The Obama administration heralds this as a tremendous bargain for states. That’s simply not the case. The administration overlooks that Medicaid is largely failing current enrollees with its outdated model that costs billions of taxpayer dollars and produces poor outcomes.
Medicaid operates under a 1960s model of medicine, with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility. Expanding the entitlement program as it stands would further cement a separate and unequal tier of health coverage. Without fundamental reform, Medicaid will continue to deliver what it has for decades: limited access, poor quality and budget deficits.
Fortunately, after nearly a half-century of running this program, states know its problems and how to address them.
A number of Republican governors have asked to meet with President Obama to discuss their solutions, but the White House has ignored these requests. The president claims that he wants to work across party lines to get things done for the American people, so perhaps he could start by meeting with Republican governors who want to solve our nation’s health-care problems.
Our ideas to fix Medicaid target several areas for reform: eligibility, benefit design, cost-sharing, use of the private insurance market, financing and accountability.
First, the process to determine eligibility should be simple, accurate and fair. There are far too many complicated categories of Medicaid eligibility. The process should be easier for consumers to navigate and for states to administer. States should have the flexibility to set eligibility standards that make sense for residents, instead of the rigid, one-size-fits-all approach dictated by Washington. For any expansion, there must be straightforward rules to identify who is newly eligible for Medicaid vs. those who would have traditionally been eligible. Our country cannot afford billions of dollars in payments on untested methodologies.
States should be allowed to design their programs to promote value and individual ownership in health-care decisions. This includes using consumer-directed products, flexible benefit design, and reasonable and enforceable cost-sharing requirements. States must be freed from decades-old rules that are no longer relevant to 21st-century health care. For example, just like those of us who have employer-sponsored coverage or Medicare, Medicaid recipients shouldn’t have free access to hospital emergency rooms for routine care. When individuals have no skin in the game, they are less likely to consume care responsibly.