Doctors and medical associations had a big effect on public opinion during the fight over the Affordable Care Act. We’ll see whether that is true during the fight over Medicaid.
“Unless our state leaders can come up with a financing plan to replace the current Medicaid structure that’s even better than what we have now, I think it will ultimately end up backfiring and costing more in the long run,” said Dr. Susan Bailey, a Fort Worth allergist and president of the Texas Medical Association.
Republican Rep. Mark Shelton, a Fort Worth pediatrician, said: “I think opting out of Medicaid without a viable alternative is not a good idea. We need to make sure … the vulnerable people in our society — the poor, children and the elderly — are taken care of.”
Shelton is certainly a conservative, so seeing him take this position is notable. I don’t know how much influence he has as a legislator, but as a doctor he might get some of his colleagues to pay attention.
The state’s nearly 500 hospitals have a big stake in the issue, with Medicaid covering more than half the births in Texas. Additionally, federal law requires hospitals to provide emergency room treatment to anyone who needs it, including the indigent. More than $7 billion in Medicaid payments went to hospitals last year, including $4.5 billion in federal money.
Medicaid covers children, people with disabilities, pregnant women and the elderly. Nearly two-thirds of the state’s 90,000 nursing home residents depend on Medicaid, said Tim Graves, president and CEO of the Texas Health Care Association.
“We certainly understand the need to look at options because the state budget is in such bad shape, but I don’t understand how getting out of Medicaid would help,” Graves said.
The loss of billions of federal Medicaid dollars could have a “devastating effect” on Texas healthcare, he said.
Did you hear all that, Warren Chisum? Do children, people with disabilities, pregnant women, and the elderly meet your standard of who is worthy of receiving health care? Or will you find some reason to blame them for their lack of resources?
Perhaps we should learn from what other states have already figured out.
A Wyoming Department of Health study, released in September, on the impact of a Medicaid opt-out said: “While some that lose Medicaid coverage under an opt-out scenario may find coverage as a result of health care reform, it is clear that coverage may not be affordable nor provide the services needed by many. There would also likely remain a significant number of individuals who would not be able to obtain coverage under the current health reform bills.”
The study also said: “The strain that will ensue should Wyoming determine to opt-out of participating in Medicaid without a solid plan to replace it is truly immeasurable. Further, Wyoming residents will be paying Federal taxes for services that residents of this state will never benefit from.”
Texas Health and Human Services is conducting a similar review. Findings are expected in December.
Remember, one of the cornerstones of the Affordable Care Act was making more people eligible for Medicaid. The only way that giving them a subsidy to buy insurance from a private for-profit enterprise makes sense as an alternative to that is if the subsidies are only sufficient to purchase crappy, bare-bones plans. Everything is less expensive if you don’t care about quality or adequacy. If Republicans believe that letting more people, in particular more children, people with disabilities, pregnant women, and the elderly, get sick and die as a means to balancing the budget is an acceptable outcome, then by all means they can go ahead and figure out the best way to make that happen. It’s up to all of us Democrats to make it clear that this is what they’re doing.