The Missouri legislature recently engineered some pretty impressive sleight of hand in response to growing support for the Affordable Care Act expansion of Medicaid.
The legislature’s budget “expanded” the entire Medicaid program into managed care insurance contracts. At the last minute, as a result of intense lobbying by the Missouri Hospital Association, among others, they postponed the effective date to June 1, 2016, instead of July 1, 2015. But the tactic is still in place.
Many people are paying attention to the Medicaid expansion issue. Depending on your political persuasion – and/or how much you are paying attention – it is either one more big government giveaway or a rational distribution of the existing cost of providing a necessary service.
People do understand health care coverage is much like automobile insurance coverage. We all pay for the people who do not pay; so, it ends up being cheaper and better to require everybody to pay. Society says, if you drive, you pay for coverage. You can choose not to drive, but you cannot choose to stay out of the hospital.
I can hear voices in opposition to that statement, but consider this: Even if you claim to be someone who would rather die than incur a hospital bill, you could be unconscious or otherwise lacking capacity to refuse treatment, and you could end up in the hospital because someone else took you there.
Society says, if you need treatment in a hospital, the hospital must treat you. If you do not have coverage or otherwise pay, those with coverage pay for your care.
The expansion of Medicaid under the Affordable Care Act was part of a system redesign intended to reduce the cost of health care by making more people have health care coverage; by paying for that coverage; and by using health care coverage to keep people healthier so they stay out of hospitals. The system redesign is working – particularly in those states that expanded Medicaid.
There are millions of Americans who have health care coverage as a result of the Affordable Care Act. It is working so well the Republican Party – at least on the national level – abandoned its platform goal of repealing “Obamacare.” The end result is the cost of care has been under better control the last several years than at any time during the last generation.
So what is the deal about the expansion of Medicaid managed care in Missouri? Even people who are paying attention to the Medicaid expansion issue do not understand and will not care about the expansion of Medicaid managed care.
The design of Missouri’s Medicaid program is too complicated to be compressed into a 10-second sound bite that the talking heads of television and radio can yell repeatedly in our ears.
If the Missouri legislature says they are “expanding” Medicaid managed care, many people will assume the legislature is doing something positive about the Medicaid expansion issue.
The truth is any expansion of Medicaid managed care, by itself, would do nothing to expand the number of persons covered by Medicaid.
This budget expansion of Medicaid managed care in Missouri will increased the cost of providing care for the same number of Missourians. The truth is the expansion of Medicaid managed care is simply an attempt by the Missouri legislature to hand taxpayer money over to their big-business patrons in callous disregard for the interests of the people.
Medicare and Medicaid managed care products invariably cost taxpayers more than the traditional programs. It is really this simple: the managed care contract adds another mouth to feed. I don’t know about you, but I think the insurance companies already are making enough money.
I don’t mind so much when it comes to cars, because I could choose to walk or take a bus. But if I get hit by a bus while walking and someone takes me to the hospital, I don’t think you all should have to pay both the hospital and the insurance company.
Paul Taylor is CEO of Ozarks Community Hospital. He can be reached at info@ochonline.com.[[In-content Ad]]
