Aloha State’s experience might offer lessons for Medicaid, too
Regarding the article “In Medicare, states are far from equal” (April 17, p. 12), while Hawaii has had lower costs per beneficiary in Medicare, it also has historically had more generous Medicaid eligibility, including for those disabled adults receiving general assistance making less than 200% of the federal poverty level prior to the ACA. We have also had broader participation historically by private-sector physicians compared to most states, although increased managed-care restrictions have reduced physician participation since 2009.
Perhaps the truth is that broader access to outpatient care correlates with lower ER and hospital utilization, leading to lower total Medicaid spending. Maybe efforts by many states to control Medicaid costs by restricting utilization of care via restricting eligibility and benefits are actually having the effect of driving total spending per beneficiary up, not down. Restricting care does not restrict disease, which often comes back in more expensive forms.
Dr. Stephen Kemble Assistant clinical professor of medicine John A. Burns School of Medicine University of Hawaii at Honolulu