By Charlotte Chinana
“The first step for a successful Medicaid transformation is the full repeal of the Patient Protection and Affordable Care Act.”
– An excerpt from a letter signed by 29 Republican Governors – including New Mexico’s
Susana Martinez – outlining seven principles for Medicaid Reform.
A day before the Health and Human Services Interim Committee met and heard from the NM’s Human Services Department (HSD), about their plans to redesign the state’s Medicaid program, Gov. Martinez joined several of her colleagues in signing on to a letter calling for the “full repeal” of the Federal Health Reform Act (otherwise known as the “Patient Protection and Affordable Care Act” – or PPACA).
The repeal-support letter, written as a response to a report released in March, by Senate Finance Committee Ranking Member Orrin Hatch (R-UT), and House Energy and Commerce Committee Chairman Fred Upton (R-MI), reiterates the claims made regarding costs that the states would assume, by expanding Medicaid under PPACA.
According to the Hatch-Upton report, it “conservatively estimates” that the PPACA Medicaid expansion would “cost state taxpayers at least $118.04 billion through 2023” – and provided state-by-state projections.
The report and its findings, however, were subsequently challenged by the Center on Budget and Policy Priorities, on the grounds that the report is “wholly unsound”:
“…It uses non-comparable state estimates that have widely varying scope, and uses different time periods…[making] no effort to standardize them. It picks and chooses among available estimates, selecting only the estimates with the highest costs and ignoring the others (and failing to disclose their existence). In addition, a number of the state estimates it uses are highly unreliable and overstated because they rest on severely flawed assumptions, including the following:
- Inflated participation-rate assumptions for individuals eligible for Medicaid, including assumptions that 100 percent of eligible people will enroll, despite the fact that 100 percent participation has never been achieved in any means-tested program in the decades those programs have operated. Such assumptions result in overblown estimates of Medicaid enrollment increases and costs.
- Estimates of the costs per newly enrolled Medicaid beneficiary that are highly inflated, as can readily be seen by comparing them to current Medicaid cost data; and
- The inclusion of costs that are not required under the Affordable Care Act.
Furthermore, few of the state analyses cited in the Hatch-Upton report account for any of the savings that would accrue to the states, as a result of having more people insured, or from other provisions of the Affordable Care Act…”
In New Mexico, the PPACA is estimated to benefit people in a number of ways, including (but not limited to):
- Reducing the number of uninsured New Mexicans, by expanding Medicaid eligibility and providing financial support for qualified individuals to purchase health insurance;
- Providing tax benefits that help small businesses afford coverage for their employees; and
- Reducing out of pocket costs for seniors who surpass a certain prescription drug coverage limit under Medicare Part D (informally known as “the donut hole” gap in coverage)
According to the PPACA repeal letter, the co-signing Governors feel as though there has been an increase in “intensive federal constraints” that “add little to the value or quality of services being delivered,” and that all of the time consuming, extensive, federal mandates, “thwart the creativity of the states.”
The letter also reminds Congressional leaders that the “states have proven themselves to be the real innovators in health care delivery” – and outlines seven “guiding principles” that “provide a pathway for true innovation” in State Medicaid programs.
What the letter doesn’t mention, are some examples of said “thwarted creativity” – such as attempting to pull one’s state out of Medicaid altogether – to achieve the “innovative goal” of loosing an enormous amount of federal funding, while simultaneously creating an even larger percentage of uninsured residents, in a state that already boasts one of the highest numbers of uninsured individuals (TX).
Or proposed measures that “add to the value and quality” of Medicaid services, like:
- Vetoing funds for vaccinations for postpartum women on Medicaid – along with other cuts that would affect health services for mostly low-income women and children – from that state’s budget (FL);
- Creating legally questionable rate reductions (NV); and
- Proposed enrollment freezes (AZ).
And then there’s the suggested “pathway for true innovation” – in claiming that a family of four making $6,0000 a year, “makes too much to qualify” for that state’s Medicaid program (NJ).
Lots to think about as New Mexico moves forward with it’s own redesign process…