An Aug. 6 Tweet on Medicaid reforms from Gov. Bob Ferguson could benefit from a few more paragraphs for better understanding and fuller perspective. I’ll take a stab. Washingtonians need more than MAGA Congress bad.
The sky is falling a bit in health care in Washington state, but that’s not because temporary, enhanced COVID subsidies will lessen or because more will be expected of Medicaid recipients who receive taxpayer-financed care. Those expectations will include more frequent determinations of eligibility and at least part-time work or community-engagement participation among able-bodied adults in Medicaid’s expansion population.
The good news in that reform is that it could lift some people out of poverty or hardship — something everyone should want. And then we could possibly see more health care cost-containment in the state. It could also help prevent millions of dollars the state spends each year in unnecessary double payments and other waste.
Higher insurance premiums and other health care cost increases in our state are due to a host of factors, such as high labor and supply costs, advanced technology, more frequent or inappropriate use of services, an aging population, facility upgrades and rising prescription drug costs, and a host of problems, many state-inflicted. Those problems include many regulations on insurers, laws that rely on cost-shifting, low government reimbursement for services, taxes on providers and a Medicaid-like program for undocumented workers, to name a handful.
Instead of controlling what our legislators can control with priority-based budgets and discontinuing the practice of adding to Washingtonians’ health care bills with misguided legislative activity, many Washington lawmakers are busy pointing at the feds and suggesting the high cost of health care is all on them. Nonsense.
Let’s look at Ferguson’s X post. He or a staff member wrote:
— “Washington is among the states hit hardest by cuts from President Trump and the MAGA Congress.”
It’s true that we will be impacted by Medicaid reforms more than other states. Why? In part because we’re what is called a “Medicaid expansion” state that allows more than traditional Medicaid recipients in the program. About a third of Washington state’s 2 million Medicaid recipients are able-bodied adults with lower incomes, not those considered vulnerable by Medicaid implementation standards.
Another reason the state will see a bigger impact than most? Washington state created a Medicaid-like program for undocumented workers. Federal Medicaid dollars are not allowed to go to that population’s services, outside of emergency care and a few other reasons, so the state shoulders the bill for the undocumented program without federal contribution. Because the state has this program, it will see federal-contribution decreases, from 90% to 80%, for the allowable Medicaid expansion group in the state. (That’s the group of low-income, able-bodied adults age 19 to 64 I spoke of earlier that make up about 1/3 of those receiving Medicaid in the evergreen state.)
This is not a cut to funding for the undocumented population itself (which, again, benefits from a state-only-funded program), but it is a financial disincentive for states to go this route or continue this route.
— “The most vulnerable will lose their coverage or even lose services at their closest hospital. These cuts will be felt by all Washingtonians,” Ferguson continues.
Hospital services were already thought to be at risk for many reasons. When the Legislature was passing several bills this past legislative session, hospitals and providers told lawmakers they would increase the cost of care here or shut down services.
If hospitals have to give more uncompensated care to uninsured people, that won’t help. If Medicaid recipients don’t meet modest expectations or taxpayer-subsidized people on the marketplace choose to go without insurance, that might happen.
The state has big reason to help get their expansion population on more solid footing and finding other insurance, not going without. Lawmakers could explore helping hospitals with increases in uncompensated care costs, if they occur, given that they treat whoever walks through their doors. With potential Medicaid savings that come from fewer people on Medicaid, such an expenditure should be considered.
A few other thoughts about the messaging and graph from the governor on Aug. 6:
— If there are fewer people on Medicaid because of work reforms and more frequent eligibility checks, the federal contribution goes down, but so does the state’s. Medicaid is a state-federal program with shared responsibility and cost. (Unless Washington state insists on funding these people in other ways on the state’s dime.)
— Increased subsidies for people with insurance through the state’s health care exchange should have been expected and planned for. These extra subsidies were temporary COVID adjustments that have burdened taxpayers for too long. The state marketplace subsidizes the vast majority of people who use insurance through it. Even after federal changes, some middle- and even higher-income households could still qualify for some level of subsidy.
— If it is a top priority for the governor to keep people insured or subsidized, then he should take some of the billions of dollars in new taxes state leaders are taking from taxpayers in the state and use it in key areas. More prioritizing is needed in our state.
Health care is expensive. It needs to be prioritized by governments and individuals. Having state lawmakers and state residents working with the federal government on cost-containment is the best way forward for all Washingtonians — those dependent on the government for health care and commercial payers seeing increased premiums and costs.
We definitely need to encourage innovation, welcome more competition, approve less regulation and quit the blame game.
