The Nov. 30 editorial “Fixing Medicaid” glossed over a fundamental reason for provider taxes: They were designed to get health care to those greatest in need. Critics of provider taxes don’t appreciate how the funds help providers who take Medicaid patients. Without them, those providers willing to care for the poorest of the poor could not make it.

The Post was right about one thing, though: A cut to provider taxes is not the same as a cut to Medicaid. It’s worse. The gap between the haves and the have-nots in health care would only grow. While per capita Medicaid spending is growing at a slower rate, the same doesn’t hold for care in nursing homes. Last year, an independent study found that Medicaid underpaid skilled nursing providers by $19 per patient per day. That’s an annual shortfall of more than $6 billion for nursing-home providers. Provider assessments help to cover those rising costs.

Limiting states’ abilities to finance Medicaid would do nothing to reduce the cost of health care or make Medicaid more efficient. We need comprehensive Medicaid reform to rein in costs rather than to simply plug leaks in the current system.

Mark Parkinson, Washington

The writer is president and chief executive of the American Health Care Association.


The attention to how Medicaid financing is sometimes manipulated is a welcome call to action, but it should not stop there, and Congress needs to be taken to task. States or providers shouldn’t be blamed for slipping through loopholes that Congress created and prevented the executive branch from closing.

Fleecing Medicare and Medicaid has been a bipartisan effort for a long time. Billions could be saved by getting rid of all the special financing deals that exist in Medicaid and Medicare.

If we are going to start down this road, however, let’s not stop at Medicaid provider taxes. Let’s have the courage to go after other taxes as well. For example, the new tax on health insurance plans will be applied to Medicaid managed-care plans. These taxes will end up being paid by taxpayers in the form of higher plan rates.

Dennis G. Smith, Madison, Wis.

The writer is secretary of the Wisconsin Department of Health Services.