What is the Future of Medicaid Reform?
Grace-Marie: Now, I am distressed that more states did not demand more flexibility with this program in exchange for expanding Medicaid. About half of the states have decided to expand it; about half have not after the Supreme Court re-wrote the ACA and made expansion of Medicaid up to 138% of poverty an option for the states. But I think about 24 states now are resisting expansion for a number of reasons.
First of all, Medicaid is –as I said – really a program desperately in need of reform. When I served on the Medicaid Commission in 2005/2006 we did hearings around the country to look at the Medicaid program – to learn about it – because it’s really 50 different programs because each state runs its own. We found so many instances in our hearings around the country in which people were desperately dependent upon Medicaid and yet it was not serving them. States continue to expand access to benefits, but they also continue to cut payments to providers. States – if they were given more flexibility – could make a significant amount of Medicaid dollars go much further to cover more people. But, they are absolutely constrained by having to go to the Centers for Medicare and Medicaid Services playing “Mother May I?” every time they want to make a change to their program.
So, I think that the states really missed an opportunity for more flexibility with Medicaid. There was just a waiver --- it looks like a waiver is going to be given to Indiana to promote or continue a program that former Governor Mitch Daniels created called: “The Healthy Indiana Program” that really does begin to move Medicaid into a much more modern model. I think that that is a platform that some other states may be looking at. But, I think there’s a lot of resistance to expanding the program because people are seeing increasingly – and a lot of studies are showing – that people can be worse off on Medicaid than being uninsured. It’s just criminal that we are putting tens of millions of more people on this program and not improving it.
So, I think states are going to increasingly resist expansion of Medicaid unless they get more flexibility to control the program themselves and be able to save money and be able to provide better benefits to their citizens often in giving them the option of private coverage. So, I think that the future of Medicaid is more governors demanding more flexibility and then giving the patients on Medicaid more options for private coverage. There is no reason that they should be segregated into this ghetto of a program when so many people really could do so much better if they had options for true private coverage – not necessarily the fake private coverage that many of the states plans pretend to offer.