That's why the headline in the "Texas & Southwest" section of Saturday's edition of The Dallas Morning News caught my eye: "State plans Medicaid experiment" (Saturday, January 27, 2007, page 3A).
On Friday, Governor Rick Perry, "key GOP lawmakers," and Albert Hawkins, Texas' health and welfare czar, met with U. S. Health and Human Services Secretary Mike Leavitt. No doubt Medicaid financing poses a formidable challenge to the state, given that 25% of the state budget is earmarked for funding the health care delivery system designed to serve the poorest of our residents.
According to the report, the Governor wants to:
- Offer subsidies to small businesses to fund the purchase of health insurance for their employees.
- Give "customized" benefit plans to certain groups of Medicaid patients.
- Transfer part of the funding to "savings accounts" for the patients.
I will reserve judgment until all of the details are revealed and worked through during this session of the Texas Legislature, but I have noted a trend following the announcement of these kinds of plans.
First, the cost involved is often covered by reducing overall benefits to the poor, and sometimes those who need help the most are cut off.
The last time Medicaid was "reformed" in Texas, benefits were cut, people found it harder to be certified and private industry got involved in trying to administer programs. The result to date has been a disaster, and I happened to be in on one of the original planning groups for Accenture, the private company contracted to "improve service and access" to the poor. Hasn't happened.
Second, whenever government begins suggesting private insurance as a remedy for bulging health care costs, I counsel my low-income friends to head for cover!
President Bush's current plan for a health care overhaul includes inducements in the form of tax breaks to motivate more Americans to buy private insurance. According to Dr. Ron Anderson, President and CEO for the Parkland Health and Hospital System, Dallas' public health care institution, the costs associated with these tax breaks would be covered by cuts in funding to hospitals like Parkland that treat the poor and uninsured. Dr. Anderson estimates that under such a plan the loss in Medicaid revenue to Parkland could be up to $83 million annually.
One note of concern for me, as I read the report, is the fact that our Governor asked Secretary Leavitt for "as much leeway as states can be given to tinker with Medicaid." I'd love to know the definition of "tinker" here. One thing I do know, shifting around already limited Medicaid funds never seems to benefit the poor.
I'll stay tuned, but I'm not optimistic.