Tuesday, July 13, 2004
Congress gearing up for Medicaid reform
[Joel B. Finkelstein, "Congressional task force ready to tackle Medicaid reform," American Medical News, 19 July 2004.]
Now that members of Congress consider their work on Medicare complete, they are turning their attention to Medicaid. In this interview with Rep. Heather Wilson (R, N.M.), chair of the Republican House Task Force on Medicaid Reform, it appears as though the reform efforts may be on the right track:
Q: When considering Medicaid patients' ability to get the care they need when they need it, what do you see as problems with the program and how would you like to see them remedied?
A: The first one is the financing scheme for Medicaid, which is much more complicated than for Medicare. It's a joint state-federal operation that results in these Rube Goldberg schemes for states to shuffle money around and draw down more federal dollars. That is an inherent problem we are going to have to address. The financing mechanisms ... they're tied together with bailing wire and duct tape. They're fundamentally flawed.
The second major problem is that it does not focus on improving people's health, the quality of their lives. It is an old-fashion insurance-claims payment system. We have asked Medicaid directors: How do you measure the health status of the people who depend on Medicaid and what are you finding? They look at you like you're from Mars because that's not part of their work. They administer a federal program. Their job isn't to improve anybody's health. The program was not set up to improve anyone's health.
There is also a lack of flexibility. It's come to the point where it seems like the only thing that works with Medicaid is when you get a waiver. You need a waiver from the federal program to run a disease management operation. That makes no sense. We need to reform this program.
Q: In some states, Medicaid reimbursement rates have been frozen for years. How concerned are you that access to physicians is being limited by these low payments?
A: There is a significant underpayment with Medicaid, and it does create a problem, particularly in more affluent areas where you have a small percentage of folks who are on Medicaid, because doctors can say: "We don't take Medicaid." So [patients] end up in the emergency room when things just get too bad and they're often sicker. That's not a very cost-effective way to provide care.
Q: Which of the reforms you have discussed are needed right away and which will require sustained efforts?
A: We're going to try to move toward a comprehensive Medicaid reform bill. I don't underestimate the difficulty of doing that. ... There are little things we can do, an incremental bill we can introduce to fix things here and there. But the big problems with Medicaid are just that -- big problems -- and so we have to come up with comprehensive solutions and at least get them on the table.
[Joel B. Finkelstein, "Congressional task force ready to tackle Medicaid reform," American Medical News, 19 July 2004.]
Now that members of Congress consider their work on Medicare complete, they are turning their attention to Medicaid. In this interview with Rep. Heather Wilson (R, N.M.), chair of the Republican House Task Force on Medicaid Reform, it appears as though the reform efforts may be on the right track:
Q: When considering Medicaid patients' ability to get the care they need when they need it, what do you see as problems with the program and how would you like to see them remedied?
A: The first one is the financing scheme for Medicaid, which is much more complicated than for Medicare. It's a joint state-federal operation that results in these Rube Goldberg schemes for states to shuffle money around and draw down more federal dollars. That is an inherent problem we are going to have to address. The financing mechanisms ... they're tied together with bailing wire and duct tape. They're fundamentally flawed.
The second major problem is that it does not focus on improving people's health, the quality of their lives. It is an old-fashion insurance-claims payment system. We have asked Medicaid directors: How do you measure the health status of the people who depend on Medicaid and what are you finding? They look at you like you're from Mars because that's not part of their work. They administer a federal program. Their job isn't to improve anybody's health. The program was not set up to improve anyone's health.
There is also a lack of flexibility. It's come to the point where it seems like the only thing that works with Medicaid is when you get a waiver. You need a waiver from the federal program to run a disease management operation. That makes no sense. We need to reform this program.
Q: In some states, Medicaid reimbursement rates have been frozen for years. How concerned are you that access to physicians is being limited by these low payments?
A: There is a significant underpayment with Medicaid, and it does create a problem, particularly in more affluent areas where you have a small percentage of folks who are on Medicaid, because doctors can say: "We don't take Medicaid." So [patients] end up in the emergency room when things just get too bad and they're often sicker. That's not a very cost-effective way to provide care.
Q: Which of the reforms you have discussed are needed right away and which will require sustained efforts?
A: We're going to try to move toward a comprehensive Medicaid reform bill. I don't underestimate the difficulty of doing that. ... There are little things we can do, an incremental bill we can introduce to fix things here and there. But the big problems with Medicaid are just that -- big problems -- and so we have to come up with comprehensive solutions and at least get them on the table.
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