Patricia Kilday Hart asks an excellent question.
[Rep. Garnet] Coleman’s observation provides part of the answer: Just last session, the Legislature trimmed $486 million in state money paid to Medicaid providers, and ended a student loan-forgiveness program for new doctors exclusively serving Medicaid patients.
The federal government, which has established some rules that restrict the state’s ability to rein in costs, also bears some responsibility.
For example, the federal government will not allow states to charge even small co-pays, which could discourage overuse of services.
In 2009, the Texas Medicaid program paid $467 million for almost 2.5 million emergency room visits – but half of those visits were not emergencies, according to Stephanie Goodman, communications director for the Health and Human Services Commission.
“Private insurance plans typically charge a higher co-pay for an emergency room visit than for going to a doctor’s office because they want to create an incentive to choose the right level of care for the situation,” she said. “Medicaid should do the same.”
Medicaid has kept its costs down better than other sectors of the health care system. On a per-beneficiary basis, the program’s costs grew only 4.6 percent between 2000 and 2009, compared with a 5.1 percent increase in Medicare and a 7.2 percent increase in costs for patients covered by private insurance, according to the national Center for Budget and Policy Priorities, which focuses on policies affecting low-income families.
“Medicaid is the victim of Swift-boating,” said Anne Dunkelberg, analyst for the Austin-based Center for Public Policy Priorities, referring to the political ad campaign that torpedoed Sen. John Kerry’s 2004 presidential bid. “It is the power of the talking point that is repeated so often that people believe it.”
Medicaid is spending less per recipient today than in 2001, Dunkelberg says. The program’s bigger footprint can be traced to demographics, not overuse, she argued. Texas accounts for half the increase in children in the U.S., says the census, and most of them are poor.
The point about the reimbursement rates being set by the Legislature has been made before, but can’t be made often enough. If you don’t maintain your car, you have no business complaining when it craps out on you. Given the flexibility that the federal government has already shown Florida and Arkansas, there’s no question that co-pays will be allowed – Rep. Coleman has been talking about that, and some other items on Texas’ wish list, all along. The rest is up to us. And please note, if we really cared about controlling costs we’d be all over the Medicaid option. There’s no reason at all to believe that the private insurance way – the Arkansas option – will be less expensive. At the end of the day, if we don’t expand access to health care, via Medicaid or some convoluted not-Medicaid process, it will be because the Republicans chose not to, not because it didn’t make sense not to do so. Burka has more.