Sunday, December 11, 2005

This Medicaid Stuff I Keep Talking About

by Kyle Michaelis
Updated - see below

Almost each and every time the Republican candidates for governor have whipped out their respective tax cut plans so that voters can play Goldilocks and decide which proposal is "just right" for them, I have generally decried these efforts as irresponsible in the extreme.

Much of this response is founded in the state's ever-expanding Medicaid obligation, to which none of the candidates have proposed a solution while each trying very hard to make the budget shortfall it foretells a whole lot worse. Our state will either be prepared for this problem when it hits critical mass or we will see a wholesale cut in state services that brutalizes and abandons the state's neediest and most elderly citizens.

By not talking about and recognizing this problem now, these Republican candidates for governor are sealing the fate of Nebraska's least fortunate and washing our hands of their suffering.

Of course, outside the spotlight, where common sense is still generally free to tread, a statewide panel does exist to analyze this problem and hopefully pave the way for the necessary changes that will prevent an outright disaster in the coming years. They've just released a report, however, that shows neither the willingness or the creativity to address the enormous magnitude of the coming Medicaid crisis.

The AP reports:
Sticking with the current Medicaid program, and not looking at wholesale changes in eligibility or services, won endorsement Wednesday from a council formed to recommend reforms.

The panel did not want to shift toward a defined contribution system where benefits available to recipients are variable and targeted to needs, as opposed to the current system where benefits are fixed.

Also supported was a Medicaid reform report's recommendation that no substantial changes be made to current eligibility standards.

"We haven't come up with any bold ideas for Medicaid reform and neither has anybody else across the country," said Ron Ross, currently state treasurer and former director of the Health and Human Services Department. Given that, changes will have to be made incrementally instead, he said.

The report contains 28 recommendations for improving Medicaid....

Sen. Don Pederson, chairman of the reform council and also of the Legislature's budget-writing Appropriations Committee, acknowledged that the recommendations included in the report will not "turn the battleship around" but instead will "help slow the growth of this program."

The push for reform comes as costs of Medicaid have grown 11 percent a year since 1985 and last year took up 17 percent of the entire state budget. Left unchecked, Medicaid is poised to take up larger portions of the state budget, leaving little money for anything else.

Not surprisingly, the report ordered by the Legislature concluded that the current program is not sustainable. Immediate changes would save $72 million in state and federal funds in the first year. Last year Medicaid cost the state $470 million.

"It took us a long time to get into this mess, and it's going to take us a long time to get out of it," Pederson said....

The state health system will monitor reform efforts in other states, so Nebraska won't be a laboratory for bad ideas....

Recommendations for change approved by the reform council will be forwarded to the Legislature, which will likely use them as the basis for bills introduced next month.

Medicaid is the health insurance program for the poor and disabled...One in seven Nebraskans - some 241,000 - receive Medicaid, including more than half of the state's 15,000 nursing home residents.

Sure, we don't want to be a laboratory of bad ideas, but, right now, the worst possible idea is to do nothing - which, in too many ways, is precisely what this panel proposes. Their wait-and-see approach is at our state's peril. Absent a national reorganization of the Medicaid program, likely in the form of a total overhaul of the U.S. health care system, we are just taking another step up the ladder, setting ourselves up for that much bigger a fall.

While understandable that they want to avoid "Chicken Little"-hysterics, I fear politics has more to do with this panel's silence than the actual reality of the situation, in which the sky is not yet falling but EVERY indicator says it will (and soon). For this panel to not at least reprimand politicians for engaging in the tax cut-equivelant of an arms race while this outstanding obligation looms over our heads is only further testament to the meekness and inadequacy of their recommendations.

**Update - 5:22 pm -
Both the Omaha World-Herald and the Lincoln Journal-Star weighed in today with their own responses to these proposed Medicaid reforms. Both are far more positive about the "cautious" appoach than I am. Interestingly, both also neglect to make any mention of the tax cuts being talked about and promised in the coming legislative session, as if their were no connection whatsoever between a state's tax receipts and its spending on social services. How very conveniently divorced from reality of them - even President Bush would have to be impressed.

Of course, there's no way to tax ourselves out of this problem, but disregarding how policy changes might hasten or provoke a budgetary shortfall is just plain absurd.

You know what else both newspapers fail to mention - the imminent need for reform at the federal level and the failure of this panel to advocate a more national approach, calling on Nebraska's Congressional delegation to enter the debate with ideas of their own. It is a glaring oversight that completely misconstrues the depth of this problem and the breadth required of any true solutions.

The will does not exist for reform at the state level. Meanwhile, you can't even get the average Republican in Washington D.C. to say the words "health care" because they're so devoid of ideas and invested in/owned by the purveyors and profiteers of the evermore broken system in place.

Strange days ahead. With such incompetent, non-existent leadership, can there be any doubt about our ultimate destination?


Anonymous Anonymous said...

Medicaid is a great form of health insurance for many individuals and there is no way it should be cut off as health coverage is a major importance to many.


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