Health Care Policy Report™ offers the inside story on health care regulation and policy, with behind-the-scenes news and analysis of developments in Congress, the federal agencies, and the...
A “pretty severe political backlash” has dimmed the health reform law's promise of expanded Medicaid coverage, and budget concerns now threaten whether that expansion will take place, a top official with the National Association of Public Hospitals and Health Systems said June 15.
Describing the current political environment for Medicaid as a “time of promise and peril,” Bruce Siegel, the group's CEO, said, “Our discussion seems to have suddenly lurched from how we plan for this expansion to how quickly we can undermine the foundations which the expansion would be based upon.”
Siegel, whose association represents many of the nation's largest Medicaid providers, spoke on the final day of a three-day National Medicaid Congress, sponsored by health policy organizations and private health care groups.
By 2019, expanded eligibility guidelines mandated by the Patient Protection and Affordable Care Act (PPACA) would add an estimated 16 million currently uninsured individuals to the Medicaid program, which is funded jointly by states and the federal government.
But a new Republican majority in the House and strained state budgets have placed Medicaid in the crosshairs of public officials looking for ways to cut costs, Siegel noted.
“Our first impulse is to be apologetic” about Medicaid, Siegel said, “to say, ‘sorry it's gotten so big.' ”
Describing that as the wrong response, Siegel countered: “Medicaid has done exactly what we have asked it to do. Medicaid rolls did not expand for some mysterious reason in the last few years. They expanded because millions of Americans lost their jobs, and they turned to a health care safety net to keep that between themselves and bankruptcy, disease, or disability.”
In other words, “Medicaid growth is not due to some inherent flaw in the program,” he said. “It's a commentary on the state of our economy.”
A combination of state and federal pressures to trim benefits has placed the Medicaid program in an “untenable situation,” according to Siegel. California, Florida, Indiana, Texas, and New Jersey have recently sought approval from the Department of Health and Human Services for major cutbacks in their state Medicaid programs, Siegel noted.
Moreover, at the federal level, several proposals—including one to cap the growth rate of Medicaid expenditures—threaten the long-term viability of the program, Siegel warned.
In addition, legislation is circulating on Capitol Hill to repeal the “maintenance-of-effort” requirements in PPACA, Siegel said. The MOE requirements—in effect until 2014 when state health insurance exchanges are supposed to be established—would penalize states that reduce their Medicaid funding levels by rescinding their federal matching funds.
“It's unclear to me how we can be talking about coverage expansion in 2014 when, at the same time, we're talking about removing one of the main legs of the stool to promote this expansion,” Siegel said, referring to the MOE requirement.
Because of lingering weakness in the economy, budgetary pressures are likely to continue to threaten the Medicaid program for the foreseeable future, in Siegel's view.
“I hope we can change the debate, and change the trajectory to begin discussing what are we going to do to bend the cost curve and provide better care,” he said. “But it's hard to do with all this smoke and fire about deficit reduction.”
The outlook for Medicaid is not entirely bleak, Siegel said, pointing to “some good news” that the program “has entered public consciousness in ways we haven't seen before.”
For example, a recent poll conducted by the Kaiser Family Foundation found that more than half of all Americans are opposed to cuts in Medicaid.
“I was floored by those results,” Siegel said. “Medicaid now touches more and more Americans in important ways,” he said, adding, “Medicaid is now a core issue in terms of how Americans perceive their well-being.”
By Ralph Lindeman
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)