Medicaid: Federal Program, State Complications

Medicaid has emerged as an oft-repeated talking point during the current prolonged financial crisis. Obviously, as a state ‘entitlement’ program, Medicaid finds few allies among the GOP, Tea Party, and Libertarian end of the political spectrum. Over the past few years, however, even less ideologically-opposed policy-makers have been forced to consider how best to fund and defend a program that is under such consistent scrutiny.

The biggest battles around Medicaid are currently occurring not on the federal level, but in the individual states that actually manage and administer the funds. Most recently, California has raised a fuss all the way to the US Supreme Court, seemingly about how much freedom the individual states have to reduce payments to health care providers.

At first, this may seem like merely a control issue rather than an economic one. So changes in the rules of Medicaid shouldn’t mean much to California’s struggling budget, right?

According to Gov. Brown, it means a cool $709 million saved in Medicaid reimbursements over the first year alone.

The matter at hand is a bit more complex. Medi-Cal, like all other state Medicaid entities, is a shared program between the Federal government and the states. So when Medicaid reimbursements are reduced, the savings is not simply in the existing Federal funding but also in the state’s contributions.

However, there is a difference in opinion as to the exact nature of the review. Some prefer to stress that California (and 22 other states that support the Supreme Court review) is asking for limits to private lawsuits over public benefits. Opponents of the review, however, tend to see this as obscuring the fact that the outcome will simply be fewer people getting needed healthcare — and that California’s contributions are among the lowest in the country already.

There are a number of growing problems with our healthcare system. Many people claim that they are fixable and that the best way to do this is to make everyone buy insurance. It is my opinion that this is 100% against the constitution that we are governed by. It is unbelievable that the government is literally trying to side step the foundation that this great nation is built on in order to reach their own goals. This would not be so bad if these very same politicians had not voted in a provision which totally releases them from the same requirement which forces the general public to become members of this health care system. I don’t care what the problem is, turning our democratic republic into a socialist system because the a certain few people refuse to take proper care of themselves is the wrong move.

I recently saw how the healthcare system often falls in the treatment of alcoholism and not for the reasons you might assume. If you first assume the person has some type of health insurance, it isn’t that they may or may not get treatment. It is that the treatment they most likely will receive will not be successful in about 90% of the cases. And let’s face it, that’s a high failure rate. For too long people with a drinking problem have been forced to keep their drinking problem secret lest they end up labeled an “alcoholic” and spend the rest of their days abstinent, fighting cravings, and in rehab or AA meetings. Current alcohol treatment programs have barely changed since the 1950’s. The medical profession along with Alcoholics Anonymous still consider alcoholism a disease, rather than a symptom of a larger psychological issue(s). Recently I read an article about Baclofen, a drug for alcoholism recovery. It removes or strongly suppresses cravings for alcohol in 92% of people. Clinical trials give Baclofen a 65% success rate. Many treatment-resistant alcoholics return to low- or medium-risk drinking, while 50% of those who succeed using Baclofen go even further and quit drinking entirely by choice. I found a website called LifeBac that combines the use of Baclofen with pharmacotherapy and psychotherapy. And amazingly their modern approach is delivered mainly online with additional technology based support. Doctors in Europe prescribe baclofen as the primary treatment for alcohol misuse. Although Baclofen has 65% success rates compared with 7% for Alcoholics Anonymous and most rehab programs, most US physicians still recommend AA and rehab over medications. It’s amazing that only 1% of people seeking help with an addiction in the U.S. receive medication. Hopefully as the news about Baclofen becomes more wide spread, people will start requesting it. The next big question will be, will medical insurance cover alcohol treatment with a drug that has been approved by the FDA as safe to be used primarily as a muscle relaxant?

With the implementation of the Affordable Care Act colloquially known as Obamacare and the amazing number of people who have signed up, I need to reassess my opinion of “forcing” people to buy health insurance is 100% against the constitution. Obviously the court system, up to the Supreme Court don’t think it is. Of course there are some states who embrace Obamacare and others that did not. The States reactions either for or against it have directly affected their populations in regards to getting health insurance, as well as cause a lot of confusion. It reminds me of the confusion people have regarding car accidents and car insurance. With no fault states and fault states it is almost mandatory to hire a specialist lawyer for car accident if you are unfortunate to be in an accident and sustain serious injuries. Today when someone is injured in a car accident due to another driver’s negligence, there is no guarantee medical bills will be covered by the other driver’s car insurance company. In fact the circumstances under which you can even consider filing a car accident injury claim vary from state to state in no-fault states. On top of everything else, not reporting a car accident in a timely manner could limit your ability to collect compensation for injuries and other damages. For those living in California, you do not have to worry about having no fault insurance coverage since it is one of many states that use the Financial Responsibility Law. This law is to make sure that drivers will be able to pay any damages they cause if they are at fault in an accident. In addition California drivers are required to carry insurance that will provide coverage for damages to others who are not at fault in an accident. Even though it is not required in California, drivers can still have no fault insurance. This all starts to get to complicated after a while. If you are injured in an accident let’s hope you also carry health insurance. Perhaps you were able to afford insurance because of the Affordable Care Act. The Affordable Care Act definitely helped make health care more affordable, accessible, and high quality for the people of California. Five years after it’s rocky roll out more than 16.4 million uninsured people have gained health insurance coverage – the largest reduction in the uninsured in four decades. There are still complaints about it, particularly regarding the mandate that all people should have insurance or be penalized, but the Affordable Care Act did expand affordable Medicaid coverage for millions of low-income Americans and made numerous improvements to both Medicaid and the Children’s Health Insurance Program (CHIP).

Lots has changed since California raised a fuss all the way to the US Supreme Court.

Leave a Reply

Your email address will not be published. Required fields are marked *