ABQJOURNAL OPINION/GUEST_COLUMNS: Medicaid Grants Would Hurt Young

MEDICAID GRANTS WOULD HURT YOUNG

Saturday, April 23, 2011

Medicaid Grants Would Hurt Young

By Dr. Benjamin Hoffman
President, New Mexico Pediatric Society
          As the guardians of child health, pediatricians and child health providers must fight every day to demand that our leaders and policymakers are held accountable to answer the question "What is best for kids?" It seems that every time we think we have beaten back the greatest enemy, another one comes along to take its place.
        The recession has hit everyone hard, as evidenced by high unemployment rates and $4 gas. States face significant budget deficits and the federal government continues to raise the debt ceiling in the face of multitrillion-dollar shortfalls.
        Since measures to raise revenue, including tax increases, remain politically unpopular, the focus has been on reducing spending.
        Rep. Paul Ryan, R.-Wisc, recently introduced his budget proposal. Included in this proposal was yet another attempt to fundamentally dismantle the child health safety net of Medicaid with the introduction of block grants. Simply put, this would be a disaster for New Mexico children.
        Medicaid provides federal dollars that match state expenditures to provide health care to lower-income children and pregnant women, seniors and people with disabilities. In our state, where 25 percent of our children live in poverty, about 335,000 children receive health care through Medicaid. Since Medicaid is jointly financed, the federal government provides us about $3 for every dollar New Mexico spends.
        As it currently stands, Medicaid is an open-ended program from the federal side, meaning that there is no limit to the number of children who can be enrolled. Consequently, the amount of federal money sent to New Mexico depends only on the number of children enrolled, and the amount paid to the private insurance companies that administer Medicaid in our state.
        Even with rising health care costs, Medicaid remains a good value. According to a 2005 study by the Center on Budget and Policy Priorities, it costs 37 percent less to cover a child with Medicaid than with private insurance. Further, costs per beneficiary in Medicaid have risen much more slowly than those among the privately insured.
        Medicaid controls costs through lower administrative expenses and provider payments than those seen with private insurance. While this sometimes forces providers to limit their exposure to Medicaid, this program works and helps ensure that poor kids have access to the care they need. This decreases the illness burden among the community, saving lives and money.
        Ryan's budget proposal would change the federal investment in Medicaid from its current matching system to a block grant system — meaning one block of money. Federal funding would no longer be tied to demonstrated need but would amount to an educated guess about the total number of dollars we would need to provide care. This would shift much more of the cost from the federal government to the states.
        This changing of the way the federal government funds Medicaid is not about reforming the health care system or lowering health care costs. It is about spending less money by essentially capping care.
        As a poor, rural state, New Mexico cannot accept the human and financial risks associated with a block Medicaid grant. With fewer federal dollars, we will be forced to slash services and perhaps eligibility. Those of us who care for children already know that this safety net is threadbare as it is.
        Getting prescription medications, access to specialty care, and oral health and behavioral health care is already complex and difficult for families on Medicaid. I shudder to think about what would happen to children should we be forced to further cut services.
        In times of recession, Medicaid enrollment increases. Block grants ensure that all costs associated with enrollment increases are solely the responsibility of the state. We would have no choice but to slash enrollment and services.
        We cannot afford to balance the federal budget on the backs of New Mexico's children through Medicaid block grants. I urge each and every one of you to ask yourself "What is best for kids," and to contact your congressional representatives and tell them how you feel. Medicaid block grants are among the next great threats to our kids, and it is a threat that our kids cannot afford.

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