What Next?
So, the talk is that the Republicans want to get rid of Medicaid. OK, but what next?
There would be lots of ways to walk this program back.
Let me remind you, nobody likes it.
Doctors hate it because it pays about 30 cents on the dollar of what they charge. They love private insurance because it pays 70 cents, but they hate the prior authorizations the insurance companies use that extra 40 cents to staff. Keep in mind, what they charge is what they charge.
Patients hate it because it’s “charity” and the doctor’s offices look down their nose at them.
Hospitals don’t hate it too much since they would be having to put these poor dying patients out on the sidewalk and that really looks bad. But the Medicaid payments don’t cover their costs. So, for them it’s a lose/lose.
So, we have built a federal state partnership program everybody hates. What a great government solution. But do you like your private enterprise insurance benefits? Do you like how much this all costs you? Remember, us Americans pay more, almost twice for healthcare than any other country in the world. And this is what we get.
We, our country could do better. Our new President has resolved to make America great again.
Should we redo the primer on what exactly Medicaid is? Skip the following paragraphs if you passed the pretest.
Medicaid was added to the Social Security program in 1965. Idaho agreed to the partnership in 1966, a very early state to agree. The federal government agrees to pay a certain percent based on the state’s poverty level. The state pays the rest. In Idaho’s case, it’s about 70/30, federal/state.
Don’t get confused about Medicaid Expansion costs. That match is 90/10 and always will be unless somebody wants to change that law.
The most expensive patients on Medicaid are the severely disabled. This is a small but expensive group. Do you think they should have health care supported by taxpayers?
The largest group is children in low-income families. They are cheap since most are healthy. Do you think they should have taxpayer supported healthcare?
Then there’s low-income uninsured pregnant women. Do you think…maybe not.
Then there’s the Medicaid expansion population who don’t make enough to get insurance on the exchange. Most (80%) are working with a reportable income, but it’s below the poverty level. I know 60% of Idahoans think they deserve health insurance, but I don’t think the Idaho legislature would agree.
When I got elected to the Idaho legislature, I was all in favor of what Paul Ryan was proposing for Medicaid, block grants to states. I saw the current funding mechanism based on percentage of poverty as no incentive for a state to try to control costs. If we only saved a third of every dollar, would it be worth it? Block grants would offer a greater incentive.
But then I got to understand how block grants get twisted by state legislatures.
It all comes down to the questions I have been asking of you. Do you think all people should have access to health care?
Most, when asked this question, throw up their hands and say, “Of course, if we could afford it!”
They have been trained by the medical industrial complex to consider this as a dear resource. They forget we are already paying TWICE what any other civilized country pays. We have been brainwashed into considering it’s just too expensive.
Your yearly deductible teaches you that. Finish paying out of pocket, then go get what’s fully covered.
Switching insurance teaches you that. Insurance companies are scanning the field for the low-cost enrollees. If they get too many expensive patients or can’t make the right deals with providers, they drop coverage.
We can afford to do this. But it will take a great effort. It could make America great.