Second editorial in 2 weeks touting "Medicaid Reform" ... help me formulate a rebuttal

[w8liftinglady]

first 2/24/11

http://www.thedailylight.com/articles/2011/02/24/opinion/doc4d6694a729493862377940.txt

Proposal outlines alternative to failed Medicaid program
Published: Thursday, February 24, 2011 11:34 AM CST
Arlene Wohlgemuth
Texas Public Policy Foundation

The Texas Public Policy Foundation unveiled a proposal that would replace the federal Medicaid program with a state-driven TexHealth program, dramatically transforming the way medical care and services are provided to low-income individuals.

The federal Medicaid program is structurally designed to make states spend money in ineffective ways. However, Texas now has the opportunity to reform our state’s Medicaid program so that it better meets the needs of both the individuals it serves and the taxpayers who support it.

The TexHealth proposal was contained in the Foundation’s new report, “Medicaid Reform: Constructive Alternatives to a Failed Program,” which was released at a 9:45 a.m. press conference Tuesday at the Texas State Capitol. Lt. Gov. David Dewhurst and Texas House Public Health Chair Lois Kolkhorst also spoke at the press conference.

This report marks the first time that anyone has laid out a full alternative to Medicaid that is not a single-payer model. A system where government makes all the decisions and holds all the authority is not the Texas way of doing things.

Medicaid is a federal-state partnership to provide health care to two distinct populations: low-income individuals who are predominantly women and children; and aged, blind, and disabled individuals who require long-term care. While the federal government provides a majority of the funding for Medicaid in Texas, federal program rules are co-opting a growing share of Texas’ general revenue funds and crowding out other state functions such as education and public safety.

This session, we are seeing the tug of war between education and Medicaid for limited state funds. If we do not reform Medicaid this session, it will require between $10 billion and $14 billion in additional state revenues two years from now.

The Foundation’s TexHealth proposal would reform Medicaid along free market principles, converting the program in Texas from a defined benefit to a defined contribution for the purchase of health insurance. TexHealth would subsidize the costs of the insurance premium in the private market, providing support for individuals on a sliding scale tied to the individual’s income and assets. The state’s role would shift from that of a benefit provider to one of determining eligibility through a simplified application and then allowing individuals to select an insurance provider.

By switching to a premium subsidy, TexHealth will provide better access to health care services and be available to potentially 4 million more individuals than currently served. Not only can TexHealth provide better health care, but we can do it at a lower cost to taxpayers.

For long-term care benefits, all current recipients of long-term services and support would be grandfathered at the current eligibility level. However, the TexHealth model would apply a more stringent income and assets test to subsequent enrollees, as well as close a legal loophole that allows wealthier individuals to shift assets in order to be eligible for the low-income safety net.

We want to make sure that our aged or disabled Texans know that the services they currently receive will continue uninterrupted.

The report outlines three options through which Texas can gain control of its federal Medicaid funds and effect the transition to TexHealth:

• An interstate compact. The ideal method of financing available to Texas involves entering into an interstate compact stipulating receipt of the aggregated amount of funding that Texas received in 2010 from the federal government with allowance in the formula for inflation and population changes. Because the outlined plan would spend money more efficiently and provide better service to low-income people, Texas could go a step further and take only 95 percent of the aggregated amount of funding. The proposed plan will be budget-neutral but more likely budget-positive for both Texas and the federal government.

• Placement of Texas’ Medicaid population into a health insurance exchange. If Texas no longer operates a Medicaid program, the federal government has obligated itself to fully fund insurance for those whose incomes are below the federal poverty limit. Texas would then use the general revenue funds it had previously used for Medicaid to provide wrap-around benefits for long-term care to the aged and disabled. While this is the most easily achieved option in the short term, the long term financing of health care through this model may provide cause for concern.

