We must pro­vide needed ser­vices

Chal­lenge for gov­ern­ment, health­care: Help­ing poor with­out go­ing broke

Modern Healthcare - - Opinions Editorials -

As I write this es­say, our na­tional lead­ers just con­cluded con­tentious ne­go­ti­a­tions re­lated to rais­ing the debt ceil­ing. There was high anx­i­ety in all quar­ters be­cause both par­ties agreed that deep cuts must be made in gov­ern­ment spend­ing. Even pre­vi­ously pro­tected pro­grams were “on the ta­ble,” such as So­cial Se­cu­rity, Medi­care and, es­pe­cially, Med­i­caid.

Med­i­caid—a col­lab­o­ra­tion be­tween fed­eral and state gov­ern­ments to pro­vide health in­surance cov­er­age for the poor and dis­abled—has grown so much and be­come so costly for state gov­ern­ments that it is un­der at­tack. Med­i­caid now cov­ers about 67 mil­lion peo­ple in the U.S., more than one-fifth of our pop­u­la­tion.

Se­ri­ous, though dis­parate, ef­forts are al­ready un­der way to “re­form” Med­i­caid. Many Democrats see Med­i­caid as part of the so­lu­tion to ad­dress­ing the prob­lem of in­di­vid­u­als. For ex­am­ple, in my state, Utah, the fed­eral share for the newly el­i­gi­ble would in­crease from 70% to 100% for 2014 and 2015, and would be phased down to 90% by 2020. But many worry that af­ter 2020, the fed­eral gov­ern­ment will not keep up with the en­hanced pay­ments and the states will be left hold­ing the bag.

Most Repub­li­cans see Med­i­caid as costly and com­plex and want to re­peal cur­rent reg­u­la­tions re­lated to de­ter­min­ing el­i­gi­bil­ity. Sen. Or­rin Hatch (R-Utah) has in­tro­duced leg­is­la­tion that would re­peal re­quire­ments that states must main­tain cur­rent lev­els of ser­vice to those al­ready en­rolled in the pro­gram. Re­cently, 29 gov­er­nors signed on to a letter ad­dressed to Hatch and Rep. Fred Up­ton (R-Mich.) ask­ing for re­peal of the Af­ford-

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