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Medicaid: 6 Points
Debate about cutting Medicaid is dominated by myths and misimpressions. Health care is a large part of the state budget, and those myths and misimpressions make it an easy target for people who want to cut spending. Here are some key things to remember.
People who want to cut Medicaid donít like to say they are mainly cutting health care for the elderly and disabled. But that is what they are doing.
Medicaid is usually referred to as paying for health care
Dollars spent on health care pay for the system we all depend on. When you cut the income of a hospital, nursing home, home health agency, or community health center, whether from consumersí pockets, insurance companies, or Medicaid, then staff and services get cut. Care is stretched thinner. Any patient - rich or poor - arriving with a heart attack will get poorer quality of care and be more likely to suffer a bad outcome.
People who want to cut Medicaid talk as if the program throws money around willy-nilly. They use words like
Through managed care, strict limits and freezes on provider reimbursement rates, and other tools, Medicaid does limit the growth of spending. (One big exception is virtually uncontrolled payment to drug companies. While private health plans have mechanisms to limit spending on drugs, the drug companies have avoided even the most reasonable controls under Medicaid.)
Control of Medicaid spending could come from better investment in preventive care, more intelligent case management, or a health planning system that could reasonably control excess capacity in the system. But instead, Governor Pataki proposes eliminating whole categories of care for many recipients (e.g., mental health care), or refusing to reimburse hospitals and nursing homes for increased costs of labor and supplies, or shutting down programs that help eligible people apply for coverage. Thatís not
New York is one of the few states that requires counties and New York City to pay a portion of the stateís share of Medicaid. Because counties donít pay for education and many other local costs, Medicaid looms large in their budgets. County elected officials donít want Medicaid paid for by the taxes they impose; instead, they want it paid for by the taxes that state elected officials impose.
There are good policy reasons for shifting the
We need to pick up more of the roughly $7 billion statewide local share for the rest of Medicaid. That will cost the state budget hundreds of millions. However we finance it, it should not come from irrational cuts in health care, as Governor Pataki has proposed.
Almost half the uninsured people in New York - 1.3 million - are working people and their families who are entitled to free or low cost coverage under Medicaid, Child Health Plus or Family Health Plus, but not getting it. We can do more than any other state to reduce the number of uninsured without creating any new program if we overcome the bureaucratic obstacles to getting this coverage.
The Assembly has unanimously passed legislation to simplify enrollment and recertification under all three programs by reducing documentation requirements, simplifying applications, eliminating the need for personal interviews, allowing mail-in applications, and using existing government databases to confirm eligibility. That would be real health care reform.
People often ask why New York Medicaid spends so much more than California per Medicaid recipient. There are good and important reasons.
Weíve shifted most of our mental health spending into Medicaid, in order to draw down massive Federal matching funds. Weíre smart to do that. California doesnít. Mental health patients consume a lot of resources and increase our
New York provides good care for elderly and disabled patients, including much more home health care than California. This care is expensive and drives up New Yorkís
Our payments to hospitals, nursing homes, home care agencies, and health centers are more closely related to the real cost of providing care than California. If we were to slash those rates, we would devastate the health care system we all depend on.
California may call itself the Golden State, but its Medicaid program is actually one of the worst in the country - spending less per recipient than any state, including Mississippi. New Yorkís Medicaid spending is not much different from neighboring states like Connecticut, New Jersey, and Massachusetts.
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