Those who don’t believe that the decline in the U.S. economy has made healthcare reform essential should take a look at the Alabama Medicaid rolls.
As of September, Medicaid enrollment in Alabama had jumped by nearly 50,000 people in the past two years, with the largest increase coming in the categories of children, teens and pregnant women. These expanding enrollee categories suggest that more families with low-income jobs are being forced onto Medicaid.
Alabama is also seeing an increase in families who are applying for Medicaid for the first time. Children from these families now qualify for Medicaid, because their parents have lost income as a result of the recession.
Why are the Medicaid rolls in one state important? Very simply, because the Alabama data is indicative of a national trend.
A recent report by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured revealed that Medicaid enrollment grew by an average of 5.4 percent in fiscal year 2009, the highest rate in six years.
The annual 50-state survey of state Medicaid officials also found that total Medicaid spending growth averaged 7.9 percent in Fiscal Year 2009, the highest rate in five years, and well above the 5.8 percent projected growth.
Sadly, things will almost certainly get worse in FY 2010.
As evidence, the survey found that, based on initial legislative appropriations, Medicaid spending across the states is expected to grow by an average of at least 6.3 percent in fiscal 2010, and Medicaid enrollment will likely grow by 6.6 percent over FY 2009 levels.
States are convinced that current appropriations will not be enough, leading to more pressure to trim services and spending.
Conditions would be even worse for low-income families were it not for the $87 billion in increased Medicaid funding granted to the states through the American Recovery and Reinvestment Act.
The stimulus package money only lasts through Dec. 31, 2010, however, and was not intended to be a long-term fix to the problem of the low-income uninsured. It will only forestall temporarily the inevitable cuts in Medicaid provider payments and enrollee benefits.
Even with the stimulus funds, 33 states cut or froze provider rates in FY 2009, and 39 states are slated to cut or freeze rates for FY 2010.
If it is to have any real impact, the health reform legislation that comes out of Congress must include measures to expand health insurance for low-income patients.
But hand-in-hand with health insurance reform must go delivery system reform that lowers costs and improves care for those who currently suffer most from the inequities in our healthcare system.
To that end, the George Washington University School of Public Health and Health Services has proffered one of the best comprehensive reform suggestions I have read in recent months.
Titled “Using Primary Care to Bend the Curve,” the study recommends coupling insurance reforms with a 20-million patient increase in community health center capacity over the next 10 years.
According to the GWU researchers, boosting health center capacity would generate cumulative health system savings over 10 years of an estimated $212 billion. The expansion would generate so much in savings because of the lower overall medical expenditures associated with health center patients.
Just as impressive, at 20 million additional patients served, Medicaid savings would reach $59 billion over the 10-year time frame. Were the number of additional patients served by health centers to rise to 22 million, federal Medicaid savings would exceed $70 billion.
Investing in primary care infrastructure and expanding health insurance coverage would not only be cost-effective, but would promote the common good.