It looks like Louisiana is about to add between 200,000 and 300,000 people to the Medicaid rolls, assuming Gov.-elect John Bel Edwards follows through on his campaign promise to join the Medicaid portion of the Affordable Care Act (Obamacare), as I think he will.
Here’s my request of our new governor and Legislature: If Medicaid expansion is to become the law of the land in Louisiana, then toss in some taxpayer-friendly safeguards as Arkansas, Iowa, Pennsylvania, Michigan, Arizona and other states did. Medicaid is a massively expensive program, and we’re combing the couch cushions for loose change as it is. We need to inject the Medicaid program with a healthy dose of common sense reform.
Americans are the most generous, compassionate people in the world. If you are hungry, we will feed you. If you are homeless, we will house you. If you are sick, we will pay for your doctor. But this generosity comes at a cost. With Medicaid, you want people who qualify to benefit from the program. You don’t want unqualified people to be able to game the system. You also don’t want a Rolls Royce model for delivering Medicaid. You want a trusty model that works while making every taxpayer dollar stretch as far as it can.
It’s no secret that I’m among the skeptics when it comes to the current structure of the Medicaid program. I just don’t think it’s a good model for delivering health care. Every year taxpayers spend more and more money, yet Medicaid patients seem to get sicker and sicker.
Medicaid will cost Louisiana more than $8 billion this year, and we’re already running short of the money needed to cover expenses. Medicaid enrollment swelled, among other things, catching us by surprise to the tune of more than $500 million. The program isn’t sustainable unless we want to close LSU, let everyone off death row, tell our kids to learn to read on their own and commit every single taxpayer dollar we take in to Medicaid. We’re at the tipping point.
We also now know that Medicaid expansion isn’t going to save the state more than $100 million as promised. The Legislative Fiscal Office has warned that the projected savings need to be decreased. Other states thought hard about controlling Medicaid costs when they expanded Medicaid under Obamacare and came up with some ideas that we should consider. They include:
1. Using the new Medicaid funds to buy private insurance for patients or to enroll them in cost-saving managed care programs.
2. Reserving the right to terminate the Medicaid expansion if the federal government backs out of its promise to pay 90% of the costs.
3. Providing incentives for patients to quit smoking, lose weight and change unhealthy behavior.
4. Requiring small premiums of $5 to $10 a month, so patients have “skin in the game.”
5. Requiring co-payments of a few dollars for each doctor or hospital visit, again requiring skin in the game.
6. Declining to pay for nonemergency transportation to the doctor or hospital.
7. Requiring larger co-payments for visits to expensive emergency rooms for nonemergencies.
8. Requiring able-bodied Medicaid recipients to get a job or take job training classes.
These reforms are quite modest, will save millions of dollars and will only apply to the new Medicaid patients added under Obamacare, who make more money than traditional Medicaid patients.
Just because we expand Medicaid doesn’t mean we have to do it strictly on the federal government’s terms. We, as a state, put taxpayer money into Medicaid, too. We should have input into how health care is delivered, especially when taxpayer dollars are paying for it.
John Kennedy is Treasurer for the State of Louisiana.