By Speaker William J. Howell
Under the Affordable Care Act, also known as ObamaCare, states have the option to expand Medicaid eligibility. The federal government, which is $16 trillion in debt and hasn’t passed a budget in four years, says they will pay the hundreds of billions of dollars in new costs. Advocates for Medicaid expansion have misleadingly claimed expansion will create jobs and that it’s “free” federal money. I have been around long enough to know there is no such thing as free money from the federal government and no such thing as a bigger program that costs less and works better. Medicaid expansion is not the right approach for Virginia and is a false promise to poor Virginians.
Medicaid is in need of reform. There are three key problems with Medicaid that need to be addressed to protect its long-term strength.
First, Medicaid is the fastest growing line item in Virginia’s state budget. It consumes about 25 percent of our state budget and is threatening to crowd out other core government services like education, transportation and mass transit, public safety and other health care programs.
Second, Medicaid is an inflexible, rigid program that doesn’t allow patients to receive the care they need. The coverage mandates require that all patients fit under a one-size fits all umbrella of offered services. That increases costs and means lower quality health care for all Medicaid recipients.
Third, and most importantly, Medicaid isn’t offering the kind of medical care that low income Virginians deserve. The program lacks long-term wellness and coordinated care options. It doesn’t encourage healthy lifestyles. Medicaid pays doctors so little that many physicians refuse to see Medicaid patients. And a recent study done at the University of Virginia showed that Medicaid patients had a higher chance of dying in the hospital, stayed longer in the hospital and were charged almost 20 percent more per visit when compared to privately insured and uninsured individuals. In other words, uninsured people are receiving better care than people on Medicaid.
Another concern, unrelated to the program itself, is how do we pay for it? The federal government has promised to cover all the costs of expansion. The nation is $16 trillion in debt. Our Congress hasn’t passed a budget in four years. Advocates for expansion claim “free federal money” will pay for expansion, but the truth is the federal government cannot afford to pay for Medicaid expansion without adding hundreds of billions of dollars in debt that will burden our children and grandchildren.
In short, Medicaid is an expensive, broken program. And Virginia taxpayers will eventually get stuck with the tab. You don’t fix a broken program by putting more people in it. And you certainly don’t help poor Virginians by putting them in a broken program. Enrolling low-income Virginians in a broken program that we cannot afford is a false promise and a fool’s paradise.
Republicans in the Virginia House of Delegates – and Governor Bob McDonnell – want to fix Medicaid and preserve it for the neediest Virginians.
We need to enact reforms that will reduce costs and make the program more efficient. Doing so will preserve the long-term strength of Medicaid. If the federal government allowed Virginia to have a waiver, we could provide more flexible coverage and tailor the program to meet the needs of specific individuals. That would work better than a one size fits all approach. We need to provide higher quality care by encouraging a healthy lifestyle and improving access to high-quality care for Medicaid patients.
Over 1 million low-income Virginians rely on Medicaid. Over 60 percent of Medicaid recipients are children. For many of these people, Medicaid is the only way they can receive medical care and get medicine. This is an absolutely critical program and a very important part of our health care safety net. If we don’t make changes soon, the program might not be there for those who truly need it.
Advocates for expansion also claim that we can do both at the same time – reform and expand Medicaid. That’s unrealistic and ignores the history of social programs. Can you imagine a bigger program that costs less and works better?
I do not think enrolling hundreds of thousands of poor Virginians in a broken program is the compassionate or the right thing to do. It is the false promise of a better tomorrow that they will never see. The compassionate and right thing to do is to fix Medicaid and preserve it for those already enrolled – the neediest Virginians. We have formed the Medicaid Innovation and Reform Commission to oversee the implementation of the reforms I discussed here. Those reforms are critical to protecting the future of Medicaid.
Speaker Howell is 54th Speaker of the House of Delegates. He represents Virginia’s 28th District and is chairman of the National Speakers Conference.
