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Medicaid a Broken System That Can’t Withstand More Pressure


Carol Vliet was 53 years old when she discovered her cancer had returned and spread to her brain, liver, kidneys and throat. With her life on the line, she turned to her primary care physician, who had monitored her health for the past two years.

But shortly after consulting with her doctor, she was devastated to learn that his practice was no longer accepting Medicaid patients. She would have to go elsewhere for treatment.

Unfortunately, Carol’s predicament isn’t unique among those covered by Medicaid. Over the years, Medicaid patients have suffered from dropped coverage, denied care and poorer health outcomes – sometimes placing patients in worse situations than those encountered by the completely uninsured.

Ultimately, Medicaid is a broken program.

When politicians speak of Medicaid, it’s often in glowing terms. Sen. Jeff Bingaman recently said in a statement that Medicaid stands to “improve the quality of life for many New Mexicans” and, when part of Medicaid was reauthorized, New Mexico Rep. Martin Heinrich called it “the change the American public wants and the change our children deserve.”

But if these politicians had to live with Medicaid, they’d certainly get a reality-check. Being covered under Medicaid isn’t a picnic.

One of the primary difficulties with Medicaid coverage is that fewer health care providers are accepting Medicaid patients. The New England Journal of Medicine published a study last year that showed that two-thirds of children on Medicaid are denied appointments to deal with serious medical conditions (compared with 11 percent of privately insured children).

Now nearly three in 10 physicians across the nation will not accept Medicaid patients.

Doctors aren’t refusing to take Medicaid patients out of cruelty. Many have admitted to feeling guilty over refusing these patients and have put off denying care for as long as possible. But, ultimately, accepting Medicaid has been costing health care providers just too much.

Currently, Medicaid reimburses doctors only 55 percent compared with private insurers. Moreover, those payments are often below the actual costs of providing the health care (meaning physicians lose money on every Medicaid patient).

This simply is not sustainable for any length of time.

Even for those patients who can find doctors that accept Medicaid insurance, studies have shown that they often receive worse care than those with private insurance and even, sometimes, those who are uninsured. A study published by the University of Virginia found that the mortality rate among surgical patients on Medicaid is 97 percent higher than those with private insurance and 13 percent higher than those uninsured.

If this is life with Medicaid currently, we have to ask ourselves – what will life be like if New Mexico implements the Medicaid expansion called for in President Obama’s health care reform? How many more doctors will decide to close their doors to all Medicaid patients when more than 200,000 new enrollees are added to the program in our state? How many more Carol Vliets will it take before our politicians see that Medicaid can’t withstand the strain of additional enrollees served by a diminishing pool of medical professionals?

Additionally, as more and more Americans join Medicaid, the costs for states and the federal government skyrocket.

And while some call this expansion the “deal of a decade,” because the federal government would pay the full cost for the first three years, either way, the average taxpayer is paying for it. Keep in mind, the same source of money on the federal level is the same source of money on the state level: the taxpayer.

New Mexico’s portion after the initial three years of Medicaid expansion could exceed $200 million.

Expanding a broken, overstretched program is not the right policy for New Mexico. Instead of breaking budgets and subjecting more New Mexicans to a broken health care system, Gov. Susana Martinez should pressure Washington for real, patient-centered reform.

This just simply isn’t “the change our children deserve.”

Americans for Prosperity is national conservative political advocacy group that promotes economic freedom.

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