Fix Medicaid's problems before expanding system

Posted Saturday, Mar. 02, 2013  comments  Print Reprints
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Medicaid today is an inefficient, broken federal program needing to be fixed before any expansion occurs. Medicaid, as we know it, cannot continue without breaking our state budget or drowning the federal government in more massive debt.

On the surface, Medicaid expansion sounds worthy, as it would provide healthcare to an estimated 1.8 million additional Texans and $100 billion in federal funding over 10 years to Texas while the state puts up approximately $15 billion. But pouring all that money into an inefficient and broken system makes no sense.

Texas needs flexibility to administer a Texas solution unique to our state's Medicaid population, versus the current system obligating us to offer everything -- or nothing. Some Medicaid patients may need only two or three services, so forcing Texas to provide more services than a patient needs is inefficient, costly and fairly ridiculous.

It's important that we provide healthcare to Texans without the means to help themselves. Patients without healthcare options end up using expensive emergency room services for what should be routine medical care.

Taxpayers are paying for an inefficient system funded by property taxes to cover uncompensated healthcare in our local public hospitals -- and with higher insurance premiums to cover the cost of our uninsured population.

A one-size approach doesn't allow Texas to develop ways to encourage healthy habits and program efficiencies, or to target the program's growing fraud and abuse in more meaningful and effective ways.

As a taxpayer, businessman and elected steward of our tax dollars, I am very concerned about costs. Presently, Texas pays 40 percent of Medicaid costs; the federal government pays 60 percent.

In Texas, Medicaid currently costs nearly as much as education when you look at all funding sources. Since 2000, the state's Medicaid share has nearly tripled, climbing to approximately $11 billion per year. At this rate, we will be spending more than $30 billion per year in state money by 2024.

The more we spend on Medicaid, the less money we will have for education, highways, mental health services, financial aid for college students and many other important functions.

Here are a few elements of what a "Texas Solution to Medicaid" might look like.

Charge co-pays and deductibles for Medicaid recipients so individuals have skin in the game when it comes to their healthcare.

Establish reimbursement rates designed to encourage quality patient outcomes and efficient use of taxpayer resources.

Expand Medicaid "managed care" programs to improve and streamline services, reduce costs and provide quality and cost-effective healthcare to serve more Texans.

Add incentives to encourage Medicaid patients to use routine healthcare services to reduce costly emergency-room care.

Allow Texas to require individuals to enroll in private or employer plans if available.

Include flexibility for Texans to develop tailored benefit packages for healthier Medicaid recipients.

Eliminate burdensome federal administrative reporting requirements and complicated approval process for minor Medicaid changes.

Any expansion of Medicaid must allow Texas to pull out of the program if the federal government fails to honor its funding commitment of the expanded program.

Because expansion is not set to begin until 2014, I believe we have time to draft a solution to ensure people who need healthcare will get it, and the Texas taxpayer won't go broke in the process.

The current system is neither rational nor efficient. That's why Medicaid must be fixed before it is expanded.

State Sen. Tommy Williams, R-The Woodlands, represents Senate District 4 and is chairman of the Senate Finance Committee.

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