Comments on: Medicaid: Uniquely Prepared To Deliver On Health Care Reform

By: Medicaid – You already pay for it, and soon you might pay more… « What You May Have Missed in Health Care Reform When Glenn Beck and Keith Olbermann Were Wasting Your Time Which You'll Never Get Back

Mon, 19 Oct 2009 18:34:01 +0000

[...] million in the next decade. It’s a major market leader, and has tremendous purchasing power. As the Health Affairs Blog says, “Medicaid expansion is less expensive (both to government and to the beneficiaries) than [...]

By: Neil Gardner

Neil Gardner — Wed, 15 Jul 2009 21:24:07 +0000

Stephen Somers, thanks for your reply, but you still did not answer the question of whether a 40 year history of failure indicates a good program to build upon.

Let me get at my point by trying this series of questions. A society through its government functions creates a monopoly profession to deal with a certain disease, and only that monopoly profession can deal with that disease! That same society through its government functions also deems childhood dental disease an important enough entity to be treated for all and offers to pay for such treatments for its poorest children citizens. However, that government created monopoly entity, again which is the only entity that can treat such disease, almost entirely refuses to see those children whose disease that same government has deemed important enough to get treated. The situation as described goes on for more than 40 years with little real solutions.

What is wrong with this picture, and what real solutions are p

By: Stephen Somers

Stephen Somers — Wed, 15 Jul 2009 20:55:20 +0000

Yes, we are intimately aware of the challenges that state Medicaid agencies face in ensuring that children and adults have access to quality dental care. One of the critical obstacles is the national dearth of dentists to care for the Medicaid population. The Center for Health Care Strategies, through funding from the Robert Wood Johnson Foundation, recently worked with six states in the State Action for Oral Health Access initiative (http://www.chcs.org/publications3960/publications_show.htm?doc_id=390279) to test new strategies to expand dental access to low-income, racially/ethnically diverse, and disabled populations served through Medicaid, SCHIP, and the public health system. Several states, including Michigan, New Jersey, Oregon, Rhode Island, and Vermont, have developed innovative programs to improve children’s access to oral health services, particularly basic preventive services and screening. Although dental reform has been successful in some states, it has not yet had a national impact and it is too early to build upon in terms of broader reform models. Fortunately, Medicaid’s track record extends far beyond dental care – the program provides a rich set of cost-effective benefits for physical, behavioral health, and long-term care services for some of the nation’s most complex need populations.

By: Bobby Peterson

Bobby Peterson — Mon, 13 Jul 2009 21:01:47 +0000

The authors are so correct!! Medicaid is a logical choice to use as a vehicle for reform. The authors fail to note, however, the legal protections afforded Medicaid recipients including constitutionally enshrined due process of law. The debate over Health reform has lacked a meaningful discussion of consumer protection and patient advocacy. Our organization released a health reform proposal that builds of the Medicaid program and includes important consumer protections.

http://www.safetyweb.org/common/AmeriCare%20Choice%20Proposal.pdf

By: RogerCollier

RogerCollier — Sun, 12 Jul 2009 23:02:40 +0000

Somers and Sparer are to be commended for asking a question that has not been raised publicly by congressional policymakers. Certainly, it’s reasonable to wonder why we need yet another government-administered health care program. However…

1. Congressional committees are already considering a huge expansion of Medicaid to supplement the proposed health care reform legislation. The CBO estimates that expansion of eligibility to cover all those with incomes below 150 percent of FFP could add up to 20 million people to Medicaid rolls and cost some $500 billion over ten years.

2. Given that many Medicaid eligibles already find difficulty in getting care, a one-third growth in demand may be impossible to satisfy without much more generous provider payments.

3. Unless expansion funding comes entirely from the federal government, it’s hard to see how cash-strapped states can afford even the expansion currently being considered, let alone a replacement for the insurance exchange model.

On the other hand, there may be some merit, from the viewpoint of reform cost-containment, of reducing the proposed subsidies for lower-income exchange participants to the level of per capita Medicaid expenditures and then allowing these individuals to buy into Medicaid.

By: Neil Gardner

Neil Gardner — Fri, 10 Jul 2009 20:41:37 +0000

Are the authors of this article familiar with the Medicaid dental track record over the last 40 years especially for children’s dental access?? If so, do they consider that a successful model to build upon?

If an entire profession outside of some safety net clinics reject a needed program, is that a success to build upon?