The Washington Post
November 30, 2001
by Rebecca Cook, Associated Press Writer
“In a groundbreaking proposal that could set a national precedent, Washington state has asked the federal government’s permission to make some Medicaid recipients pay for services and cap enrollment for some programs.”
“If the Bush administration approves Washington’s request for a waiver of the normal Medicaid rules, it would give states new cost-cutting powers.”
“Details would be subject to legislative approval, but state officials say no Medicaid family would pay more than about 5 percent of their yearly income.”
Dennis Braddock, the head of Washington’s Department of Social and Health Services:
“We have a lot of programs more important than health insurance. There are greater costs to society than someone not getting their physical.”
Comment: Now that we are exiting the age of managed care and are entering the age of the “empowered consumer,” more and more of the costs of health care are being shifted to the individual patient. Current trends suggest that the affordability of health care for average income individuals will soon be threatened. While our nation’s policy makers are ignoring that threat, they contend that, as least for low income individuals, protection from cost sharing is afforded by the Medicaid program. The proposed solution for Washington state would eliminate that protection.
Cost sharing by low income individuals will erect an insurmountable financial barrier to care. Medicaid’s primary deficiency is under-funding. States are being challenged by budget deficits. But states cannot address their fiscal problems by policies that prevent access to medical care for their most vulnerable populations.
Because of chronic under-funding, Medicaid has been shifting costs to other sectors. But these sources have been squeezed dry. The only realistic option for ending under-funding and cost shifting is to establish a universal risk pool and boost funding by eliminating the waste of the fragmented system of private health plan bureaucracies. With our great wealth, we could provide high quality, comprehensive health care for everyone merely by establishing equity in the funding and in the allocation of our health care resources. A publicly administered program of universal health insurance would do just that.
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