The Commonwealth Iconoclast

A site dedicated to covering issues relevant to the Commonwealth of Virginia, and nation at large, plus other interesting things too, as I see fit...

Monday, November 28, 2005

The Medicaid Conundrum

Today's DNR pick-uped an article from none other than the Washington Post. It only ran half the article, the full article from the Post is here. Essentially, the article discusses the Medicaid cuts and "reforms" passed by the House of Representatives. The interesting thing was that the article asserts that there is a split between the Congressional Democrats and Democratic governors on this issue. Congressional Democrats are using the cuts as part of a political attack on Congressional Republicans. The governors on the other hand, are looking at the potential explosion and Medicaid costs over the next ten years and are desperate to find ways to control those costs.

While I think these articles make more out of the divide among Democrats than is in fact there, it does raise important issues. Basically, how to fix a system that is increasingly straining state budgets. Some of the reforms proposed in the legislation have in fact been floated by Democrats as a way to help control costs. Specifically, the ability to charge co-pays and co-insurance for doctor's visits and penalties for using the emergency room instead of a general practicioner for minor medical problems. These are sensible reforms. Co-pays discourage unnecessary medical treatment. The key is to find the amount that will be enough of a financial disincentive to make Medicaid recipients seek treatment only when needed. The problem is that there is no real oversite of the amount of co-pays on the working poor. States could essentially price the working poor out of health care altogether, or worse, create a incentive to drop one's income below the poverty line in order to get more coverage.

The fact is there isn't a divide on this issue in any real sense. Governors want more control and there is nothing wrong with that. What ultimately unites the legislators and the governors is the desire for the nation's most vulnerable people to continue to get access to healthcare and for any savings from Medicaid reforms to remain in the program. What no one wants is for the nation's poor carry the burden of tax cuts for the wealthy. If you work full time and still are in poverty, you need more help not less.

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