Medicaid cuts hurt all

Most Americans agree that our government could use a careful examination of operations for improving efficiencies and reducing costs, fraud and waste. But there should be careful oversight, with checks and balances, before slashing personnel and funding.

Right now we are in a fight to preserve Medicaid, which provides health insurance for more than 80 million Americans. If Congress imposes huge cuts, they will financially harm nearly every American with private health insurance.

Consider the math. If poor people are denied coverage, they still use health care. They just don’t access it in a preventive or timely way. They don’t access it at a doctor’s office but at the emergency room, where the cost is most expensive. 

And when they don’t pay for that care, who does? Everyone with health insurance, whose rates (whether it’s premiums or out-of-pocket costs) must rise to cover the cost of uncompensated care. Gutting Medicaid is essentially a way to shift costs from government to the private sector, a prescription for returning to the pre-Affordable Care Act era of rapidly rising premium costs.

Cutting Medicaid will not just be an issue for the poor. It will affect the middle class and seniors who are dual enrolled in Medicaid and Medicare. Cuts to Medicaid could take coverage away from up to 20 million people, with devastating impacts on children, low-income workers, the elderly and their families. 

Any cuts at the federal level will lead to devastating cuts at the state level. Colorado would be disproportionately harmed. There are 1.1 million Coloradans on Medicaid. Proposed cuts to Medicaid expansion alone would mean Colorado loses $1B a year, and as many as 400,000 Coloradans lose coverage. Hospitals, clinics and providers (especially in rural areas) would be at extreme risk of closing, causing further economic fallout, higher costs and limited access. This is a measure that rips away life-sustaining healthcare and retirement benefits from everyday Americans.

Here are some suggestions for cutting healthcare spending, fraud and waste without causing fear, pain and lack of access:

• Cut prices on drugs now. Originally, pharmacy benefit managers helped cut prices, but recently an FTC study showed that big insurance’s PBMs profit at the expense of patients by inflating drug costs and squeezing pharmacies. Americans should pay no more for medications than citizens of other prosperous countries.

• Eliminate “upcoding” (falsely exaggerating ill health) in Medicare Advantage (M.A.) plans. A recent report by the Congressional Medicare Payment Advisory Commission, an independent advisory agency, found that upcoding generated nearly $124 billion in excess payments annually. Now, there’s some fraud that could be clawed back by the government.

• Decrease the allowable percentage of M.A. insurance revenues that go for “administration” instead of medical care from 15% to 10%.  By comparison, traditional Medicare’s administration is an efficient 2-3%. M.A. programs annually cost $83 billion more than traditional Medicare and have more limited networks of providers, more prior authorizations delaying care and higher rates of denials.

• Reduce misleading and inaccurate ads during the Medicare and M.A. open enrollment period.

It’s time to call our legislators and let them know how we feel about these pending cuts and privatization/profitization of healthcare.

– Jan Phillips, Durango