Medicaid needs accountability for cost control

New York’s Medicaid system is the second-costliest in the nation as our total bill comes to around $62 billion per year. California pays out $18 billion more than we do, but their population is nearly twice ours.

The feds fund 51% of New York’s expense, but you can readily see what you contribute to the program: In most counties across the state 54% to 62% of the county property tax goes towards Medicaid and many also designate 1 full percentage point of their sales tax for the program (they call it “the Medicaid penny”).

That’s a pretty significant sacrifice by taxpayers at the local level and it is perhaps the biggest contributor to one of New York’s most dramatic and damning flaws – inordinately high property taxes.

In order to contain those costs, Medicaid needs a total overhaul. That’s been written about here on this page many times before, as I’ve touched on everything from residency requirements to downsizing of the program’s benefits to utilizing Medicaid funds to pay for private insurance.

But, what I haven’t touched on before is personal and financial accountability by Medicaid recipients.

Why isn’t that a focus of the State?

It is for everyone else in their day-to-day lives.  

If you are one of the 9 million New Yorkers who receives health care through your employer or a family member’s employer you know full well the pressure to cut costs and/or lessen the growth in them. You’re likely inundated with documents and edicts from your boss or insurer to get a primary care physician, have an annual physical, participate in wellness and cessation programs, shop frugally for prescriptions, and choose care venues properly.

It’s been drilled into our heads that if we don’t do these sorts of things the employer will pay more for insurance as will the employee, be it with higher premiums, deductibles, or copays.

It’s good business and personal finance to do those activities. Why waste money and pay more for anything?

But, more importantly, it’s good for the body. We should actively pursue preventive practices and good behaviors – even without the carrot of savings.

Unfortunately, that same code of conduct is not applied to the 6.4 million people in the state who receive Medicaid and, as noted above, everyone is paying dearly for that.

State officials should bring those practices to Medicaid.

Insurers press their clients to have a doctor and some have gone so far as to work with employers to penalize those who don’t – and don’t get an annual physical – with higher premiums the following year. You really can’t do that exactly to a Medicaid client (there are no premiums) but the state could assess penalties, a fine if you will, every year for those who don’t engage primary care. Having a doctor is critical – he or she has the knowledge and skill to identify and address illnesses and set patients on the paths to better health (and lower costs). 

Likewise, penalties need to be exercised on those who don’t participate in defined wellness programs. It’s no different than a private insurer or employer charging higher premiums to those who smoke. This is an absolute must-have for Medicaid. 29% of adults on Medicaid smoke, a rate more than double that of the privately insured. Persistence of this statistic leads to lung cancer, COPD, congestive issues, and more.

Proper venue selection is critical in cutting back on Medicaid expenditures. In your insurance bulletins or employee newsletters you’ve likely been told that you should never go to an emergency room unless of course it’s an actual emergency (hence the name); you should always go to your doctor or urgent care. The common number thrown around is that an ER is 10 times more expensive than urgent care.

That pressure isn’t there in Medicaid and it shows. Using Kentucky as an example, in 2015, nearly half of all ER visits were funded by Medicaid. A University of Colorado study completed last year found that half of Medicaid recipients prefer ERs over doctors and UC because they are “convenient”. That said, it is high time that a substantial copay was put into effect for ER use and one that is especially punitive for non-emergencies, so “what’s best” is chosen over “what’s most convenient”.

All of this can only work if care is managed.

In the workplace, insurers and employers consistently educate the insured on health care, what options exist, and what is encouraged and discouraged, statements that are then repeated by the employees’ doctors.

Medicaid patients aren’t, for the most part, afforded that. They don’t have someone in their face all of the time expounding the virtues of costs savings and the benefits of healthy living.

It’s time the state picked up that mantle and utilized best practices to not only save money, but also to improve, and even save, the lives of New York’s Medicaid population.

From the 27 August 2018 Greater Niagara Newspapers and Batavia Daily News