that number varies; conservative estimates of new enrollments hovers around 1.5 million.

One obstetrician in Texas spoke to The Dallas Morning News in July about his currently limited coverage of Medicaid patients:

"They're going to try to expand the rolls of Medicaid ... and at the same time they want to reduce the reimbursement to doctors," he said, noting tensions between the priorities of federal and state officials. "With the [pay] trend going downwards, I don't see additional physicians signing up. It's just not going to happen."

Physicians across the nation already limit their acceptance of Medicaid patients, if they accept them at all, and the upcoming mandates for coverage will increase Medicaid rolls across the nation.

Texas is considering, along with some other states, forming their own insurance exchange and then basically waiting to see if the government challenges them on it.  There are problems with this and we all know how well it's worked in Massachusetts, but the options are looking very narrow to legislators struggling to reconcile state budgets.  Oklahoma has hinted it may consider dropping the program as has Nevada, although the idea would get tough play by legislators there.  Indiana is also giving the thought some play.

The Heritage Foundation suggests that most states would be better off for dropping Medicaid.

It may all be moot at this point as Republicans are now poised to begin dismantling this monstrosity.


Tina said...

Boy, I hope we do! For years, Texas' Medicaid program used only the Federal funds, until the Feds forced contributions from the State. Even then eligibility levels were kept to the minimum required by the Feds, with no lollipops from the State.

I am pretty certain that if the Feds and their money are out of the picture, costs will start to fall and we'll see less fraud. We will also see higher quality of care, especially in nursing homes and in-home supportive care for the elderly, as more business people are willing to do business with the amiable State of Texas than with red-tape tangled Washington. Nursing Home costs are probably the largest expense in our Medicaid program.

Our State-funded welfare programs were, until very recently, limited to minimal amounts of aid to families with minor children, and Food Stamps were available only to families with children or disabled/elderly adults. As a result, private & local charitable food aid programs were (still are) very robust all over the state, so all true needs were met. I was shocked to learn recently that even able-bodied working adults are now eligible for food stamps in Texas.

Our Unemployment program also was very tight: requiring a person to have been laid off through no fault of their own. Benefits were not available to people who were fired for cause or who quit their job for any reason.

This bare-bones approach served the state well, resulting in self-limited immigration from other states by people who wanted these unearned benefits, and maintaining very high population ratios of self-reliant people who, regardless of income level or circumstances, are motivated to earn their own way in the world. This results in fabulous creativity, pride, and legitimate self-assurance among Texas residents.

david7134 said...

There is very little MD fraud in Medicaid or Medicare. Much of what you might see could be from chiropractors, who shouldn't be on the program to begin with. Medicaid does not pay the doctor anything!! If you see medicaid patients it is a public service. Fraud is prosecuted, but it is against honest doctors. It was fired for medicare fraud because the hospital did not properly store and record a handfull of records. That is despite the fact that I was dilegent in providing notes. The fact is, that the laws are so screwed up that just by filing against medicaid/medicare, you are commiting a crime. You actually do the same when you file you income tax. We need the government out of our lives. It is getting worse every day.

Tina said...

Hi David, thanks for sharing your perspective. I know there are cases where good people are wrongly accused, and I'm sorry to hear about your bad experience.
When I mentioned Medicaid Fraud, I was actually thinking of the kinds of things seen here:

As you say, there aren't many physicians on the list - most charges are against other kinds of service providers. And even at that we should not generalize about any one source. Well, except for the common denominators all fraud has in common: dishonesty, greed, and a penchant for stealing.

Texas is experiencing "creeping welfarism". I spent a long time in social work fields and my compassion is high, but I came to see that the best sources for aiding the needy are those that are privately funded, that receive no government funding at all - not even grants. Privately funded programs are more effective, more efficient, and - believe it or not - more equitable than those funded, operated, or regulated by the government. A magnificent example of what the private sector has done all along is the network of Shriner's Hospitals for Children:

There are many good things that can come if the government will get out of the way. Let us hope this is a beginning.