Gov. Sam Brownback's administration held a public forum on Medicaid reform in Wichita last week. Brownback has stated his goal to cut $200 million to $400 million from the state share of Medicaid. He also has said he wants to improve the quality of services provided under Medicaid.
Medicaid is a health insurance plan for poor infants and children, poor senior citizens and people with disabilities. This health care insurance plan is paid for by a partnership between the federal and state governments.
Nearly 325,000 people in Kansas are served by Medicaid; more than half are children. Medicaid pays for 41 percent of all births in Kansas. Medicaid provides medical services for nearly 60,000 disabled Kansans. Medicaid is the last resort for nearly 57,000 elderly Kansans. Eligibility is based on income; the lower your income, the more likely you are to qualify for the insurance. The administrative cost of Medicaid is about 2 percent, less than most private insurance plans.
Currently, the Kansas Medicaid budget is $2.8 billion. About $1.2 billion comes from the state budget, and the rest is federal money. The share of state budget dollars is expected to increase over the next few years.
Some federal dollars are being reduced because stimulus money, which provided help to the states in the area of Medicaid, has expired. The state's unemployment continues at unusually high rates, impoverishing more children.
In addition, the cost of health care continues to skyrocket. The United States spends 16 percent of its gross domestic product on health care. Americans spend more than twice as much on health care per capita as residents of any other country.
The cuts most commonly talked about in Medicaid involve cutting the number of people eligible for coverage under Medicaid and cutting the benefits. Kansas currently has some of the most restrictive eligibility requirements in the nation. And Brownback already has made significant cuts to community mental health services, psychological services, and home- and community-based services.
Another option is to cut the amount paid to doctors, nurses and hospitals. These professionals already take reduced payment to serve Medicaid patients. Additional cuts to reimbursement rates will cause more health professionals to stop taking Medicaid patients.
Each of these cuts has significant negative impact on the quality of care provided by Medicaid.
Other ideas being discussed are developing managed-care plans for Medicaid, creating a case-management system for chronic illnesses such as diabetes and hypertension, and developing wellness programs to reduce obesity and cut the number of smokers. None of these ideas has been shown to produce the amount of immediate savings needed to meet the governor's stated goal of cutting $200 million to $400 million in the state's share of Medicaid.
The Medicaid reform initiative is a worthy process. But the governor and members of this initiative would be wise to remember the first directive from the physician's Hippocratic oath: Do no harm.