Medicaid Update Special: A 445 Increase from 1990 to 2010

Over next 10 years with implementation of Obamacare $100 billion in Texas funds. By State Rep. Linda Harper-Brown Texas Insider Report: AUSTIN Texas  Recently there has been a great deal of debate regarding the expansion of Medicaid in Texas. Im sure many of you have heard proponents of Medicaid expansion argue that if we do not participate in the expansion were leaving free money" on the table. I would like to take this opportunity to explain why expanding Medicaid is a bad choice for both Texas and the Nation.   MEDICAID: BROKEN & UNSUSTAINABLE The facts are this:

1. The growth of Medicaid spending is out of control. From 1990 to 2010 national Medicaid expenditures (both State & Federal funds) rose from $73.7 billion to $401.4 billion an increase of about 445.
2. In Texas Medicaid spending currently comprises one quarter of the states General Revenue (GR) spending and with the onset of Obamacare things will only get worse.
3. Over the next 10 years full implementation of Obamacare including Medicaid expansion provider rate increases and coverage for additional Medicaid eligible but un-enrolled would cost Texas over $18 billion in GR and well over $100 billion in all funds.
4. Under expansion GR spending on Medicaid would comprise 33& of the budget or $160.4 billion by 2040.
5. It is plain to see that the cost of Medicaid expansion is dramatic and simply unaffordable.

It is also important to keep in mind that expansion is intended to provide coverage to currently uninsured low income adults not provide additional resources to those already receiving Medicaid benefits. This is important because the current Medicaid program often fails to deliver access to needed services due to lack of resources inefficiency and fraud. In fact most physicians decline to participate in the Medicaid program due to low reimbursement rates. Medicaid expansion will trap millions more into Medicaids fundamentally flawed system. This begs the question why should we pour more money into a broken system? NO SUCH THING AS FREE MONEY Some have even gone so far as to argue that the money we would pull down from the federal government would be a great economic booster. To those who espouse the belief that Medicaid expansion is a business opportunity" that we should not decline I want to remind them that our would-be partner in this effort the federal government has over $16 trillion dollars in debt and is currently running over $1 trillion in annual deficit spending. This is not sustainable and its unlikely that the federal government will continue to carry over 90 percent of the fiscal burden for the expansion. In order to pay its $4.88 trillion portion of projected Medicaid costs through 2023 the federal government will have to borrow a substantial portion of this amount from creditors that are already concerned about the United States fiscal health. According to the Congressional Budget Office federal spending on Medicaid will more than double over the next decade increasing from $265 billion to $572 billion. EXPANSION IS NOT A SILVER BULLET Medicaid expansion will not solve our health care problems. Many individuals covered by Medicaid will still have difficulty accessing care and will continue to find their way into our emergency departments where they receive more costly treatment further adding to the burden on our hospitals. According to the Health and Human Services Commission Medicaid expansion would only reduce the share of Texas current population that is uninsured from 16 percent to 12 percent a difference of just over 1 million people. This leaves another 3.1 million still without coverage. Furthermore increasing the number of people on Medicaid will decrease their access to Medicaid providers. Currently 70 percent of Texas physicians will not accept new Medicaid patients leaving enrollees with inadequate access to primary care. As a result they often seek care in hospital emergency rooms driving up uncompensated care costs. Last year uncompensated care costs totaled about $5 billion; under expansion that total would likely increase as Medicaid patients are forced to seek care in hospitals.

1. Texas uninsured rate is about 24 or approximately 6 million people.
2. Of these 35.8 more than 2 million people earn more than $50000 per year.
3. Among that group nearly 1 million earn more than $75000 per year.
4. Additionally approximately 30 of the uninsured are noncitizens both legal and illegal who are not eligible for Medicaid (U.S. Census Bureau 2011).

IF NOT EXPANSION THEN WHAT? We should reform Medicaid to more effectively address the needs of the current Medicaid population at a lower cost to Texas and the federal government while also improving access to care for those individuals that are the target of Medicaid expansion. In the past I have supported the idea of requesting that the federal government block grant Medicaid dollars to the state so that we have full flexibility to manage Medicaid funds in a way that makes sense for Texas. Medicaid enrollees should not be asked to remain in a program that gives them increasingly poor health outcomes and a declining access to care. States not the federal government are best-suited to design and implement reforms that will control costs and improve outcomes. I hope this information proves useful to you as the debate over Medicaid expansion rages on. I think it is important to know all of the facts when it comes to an issue as important as this. If you have any thoughts or additional questions regarding Medicaid expansion please do not hesitate to contact me. As always it is an honor to serve you in the Texas House of Representatives. State Rep. Harper Brown represents District 103 based out Irving Texas. She sits on the House Committee on Transportation and is Chair of the Government Efficiency & Reform Committee.  She was recently elected by her peers to serve a 5th term as Treasurer of the House Republican Caucus.  She is also Vice-President of the Texas Conservative Coalition (TCC) and the TCC Foundation Board of Directors.