Kansas Health

Medicaid battle brewing

[Alexandra Marks, "Debate grows over who owns Medicaid costs," The Christian Science Monitor, 4 February 2005.]

State and the federal officials are beginning to recognize that time is running out to fix Medicaid. Everyone knew that shifting existing funds around and relying on accounting gimmicks as a way to deal with decreasing returns and increasing costs could only last for so long, but somehow other "priorities" always got in the way of reform.

As President Bush prepares to present his budget next Monday, the nation's governors have put him on notice: Don't try to balance it on our backs.

Their top concern is Medicaid - the $300 billion healthcare program that provides coverage for the disabled, 70 percent of the elderly in nursing homes, and low-income people.

Its costs are spiraling upward, draining state coffers as well as the federal treasury. The primary reason is that as more people lose private insurance, they end up in the Medicaid safety net. Over the past four years, the Medicaid rolls have jumped more than 30 percent. Combine that with the growing number of elderly in nursing homes, and you get a runaway fiscal train that both the states and federal governments agree has to be stopped. But there's a major fight brewing over how to do it.

On Monday, President Bush is expected to propose limiting the federal government's share of the Medicaid bill - perhaps cutting as much as $50 billion over five years. Federal spending on the program is now $180 billion a year. He'd do it by capping the federal allotment in exchange for giving states more flexibility in running their programs.

While the federal government can offer some assistance in terms of allowing for more flexibility in program design, the real onus for restructuring Medicaid falls on the states. Will Ohio follow the lead of states such as Florida, South Carolina and New Hampshire and settle the matter before it grows worse?

[Matthew Hisrich, "A Backgrounder on Kansas Medicaid," The Flint Hills Center, 19 July 2004.]