President Obama picked up a good idea from the Republicans at last week’s health care summit, one that will add a badly needed dose of fiscal reality to the health care bill. What’s more, this Republican idea will improve the lives of tens of millions of poor people.
It has to do with the dramatic expansion of Medicaid that is envisioned under the health care bill. Obama mentioned it among four GOP proposals that he embraced in his letter to congressional leaders on Tuesday:
3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.
Nearly half of the people who would gain coverage under this bill–15 million of the estimated 31 million newly insured people–would get it through an expansion of Medicaid and the Children’s Health Insurance Program. Why did Congress do it this way? In part because it is cheaper, as we have written here before. The Medicaid program varies by state, but it generally pays health care providers significantly less than either private insurance or the Medicare program.
To keep the official price tag of the bill down, lawmakers have written it with an assumption that Medicaid would continue to reimburse health care providers at its current rock-bottom rates. But in the real world, that can’t happen. As many governors have pointed out, that is a totally unrealistic assumption that would only compound what is already a grave problem. In many parts of the country, it is difficult to find providers willing to accept Medicaid patients already enrolled in the program. Is it reasonable to expect that the government could add 15 million more, without raising what it pays providers to treat them?
The Republicans deserve credit here for forcing some realism into this aspect of the health care debate.
More of this, please.