OPINION — When a conservative proposes changes to a program loved by liberals, expect biblical-scale weeping and gnashing of teeth. For liberals, any change that might limit benefits, no matter how modest and reasonable, puts a beloved program on a slippery slope to oblivion.
Medicaid cries out for reform. What started out as health care for impoverished women and children is now the third-largest program in the nation’s budget and its fastest growing. It covers over 70 million people, 1 out of 5 Americans.
Scary thought: Single-payer health care is closer than you think.
Three Medicaid reform proposals offer a modest start at taming this runaway entitlement. All are threatened by knee-jerk liberal reactions to even the slightest hint of restraint.
First, Medicaid needs the same work and job training requirements that federal welfare has had for decades.
Obamacare expanded Medicaid to healthy, working-age adults above the poverty level. Many of these folks work in low-paying jobs without employer-provided health insurance. Medicaid became their fallback.
So far, so good. But what about Medicaid recipients who are not working?
As reported in St. George News in January, the Trump administration proposes to allow states to impose work or job training requirements on unemployed, working-age Medicaid recipients without disabilities and without dependents.
The new guidance is intended to encourage “work and community engagement” among able-bodied adults and “help individuals and families rise out of poverty and attain independence in furtherance of Medicaid objectives.”
Welfare programs should be judged not by how many people are enrolled but by how many former beneficiaries no longer need them.
Liberal reaction was predictably shrill and mirrored their reaction to federal welfare reform in 1996. Recall that Republicans imposed similar work or job-training requirements on federal welfare recipients. Liberals howled. President Clinton signed the bill anyway saying, “Today, we are ending welfare as we know it.”
Looking back, even the liberal Atlantic magazine acknowledges that “by the numbers, welfare reform was a success.” Nonetheless, in typical liberal fashion, the magazine goes on to complain about those who’ve fallen through cracks in the safety net.
Liberals are willing to spend billions on the unqualified to ensure that not one worthy recipient is overlooked. As a result, billions are squandered.
Responding to Trump’s initiative, a bipartisan majority in Utah’s legislature passed a bill in early March to take advantage of this opportunity. The state will seek federal approval to expand Medicaid coverage to as many as 60,000 able-bodied Utahns provided they seek jobs.
A second reform – auditing current recipients for eligibility – has the potential to save billions while not reducing benefits for even one of today’s eligible participants.
The bright blue state of Oregon demonstrated both how government entitlement programs are routinely abused and pointed the way to dramatic cost savings.
In an audit of Medicaid recipients, Oregon found that almost half of those it checked no longer qualified. The state had given $191 million in health care benefits to these folks. You and I helped pay for this entitlement failure since our federal taxes cover about 75 percent of Medicaid costs for all states.
Extrapolate Oregon’s experience to the country at large and we’re talking savings in the $20 billion range.
Turn now to a third, more difficult reform: ensuring Medicare doesn’t add to the nation’s opioid epidemic.
Medicaid offers cheap access to pills that can be resold on the black market. For as low as a $1 co-pay Medicaid beneficiaries with complicit or unwitting doctors can get up to 240 oxycodone pills that can be resold for $4,000.
As reported by the Senate Homeland Security and Governmental Affairs Committee, since 2010 more than 1,000 people across the country have been charged with or convicted of improper use of Medicaid to obtain prescription opioids.
The Senate committee found that the problem seems to be worse in states that expanded Medicaid as part of Obamacare. More than 80 percent of nearly 300 cases were filed in Medicaid expansion states with New York, Michigan, Louisiana, New Jersey and Ohio at the top of the list.
Moreover, “the number of criminal cases increased 55 percent in the first four years after Medicaid expansion, from 2014 to 2017, compared to the four-year period before expansion.”
Doctors who treat Medicaid patients prescribe a disproportionate share of opioids. Finding out why could go a long way toward reducing the opioid epidemic plaguing the country. Opioid addiction treatment center fraudsters continue to prey on low-income addicts and then bill Medicaid.
These findings don’t prove Medicaid causes these problems. Illicit fentanyl and heroin cause most opioid deaths. But any Medicaid contribution certainly warrants a careful review by the Health and Human Services Department and by outside researchers.
President Trump’s bipartisan Presidential Commission on Combating Drug Addiction and the Opioid Crisis offered 56 recommendations, all of which he accepted.
One of the commission’s goals: reducing opioid prescriptions by one-third nationwide. A common sense step in that direction is removing questions about pain on patient surveys “so that providers are never incentivized for offering opioids to raise their survey score.”
Opioids are a tough problem with no easy solutions, but one clearly deserving nonpartisan attention.
Medicaid, coupled with its larger entitlement sisters, Social Security and Medicare, is on a collision course with fiscal reality. But of the three, both politically and practically, Medicaid seems to offer the best prospect of matching its goals to what the country can afford.
These three proposals are a modest start.
Howard Sierer is an opinion columnist for St. George News. The opinions stated in this article are his own and may not be representative of St. George News.
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