• Section 1115 waiver. This waiver – named after a provision of the Social Security Act – would allow Texas to test policy innovations for five years, so long as the proposed reforms demonstrate no additional cost to the federal government and are approved by the Centers for Medicare and Medicaid, the Office of Management and Budget, and the U.S. Secretary of Health and Human Services. Texas used an 1115 waiver in the mid-1990s to implement welfare reform, which inspired the federal government to incorporate Texas’ successful principles on a national basis.



The Honorable Arlene Wohlgemuth is the Executive Director and Director of the Center for Health Care Policy at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. She served 10 years in the Texas House of Representatives, specializing in health care issues.

[w8liftinglady]

1. and today's

http://www.thedailylight.com/articles/2011/03/06/opinion/doc4d7327fe0b0fe486456819.txt

Medicaid reform
Published: Sunday, March 6, 2011 12:32 AM CST
Arlene Wohlgemuth
Texas Public Policy Foundation

Medicaid is broken. The venerable government program that promises health care help for low-income and elderly Americans may end up useless to both unless decisive and dramatic action is taken – soon.

The Texas Public Policy Foundation’s research shows that ObamaCare has pushed Medicaid over the edge.

Currently at 28.2 percent of Texas state budget, Medicaid was already on track to consume 30.8 percent of the 2014-15 budget. Now, the President’s health care “reform” has pushed that to a whopping 46.4 percent.

You think the proposed budget cuts for public education are bad now? The Foundation’s report “The Big Squeeze” concluded that K-12 education will face even deeper cuts next session as an additional $10-14 billion will be required for Medicaid.

The good news is that this problem is fixable – if Texas can escape the shackles of federal restrictions and requirements. There is enough money in the system to pay for reform and make coverage available for more people.

The two questions that must be answered: how to get back our federal money, and what a better system would look like.

Getting back the federal money is possible under three different scenarios. The optimal way is for two or more states to pass an interstate compact giving them the authority to govern their own health care programs. Once ratified by Congress, states in the compact would be free to construct their own programs.

Other options for reclaiming the federal portion of Medicaid include establishment of an insurance exchange as required by ObamaCare – except that Texas would use it to provide private health insurance to cover medical needs. While that is the least desirable for a lasting solution, it remains on the table.

The most viable option is to push reform up from the states in the form of a waiver that would establish a pass-through for federal tax receipts back to the states. The waiver model was used successfully to reform the welfare entitlement, and it is time for the states to use it again to pressure Congress for Medicaid reform.

After the states have the freedom and the funding, what would they do with it? While Vermont has expressed interest in establishing a single-payer system, Texas should design a plan that employs the market forces that have successfully lowered costs and improved quality in other sectors of our economy.

First, our Medicaid alternative would be based on a sliding scale. That change focuses funding on those who need the most assistance, stretches the dollars further, and cultivates personal responsibility. This is a tremendous change from the existing Medicaid system that provides a perverse incentive to remain in poverty.

The reform plan would include an incentive for selecting a health savings account (HSA) plan. Such plans have demonstrated premium savings of 10 to 12 percent in the first year and restraining premium increases to half that of traditional plans in subsequent years. HSAs help patients to become informed consumers, making value decisions about health care services.

The Foundation’s research demonstrates that by transforming the program into a subsidy for private insurance, the state would be able to provide assistance to everyone below 175 percent of the federal poverty limit with enough remaining to continue the long-term care and support services for the aged and disabled as that program currently exists – in effect, grandfathering them in. Changes could then be made to future enrollee benefits to streamline the program.

The consumer choices for the purchase of support services that disability advocates have clamored for would be offered, again lowering costs while providing better care.

Of course, there are many details to be worked out. But the goal of salvaging the state’s budget while improving assistance to the poor is achievable. It is time for the Texas Legislature to find ways to serve this population while protecting the taxpayer.

The Honorable Arlene Wohlgemuth is the Executive Director and Director of the Center for Health Care Policy at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. She served 10 years in the Texas House of Representatives, specializing in health care issues.

[AdHocSolver]

2. It sounds like another way of "privatizing" medicaid.

Compare it to so-called Medicare Advantage which cost the government more than Medicare, and reduced coverage for the people.