With Congress poised to approve $10 billion in cuts to Medicaid, a national health policy expert told community health center leaders in Rhode Island last week that the current administration’s prescription for reform is all wrong, and urged them to fight hard for a better approach.
“Recognize that your future is inevitably, intrinsically, forever linked to Medicaid, for good or for bad,” Christopher Jennings, former senior health policy adviser to President Bill Clinton, told members of the Rhode Island Health Center Association on Monday.
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Nationally, about 40 percent of community health centers’ revenues come from Medicaid, according to Jennings, but in Rhode Island, the health center association’s figures show, it’s even more, 46 percent. And for the HMO created in 1993 by the centers, Neighborhood Health Plan of Rhode Island, which serves about 75,000 RIte Care recipients, Medicaid is the lifeblood.
No one expects a $10-billion cut to destroy Medicaid, but given that costs keep rising, and states’ budgets are already strained, many worry that program cuts are inevitable, and some states are already reducing eligibility and curbing benefits.
Just days ago, U.S. Secretary of Health and Human Services Michael O. Leavitt approved a sweeping reform of Florida’s Medicaid program that will force all recipients into managed care, cap per-person spending and give private health plans the power to define benefits.
Critics call the plan “radical,” but Leavitt and other top officials said it could serve as a helpful “framework” for other states. Similarly dramatic changes are being considered elsewhere, and Tennessee, which, like Rhode Island, had used Medicaid to provide insurance to some of the working poor, has now sharply curbed its TennCare program.
Locally, the business-backed Rhode Island Public Expenditure Council just issued a report calling for some kind of Medicaid reform to limit fast-rising costs, and while RIPEC didn’t specify what should be done, it noted that by 2010 nearly one in five Rhode Islanders would be getting benefits from the program.
Speaking to an audience that would, for the most part, naturally disapprove of Medicaid cuts, Jennings said the current reform plans are all based on a “flawed” neo-conservative view of the program as “out of control,” rife with fraud and mismanagement, and overly generous.
Those who oppose cuts, Jennings said, are accused of supporting an “unsustainable status quo.”
Per-person Medicaid costs are, in fact, growing much slower than Medicare and the private sector, Jennings said, and what conservatives call “fraud” – states’ use of Medicaid for non-health programs, for example – was, for the most part, specifically authorized by Congress, or simply requires better enforcement of existing rules by the federal authorities.
As for the supposedly “Cadillac”-quality benefits, Jennings said, in reality they’re similar to private-sector benefits, and out-of-pocket costs for recipients are higher, when viewed as a percentage of income. As for Medicaid disability and long-term care benefits, which are outside the norm, they’re needed precisely because no one else offers them, he said.
Yet Medicaid is really being strained, Jennings said – by fast-rising health care costs, enrollment increases due to the decline in employer-paid insurance and the “overwhelming” burden of dual Medicare and Medicaid recipients, whose medical costs and long-term care are taking up ever-larger shares of states’ Medicaid resources.
Given all this, Jennings argued, benefit cuts and eligibility restrictions are the wrong answer, especially if they undermine programs such as RIte Care, which he called “impressive” for its cost-effectiveness, quality and positive health outcomes.
Jennings didn’t go into much detail about what would be effective reforms, but he suggested that any savings achieved should be redirected into the health care system (instead of helping to finance tax cuts), and that coverage for the uninsured should be a priority. Simply going on the defensive, however, won’t do, Jennings said, because that will only strengthen Medicaid critics’ position.
