Waiver Wire: Why Top-Down Washington Solutions Don’t Work
Leading the news this morning are two stories about waivers granted by Washington bureaucrats from mandates in the health care law. The New York Times reports on a House hearing held yesterday regarding the more than 900 waivers granted to various states, employers, and insurance companies from several of the law’s new insurance mandates. However, the story also notes that the waivers are temporary in nature, and are only intended to last until the new insurance Exchanges kick in. In other words, the Administration’s new position appears to be that “If you like your current coverage, you MAY be able to keep it – but only until 2014, and only if you’re politically savvy enough to apply for and obtain a waiver from Washington bureaucrats.”
On another waiver-related story, both Kaiser Health News and the Washington Post report on Arizona’s application for a waiver of the Medicaid maintenance of effort requirements included in the health care law. A letter sent by Secretary Sebelius to Arizona’s governor on Tuesday indicated that HHS believes Arizona’s current demonstration waiver can expire as scheduled later this year without violating the maintenance of effort requirements. However, as both stories clearly indicate, it’s far from clear that the circumstances unique to Arizona’s situation occur in other states, meaning that at a time when they face acute fiscal stress, dozens of other states could still be left “holding the bag” for the onerous maintenance of effort mandates included in the health care law – mandates that prevent state flexibility in managing their Medicaid programs.
And a federal study released yesterday demonstrated exactly why states need MORE flexibility, not less, in running their Medicaid programs. The Centers for Disease Control’s survey on Americans’ health* found that Medicaid patients visit the emergency room at nearly twice the rate of uninsured patients. Tables 88 and 89 (pages 321 through 326) tell the tale:
- Nearly one-third (33%) of children on Medicaid visited the emergency room at least once in 2009, compared to 20.9% of privately insured children and 23% of uninsured children.
- More than one in ten children on Medicaid (10.6%) visited the emergency room more than once in 2009, compared to 5.7% of uninsured children and only 4.2% of privately insured children.
- Among adults, more than four in ten patients on Medicaid (41.5%) visited the emergency room at least once in 2009, nearly double the rate of uninsured adults (21.2%) and more than double the rate of privately insured adults (16.7%).
The fact that Medicaid patients visit the emergency room so much more frequently than even uninsured patients – often because they do not have regular access to physician care – speaks volumes to why states need the additional flexibility to manage their programs without intrusive mandates coming from Washington. Continued federal dictates to maintain a broken Medicaid system will not only further squeeze states’ budgets – it will perpetuate the poor access and problems obtaining care that many beneficiaries currently receive.
* The CDC survey on Americans’ health also includes other interesting nuggets. For instance, Table 120 (page 381) demonstrates how the United States leads the world in availability of magnetic resonance imaging equipment, and ranks second to Belgium in the number of CT scanners (both adjusted based on availability per million population). For the record, Canada’s system of socialized medicine has just over one-quarter the number of MRI units and a little more than a third the number of CT scanners as the United States (again, based on availability per million population).