Time for a new look at Medicaid
New York’s budget is going to be late, at least by a few days, in no small measure because of a fight over Medicaid, the health program for the poor.
Gov. Kathy Hochul wants to slow the growth of a program that’s projected to cost $100.7 billion this coming year in combined state, federal and local spending. The Legislature wants to spend more.
For every gee-whiz statistic some advocate or critic of the program holds up to support their position, there is often a competing one that paints a different picture of excess or prudence. So, yes, New York spends the most of any state per capita on Medicaid, but not the most per enrollee, a distinction that goes to North Dakota, according to the Centers for Medicare & Medicaid Services. And, yes, New York spends more on Medicare than it did a decade ago, but spending per enrollee has been going down in recent years, and the percentage increase over the past 30 years has been lower than the national average.
We could go on, but the point is simple enough: Dueling statistics and some vague notion of compromise for compromise’s sake won’t yield an intelligent plan that provides New York with a Medicaid program that serves its central, critical purpose: comprehensive health care for 7.6 million of the state’s neediest people.
What’s required here is a serious look at Medicaid, an assessment that’s both compassionate and dispassionate.
Compassionate in the sense that the state needs to ensure the program is receiving enough funds to provide for enrollees’ needs, including preventive and primary care that helps people stay healthy and not require costlier services down the line. It must also provide a reasonable reimbursement rate for providers.
Dispassionate in the sense that there ought to be no sacred cows spared simply to protect some perceived vested interest or lawmakers’ desire to enhance their reelection prospects. And dispassionate in the sense that the state is more committed than ever to guarding against abuses of public funds. It’s puzzling, in that light, that the governor proposes cutting the Medicaid Inspector General’s funding from $57.5 million to $35.7 million.
We need, too, a reasonably detailed account of all that Medicaid funds now, and to understand how much of that goes to the program’s central mission of providing individual health care, and how much goes to institutions like hospitals and other nonprofits. That’s not to say all that spending on health care isn’t necessary. It is to say that we need to know whether Medicaid, as New York defines it, is doing more than it was intended to do – and consequently if it’s really as expensive as it’s said to be in relation to other states.
We realize such a comprehensive look — and the thoughtful, well-founded recommendations that ought to spring from it — are too much to expect while the budget clock is ticking.
So a budget deal needs to include two essential things when it comes to Medicaid: a best estimate of what it will take to maintain the program as it is this coming year — less any cuts both sides can readily agree on — and the establishment of a commission to undertake a study and deliver a report and recommendations this year, before the next state budget debate comes around.
It’s true that such a plan — to mix our metaphors — does kick the can down the road a bit, but it just might spare Medicaid from being a political football for years to come.