Joe Balyeat: Why We Should Reject Medicaid Expansion
The battle over Medicaid expansion promises to be Montana’s biggest legislative battle in the 63rd Legislative Session. There are 3 Medicaid bill hearings before the House Human Services Committee. We urge you to oppose two bills – HB 458 and HB 590, the Governor’s Medicaid Expansion bill which will be heard on Monday, March 25th. We also urge you to support HB 604, to be heard this Friday, March 22nd, proposes to study Medicaid innovation and reform extensively before expanding the system.
(We’ll also oppose Senate Medicaid expansion bills later on.)
Our Deputy State Director will be testifying at Monday’s hearings. If you cannot join him, then take a few minutes and email members of the House Human Services Committee today!
HB 458 and HB 590 would expand Medicaid to include those at 138% of the poverty level and will result in an estimated 70,000 new Montana participants, further decreasing the quality and access to medical care in Montana. Expanding Medicaid is presumably done using 100% federal funding for the first few years and then dropping to 90%. Accepting “free money” is enticing to anyone, especially legislators, hospitals, and health care administrators. However, there are many problems with the current Medicaid system. Expanding Medicaid exacerbates these problems.
Expanding Medicaid would further compromise an already failing system. Research indicates that Medicaid results in poorer care. Medicaid surgical patients are twice as likely to die as those with private insurance, and 13% more likely to die than even uninsured patients. Even with federal subsidies, a vast influx of up to 70,000 may not improve access to quality care. In fact, without knowing the medical infrastructure of each Montana county, it’s likely that Medicaid expansion will result in poorer access to quality care for everyone as the infrastructure will be overloaded.
Research also indicates that expanding Medicaid is likely to attract many young, single and healthy individuals into a fully subsidized federal program. Because it is “means-tested”, it’ll result in a disincentive for these people to work hard and succeed and, instead, it will further increase a dependent class.
Expanding Medicaid is another way for the government to pick winners and losers. In this case, hospitals think they may be winners as they line up to receive free federal funding. Proponents argue that more health care jobs will be created but it is unlikely that these jobs will actually result in increased quality of care, which is the ultimate goal.
In addition, because Medicaid reimburses at lower rates than private insurance, many practitioners reject Medicaid patients. More than 30% of doctors nationally don’t accept new Medicaid patients. Medicaid makes the work of doctors harder. It greatly increases patient work load and provides lower reimbursement. It interjects the federal bureaucracy into the doctor/patient relationship. Instead of providing the best individualized treatment, doctors are limited to providing what Medicaid will reimburse.
The result—shifting a large segment of Montanans to Medicaid and away from private insurance, may force even more doctors into early retirement or to work for hospitals—a major step towards a single payer, single provider system.
With all the federal spending problems and the increased national debt approaching $17 trillion, there’s no guarantee of promised ongoing federal funding. And nothing is free. Just the cost of administering Medicaid expansion in Montana through 2021 is estimated at $50-$110 million… all paid for by Montana taxpayers. While hospitals might propose to cover these costs, these costs will ultimately be passed down to patients.
Before expanding a flawed Medicaid program, the legislature should study ways to improve and reform the system.
Medicaid spending is already huge. It accounts for 25% of the total proposed state budget for the 2015 biennium. The legislature should consider alternatives like requesting federal block grants and more flexibility in state management of Medicaid. HB 604 would create a select bi-partisan and bi-cameral committee that would study Medicaid innovation, reform, and expansion over the next two years at a cost of $400,000 – that’s an investment worthmaking.
Considering all the above concerns, we strongly oppose Medicaid expansion bills HB 458 and HB 590 and support HB 604 and would urge you to do the same.
You can take action now by clicking here to email members of the House Human Services Committee.