February 10, 2013
By Nina Owcharenko
Pressure is mounting on Gov. Scott Walker to expand Medicaid as part of the Affordable Care Act. Obamacare proponents say the expansion is a no-brainer - that the federal government will pick up the tab and bring even more doctors into the struggling health care program for the poor.
But this deal is too good to be true. The proposed Medicaid expansion would likely end up busting the state budget, crowding out other state priorities like education, transportation and emergency services. Meanwhile, the promise of quality health care for low-income Wisconsinites will prove empty.
About that claim that the feds will pay for all of the expansion . . . read the fine print. Obamacare promises to pick up 100 percent of the expansion costs for only three years. After that, Wisconsin taxpayers would have to start paying its share of the expansion costs on top of maintaining the other expenses for the program. And that assumes the federal government doesn't change its mind down the line. What's worse, the Obama administration expects states to expand Medicaid without giving them any new flexibility in how they can manage the puffed-up program.
And how sure is that federal funding, anyway? Washington has amassed a $16 trillion-plus debt and runs nearly $1 trillion more in debt each year. Any serious effort to fix America's debt mess will have to address runaway spending on entitlement programs like Medicaid. While the Obama administration is trying to distance itself from its previous proposal to change Medicaid's financing, it is hard to guarantee that federal dollars to the program will go untouched.
Low-income residents who want access to quality, affordable care have trouble finding it in Medicaid. It is becoming increasingly difficult to find doctors who will accept new Medicaid patients, mainly because the program's reimbursement rates are too low. Obamacare claims to fix this mess by increasing the pay for Medicaid primary-care doctors, raising it to equivalent Medicare levels.
But this is another limited-time offer. By 2015, it would be up to Wisconsin to pay for the new reimbursement rates to primary-care physicians, or let reimbursement drop down to the old rates. If the state somehow scrounges enough funds together to keep those rates at the higher level, expect to see specialists and other health professionals demanding a pay increase to be part of Medicaid.
Absent adequate reimbursement, health care providers will surely continue to leave the program, a trend in evidence for decades. Ultimately, Medicaid patients would be hurt by the result of higher wait times and fewer access points for care.
There is a better solution for low-income residents who need affordable health coverage. Rather than expand a bad deal, Medicaid needs a complete makeover that gives the working poor access to private health insurance, like a vast majority of Americans enjoy today.
Congress must restore Medicaid to be a true safety net for the most vulnerable in society and allow states the flexibility to tailor their Medicaid programs to their population demographics. That seems like a better bargain.
-Nina Owcharenko is the director for Center for Health Policy Studies at The Heritage Foundation.
First appeared in The Milwaukee Journal Sentinel.
Director, Center for Health Policy Studies and Preston A. Wells, Jr. Fellow
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