Rep. Upton (MI): Time to save Medicaid

Costly waste makes program’s path unsustainable

By: Rep. Fred Upton (R-MI), Chairman of the House Committee on Energy and Commerce

Americans’ frustration with Washington’s inability to cut spending is mounting. For two years, Congress has been entangled in a disorienting tango, stumbling to reach a bipartisan agreement on deficit reduction. While the left seems obsessed with increasing taxes and spending even more money, conservatives have focused more heavily on the need for spending restraint and entitlement reform — primarily to preserve and protect the future of the Medicare program. Overlooked in all of this is the future of Medicaid.

Medicaid has consistently flown beneath the radar in debates, almost disregarded at times and even deemed untouchable by progressive ideologues. Yet without reform, this program will continue to decline, sentencing our most vulnerable citizens to inferior health care.

Under President Obama’s new health care law, Medicaid will become a very different health coverage program than first envisioned. While the program covered fewer than 5 million low-income individuals in the late 1960s, its growth has exploded more than tenfold, with approximately 60 million Americans on Medicaid last year. By 2022, a staggering 1 in 4 Americans could be on Medicaid, and the estimated spending will be overwhelming. This path is unsustainable and will create a health care crisis for those most in need.

Originally created to serve the poorest and sickest among us, the Medicaid program has grown dramatically but still doesn’t include the kind of flexibility that states need to provide better health care for the poor and disadvantaged.

Rather than increasing access to a variety of affordable health care coverage choices, the president’s massive Medicaid expansion forces millions of able-bodied adults into this already strained safety net program that is struggling to succeed under today’s current level of enrollment.

Recent studies have found that current Medicaid enrollees were twice as likely to report difficulty in accessing primary care services as those with private insurance, and more likely to seek care in costly settings — normally in our nation’s already-crowded emergency rooms. Additional research has shown that the quality of care received is substandard at best, with Medicaid enrollees faring worse than those with private insurance or even no insurance at all.

Medicaid is also at high risk for financial errors, with enormous potential for abuse and overpayments. Rather than ensuring every dollar spent is used for truly eligible beneficiaries, the Obama administration has imposed significant restrictions on states wishing to improve their eligibility verification systems. This increases the risk for greater waste, fraud and abuse in the program.

According to the Centers for Medicare and Medicaid Services, Medicaid generated an average $21.9 billion in annual improper payments over fiscal years 2009 to 2011, with approximately $15.8 billion in overpayments made for individuals enrolled in the program who were either not truly eligible or lacked proper verification of eligibility. Medicaid is hemorrhaging taxpayer dollars at a time when we can least afford it.

Sadly, today’s Medicaid program reveals the worst features of government-run health care. States tell me they could do better, but they need some relief from strict federal rules that prevent them from ensuring their neediest populations receive the care they deserve. We can do better for the most vulnerable among us, and Republicans have offered proposals to improve health care by removing Washington’s stranglehold on flexibility by states and encouraging innovation to provide better services for the poor and disabled.

Worse yet, even with this program’s poor track record and our current spending crisis, the Obamacare expansion will cost more than $600 billion over the next 10 years. We’re in an unimaginable fiscal hole as a nation, yet Obamacare calls for continued digging with no guarantees of better health outcomes. We know such areas of outrageous spending demand program improvements, and we must have the courage to do what is right to rescue future generations.

Congress has been debating whether or not to increase the nation’s credit card limit — often referred to as the “debt ceiling.” That debate is as vigorous as it is important.

As a part of any long-term agreement, Congress should reform the Medicaid program for the sake of the most vulnerable Americans who depend on its benefits. The national debate on health care once centered on improving access to quality care, yet the effect of Obamacare will be the exact opposite, resulting in the shameful degradation of care for the neediest individuals.

Medicaid reform should provide states greater flexibility to modernize their programs to meet the needs of their own residents, improve quality and reduce costs. Our nation’s governors know better what works for their own populations than bureaucrats in Washington.

Busy with their budgetary tango, Mr. Obama and Democrats in Congress have long danced around the weakness and vulnerability of the Medicaid program — ignoring the need for reform and dismissing the program’s dramatic cost trends. Congressional Republicans and governors from both parties have called for responsible Medicaid changes. The music is about to stop. It’s time the White House and its congressional allies stop stepping on the toes of reform and improve health care for these most vulnerable Americans.

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