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Medicaid expansion's false promise: As I See It

June 07, 2013 J

Op Ed on PennLive.com By Nicholas Pandelidis and Donna Baver Rovito

Gov. Tom Corbett was fiscally and morally correct to reject expanding the financially untenable and second-rate Medicaid program, and he shouldn’t let pressure from Kathleen Sebelius and special interest groups sway his good judgement. Good intentions alone do not result in desired outcomes, and expanding non-viable programs is not only an intellectual lapse, but a moral one.

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Claims that Medicaid is financially viable and provides good healthcare for the indigent only perpetuate poor healthcare for the indigent and block development of better solutions. Medicaid costs are rapidly increasing with states picking up about half the tab. Pennsylvania’s 2010 cost of $18 billion is expected to hit $22 billion by 2020. As the Medicaid burden has grown, it has crowded out spending for education and infrastructure.

While the federal government (“taxpayers”) will cover 100 percent of new Medicaid expenditures for three years and 90 percent going forward to 2020, states must cover administrative costs. States must also cover adding millions up to 100 percent of federal poverty level (FPL) who currently qualify, but haven’t enrolled – as high as 50 percent in some states (about 175,000 in Pennsylvania). Perhaps they heard that the uninsured get better care.

ObamaCare’s individual mandate forces them to enroll in Medicaid when they apply for other benefits – and states must bear the pre-Obamacare proportion (about half) of cost for those “old eligibles,” not the 90% or 100% promised by the feds for the “new eligibles” (100% to 138 percent of federal poverty level). Plus, there’s no guarantee the new matching fund levels will continue beyond 2020.

About 30 to 40 percent of physicians restrict the number of Medicaid patients they’ll see or don’t participate at all because reimbursements are below the cost of care. As a result, the uninsured are more likely to get primary care appointments, forcing Medicaid patients to utilize emergency departments twice as frequently as those with private insurance, and even more than those with no insurance at all.

Poor access results in more expensive care and markedly worse outcomes for Medicaid. A recent study of 900,000 surgical cases showed Medicaid patient mortality rates were twice that of patients with private insurance. A study of 11,000 cancer patients found Medicaid patients had less than half the five year survival of non-Medicaid patients. Sadly, delayed access results in later presentation of problems and fewer options for care – hence, dismal outcomes.

It’s not possible to “fix” either the problem of the uninsured or Medicaid’s substandard care by handing out shiny new Medicaid cards to millions of Americans. A Medicaid card is a bogus promise of care that doctors can’t afford to provide, a cynical lie perpetrated on some of our most vulnerable citizens. Those who pretend an Access Card guarantees access to care, or are trying to convince others of that falsehood, should be ashamed of themselves.

Nicholas Pandelidis is an Orthopedic surgeon from York. Donna Baver Rovito is a member of the Lehigh Valley Coalition for Health Care Reform in Allentown.

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