HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, June 17, 2011

Not a great Week for Medicaid

If Medicaid were a person this week would probably have seen it resigning to spend more time with its family.

First, according to an audit study by Bisgaier and Rhodes published in the New England journal, here, 66% of the callers to Illinois specialty clinics for their children reporting Medicaid–CHIP coverage were denied an appointment, compared with 11% of the callers reporting Blue Cross Blue Shield insurance. When appointments were offered to both cohorts, the wait for an appointment was roughly twice the number of days for a publicly insured child compared to a privately insured one. Over at The Incidental Economist, here, Harold Pollack makes some excellent points about this study and Medicaid generally. And, Ezra Klein at the Post, here, has his usual succinct commentary both on the audit and the furore surrounding it.

According to Robert Pear, writing in the New York Times, here, the downward spiral of Medicaid seems unstoppable. The $90 billion stimulus package is about over, physician reimbursement will decrease, and hospitals are looking to cross-subsidize some of their Medicaid patient expenditures from the privately insured. The bottom line-Medicaid patients are not an influential voting block, federal funding is not going to increase and states have to reduce costs. Sommers and Epstein, again in the New England Journal, here, provide more data noting that Medicaid absorbs 12% of state revenues and, because the program is countercyclical, during the recession states are facing lower revenues while enrollment increases. They also tie the Medicaid issue into healthcare reform noting, "Although states will receive a large infusion of federal dollars under the ACA, other less-publicized features of the legislation render Medicaid a looming fiscal threat and administrative challenge. In combination with political considerations, these factors have made Medicaid the perfect ideological punching bag for conservatives." And, if you thought that using managed care companies to delver Medicaid services would reduce costs and improve, you should read this sobering report from the Commonwealth Fund, here.

If you can't stomach the current deficit debate and what is likely to happen to Medicaid as discussed here, then look forward courtesy of Nicole Huberfeld's upcoming piece "Federalizing Medicaid," available here. Nicole argues:

Medicaid is often described as a classic example of cooperative federalism, but the program’s design is creating more discord than cooperation. An overlooked fact is that Medicaid is not a purposefully structured cooperative federalism program. Medicaid is an outgrowth of very old assumptions about the role that localities play in providing welfare-type programs. Despite being an area of traditional state regulation, healthcare should no longer be left to the economic and political whims of the states: Medicaid should be federalized. Admittedly, some would oppose centralization on the ideological grounds that more federal government power is bad, and more state or local power is good. But Medicaid was built on a feeble foundation that allowed a patchwork program to continue and has been solicitous of state control over welfare programs ever since -- not exactly a strong argument for the significant medical variations that occur as a result of Medicaid’s divided structure. In other words, Medicaid is not an effective Brandeisian “laboratory of the states.”


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