On Medicaid: Mississippi right, Biden wrong
A recent article by Bobby Harrison of Mississippi Today reported that "Senate Republicans [in the Miss. state legislature] Reject Plan to Expand Medicaid." Harrison's subtitle, failing to "Provide Health Care Coverage To 300,000 More Mississippians," clearly supports the Biden falsehood that Medicaid expansion is good for Americans.
One of Biden's first executive orders was to "strengthen Medicaid" by extending the enrollment period. The Biden Health Plan seeks to do an end run around in those states that resisted expansion such as Mississippi and Texas by offering his "public option" at no charge. This is simply Medicaid in disguise.
Medicaid is bad for Americans' health.
Coverage doesn't equal CARE, though politicians, policy wonks, and even the AMA conflate the two. The Mississippi Today report estimates there are "300,000 Mississippians who cannot otherwise afford health care." Medicaid provides an affordable — i.e., free — piece of paper, not timely medical assistance.
Biden's Medicaid "strengthening" and expansion offer Americans a Potemkin village, a façade of health security. His vaunted Medicaid insurance fails to provide the medical care we need.
According to documents from the Illinois Department of Human Services, "752 Illinoisans on the state's Medicaid waiting list have died awaiting needed care." What good is insurance if it doesn't ensure life-saving care?
As a result of the ACA's Medicaid expansion that Biden wants to expand further, wait times to see a primary care physician increased from an unacceptable 99 days to a medically unconscionable 176 days. That's four months to learn whether your belly pain is gas, an ulcer, or cancer, assuming you can find a doctor who accepts Medicaid.
The Medicaid acceptance rate is the percentage of physicians who accept new Medicaid patients. Nationally, nearly one third of doctors say no. In Texas, more than half of licensed M.D.s refuse to take on patients enrolled in Medicaid. So, as the number of people with free Medicaid coverage increases, the number of people to provide care decreases.
Biden's plans are a recipe for death-by-queuing: Americans "covered" by government insurance who have treatable illnesses and yet die while waiting in line for care. Such death-by-queueing was documented in Medicaid and in our V.A. system and is a common occurrence in single-payer health systems such as Great Britain's National Health Service.
Deamonte Driver, a 12-year-old Medicaid-eligible boy, is another case in point. He died needlessly from a cavity in a tooth! There were no pediatric dentists who accepted Medicaid patients in Prince George, Maryland, where Deamonte lived. So the dental infection went untreated and eventually extended into his brain. Only when he developed seizures from a brain abscess did he get care. After two brain surgeries, Deamonte died, when he could have been saved by simple routine dentistry.
Deamonte's hospital bill was approximately $250,000. The dental care that could have prevented his death would have cost less than $100.
The Medicaid boondoggle is fiscal as well as medical.
Governor Tate Reeves of Mississippi and reporter Harrison seem mesmerized by all the shiny new federal dollars that would roll into state coffers. With expansion, the Hospitality State "would receive an estimated $1 billion per year in federal funds." How can one resist a cool, free billion bucks? You can do so easily if you include expenses in your fiscal calculations.
When New Mexico expanded Medicaid in 2013, the Land of Enchantment received an influx of 3 billion federal dollars. The cost of the mandatory coverage benefits, money paid to insurance companies, not providers, was $3.417 billion. With a $417-million shortfall, to balance its budget, New Mexico Medicaid had to cut reimbursements to providers. The net effect was insurance coverage went up, and access to care went down.
Economic studies projected that by expanding Medicaid, Mississippi "would add as many as 9,000 jobs." This would benefit 9,000 Mississippi administrators, accountants, billers and coders, compliance officers, managers, regulators, and other bureaucrats, but not the Mississippians who pay their salaries. That money would be "health care" dollars that could not then be used to pay for care. This phenomenon, known as bureaucratic diversion, consumes between 31 percent and 50 percent of all health care spending in the U.S.
Washington controls all state Medicaid programs with its one-size-fits-all approach. This is a violation of Washington's own 1965 Medicaid law that clearly defines Washington's role in the administration of state Medicaid programs: none. Sections 1801 is titled, "Prohibition against any federal interference."
When viewed through a lens of hard facts and solid evidence, rather than political rhetoric and wishful thinking, Medicaid is a massive boondoggle. Mississippi was right to reject expansion, and Biden is wrong to keep pushing it.
Deane Waldman, M.D., MBA is an Professor Emeritus of Pediatrics, Pathology, and Decision Science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.