Michael Quinn Sullivan, Local Contributor
Medicaid is failing Texans. Recipients are dissatisfied with the care they receive, and fewer doctors are participating in the program.
By refusing to expand Medicaid at the whim of the expensive Patient Protection and Affordable Care Act, Gov. Rick Perry is recognizing that the first step in getting healthy begins with stopping what has made us ill.
Let's be clear: the Obamacare expansion of Medicaid being discussed isn't about more help for the poor, it is about expanding the program well past the poverty line and into the middle class.
If the only measure of success is found in spending money, then Medicaid fits that bill. As the Texas Conservative Coalition Research Institute noted earlier this year, "total Medicaid spending more than doubled between 1991 and 2001, and has more than doubled again over the past decade."
One oft-cited justification for expanding Medicaid is the number of uninsured Texans. Yet uninsured status is a misleading measure of access to care. As the conservative coalition points out, if Medicaid spending had any substantive relationship with the state's uninsured rate, the number of uninsured should have dropped as spending increased. But it has not.
Rather than discussing whether to expand Medicaid, Texas and every other state is close to wondering whether it can afford this federally mandated cost-driver at all.
Studies by the Texas Comptroller's Office and the Texas Public Policy Foundation paint the same bleak forecast: Medicaid spending is outstripping Texans' ability to pay for it. In a decade, it could consume nearly 40 percent of the state's budget.
Medicaid spending is crowding out funding for public education, law enforcement and transportation. In short, Texas' core responsibilities will be on the chopping block to feed Medicaid.
If the program actually performed, that would change the discussion. But it has not, does not and will not, as long as the federal government remains in the driver's seat.
Medicaid is ultimately an inflexible model for delivering health care, mandated by Washington bureaucrats with little knowledge of the diverse needs of Texas' dynamic, growing population. The challenges faced by Medicaid-eligible individuals vary. The inflexibility of a one-size-fits-all approach just doesn't fit the needs of Texans.
More than a million Texans are legally eligible to receive Medicaid benefits yet do not chose to enter the program. Why? It might be because they simply don't trust Medicaid to deliver. Volumes of clinical research bear out such concerns.
A nationwide study of 900,000 surgical procedures from 2003 to 2007 by the University of Virginia found Medicaid patients were 13 percent more likely to die than those without any insurance normalizing for the procedure performed, age, gender and other factors. Similar findings have been reported by the University of Pennsylvania and other studies.
If Medicaid is having a hard time recruiting new clients, it's losing providers at an even faster clip. WOAI, the NBC affiliate in San Antonio, recently reported that the number of doctors accepting new Medicaid patients has been on a steady decline because he program doesn't begin to reimburse them for the cost of care. Private insurance might pay 80 percent of the bill, but Medicaid reimburses physicians up to just 60 percent. Medicaid spending has risen faster than any other facet of the budget it has far outpaced population growth and inflation — but it isn't even adequately paying doctors for their medical services!
We're constantly told by Medicaid advocates, including those at the Center for Public Policy Priorities, that increasing services and spending will reduce costs elsewhere, such as by limiting "the money (Texas) spends providing health care in emergency rooms and health clinics to people without insurance."
I am entertained when fiscal conservatism is used as an excuse for irresponsible government expansion. The inconvenient truth is that as Medicaid has expanded over the last decade, use of emergency room services for non-emergency cases has escalated. That requires a solution other than a glib demand to expand Medicaid.
Let's allow Texans take care of Texas. We should demand that Washington let Texas redesign Medicaid to fit its health care needs. We should give Texas' Medicaid-eligible population the dignity of a program that serves their needs well, while not bankrupting their fellow Texans.
Following the governor's lead, Texas legislators should aggressively pursue every avenue for increasing the state's Medicaid flexibility, whether through block grants or waivers. It is abundantly clear that Washington must not be allowed to continue dictating health care policy to Texans.
A program that is outlandishly expensive and provides too little satisfaction for patients and doctors should be discontinued, not put on steroids. Doing more of the same with more dollars is a prescription for bigger bills, not a healthier Texas.
Sullivan is president of Empower Texans and Texans for Fiscal Responsibility; empowertexans.com.
