Anne Dunkelberg
Robert Restuccia
By Anne Dunkelberg and Robert Restuccia
Texans count on Medicaid and the Children’s Health Insurance Program (CHIP) every day. That’s why we need straight answers from elected officials about proposals to gut Medicaid and CHIP.

When our parents can’t live on their own, it’s Medicaid that provides help to keep them at home, or in nursing home care when home care isn’t enough. When our neighbors living with disabilities need wheelchairs, prosthetics and basic supports to stay independent, Medicaid allows them to continue contributing to our communities. And when parents can’t afford private health insurance or lose their jobs, Texas Medicaid and CHIP protect their kids from becoming uninsured by providing the preventive care they need to stay healthy and letting them see a doctor when they get sick or injured.

Medicaid’s federal and state partnership also protects Texas jobs. Clinics, doctors’ offices, hospitals and other health care businesses count on Medicaid for a dependable source of revenue that supports local jobs.

But Congress is considering proposals that put our families, friends, neighbors and local jobs at risk. Making Medicaid a fixed pot of money that doesn’t grow with need -- commonly referred to as a block grant -- or imposing an unrealistic health care spending cap would set arbitrary limits on federal Medicaid investments.

These proposals do nothing to bring down health care costs. Instead, they just shift costs from the federal government to states, and then on to taxpayers, families and charities. They leave states few choices. States can cut off coverage and make kids, seniors, families and people with disabilities uninsured, which is proven to raise premiums for everyone who has insurance and drives up costs when the uninsured are forced to seek expensive emergency room care.

They can cut payments to doctors’ offices, hospitals and nursing homes, but this puts care and jobs at risk. Congress shifting costs to states is just like an employer shifting more of the premium to the worker. Neither really reforms health care costs, they only push the costs to someone else. Either way, we pay.

Federal debt and deficit control demands serious attention to controlling health care costs, but this can be done while still protecting access and quality in Medicare and Medicaid -- without adding to the ranks of the uninsured. America’s health reform law, the Affordable Care Act, is a good start. It begins the shift away from rewarding too much or too little care, and demands improved quality, safety and outcomes. People with multiple health problems -- like high blood pressure and diabetes -- cost more to treat when their doctors don’t communicate with each other. But the health reform law rewards doctors for reducing costs by coordinating care. Because nursing homes are much more expensive than caring for seniors or people with disabilities in their own homes, the law boosts Medicaid payments when states make it easier to get help in homes or community settings. It also invests in getting more primary care physicians on the job to catch problems early and avoid expensive hospitalizations. The health reform law also cracks down on Medicaid fraud by improving policing and enforcement against overcharges.

We can and should do more. We should crack down on practices that keep more cost-effective generic medicines off the market, and close a loophole that lets drug companies charge Medicare more when seniors on Medicaid need drugs. We should speed up efforts to prevent costly medical errors or hospital-acquired infections, and reward improved care. Finally, we should adopt a budget that includes common-sense ideas such as tax incentives to reduce consumption of sugary drinks which will help cut the budget deficit and avoid costs from illnesses such as diabetes and heart disease.

These ideas will not just bring down Medicaid costs; they will actually drive down health care costs for everyone. And, unlike block grants and spending caps, they will actually improve care for children, seniors and Texans with disabilities who depend upon Medicaid every day, while still protecting health care businesses and local health care jobs.

With so much on the line, Texas families need straight answers from Washington about the real consequences of proposals to weaken Medicaid. We should all demand that Congress try every other viable option before they even consider policies that would put our health care and our economy at risk.
Dunkelberg is the associate director of Center for Public Policy Priorities, a nonpartisan, nonprofit policy institute committed to improving public policies to better the economic and social conditions of low- and moderate-income Texans. Restuccia is executive director of Community Catalyst, a nonprofit national consumer health advocacy organization based in Boston.
Copyright (C) 2011 by the Texas Lone Star Forum. 7/11