1. Opinion

Column: Expanding Medicaid would have been wrong move

Published Aug. 27, 2015

The debate over Medicaid expansion was among the most contentious in recent Florida history — and it shows no signs of ending any time soon.

My organization, Americans for Prosperity, recently launched television and digital advertisements thanking state legislators for not expanding the Affordable Care Act. This paper responded with a critical editorial and some questionable claims about the federal money Florida is supposedly giving up. More importantly, the Times conflated Medicaid expansion with increased access to quality health — a claim they offer no facts to support.

The cost of expanding Medicaid by 800,000 enrollees would be immense. Nearly every state that has expanded has experienced massive cost overruns. Illinois ran $800 million over budget in 2014; Ohio ran $1.5 billion over in its first 18 months; Kentucky is projected to run $1.8 billion over in its first two years; Washington state had to increase its budget by $2.3 billion. The list goes on. It's unlikely Florida would be any different.

Expansion advocates claim this will be mostly "free money," since the federal government promises to pick up 100 percent of the tab for the first three years and 90 percent thereafter. This is misleading at best. Floridians are also federal taxpayers and will also bear those costs.

This also assumes the federal government will keep its word, which as our recent spat over Low-Income Pool funding shows, is far from certain. After Gov. Rick Scott held firm on Medicaid expansion, the Obama administration threatened to withhold over $1 billion in other health care funds. We should know by now federal funding always comes with strings attached, if it comes at all.

Expansion would also place enormous burdens on our health care system. Sixty-three of our state's 67 counties already report medical provider shortages, and nearly 40 percent of physicians either do not accept or limit the number of new Medicaid patients they see. Doctors simply don't have the time and resources to navigate Medicaid's red tape.

In light of the evidence, the state Legislature should be praised for rejecting this program. They should also be praised for promoting patient-centered reforms that actually can lower costs, increase access, and improve the quality of care.

Chief among them was to increase low-income Floridians' access to "Direct Primary Care." Unlike traditional practices that accept Medicaid or insurance, DPC has flat monthly fees averaging between $50 and $125. No premiums. No co-pays. This covers all the primary care a patient needs, from preventive services like checkups and vaccinations to casts for broken bones — in other words, the vast majority of medical needs.

A study published in the American Journal of Managed Care found one large DPC practice saved $2,551 per patient. The savings were especially high for patients with chronic conditions, who had 56 percent fewer non-elective hospital admissions, 49 percent fewer avoidable admissions, and 63 percent fewer admissions for non-avoidable medical issues.

That's the sort of high-quality, affordable service Medicaid could never provide. When you get insurers and bureaucrats out of the equation, costs go down and quality goes up.

Another worthy bill would have repealed our state's byzantine "certificate of need" law. This requires health care providers to obtain government permission before opening or expanding facilities, or even adding new equipment like hospital beds. By shackling entrepreneurial physicians, this red tape reduces access to care and increases its costs.

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A recent study by the Mercatus Center at George Mason University illustrates these harmful effects. States with certificates of need had 35 percent fewer hospital beds per 100,000 persons than the national average. In Miami-Dade County, for example, this equates to 3,428 fewer beds. Researchers also found it limits the number of facilities with MRI and CT scans, which leads to longer waits and higher costs.

Unfortunately, there are many who can't afford a single dollar of health care. But that doesn't mean expanding Medicaid is the best way to help them. It merely gives Florida an incentive to develop targeted programs that help those truly in need.

No one is suggesting these individual free market reforms, taken in isolation, are the elixir of life — neither is expanding Medicaid, as the evidence shows. But they have the potential to provide high quality, affordable health care at far lower costs than today, thus reducing the burden on our social safety net.

That's good for patients and taxpayers alike. No matter how nasty the debate over Medicaid expansion gets, we will continue encouraging lawmakers to support free market policies that strengthen health care for all Floridians.

Chris Hudson is the Florida state director of Americans for Prosperity.


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