Indystar - Indiana can do Better than Expanding Broken Medicaid System

Op-Ed

By Rep Todd Rokita

During a recent House Budget Committee hearing, I had an exchange with the director of the White House's Office of Management and Budget, Jeff Zients, about President Obama's budget proposal for fiscal year 2014 and how it addresses Medicaid.

Medicaid is one of the biggest drivers of our nearly $17 trillion national debt, and that will only grow worse with the rapid expansion of Medicaid under Obamacare. I noted to Zients that the White House budget does little to deal with the rising costs of this unsustainable program, other than going after "waste, fraud, and abuse." I specifically asked Zients whether he thought Medicaid is part of our deficit and debt problem.

He did not answer my question directly, but instead began to discuss the benefits of Medicaid, claiming that it "works well." The facts say otherwise.

As I told Zients, according to a 2010 study by researchers at the University of Virginia, Medicaid recipients who undergo surgery are 13 percent more likely to die than those who have no insurance at all, and 97 percent more likely to die than those with private insurance.

Many other researchers have found similar results. A University of Pennsylvania study, for example, found that the rates of mortality and surgical complications were significantly higher for colon cancer patients on Medicaid than those on other types of insurance (or no insurance at all).

In addition to worse health outcomes, Medicaid patients have a harder time finding doctors, because Medicaid pays physicians approximately 56 percent of what private sector insurers pay.

And even with low payments to providers, the program is still fiscally unsustainable. States are now spending more on Medicaid than any other expense. According to the Congressional Budget Office, the federal government spent $251 billion on Medicaid last year, a number that is expected to jump to $572 billion by 2023.

While the federal government has promised to fund states that opt into Medicaid expansion, with a national debt approaching $17 trillion, that promise will likely not be kept long term, leaving states holding the bag.

In light of all of this evidence, an objective observer would conclude that there are serious problems with Medicaid, and the program is in dire need of reform. We certainly can't say it "works well." And the last thing we should do is exactly what Obamacare does -- shove millions more Americans into this already overtaxed, inefficient, broken system.

Instead of one-size-fits-all Medicaid, with federal mandates imposed on the states, let's unleash state creativity to truly reform Medicaid for our most vulnerable citizens -- just as we've done here in Indiana.

Our Healthy Indiana Plan covers low-income Hoosiers up to 200 percent of the Federal Poverty Line through health savingsaccounts and high-deductible insurance plans. The program has a 98 percent approval rating.

Rhode Island also has had success with its own Medicaid solution. A few years ago, Rhode Island accepted a capped Medicaid amount for five years, and encouraged beneficiaries to enroll in managed care programs, saving the state millions of dollars. A private study review of the Rhode Island approach said the reforms were "highly effective in controlling Medicaid costs" while improving "access to more appropriate services."

The best way to ensure that Medicaid continues to serve those whom it was intended to serve -- the poorest among us -- is by empowering states with the flexibility to tailor the program to their unique populations.

That's why I, along with Reps. Larry Bucshon and Marlin Stutzman, have introduced a bill that would accomplish this goal, elements of which were included in the House-passed budget. The State Health Flexibility Act would allow states to design programs that best serve their own residents.

This would be especially important to Indiana, where our state has demonstrated success when given flexibility. Gov. Mike Pence has asked for permission from the federal government to expand the Healthy Indiana Plan, but so far the Obama administration has withheld the required permission.

We don't have to accept the status quo -- a broken Medicaid system that fails patients, doctors and taxpayers. In Indiana, we have shown that we can do better. It's time to reform the broken Medicaid system that we know and allow innovative, efficient solutions to drive down costs and improve the quality of care for Hoosiers and for all Americans.

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