The
Columbus Dispatch...
Editorial: A rock and
a hard place
Health-care overhaul, Medicaid rule spell trouble for state bu
Sunday, May 15, 2011
A proposed federal Medicaid rule would put states between a rock and a
hard place, even more than they already are, and illustrates one of the
unintended consequences of the federal health-care overhaul.
States, trapped between huge budget shortfalls and ever-growing
Medicaid rolls, need to freeze or lower the rates paid to Medicaid
providers if they are to balance their budgets. The need is even keener
considering that the health-care law will add about 16 million more
Americans to Medicaid in 2014.
Yet the health-care overhaul dictates that Medicaid recipients should
have the same access to health care as does the general population.
This runs up against the reality that fewer doctors and other providers
are willing to accept Medicaid patients because reimbursements already
are low.
States that have tried to cut rates also have run up against lawsuits
from Medicaid recipients and providers.
The proposed new rule is supposed to help states, by establishing a way
to cut rates that would survive legal challenges. But states say the
lawsuit-proofing has rendered cuts all but impossible by imposing two
conditions: First, to receive approval for rate cuts, states must prove
that Medicaid patients would have adequate access to health care. It
doesn’t spell out what adequate access is or how states would prove it.
Second, states would have to review their Medicaid rates every five
years. Depending on how they stack up to those of other states, some
states could be forced to increase their rates, rather than reduce them.
The proposal has state Medicaid directors, including Ohio’s John
McCarthy, throwing up their hands. How are states to balance their
budgets?
The bad Medicaid news for Ohio doesn’t stop there.
A report last October by the Association of American Medical Colleges
projected that the nation’s shortage of primary-care physicians will
balloon to 45,000 by 2020; the shortage of physicians overall could top
91,500.
That means fewer doctors for everyone, which will result in greater
competition for their services, putting Medicaid patients at an even
greater disadvantage.
Ohio’s share of the Medicaid expansion, by one estimate, could mean
936,000 more recipients by 2014. Between 2014 and 2019, that could cost
the state an additional $2.3 billion.
Clearly, the levers put in place by the health-care law, combined with
economic reality, are setting up a colossal crash.
Read it at the Columbus Dispatch
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