This commentary was originally featured in Investor's Business Daily on August 4, 2017.
Medicaid was originally intended as a health insurance plan for those "unable to support" their health care needs, specifically children, pregnant women, seniors and the disabled. Eligibility was gradually and subtly expanded so by 2010 Medicaid was made available to the unable poor. Then, the Affordable Care Act expanded Medicaid to include all low-income individuals, both the unable and the able-bodied.
Expanding Medicaid eligibility and benefits was politically advantageous to the progressive/socialist left. Expansion was not beneficial to patients. In fact, by lowering payments to providers, Medicaid expansion reduced enrollees' access to care.
Deamonte Driver was a young boy from a low-income family in Maryland who had a tooth abscess. Though his family qualified for Medicaid coverage, his mother could not find a dentist in the area who would accept Medicaid reimbursement rates. Deamonte's infection was left untreated and got worse. The infection spread to his brain and he finally got care when he had uncontrollable seizures — but too late.
Deamonte's dental problem could and should have been cured by a simple, inexpensive procedure. Instead, lack of treatment cut short the life of a 12-year-old.
Deamonte's case was hardly an isolated event. Medicaid expansion in New Mexico added more than 325,000 to its rolls, producing a $417 million budget shortfall. To balance its state budget, the Land of Enchantment was forced to cut already-low provider-reimbursement schedules further. This made even fewer doctors available to an ever-increasing number of patients.
Supporters of Medicaid expansion often tout the 11 million newly insured individuals who received free coverage via the ACA. The goal of health policy is not to provide insurance — it is to assure timely, quality care. Insurance is worthless if it does not produce a prompt visit to the doctor's office.
In 2013, an Oregon study compared the new enrollees of expanded Medicaid to the individuals who had no insurance. Researchers found that spending $545 billion in Medicaid expansion showed "no significant improvement in measured health outcomes" in Oregon. This was in spite of Oregon's Medicaid program being considered one of the best in the country, with doctor compensation rates far above the national average.
Another study, performed by a team at Harvard, looked at three states that expanded Medicaid, and only one of them had any statistically significant reduction in mortality. A third study by the University of Virginia found that patients with Medicaid coverage did worse after surgery than uninsured patients. Because of Medicaid expansion in Illinois, nearly 800 enrollees died while waiting for medical care, called "death by queueing."
Evidence proves that Medicaid coverage does not lead to the care needed to protect the health of the most vulnerable Americans. Medicaid insurance does not produce timely care.
Do we really want to expand a program that promises care but fails to deliver? A failed program that will consume seven trillion taxpayer dollars over the next decade no less. Medicaid was already busting state budgets when it only covered the most vulnerable members of society. Medicaid expansion is a perfect storm of unsustainable cost structure, decreased access to care, and worse medical outcomes for its enrollees than for persons with no insurance at all!
Medicaid expansion has also decreased access by preventing charity care. Volunteer care providers in places like Free Clinics of Michigan offer no-charge medical care to all patients. Federal rules prohibit Medicaid-eligible patients from receiving such free care.
Following Medicaid expansion, the amount of traffic through their clinics has significantly declined. Americans who are dependent on Medicaid, with its long wait times and poor health outcomes are prevented from getting high quality care at charity clinics.
Only 40% of the people selected to participate in the Oregon study chose to return their Medicaid applications. In addition, the CBO concluded in its analysis of the recently released "Better Care Reconciliation Act" that nearly 5 million Americans would choose not to re-enroll in Medicaid if the individual mandate were repealed. The prediction that 5 million people would opt out of a free program is testament to the program's lack of perceived value.
Cuts to Medicaid are not about giving tax breaks to the rich. Political discussions surrounding Medicaid often ignore economic as well as medical realities. Without fundamental change, the program will simply not have enough money to pay for what patients need.
Since both the House and Senate bills leave the money-devouring Medicaid mandates in place, enrollees will soon find themselves in a program with no care available. Medicaid must be radically reformed, most likely at the state level, so that those whose lives literally depend on Medicaid can get the care they need before they die waiting in line.
Only after effective reform will Medicaid be able to promise the family of Deamonte Driver, "Never again."