Wednesday, November 16, 2011

From The House

Bluffton Today

We certainly appreciate all the calls and emails this last week, particularly on the Medicaid/Medicare issue. The number of constituent contacts was around 385, which is very close to record territory and uncharacteristically high for the off season. The cost of medical care is something nearly everyone is focused on, especially in light of the expected changes relating to the federal law known as the Affordable Care Act, which will start to kick in with a vengeance in 2014.

Just a reminder: If you have questions or need help with Medicaid related matters, we are the folks you want to call. If we can’t help you, we can send you to the right person or office. If your questions are concerning Medicare, please call Rep. Joe Wilson’s office.

Last week, we drew a clear distinction between Medicaid and Medicare, as well as who is covered by each program, and some commentary on why this is an important distinction. I also gave a small preview of some major changes in store for the state administered program, Medicaid. Nearly all of those changes are mandated by the aforementioned Affordable Care Act, which, in its current form, will become a factor in our state budget process beginning in 2014, and really slamming us in 2017.

One of the well-meaning, but stunningly misguided, intentions behind the Affordable Care Act is to reduce or eliminate the uninsured from our medical care delivery system. One of the ways this will theoretically be accomplished is by dramatically expanding the Medicaid program. While Medicaid is currently the state administered, state/federal jointly funded healthcare program for our very poor, elderly, and disabled, the new mandate enlarges the program to cover essentially all uninsured persons or families making less than 133 percent of the federally defined poverty standard. Although the numbers don’t always match up, this means that a family of four making less than $30,800 in 2011 would now be eligible for Medicaid. There are quite a number of folks between the ages of 26 and 65 that fall into this category.

From inception in 2014 going forward for three years, the federal government will pay for the newly eligible Medicaid enrollees. After three years, they become the responsibility of the states. Most states, and our state in particular, currently are struggling to keep up with their Medicaid obligations. By 2017, this newly created unfunded mandate will absorb an unmanageable portion of our state budget. This assumes, of course, that the feds don’t modify the system in light of the unsustainable financials, as they did with the Long Term Care portion of their “reform.”

As a consequence, we are looking at a level of imposed uncertainty on our state budget that has this legislator losing sleep. As a member of Ways and Means, I will be responsible for deciding what we will have to cut in order to comply with this federal mandate. In my view, there are not too many good options at this time. This is time when I have to ask for your help, to tap the wisdom and experience of the voters of District 118.

If, in your experience, there is a more effective way to organize our health care system, now is the time to share it. There is consensus only in the fact that our present system is headed for a point where healthcare costs and GDP become the same number. The system represented by the Affordable Care Act essentially rearranges the various payers, but does little, again in my view, to attack the core of the issue, which is how to have acceptable healthcare at an acceptable cost.

Let me hear from you.