By Ballard Pritchett
Medicaid, not Medicare, is the real Obama-Romney divide.
Medicaid is one of the most cost-effective programs by which Americans receive health insurance and is far better than private health insurance at holding down costs.
In contrast, millions of people using the health care system without health insurance increases health care costs for everyone in an uncontrolled manner. Covering people under Medicaid and its related health plan, Child Health Insurance Program (CHIP), improves the American health care system and saves money overall.
The Affordable Care Act will build upon the success of Medicaid and the health care safety net to expand access to care to 19 million additional Americans by 2019, according to the Congressional Budget Office, reducing the number of uninsured by 50 percent. The House Budget Plan advocated by the Romney-Ryan presidential ticket would decrease total Medicaid enrollment by approximately 50 percent or 37.5 million people, according to a recent Urban Institute study.
That plan would result in more than 200,000 additional Coloradans being uninsured by Medicaid. But it will not keep those people out of the emergency department or the hospital. It will drive the costs associated with their medical needs onto providers and hospitals, and ultimately onto insurance rates and the cost of care for the nation as a whole.
Eliminating insurance coverage results in less preventive and timely care, the care that can keep a person productive at work and at school, contributing to the economy and paying taxes. Eliminating coverage also results in more delayed, chronic and expensive care, and greater overall costs.
While the presidential debates and political advertisements have directed much attention to the two partys differences regarding Medicare, the much more significant policy contrast is regarding Medicaid and CHIP.
According to the Congressional Budget Office (CBO), under the (Romney-Ryan) proposal, federal spending for Medicaid would be 35 percent lower in 2022 and 49 percent lower in 2030 than currently projected federal spending. In short, the Republican plan is to cut Medicaid in half. Obamacare will expand Medicaid to cover families with incomes below 133 percent of the federal poverty line, or about $30,000 for a family of four in 2012.
Romney/Ryans plan to cut Medicaid will affect not only those covered by Medicaid. It will bring serious challenges to the doctors, nurses and services providers who deliver care as well as to the state budget and departments responsible for Medicaid in Colorado.
Not only would there be fewer recipients of Medicaid, the coverage itself would worsen. Doctors in the health care safety net and other caregivers in the Medicaid system are already underpaid. This cut would put tremendous pressure on them and their system, forcing them to cut programs and costs.
The CBO writes, even with significant efficiency gains (by states), the magnitude of the reduction in spending . . . means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both.
Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries all of which would reduce access to care.
One of the most likely programs to be cut is CHIP, a program that provides free or low-cost health coverage for more than 7 million children up to age 19.
Children will be the first to feel the impact of a 50 percent cut to Medicaid. While 77 percent of those using Medicaid are families and children (the rest are elderly or disabled), they only account for one-third of the programs costs.
Two-thirds of Medicaid spending goes to intensive care for the elderly and disabled. Medicaid money prioritizes the elderly and disabled. It will be the 77 percent children and families that will be most affected by the cut.
In other words, children will be the ones to suffer most under Romney/Ryans plan.
Ballard Pritchett is vice president of Colorado Access, the states largest public health care-oriented HMO.
Opinions communicated in Solutions represent the view of individual authors, and may not reflect the position of the University of Colorado Denver or the University of Colorado system.