Friday, September 2, 2011

Republican Governors Association Report on Medicaid

Elections have consequences.


September 2, 2011- An overlooked consequence of the November 2010 elections is that Republican Governors were elected 29 states with similar gains in state legislative bodies. This may make Medicaid as big an issue as Medicare in the upcoming Presidential elections. The health reform law, Republican governors fear, may precipitate bankruptcies in their cash-strapped states.

According to a report just released by the Republican Governor’s Association, Medicaid is the biggest budget buster. Medicaid rolls grew to 65.5 million in 2011 — more than one in five Americans. Medicaid enrollment now exceeds Medicare enrollees by more than 8.1 million based on an average monthly basis.

Here are some facts highlighted in the report.

• When Obamacare provisions take effect in 2014, the Congressional Budget Office (CBO) estimates 25.6 million more Americans will be added to the Medicaid rolls in the next decade, bringing the total Medicaid numbers to 95.1 million.

• A nationwide survey of physicians in June 2010 found 54.5 percent of primary care physicians, 45.6 percent of medical specialists, and 49.3 percent of surgical specialists no longer are accepting Medicaid patients.

• In a 2010 survey of 1,800 emergency room physicians, 71 percent of respondents expect emergency visits to increase, and 47 percent anticipate conditions will worsen for patients.

• Even more utilization of America’s emergency departments by Medicaid enrollees could cost states, hospitals and physicians as much as $35.8 billion over the next decade in unaccounted for expenditures.

The Republican Governors Association propose that the federal government permit states to design and administer their own programs with a yearly lump sum payment provided by the federal government which only would responsible to monitor the programs and establish requirements for service delivery, quality and eligibility standards.

And so the war between cash-strapped states seeking waivers to cut their Medicaid budgets with policy changes for Medicaid from the Centers for Medicare & Medicaid Services (CMS) and patient advocates and physician organizations, who claim the moves restrict access to care, continues to heat up.

The cost of Medicaid will not be lost on the Congressional supercommittee of 12 who are charged with cutting the federal deficit. The incentive for a super committee to look at these principles which include cost-saving solutions is obvious. Under the current shared state-federal formula, the federal government pays a nationwide average of 57 cents on the dollar spent on Medicaid--a program that continues to grow.

The entitlement programs of Medicare and Medicaid are the two single fastest growing drivers of the federal deficit. Medicaid differs from Medicare in that Medicaid recipients do not have the political clout of seniors, who have a more formidable voting clout. That may be about to change as Republican governors exert their political muscle.

The reality that 54.5 percent of primary care physicians, 45.6 percent of medical specialists, and 49.3 percent of surgical specialists are not accepting Medicaid patients has the potential of igniting a political crisis. The U.S, is already short 50,000 doctors, a number expected to grow to 150,000 by 2020. If half of the doctors do not accept Medicaid patients, the situation may be even worse, especially when one factors in the 78 million new baby boomers qualifying for Medicare from 2011 to 2029.

The Obama administration may be unable to deliver on its promise of greater access for the uninsured.

Tweet: Medicaid is a fast growing contributor to the states’ debt crisis. It now covers 65.5 million and will grow to 95.5 million in 2014.


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