Across the country, in response to budget pressures and poor outcomes, states are shifting their Medicaid systems away from fee-for-service toward managed care solutions. If done properly, this represents a responsible way to save states money while still providing the care needed for Medicaid recipients. So why is Louisiana House Speaker Jim Tucker (R-Algiers) opposing this step in his state?
Tucker has been pushing to kill Louisiana Governor Bobby Jindal’s plan for Coordinated Care Networks, which would move 800,000 Medicaid recipients into private managed-care networks next year—exempting the elderly and the developmentally disabled. But while blocking this reform of the system, Tucker has also endorsed a significant chop in the overall Medicaid budget of $81 million—$59 million of which will have to come out of reductions in provider rates and cutbacks in services.
This seems an irresponsible move at best. Instead of pursuing a fundamental reform of the unsustainable Medicaid system—which accounts for roughly $6.6 billion of Louisiana’s current annual budget—to allow for greater predictability in costs for the state and for a single doctor to make decisions with patients, Tucker is endorsing a chop-off-the-top cut. Perhaps this plays better as a short term political posture, but it does nothing to solve the long-term problems within the system. As anyone who’s learned from political experience in the past knows, this is a profoundly inefficient way to do things—as Secretary of Defense Robert Gates said last week, referring to cutbacks on national defense expenditures, “Salami-slicing is a way to avoid hard choices on what to fund.”
Engaging in cuts without applying pro-consumer reforms of a system is a failure of leadership. As we’ve learned time and again in the past, cuts which don’t address a fundamental problem in a program, but just shrink it—or in this case, shrink its payments to providers—results in lowered access and worse coverage. Consider past studies regarding access problems for Medicaid patients across the country, or the New York Times report from earlier this year in Louisiana itself:
From her pocketbook, she pulls an insurance card issued by the Louisiana Department of Health and Hospitals. “My Medicaid card is useless for me right now,” Ms. Dardeau said over lunch. “It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”
Tucker’s cuts won’t solve this problem, and by refusing to support a reform that could improve the situation, he’s standing in the way of good government policy. He should at least be asked to explain why.
Benjamin Domenech ([email protected]) is a research fellow for the Heartland Institute and managing editor of Health Care News. He also edits the newly launched web project ReformMedicaid.org.
