Saturday, August 15, 2009

Are states entering the misinformation fray?

broke Today, an article titled ‘Florida leaders warn health care reform could bankrupt Medicaid’ appeared in 2 of Florida’s largest newspapers. Problem is, this statement is not true for any of the bills currently under consideration in Washington.

From the article:

The analysis, done by the state Agency for Health Care Administration [AHCA], found Florida's already mushrooming Medicaid rolls would grow from 2.6 million people to about 4 million under proposals to overhaul the health-care system.

Legislation pushed by President Barack Obama would help cover Florida's 4 million uninsured by expanding Medicaid eligibility to include higher-income families and new categories of people, such as childless adults.

The total federal-state tab: $4.9 billion a year in Florida. With the federal government picking up two-thirds of Medicaid costs, that would mean a $1.6 billion hit to the state budget, the study showed. That's on top of the more than $5 billion a year the state said in February that Medicaid is costing, a figure that's likely higher today.

Florida leaders say the extra cost would be crushing, especially with the state facing a major financial jolt in 2011 when federal stimulus money runs out. Though Gov. Charlie Crist has not taken a position on the expansion, Republican legislators are worried.

"Our Medicaid program is bordering on unsustainable as it is," said House Majority Leader Adam Hasner, R-Boca Raton. "If you add this component, you are going to break the back of Florida and every other state."

Problem with AHCA’s analysis is that it assumes the expansion of Medicaid up to either 133 (House Tri-Committee) or 150 (Senate HELP Committee) percent of poverty would be financed using the normal convention known as the FMAP. Under the FMAP, the state ponies up all of the money to fund Medicaid and the Federal government reimburses them for at least half. [In Florida, the FMAP for 2009 was 55.4 percent pre-stimulus and 67.6 percent post-stimulus]

But neither of the bills currently under consideration expect states to pay their portion for the expansion (at least, not initially). To verify this, one can either read each of the 1000 page bills or they can view the nice side-by-side comparison of the bills produced by the Kaiser Family Foundation (see page 2). Both bills clearly state that the Federal government will pay 100% of the Medicaid expansion costs at least through 2014. Let me say that again, both bills clearly state that the Federal government will pay 100% of the Medicaid expansion costs at least through 2014.

Now after that, things get murky. In the Senate HELP bill, states will receive a Federal match of 100 percent until 2015 for Medicaid expansion and then in 2015, this percentage will phase down to the normal FMAP by 2020 [this info is missing from the side-by-side].

In the original House Tri-Committee bill, states will receive a Federal match of 100 percent with no end date. Two of the three committees that jointly developed the Tri-Committee bill passed it out of their respective committees without amending this provision. But, the other committee adopted an amendment where states will receive a Federal match of 100 percent until 2015 for Medicaid expansion, and then 90 percent thereafter. Clear as mud, right?

The most important thing right now is to ensure an open, honest, and thoughtful dialogue. Though the article is probably an honest oversight, it is essential right now that all information regarding the potential effects of health reform is properly vetted and placed in its proper context. As we have seen all too often this month, “once it’s out there, it’s out there” – accurate or not. ~BAA

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